A number of different oral lesions have been reported in the literature during pregnancy including pyogenic granuloma, gingival hyperplasia, oral candidiasis, cheek biting, benign migratory glossitis, aphthous ulcers, and telangiectasia. Many of these are considered to be related to immune and hormonal changes.
The aim of this review was to assess the evidence regarding the prevalence of oral mucosal lesions during pregnancy.
Methods
Searches were conducted in the CINAHL, LILACS, LIVIVO, PubMed, Scopus, Web of Science, Google Scholar, OpenGrey, and ProQuest databases with restriction on language or year of publication. Observational studies reporting the prevalence of oral mucosal disorders (aphthous ulceration, benign migratory glossitis, candidiasis, cheilitis, gingival epulis, herpes associated lesions, leukoedema, lichen planus, papilloma, pemphigus, pemphigoid, pyogenic granuloma, and ulcers) in pregnant women were considered. Studies involving gingivitis and periodontitis were excluded.
Two reviewers independently selected studies, abstracted data and assessed risk of bias with a third reviewer being consulted in case of disagreement. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess bias. Prevalence was expressed as mean of relative or absolute frequencies with 95% confidence intervals (95%CI). The overall quality of evidence was assessed using the GRADE system.
Results
- 15 studies involving a total of 5935 patients were included.
- Data was reported from Egypt, Ghana, India, Iran, Mexico, Nigeria, Pakistan, Turkey and Venezuela.
- Sample sizes ranged from 86 – 1600 patients.
- 9 studies were considered to be at moderate risk of bias and 6 at low risk of bias.
- The patients were aged between 10 and 50 years of age with the prevalence of disorders ranging from 0.22% to 31%.
- The main lesions reported were gingival hyperplasia, morsicatio buccarum (chronic cheek biting), oral candidiasis, pyogenic granuloma and benign migratory glossitis.
- The overall prevalence rate for lesions = 11.8% (95%CI; 6.5% – 18.4%)
| Mucosal disorder | Prevalence Range | Meta-analysis (95%CI) |
| gingival hyperplasia | 2.9% – 25.0% | 17.1% (5.9% -32.7%) |
| morsicatio buccarum | 3.5% – 31.0% | 9.9% (1.3% – 25.2%) |
| oral candidiasis | 1.0% – 15.0% | 4.4% (0.5% -11.8 %) |
| pyogenic granuloma | 0.22% – 16.6% | 3.0% (1.6% – 4.8%) |
- The quality of the evidence was considered to be very low using GRADE.
Conclusions
The authors concluded: –
Disorders of the oral mucosa were present in approximately 1 out of 10 pregnant women. Gingival hyperplasia was the most prevalent lesion. Further studies should apply homogeneous methodology to improve the quality of evidence.
Comments
A broad search in a wide range of databases has been undertaken for this review. Data was only identified from a limited number of countries so the findings may not be particularly generalisable. Many of the studies did not report the stage of pregnancy within findings from 5 studies that included this information suggesting that prevalence was higher in the second and third trimester. All the included studies are cross-sectional in nature and used differing methodologies and diagnostic criteria which is a further consideration to take into account when considering the findings of this review.
Links
Primary Paper
Bett JVS, Batistella EÂ, Melo G, Munhoz EA, Silva CAB, Guerra ENDS, Porporatti AL, De Luca Canto G. Prevalence of oral mucosal disorders during pregnancy: A systematic review and meta-analysis. J Oral Pathol Med. 2019 Jan 23. doi: 10.1111/jop.12831. [Epub ahead of print] Review. PubMed PMID: 30673134.
Original review protocol on PROSPERO
Other references
Dental Elf – 15th Mar 2019
Dental Elf – 27th Oct 2017
Dental Elf – 12th Jun 2015
Oral health promotion during pregnancy: little evidence available
