HJAR May/Jun 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2025 39 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas hygiene habits can have a flare up. Common oral health conditions that can occur during pregnancy include pregnancy gingivitis, gingival irritation, tooth erosion, salivary alterations, dental caries, and peri- odontitis. 6 Studies confirm that poor oral health during pregnancy can lead to signifi- cant negative outcomes for both expectant mothers and their newborn children. These include increased risk for adverse pregnancy outcomes, birth complications, and early childhood caries. 7 When a co-morbidity, such as diabetes or heart disease, is pres- ent along with poor oral health, risks are amplified. The physiological process of pregnancy, while natural, is one that accompanies sub- stantial physical and hormonal changes in women’s bodies, and the mouth is no ex- ception. Levels of hormones change dur- ing pregnancy, which can lead to pregnancy gingivitis caused by an increased level of progesterone. This progesterone increases the susceptibility of bacterial plaque, which in turn causes gingivitis, most notably in the second to third trimester of pregnan- cy. 8 Increased levels of circulating estrogen have been found in expectant mothers and are associated with a high prevalence of gingival irritations, gingivitis, and gingival hyperplasia. 9 Expectant mothers are predisposed to dental caries for several reasons. Cravings for sweet drinks or food are common. Addi- tionally, the vomiting produced by morning sickness produces an acidic environment intraorally, and this leads to growth of bac- teria. This process demineralizes and erodes OVER the period of 2018–22, Arkansas had the fourth-highest rate of maternal mortal- ity, 38.3 per 100,000 live births, among the 45 states for which data were available. Only Tennessee, Mississippi, and Alabama had higher per capita rates of maternal deaths. 1 By comparison, California had the low- est rate of maternal mortalities, at 10.5 per 100,000 live births, followed by Minnesota, Wisconsin, and Utah, according to the Cen- ters for Disease Control and Prevention. 2 These figures from America’s Health Rankings and the CDC define maternal mor- tality as deaths related to or aggravated by pregnancy, excluding accidental or inciden- tal causes, occurring within 42 days of the end of a pregnancy. 1,2 On March 6, Gov. Sanders signed an ex- ecutive order to support moms, protect babies, and improve maternal health. 3 This order followed the governor’s Feb. 20 sign- ing of the HealthyMoms, Healthy BabiesAct, which includes an investment of more than $45 million annually to improve maternal health outcomes statewide. 4 Arkansas continues to be challenged in the ranking classifications of oral health and maternal health. The status of oral health has huge implications for the expectant mother, especially one with poor oral health. In pregnancy, a woman’s oral health affects her health, as well as the overall health of her unborn child. 5 Oral health status is often overlooked in many health conditions, and pregnancy is no different, especially when the woman’s oral health status is poor. Even an expectant mother with good oral health and good oral teeth, which leads to decay. Nausea and fre- quent vomiting make it difficult for expect- ant mothers to brush their teeth, since this action often produces a gagging sensation. Periodontal disease is a risk factor for ad- verse birth outcomes. 10 This specific oral disease has been associated with preterm birth, gestational diabetes, and delivery of low birthweight infants. 11 Systemic inflam- mation caused by periodontal disease re- sults in an infection that aids bacterial colo- nization in the oral cavity. This infection is particularly problematic if it is untreated in women who have diabetes or gestational diabetes. Research provides evidence that patients with chronic periodontal disease have more destruction of the supporting structures of their teeth if they also have diabetes. Diabetic patients have poorer gly- cemic control if they also have uncontrolled or untreated periodontal disease. In essence, there is a bi-directional link in periodontitis and diabetes. 12 Periodontal pathogens reach the mater- nal reproductive systemvia the bloodstream and trigger the inflammatory process. When chronic periodontitis is uncontrolled and left untreated, this infectious process affects the whole body. These bacteria enter the blood- stream, producing a bacteremia, and travel throughout the entire body. Cytokines are produced from this infectious process and promote destruction of tissues, including the placenta. These cytokines have the potential to stimulate uterine contractions, dilate the cervix, and trigger preterm birth. 13 Mater- nal and fetal negative outcomes thus are increased if the expectant mother has active