Correlation Between Periodontal Health Status with Some Salivary Inflammatory Biomarkers in Pregnant and Lactating Women

Authors

  • Mivan Kawa Majid College of Dentistry, Hawler Medical University, Kurdistan Region, Iraq.
  • Amal Hanna Aziz College of Dentistry, Hawler Medical University, Kurdistan Region, Iraq.
  • Chenar Anwar Muhammad College of Dentistry, Hawler Medical University, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.15218/edj.2025.25

Keywords:

Pregnancy, Periodontal Diseases, Matrix Metalloproteinase 8, Tumor Necrosis Factor-alpha

Abstract

Background and Objectives: Periodontal health may be influenced by the hormonal and immunological shifts that occur during pregnancy and lactation. This study aimed to assess and compare the periodontal status and salivary concentrations of matrix metalloproteinase 8 (MMP-8) and tumor necrosis factor-alpha (TNF-α) among pregnant, post-partum lactating, and non-pregnant/non-lactating (control) women.

Methods: A case-control study was performed on 90 systemically healthy women, with an average age ranging from 25-35 years, equally divided into pregnant, postpartum lactating, and control groups. Clinical periodontal parameters, including bleeding on probing (BOP), gingival index (GI), probing pocket depth (PPD), and plaque index (PI), were examined, and salivary levels of MMP-8 and TNF-α were assessed via enzyme-linked immunosorbent assay (ELISA).

Results: The mean level of GI, BOP, PPD, MMP-8, and TNF-α were significantly elevated in pregnant women, followed by lactating and control groups, with significant differences between each two groups and among the three groups (P < 0.001), except for non-significant differences between lactating and control groups regarding MMP-8 (P =1.000). All the correlations between clinical and inflammatory biomarkers were weak and non-significant (rho < 0.4), whereas a significant negative correlation was found between GI and MMP-8 in the pregnant group (rho = -0.544, p = 0.002).

Conclusion: Pregnancy is associated with increased gingival inflammation and biochemical inflammatory markers, indicating a heightened risk for periodontal disease. Lactating women displayed intermediate changes, emphasizing the need for periodontal monitoring and preventive care throughout the peripartum period.

References

Di Stefano M, Polizzi A, Santonocito S, Romano A, Lombardi T, Isola G. Impact of oral microbiome in periodontal health and periodontitis: a critical review on prevention and treatment. International journal of molecular sciences. 2022;23(9):5142

Nazir M, Al-Ansari A, Al-Khalifa K, Alhareky M, Gaffar B, Almas K. Global prevalence of periodontal disease and lack of its surveillance. The Scientific World Journal. 2020;2020(1):2146160

Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontology 2000. 2020;83(1):154-74

Susanto A, Bawono CA, Putri SS. Hormonal Changes as the Risk Factor That Modified Periodontal Disease in Pregnant Women: A Systematic Review. Journal of International Oral Health. 2024;16(3)

Blumer S, Peretz B, Costa L. [Periodontal health during pregnancy and the dental health of the child]. Refuat Hapeh Vehashinayim (1993). 2015;32(2):28-31, 8

Badewy R, Glogauer M, Connor KL, Sgro M, Lai JY, Bazinet RP, et al. The unrevealed links: periodontal health, human milk composition, and infant gut microbiome dynamics. Primary Health Care Research & Development. 2024;25:e62

Maftei LP, Luchian I, Martu S, Solomon S-M. DISTINCTIVE FEATURES OF PERIODONTAL STATUS IN EXPECTANT MOTHERS. Romanian Journal of Medical and Dental Education. 2024;13(1)

Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, Abreu Fonseca Thomaz ÉB, Fontoura Nogueira da Cruz MC. Systemic alterations and their oral manifestations in pregnant women. Journal of Obstetrics and Gynaecology Research. 2017;43(1):16-22

Kania M, Malinowski KP, Słowik J, Władysiuk M, Szopa M. Inflammatory markers in pregnant women with periodontal diseases—Systematic review and network meta‐analysis. Oral Science International. 2023;20(2):67-77

Gomez-Lopez N, Romero R, Hassan SS, Bhatti G, Berry SM, Kusanovic JP, et al. The cellular transcriptome in the maternal circulation during normal pregnancy: a longitudinal study. Frontiers in immunology. 2019;10:2863

Ghallab NA. Diagnostic potential and future directions of biomarkers in gingival crevicular fluid and saliva of periodontal diseases: Review of the current evidence. Archives of oral biology. 2018;87:115-24

Kc S, Wang XZ, Gallagher JE. Diagnostic sensitivity and specificity of host-derived salivary biomarkers in periodontal disease amongst adults: Systematic review. J Clin Periodontol. 2020;47(3):289-308.doi:10.1111/jcpe.13218

Domokos Z, Simon F, Uhrin E, Szabó B, Váncsa S, Varga G, et al. Evaluating salivary MMP-8 as a biomarker for periodontal diseases: A systematic review and meta-analysis. Heliyon. 2024;10(22):e40402.doi:10.1016/j.heliyon.2024.e40402

De Morais E, Pinheiro J, Leite R, Santos P, Barboza C, Freitas R. Matrix metalloproteinase‐8 levels in periodontal disease patients: A systematic review. Journal of periodontal research. 2018;53(2):156-63

Varghese SS, Thomas H, Jayakumar N, Sankari M, Lakshmanan R. Estimation of salivary tumor necrosis factor-alpha in chronic and aggressive periodontitis patients. Contemporary clinical dentistry. 2015;6(Suppl 1):S152-S6

Neurath N, Kesting M. Cytokines in gingivitis and periodontitis: from pathogenesis to therapeutic targets. Front Immunol. 2024;15:1435054.doi:10.3389/fimmu.2024.1435054

Gil L, Mínguez I, Caffesse R, Llambés F. Periodontal disease in pregnancy: the influence of general factors and inflammatory mediators. Oral Health Prev Dent. 2019;17(1):69-73

Silness J, Loe H. PERIODONTAL DISEASE IN PREGNANCY. II. CORRELATION BETWEEN ORAL HYGIENE AND PERIODONTAL CONDTION. Acta Odontol Scand. 1964;22:121-35.doi:10.3109/00016356408993968

1Löe H, Silness J. Periodontal Disease in Pregnancy I. Prevalence and Severity. Acta Odontologica Scandinavica. 1963;21(6):533-51.doi:10.3109/00016356309011240

Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229-35

Lindhe J, Karring T, Lang NP. Periodontología clínica e implantología odontológica: Ed. Médica Panamericana; 2009.

Zeng Z, Liu F, Li S. Metabolic Adaptations in Pregnancy: A Review. Ann Nutr Metab. 2017;70(1):59-65.doi:10.1159/000459633

Abdal F, Roozegar M, Gholami Z, Shafiei E. The Periodontal Status of Pregnant and Lactating Women in Ilam Province, Iran (2018 - 2019). Journal of Kermanshah University of Medical Sciences. 2021;25(3).doi:10.5812/jkums.114001

Butt H, Khan N, Tahir F, Piracha M. Periodontal and gingival health of pregnant in comparison to non-pregnant women. 2022;72:551 _4.doi:10.51253/pafmj.v72i2.5463

Pradnyanaputri KE, Kusumadewi S, Susanti A. Prevalensi gingivitis pada ibu hamil berdasarkan usia kehamilan, pekerjaan, dan pendidikan di RSUD Klungkung tahun 2017. ODONTO. 2018;5(2):97-101

Jain S. Changing Pattern of Gingivitis and Periodontitis in Different Trimesters amongPregnant Women Comparing. The Same with Non Pregnant Women Attending the Government Hospitals in Delhi. Gynecology & Obstetrics. 2020;10:1-5

Talebessy R, Cecilia S. Gingivitis and oral health diseases related to pregnancy. Crown: Journal of Dentistry and Health Research. 2023;1(1):1-5

Lasisi TJ, Abdus-Salam RA. Pregnancy-induced periodontal inflammation: Influence of salivary cytokines and antimicrobial proteins. The Saudi Dental Journal. 2018;30(4):306-11

Heo SY, Lee EH. The relationship between breastfeeding and oral health. Int J Clin Prev Dent. 2018;14(2):126-31

Aghazadeh Z, Behroozian A, Najafi H, Faramarzi M. Comparison of gingival and dental indices in lactating and non-lactating mothers during the first 6 Months after delivery. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2019;19:e4586

Chen P, Hong F, Yu X. Prevalence of periodontal disease in pregnancy: A systematic review and meta-analysis. Journal of dentistry. 2022;125:104253

Torres JDA, Luzardo G. Gingival Inflammation in the Presence of Bacterial Plaque in Women in the First and Second Trimester of Pregnancy: Inflamación Gingival en Presencia de Placa Bacteriana en Mujeres que cursan el Primer y Segundo Trimestre de Embarazo. Journal of American Health. 2019;2(1):46-52

Pecci-Lloret MP, Linares-Pérez C, Pecci-Lloret MR, Rodríguez-Lozano FJ, Oñate-Sánchez RE. Oral Manifestations in Pregnant Women: A Systematic Review. J Clin Med. 2024;13(3).doi:10.3390/jcm13030707

Tedjosasongko U, Anggraeni F, Wen ML, Kuntari S, Puteri MM. Prevalence of caries and periodontal disease among Indonesian pregnant women. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2019;19:e4533

Srinivasan N, Rajasekar A. Changes in Oral Mucosa during Pregnancy. Indian Journal of Public Health Research & Development. 2020;11(6):554-8

Wu M, Chen S-W, Su W-L, Zhu H-Y, Ouyang S-Y, Cao Y-T, Jiang S-Y. Sex hormones enhance gingival inflammation without affecting IL‐1β and TNF‐α in periodontally healthy women during pregnancy. Mediators of inflammation. 2016;2016(1):4897890

González-Jaranay M, Téllez L, Roa-López A, Gómez-Moreno G, Moreu G. Periodontal status during pregnancy and postpartum. PLoS One. 2017;12(5):e0178234.doi:10.1371/journal.pone.0178234

Wu M, Chen S-W, Jiang S-Y. Relationship between gingival inflammation and pregnancy. Mediators of inflammation. 2015;2015(1):623427

Susanto A, Bawono CA, Putri SS. Hormonal changes as the risk factor that modified periodontal disease in pregnant women: A systematic review. Journal of International Oral Health. 2024;16(3):189-95

Kashetty M, Kumbhar S, Patil S, Patil P. Oral hygiene status, gingival status, periodontal status, and treatment needs among pregnant and nonpregnant women: A comparative study. Journal of Indian Society of Periodontology. 2018;22(2):164-70

Tettamanti L, Lauritano D, Nardone M, Gargari M, Silvestre-Rangil J, Gavoglio P, Tagliabue A. Pregnancy and periodontal disease: does exist a two-way relationship? ORAL & implantology. 2017;10(2):112

Morelli EL, Broadbent JM, Leichter JW, Thomson WM. Pregnancy, parity and periodontal disease. Aust Dent J. 2018.doi:10.1111/adj.12623

Raju K, Berens L. Periodontology and pregnancy: An overview of biomedical and epidemiological evidence. Periodontology 2000. 2021;87(1):132-42

Kim J-Y, Kim H-N. Changes in inflammatory cytokines in saliva after non-surgical periodontal therapy: a systematic review and meta-analysis. International journal of environmental research and public health. 2021;18(1):194

Öztürk VÖ, Emingil G, Umeizudike K, Tervahartiala T, Gieselmann D-R, Maier K, et al. Evaluation of active matrix metalloproteinase-8 (aMMP-8) chair-side test as a diagnostic biomarker in the staging of periodontal diseases. Archives of Oral Biology. 2021;124:104955

Makiya A, Moghaddam MA, Faghihinia F, Anzabi RM, Asadi H, Fathi A. Pro-inflammatory Cytokines may Associate Periodontitis with Pregnancy Complications: A Short Review. New Emirates Medical Journal. 2024;5(1):e02506882262319

Chaparro A, Realini O, Hernández M, Albers D, Weber L, Ramírez V, et al. Early pregnancy levels of gingival crevicular fluid matrix metalloproteinases‐8 and‐9 are associated with the severity of periodontitis and the development of gestational diabetes mellitus. Journal of Periodontology. 2021;92(2):205-15

Machado V, Mesquita MF, Bernardo MA, Casal E, Proença L, Mendes JJ. IL-6 and TNF-α salivary levels according to the periodontal status in Portuguese pregnant women. PeerJ. 2018;6:e4710

Ross KM, Schetter CD, Carroll JE, Mancuso RA, Breen EC, Okun ML, et al. Inflammatory and immune marker trajectories from pregnancy to one-year post-birth. Cytokine. 2022;149:155758

Cardoso EM, Reis C, Manzanares-Céspedes MC. Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgraduate medicine. 2018;130(1):98-104

Escobar-Arregoces F, Latorre-Uriza C, Velosa-Porras J, Roa-Molina N, Ruiz AJ, Silva J, et al. Inflamatory response in pregnant women with high risk of preterm delivery and its relationship with periodontal disease: a pilot study. Acta Odontol Latinoam. 2018;31(1):53-7

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Published

2025-12-30

How to Cite

1.
Majid MK, Aziz AH, Muhammad CA. Correlation Between Periodontal Health Status with Some Salivary Inflammatory Biomarkers in Pregnant and Lactating Women. EDJ [Internet]. 2025 Dec. 30 [cited 2025 Dec. 31];8(2):216-25. Available from: https://edj.hmu.edu.krd/index.php/journal/article/view/475

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