The exacerbation of a chronic gingivitis during pregnancy was confirmed in a group of 24 pregnant patients who were observed at the 14th and 30th weeks of pregnancy and postpartum. This exacerbation occurred despite a fall in the amount of plaque accumulation and confirmed that during pregnancy some factor in addition to plaque is involved in the increased inflammation. Using in vitro methods, it was shown that during pregnancy there is a depression of maternal T-cell responsiveness and it is suggested that this depression of the cell-mediated immune response could be a factor in the altered responsiveness of the gingival tissues to plaque. However lymphocytes responses to Veillonella alkalescens ultrasonicate (a plaque antigen) were generally poor and it was not possible to demonstrate any significant difference between the altered responsiveness of maternal lymphocytes to Veillonella and those of nonpregnant controls.

This investigation has confirmed that there is an increase in gingival inflammation between the 14th and 30th weeks of pregnancy and that this will occur despite a fall in the amount of plaque at the dento-gingival junction. This implicates a further factor in addition to plaque accumulation to explain the increased inflammmation. It was confirmed that there are marked increases in the plasma levels of estradiol and progesterone between the 14th and 30th weeks of pregnancy but it was not possible to demonstrate a direct association between these increases and the increase in gingival inflammation.

The relationship between the build-up of bacterial plaque at the dento-gingival junction and the development of gingivitis is well established. The susceptibility of patients requiring periodontal surgery to the pathogenic potential of plaque would seem to necessitate the protection of the surgically treated area by a periodontal dressing until adequate plaque control by the patient is possible. In the light of clinical experience, an investigation was undertaken into the antibacterial properties of certain proprietary periodontal dressings and a zinc oxide/eugenol material. None of these materials showed any marked degree of antibacterial activity. One of these materials, Coe-Pak, had been used alone or combined with Cross Pack for all the patients in the clinical survey with very satisfactory results, and it is concluded that this material is successful because of its physical properties and not its antibacterial ones. Careful attention to asepsis, gentle and controlled tissue handling, correct technique, and thorough removal of plaque and calculus are the prerequisites for successful periodontal surgery. The protection of the surgical wound by a dressing of adequate physical properties aids in ensuring uneventful healing. The use of potent antibacterial agents in the dressing is not necessary; a physical barrier to salivary/bacterial contamination and food impaction may be the most important factor.

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