A Correlative Study of Gingivitis and Alveolar Bone
The sample was divided into 2 groups which constituted the control and the experimental group of 50 non-pregnant and 50 pregnant subjects each.
The experimental (pregnant) sample was divided into 2 sub groups having 25 subjects in each, depending upon the frequency of pregnancy experience as under:
1. Gp IA - 1st Pregnancy
2. Gp IIA - More than 2 Pregnancy experiences For each experimental (pregnant) group there was a corresponding control group depending upon the non - pregnant females having lesser frequency of pregnant experience namely:
1. Gp IB - No pregnancy experience
2. Gp II B - Not more than 2 pregnancy experiences Only healthy subjects were included in the study.
Care was taken to exclude all the cases having acute diseases, chronic debilitating diseases, anterior traumatic bite, severe attrition, malocclusion and excessive decay. The 3rd molar was not considered.
The selected cases were subjected to clinical examination of all the teeth. Roentgenographic examination of maxillary and mandibular central incisors. and right and left maxillary and mandibular 1st molars was done at random. The clinical assessment of gingivitis and plaque was made by gingivitis and plaque index system proposed by Loe and Silness8 respectively.
RADIOGRAPHIC INTERPRETATIONS Alveolar bone loss was measured as percentage of
"maximum bone loss", on basis of Herulf's investigation and the criteria adopted by Oliv Schei and Waerhaugh,9 the alveolar crest was considered to be of optimum height when it was 1 mm or less from the cemento-enamel junction.
A measuring gadget was made on a translucent plastic rule. A line was made 1mm from the margin corresponding to the normal distance from the alveolar crest to the cemento-enamel junction. Close to the end of the baseline a point was chosen as center and from this center 10 radii with exactly the same distance
between each of them were made. The base, as well, formed the first radius.
During the measurement the ruler was placed over the x-ray film in such a manner that the margin of the ruler covered the cemento-enamel junction. The ruler was moved until the last radius covered the apex.
Through the translucent ruler the alveolar crest could be seen either under one of the radius or between two of them. In this way it was possible to assess the height of the bone with an accuracy of upto 5%. As alveolar crest was considered the point where the periodontal membrane space was found to be of approx normal width.
However, in many cases such a definite point could not be found, for which reason no measurement was made where no interproximal fillings were present, the CEJ could be localized with certainity. Although in most of the cases difficulties were encountered. In many cases the CEJ was observed by interproximal fillings and if so, the central margin of the fillings was chosen as the base - line. Separate measurements were made for mesial and distal surfaces of each tooth.
RESULTS
The following results were drawn from the clinical roentgenographic study of gingivitis and alveolar bone loss in multiparity -
1. Irrespective of pregnancy or non pregnant state gingivitis and plaque exhibit a strong correlation with time. The correlation being stronger in the absence of pregnancy.
2. The segment wise comparative significance of these correlations among the four groups are shown in Table 1 to 5.
3. Generally the level of gingivitis has no effect on the alveolar - bone loss during or after pregnancy.
4. Alveolar bone loss is not related to the absence or presence of pregnancy and a significant loss of alveolar bone may occur in the absence of pregnancy.
DISCUSSION
Table 1. Comparative significance of correlation coefficient values of gingivitis and percent bone loss in the maxillary anterior segment of pregnant (Groups IA and IIA) and nonpregnant (Group IB and IIB) groups
Group No. of Cases Average age (years) 'R' Normal variate 'Z'
IA IB IIA IIB
IA (Pregnant) 25 21 -0.025 - 2.01* 1.98* 2.69**
IB (Nonpregnant) 21 21 0.39 - - 1.35N.S 1.41 N.S.
IIA (Pregnant) 27 27 0.24 - - - 1.99*
IIB (Nonpregnant) 29 29 0.50 - - - -
* Significant at 5% level of hignificance,** Significant at 1% level of significane, N. S. - Not significant.
Table 2. Comparative significance of correlation coefficient values of gingivitis and percent bone loss in mandibular anterior segment of pregnant (IA & IIA) and nonpregnant (IB & IIB) groups.
Group No. of Cases Average age (years) 'R' Normal variate 'Z'
IA IB IIA IIB
IA (Pregnant) 25 21 0.077 - 0.31N.S 1.56 N.S 1.98*
IB (Nonpregnant) 25 21 0.003 - - 1.61N.S 2.01 *
IIA (Pregnant) 25 27 0.11 - - - 0.89 N.S
IIB (Nonpregnant) 25 29 0.19 - - - -
* Significant at 5% level of significance N. S. not significant
Table 5. Comparative significance of alveolar bone loss in pregnant and nonpregnant groups.
Group Mean percent IA IB IIA IIB
bone loss
IA (Pregnant) 15.387 - 0.05N.S. 0.05N.S. 0.05N.S.
IB (Nonpregnant) 10.280 - - 0.05N.S. 0.05*
IIA (Pregnant) 17.195 - - - 0.05N.S.
IIB (Nonpregnant) 22.045 - - - -
* Significant at 5% level of significance N. S. not significant
Table 4. Comparative significance of correlation coefficient values of gingivitis and percent bone loss in mandibular posterior segment of pregnant (group IA & IIA) and nonpregnant (group IB & IIB) groups.
Group No. of Cases Average age (years) 'R' Normal variate 'Z'
IA IB IIA IIB
IA (Pregnant) 25 21 -0.064 - 2.11* 1.98* 1.41N.S.
IB (Nonpregnant) 25 21 0.32 - - 1.96* 1.99*
IIA (Pregnant) 25 27 0.16 - - - 0.10N.S.
IIB (Nonpregnant) 25 29 0.10 - - - -
" Significant at 5% level of significance
" N. S. Not significant.
Table 3. Comparative significance of correlation coefficient values of gingivitis and percent bone loss in maxillary posterior segment of pregnant (group IA and IIA) and nonpregnant (group IB and IIB) groups.
Group No. of Cases Average age (years) 'R' Normal variate 'Z'
IA IB IIA IIB
IA (Pregnant) 25 21 -0.086 - 0.09N.S 2.01* 1.97*
IB (Nonpregnant) 25 21 0.083 - - 2.02* 1.98*
IIA (Pregnant) 25 27 0.29 - - - 1.21 N.S.
IIB (Nonpregnant) 25 29 0.17 - - - -
* Significant at 5% level of significance.
N.S. not significant.
Changes in the severity of periodontal disease has been documented during the course of pregnancy (Cohen 1971),2 which is reflected in terms of gingivitis.
An increased level of estrogen and progesterone in the circulating blood of females during pregnancy was noted. This, along with the dental plaque has been assumed to cause changes in the gingival tissues manifesting as gingivitis10,11. Any pre-existing gingivitis at the beginning of pregnancy appeared always to increase gradually in severity with the advancement of pregnancy and decrease after parturition (Hugoson) 197112.
Higher concentration of female sex steroids, mainly
estrogen and progesterone, acting for a longer period of time during pregnancy has been believed to have a hyperemic and permeability increasing effect on the periodontal vascular system as shown for other parts of the body (Gersh and Catchpole).13
The present study was undertaken to determine the effect of multiparity on gingival and supporting periodontal tissues, especially the alveolar bone.
In the present investigation a strong correlation between gingival and plaque scores was apparent for both pregnant and non - pregnant groups. The findings also leads to the belief that during pregnancy gingival response is associated to a lesser extent with the soft deposits around the teeth. This is in agreement with Cohen et al.2
Loe & Silness3 suggested that during pregnancy, an additional factor, probably hormonal in nature is introduced. This, together with bacteria may be responsible for the accumulated inflammatory response. The finding of this study is in agreement with those of Hugoson12 who found that gingivitis become more severe during pregnancy without any accompanying increase in the amount of bacterial
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plaque.
IOPA radiographs of both pregnant and non- pregnant females in the present investigation did not reveal a definite pattern of bone destruction in any of the groups. Evaluation of individual segments revealed that correlation between gingival score and percent bone loss was statistically insignificant.
During pregnancy, there is a lowering in the blood Ca level of mother due to increase demands of Ca.14 the total amount needed by the fetus is, however, small as compared to the total body Ca of the mother. Though periodontal disease especially alveolar atrophy is theoretically possible during pregnancy; it is actually rarely associated with it primarily (Shour 1943)15.
CONCLUSION
In conclusion it may be said that gingival changes generally associated with pregnancy with special significance of the effects of hormonal changes and even more, so due to multiparity.
Removal of oral debris and improved oral hygiene reduced gingivitis, suggesting that the marginal flora played a primary etiologic role in pregnancy gingivitis as well as in common marginal gingivitis.
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