Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews

Consensus approach to differential abundance analysis detects few differences in the oral microbiome of pregnant women due to pre-existing type 2 diabetes mellitus

Oral microbiome dysbiosis has been proposed as a potential contributing factor to rising rates of diabetes in pregnancy, with oral health previously associated with an increased risk of numerous chronic diseases and complications in pregnancy, including gestational diabetes mellitus (GDM). However, whilst most studies examining the relationship between GDM and the oral microbiome identify significant differences, these differences are highly variable between studies. Additionally, no previous research has examined the oral microbiome of women with pre-existing type 2 diabetes mellitus (T2DM), which has greater risks of complications to both mother and baby. In this study, we compared the oral microbiome of 11 pregnant women with pre-existing T2DM with 28 pregnant normoglycaemic controls. We used shotgun metagenomic sequencing to examine buccal swab and saliva rinse samples at two time points between 26 and 38 weeks of gestation. To reduce variation caused by the choice of differential abundance analysis tool, we employed a consensus approach to identify differential taxa and pathways due to diabetes status. Differences were identified at the late time point only. In swab samples, there was increased Flavobacteriaceae, Capnocytophaga, Capnocytophaga gingivalis SGB2479, Capnocytophaga leadbetteri SGB2492 and Neisseria elongata SGB9447 abundance in T2DM as well as increased Shannon diversity and richness. In rinse samples, there was an increased abundance of Haemophilus, Pasteurellaceae, Pasteurellales and Proteobacteria. In contrast to studies of the oral microbiome in T2DM or GDM that use a single differential abundance analysis tool, our consensus approach identified few differences between pregnant women with and without T2DM.

Specifying a target trial protocol to estimate the effect of preconception treatment of periodontitis on time-to-pregnancy: A commentary and applied example

BACKGROUND

The target trial framework was developed as a strategy to design and analyze observational epidemiologic studies with the aim of reducing bias due to analytic decisions. It involves designing a hypothetical randomized trial to answer a question of interest and systematically considering how to use observational data to emulate each trial component.

AIMS

The primary aim of this paper is to provide a detailed example of the application of the target trial framework to a research question in oral epidemiology.

MATERIALS AND METHODS

We describe the development of a hypothetical target trial and emulation protocol to evaluate the effect of preconception periodontitis treatment on time-to-pregnancy. We leverage data from Pregnancy Study Online (PRESTO), a preconception cohort, to ground our example in existing observational data. We discuss the decision-making process for each trial component, as well as limitations encountered.

RESULTS

Our target trial application revealed data limitations that precluded us from carrying out the proposed emulation. Implications for data quality are discussed and we provide recommendations for researchers interested in conducting trial emulations in the field of oral epidemiology.

DISCUSSION

The target trial framework has the potential to improve the validity of observational research in oral health, when properly applied.

CONCLUSION

We encourage the broad adoption of the target trial framework to the field of observational oral health research and demonstrate its value as a tool to identify directions for future research.

Relationship Between Fear of Childbirth and Oral Health-Related Quality of Life in Pregnant Women: The Mediating Effect of Pregnancy Anxiety

BACKGROUND

Psychosocial health affects oral health-related quality of life. Pregnancy, as a special time for women, produces significant psychological changes. However, the relationship between mental health during pregnancy and oral health-related quality of life is unclear.

OBJECTIVE

The study aims to explore the association between fear of childbirth and investigate the mediating effect of pregnancy anxiety.

METHODS

Using a cross-sectional design, 478 pregnant women were recruited and evaluated using the Fear of Birth Scale, the Pregnancy-Related Anxiety Questionnaire and the Oral Health Impact Profile-14. Multiple linear regressions were performed to evaluate the relationship between fear of childbirth and oral health-related quality of life. PROCESS software was applied to assess the mediating effect of pregnancy anxiety.

RESULTS

Both fear of childbirth and pregnancy anxiety were negative correlation with oral health-related quality. Pregnancy anxiety mediated 40% of the association between fear of childbirth and oral health-related quality of life (β = 0.072, SE = 0.030, 95% CI [0.015, 0.131]).

CONCLUSIONS

Pregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life in pregnant women. To improve the oral health-related quality of life among pregnant women, relevant healthcare workers should actively help pregnant women to improve psychological health.

Bioinformatics analysis of shared biomarkers and immune pathways of preeclampsia and periodontitis

BACKGROUND

Epidemiological evidence indicates that preeclampsia (PE) is associated with comorbidities such as periodontitis (PD). However, the underlying mechanism remains unclear. To enhance our understanding of their co-pathogenesis, this research investigated the shared biomarkers and pathological mechanisms.

METHODS

We systematically retrieved transcriptomic datasets from the Gene Expression Omnibus database. These datasets encompass a comparative analysis of the periodontium with and without PD and of the placenta with and without PE. Differentially Expressed Genes Analysis and Weighted Gene Go-expression Network Analysis (WGCNA) were used to identify the key crosstalk genes in patients with PD and PE. The functional characterisation of these genes was performed using enrichment analysis. Protein-protein interaction networks and machine learning methods were leveraged to identify shared hub genes. The XG-Boost algorithm was applied to construct diagnostic models to gain insight into disease aetiology. The identified genes were validated by single-cell RNA sequencing to ensure their robustness and biological relevance.

RESULTS

A total of 55 key crosstalk genes were identified, which were primarily enriched in immune-related pathways by using limma and WGCNA. Among them, twenty-four shared hub genes were identified using protein-protein interaction analysis and machine learning methods. The diagnostic model constructed using immune-related genes outperformed the other two models (area under the receiver operating characteristic curve [ROC] = 0.7786 and 0.7454 for PE and PD, respectively). Pathways involving these genes were mapped using the Kyoto Encyclopedia of Genes and Genomes analysis. In addition, single-cell RNA sequencing analysis showed that the expression of BIN2, LYN, PIK3AP1, and NEDD9 in neutrophils was significantly downregulated, and LYN in fibroblasts and endothelial cells was consistently upregulated.

CONCLUSIONS

Shared hub genes and immunologic pathways were identified in PE and PD, characterised by crosstalk between BIN2, LYN, NEDD9, and PIK3AP1, suggesting the pathogenesis of PE and PD, which could pave the way for the development of effective diagnostic, treatment, and management strategies.

The unrevealed links: periodontal health, human milk composition, and infant gut microbiome dynamics

AIM

This review aims to identify the mechanistic relationships related to periodontal diseases and its possible association with changes in human milk composition and the composition and function of infants' gut microbiome.

BACKGROUND

Maternal health conditions, especially inflammatory, are associated with altered human milk composition. It is not known whether maternal oral inflammatory diseases, including periodontal diseases, deleteriously affect human milk composition.

METHODS

A narrative review was conducted according to SANRA, the Scale for the Assessment of Narrative Review Articles, guidelines. PubMed, Google Scholar, and Cochrane database of systematic reviews were searched from September 2019 up to December 2023 using keywords such as breast/human milk, maternal health/infections, and periodontal diseases. Reference lists of relevant articles were also screened. Our primary outcome of interest was human milk composition (i.e., any changes in macronutrients, immunological components, etc.). Secondary outcomes included changes in human milk microbiome and subsequent changes in the infant gut microbiome. Outcomes were synthesized using a narrative approach where the existing evidence and current literature were summarized. No risk of bias assessment of the studies was performed in this review.

FINDINGS

The search yielded no studies investigating the relationship between periodontal diseases in nursing mothers and changes in human milk composition. However, a dose-response relationship exists between the severity of periodontal diseases and the risk of adverse pregnancy outcomes such as preterm birth. Mastitis and diabetes affected milk lipids. Immunoglobulin A (sIgA) was increased in mastitis, whereas reduced concentrations were reported in diabetes. Potential biological pathways through which periodontal diseases can negatively affect human milk composition include the systemic dissemination of inflammatory cytokines like IL-6, PGE2, and tumor necrosis factor (TNF)-β that can be up-regulated by bacterial by-products. This biological plausibility needs to be investigated, given the potentially negative impact on the quality of human milk that could be caused by periodontal inflammation.

Effect of Er: YAG laser therapy in non-surgical periodontal treatment: an umbrella review

AIM

The current umbrella review aimed to summarize the effect of erbium-doped yttrium aluminum garnet (Er: YAG) laser adjunct with the conventional non-surgical periodontal treatment which was evidenced from available systematic reviews.

METHODS

An extensive literature search was piloted by two independent reviewers in the PubMed, Scopus, Science Direct, and Google Scholar databases. The search was limited to the English language from 2011 to 2023 years. The methodological quality of systematic reviews 2 (AMSTAR 2) guideline was followed to evaluate the risk of bias for the selected studies. Cohen's kappa statistic was implemented to evaluate the level of agreement to assess the risk of bias in the selected studies.

RESULTS

A total of 472 studies were initially identified. After removing the duplicates and screening, a total of four studies were selected for the current overview. Based on the quality assessment tool, each study scored as high, moderate, low, and critically low-quality study following AMSTAR 2 tool. Inter-rater reliability by Cohen's Kappa statistics showed near-perfect agreement (0.95) between the two reviewers.

CONCLUSION

Even though weak evidence of effectiveness was observed for Er: YAG laser application in non-surgical periodontal treatment, the clinical benefits are still lacking.

Relationship between periodontal disease and preterm birth. A systematic review and meta-analysis

BACKGROUND

Periodontal disease (PD) is a chronic inflammatory disease of multifactorial origin that affects the supporting tissues of the tooth. According to WHO in 2022, it affects around 19% of the adult population worldwide. Its risk factors include the presence of periodontopathogenic bacteria in biofilm and the susceptibility of the host's immune system, among others. Preterm birth is defined as birth occurring before 37 weeks of gestational age. It also has a multifactorial origin and it's associated with risk factors such as intrauterine and extrauterine infections. There is a possibility that periodontal disease in pregnant women increases the risk of preterm birth through hematogenous pathways or the presence and intervention of inflammatory mediators.

MATERIAL AND METHODS

Through a systematic review of existing scientific articles from 2014 to 2024, five randomized clinical trials were selected, including a total of 1984 pregnant patients diagnosed with periodontal disease. Half of these patients received non-surgical treatment, while the other half did not, aiming to evaluate a possible association between periodontal disease and/or its treatment and the occurrence of preterm birth. The risk of bias was assessed using the Cochrane "RoB 2" tool, and finally, a meta-analysis was conducted to compare the results obtained in the selected studies.

RESULTS

Four articles showed a trend favoring non-surgical periodontal treatment as a preventive measure for preterm birth. These articles accounted for 92.2% of the total weight, while the remaining 7.85% corresponded to the single article that did not favor the treatment. However, none of the articles showed statistically significant results.

CONCLUSIONS

There is no demonstrated association between periodontal disease in pregnant women and the incidence of preterm birth. On the other hand, there is a slightly favorable trend towards non-surgical periodontal treatment during pregnancy as a measure to reduce the incidence of preterm birth, but it's not statistically significant. To obtain a definitive answer, more randomized clinical trials following similar study and design parameters are needed.

Vaginal microbiota in term pregnant women with differences in cervical ripeness revealed by 2bRAD-M

BACKGROUND

Cervical ripening is a multifactorial outcome, and the association between cervical ripening and vaginal microbiota remains unexplored in term primiparous women. A new sequencing technology, microbiome 2bRAD sequencing (2bRAD-M) that provides a higher level of species discrimination compared to amplicon sequencing. We applied 2bRAD-M to analyze the vaginal microbiota in a population with variations in cervical ripeness and to explore potential microbiota factors influencing cervical ripening.

METHODS

A total of 30 full-term primigravid women participated in this study, with 15 belonging to the low scoring group of cervical ripeness and 15 to the high scoring group. Clinical information was collected from the participants, and the vaginal microbiota and community structure of both groups were analyzed using 2bRAD-M sequencing. Microbiota diversity and differential analyses were conducted to explore potential factors influencing cervical ripening.

RESULTS

A total of 605 species were detected. There was no difference in vaginal microbiota diversity between the two groups, and the vaginal microbial composition was structurally similar. In the two groups, Lactobacillus crispatus and Lactobacillus iners were identified as the two pivotal species through random forest analysis. Concurrent, extensive and close connections between species within the two groups were observed in the correlation analysis, influencing the aforementioned two species. Pairwise comparisons showed that Sphingomonas (P = 0.0017) and three others were abundant in high scoring group, while Alloprevotella (P = 0.0014), Tannerella (P = 0.0033), Bacteroides (P = 0.0132), Malassezia (P = 0.0296), Catonella (P = 0.0353) and Pseudomonas (P = 0.0353) and so on showed higher abundance in low scoring group. Linear discriminant analysis effect size identified 29 discriminative feature taxa.

CONCLUSION

For the first time, vaginal microbiota was sequenced using 2bRAD-M. With a relatively simple structure, a more stable vaginal microbiota is associated with higher cervical ripeness, and certain microorganisms, such as Sphingomonas, may play a beneficial role in cervical ripening.

The oral microbiome of children in health and disease-a literature review

The oral microbiome is a complex community of microorganisms residing in the oral cavity interacting with each other and with the host in a state of equilibrium. Disruptions in this balance can result in both oral and systemic conditions. Historically, studying the oral microbiome faced limitations due to culture-dependent techniques that could not capture the complexity and diversity of the microbial community. The emergence of advanced genomic technologies and the ease of sample collection from the oral cavity has revolutionized the understanding of the oral microbiome, providing valuable insights into the bacterial community in both health and disease. This review explores the oral microbiome in children, discussing its formation and dynamics in both states of health and disease, its role in various conditions such as dental caries, periodontal disease, oral cancer, cleft lip and palate, and explores its connection to several systemic consequences.

Effects of different periodontal interventions on the risk of adverse pregnancy outcomes in pregnant women: a systematic review and network meta-analysis of randomized controlled trials

Background

Periodontal disease is widespread among pregnant women, and it is possible that taking action to improve oral health conditions can make improvements in adverse pregnancy outcomes. Herein, we summarize the recent evidence using a network meta-analysis to assess the effects of different periodontal treatment intervention strategies on the risk of adverse pregnancy outcomes in pregnant women.

Materials and methods

Randomized controlled trials were retrieved from PubMed, Web of Science, Embase, and Cochrane Library databases. After literature screening, data extraction, and quality evaluation of the included literature were performed, the R studio 4.2.2 "netmeta" package was used for the network meta-analysis.

Results

A total of 20 studies were included, and 5 adverse pregnancy outcomes (preterm birth, low birth weight, preterm birth and/or low birth weight infants, small for gestational age, and pre-eclampsia) were considered to examine the effects of different periodontal treatment interventions strategies on the risk of the abovementioned outcome indicators. The results of the network meta-analysis demonstrated that the three periodontal treatment intervention strategies of sub- and/or supra-gingival scaling and root planing + chlorhexidine rinsing (SRP + CR), sub- and/or supra-gingival scaling and root planing+chlorhexidine rinsing + tooth polishing and plaque control (SRP + CR + TP), and sub- and/or supra-gingival scaling and root planing +sonic toothbrush + tooth polishing and plaque control (SRP + ST + TP) reduced the risk of preterm birth [odds ratio (OR) = 0.29, 95% confidence interval (CI) (0.10-0.88), OR = 0.25, 95CI% (0.10-0.63), OR = 0.28, 95CI% (0.11-0.69), respectively]. In addition, two periodontal treatment intervention strategies, SRP + CR and SRP + CR + TP, were effective methods in terms of the risk of preterm birth and/or low birth weight [OR = 0.18, 95CI% (0.06-0.52), OR = 0.31, 95CI% (0.12-0.79)].

Conclusion

The available evidence suggests that the risk of preterm birth and preterm birth and/or low birth weight can be reduced with certain periodontal treatment intervention strategies. Future studies should focus on optimizing intervention strategies and the optimal timing for different periods of pregnancy, in order to provide a reference for pregnant women's healthcare.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=407901, CRD42023407901.

Genetically engineered phages and engineered phage-derived enzymes to destroy biofilms of antibiotics resistance bacteria

"An impregnable stronghold where one or more warrior clans can evade enemy attacks" may serve as a description of bacterial biofilm on a smaller level than human conflicts. Consider this hypothetical conflict: who would emerge victorious? The occupants of secure trenches or those carrying out relentless assault? Either faction has the potential for triumph; the defenders will prevail if they can fortify the trench with unwavering resolve, while the assailants will succeed if they can devise innovative means to breach the trench. Hence, bacterial biofilms pose a significant challenge and are formidable adversaries for medical professionals, often leading to the failure of antibiotic treatments in numerous hospital infections. Phage engineering has become the foundation for the targeted enhancement of various phage properties, facilitating the eradication of biofilms. Researchers across the globe have studied the impact of engineered phages and phage-derived enzymes on biofilms formed by difficult-to-treat bacteria. These novel biological agents have shown promising results in addressing biofilm-related challenges. The compilation of research findings highlights the impressive capabilities of engineered phages in combating antibiotic-resistant bacteria, superbugs, and challenging infections. Specifically, these engineered phages exhibit enhanced biofilm destruction, penetration, and prevention capabilities compared to their natural counterparts. Additionally, the engineered enzymes derived from phages demonstrate improved effectiveness in addressing bacterial biofilms. As a result, these novel solutions, which demonstrate high penetration, destruction, and inhibition of biofilms, can be regarded as a viable option for addressing infectious biofilms in the near future.

Nomogram prediction for periodontitis in Chinese pregnant women with different sociodemographic and oral health behavior characteristics: a community-based study

BACKGROUND

Periodontitis is associated with poor pregnancy outcomes, indicating periodontal health as an important health concern for pregnant women. Herein, this study identified risk indicators for periodontitis and developed a nomogram for predicting the risk of periodontitis in pregnancy by analyzing periodontitis and associated factors in pregnant women.

MATERIALS AND METHODS

A community-based cross-sectional study was conducted by including 438 pregnant women at 10-36 gestational weeks from Langfang, China. Pregnant women were examined for periodontal status, and their demographic, socioeconomic, and oral health behavior data were collected. Potential influencing factors of periodontitis were analyzed with univariate and multivariate logistic regression analyses. A nomogram was developed, followed by the assessment of its validation and discriminatory abilities.

RESULTS

The prevalence of periodontitis was 59.8% in pregnant women. Periodontitis-associated variables in pregnant women were gestational age, non-first pregnancy, daily tooth brushing frequency of ≤ 1 before pregnancy, and annual frequency of periodontal treatment < 1 (including no periodontal treatment). The risk of periodontitis was positively associated with gestational age (OR = 1.28, 95% CI = 1.17-1.39, p < 0.001). Pregnancy history showed a strong positive association (OR = 6.57, 95% CI = 1.22-35.43, p = 0.03). Daily tooth brushing frequency before pregnancy was also positively associated with periodontitis (OR = 1.54, 95% CI = 1.03-2.79, p = 0.05). Additionally, the annual frequency of periodontal treatment exhibited a positive association, with higher odds observed for those with less frequent treatment (OR = 2.28, 95% CI = 1.25-4.14, p = 0.05; OR = 7.37, 95% CI = 3.04-22.06, p < 0.001). These four factors were used to develop a nomogram for predicting periodontitis in pregnant women. The area under the receiver operating characteristic curve of the nomogram was 0.855 and 0.831 in the training and testing cohorts, respectively, reflecting the superior prediction accuracy of the nomogram. The calibration curve and decision curve analysis demonstrated the good performance and net benefit of the nomogram.

CONCLUSION

Risk factors for periodontitis in pregnant Chinese women include gestational age, non-first pregnancy, lower frequency of daily tooth brushing before pregnancy, and lower frequency of periodontal treatment. An easy-to-use nomogram with acceptable accuracy can allow for the prediction of periodontitis risk in pregnant Chinese women.

CLINICAL RELEVANCE

With the assistance of this nomogram, clinicians can evaluate the risk of periodontitis in pregnancy, thereby offering more tailored oral health education to women of reproductive age.

Effects of personalized oral hygiene management on oral health status of pregnant women

BACKGROUND

The Cariostat caries activity test (CAT) was used to evaluate the effectiveness of personalized oral hygiene management combining oral health education and professional mechanical tooth cleaning on the oral health status of pregnant women.

AIM

To investigate whether personalized oral hygiene management enhances the oral health status of pregnant women.

METHODS

A total of 114 pregnant women who were examined at Dalian Women's and Children's Medical Center were divided into four groups: High-risk experimental group (n = 29; CAT score ≥ 2; received personalized oral hygiene management training), low-risk experimental group (n = 29; CAT score ≤ 1; received oral health education), high-risk control group (n = 28; CAT score ≥ 2), and low-risk control group (n = 28; CAT score ≤ 1). No hygiene intervention was provided to control groups. CAT scores at different times were compared using independent samples t-test and least significant difference t-test.

RESULTS

No significant difference in baseline CAT scores was observed between the experimental and control groups, either in the high-risk or low-risk groups. CAT scores were reduced significantly after 3 (1.74 ± 0.47 vs 2.50 ± 0.38, P < 0.0001) and 6 months (0.53 ± 0.50 vs 2.45 ± 0.42, P < 0.0001) of personalized oral hygiene management intervention but not after oral health education alone (0.43 ± 0.39 vs 0.46 ± 0.33, P > 0.05 and 0.45 ± 0.36 vs 0.57 ± 0.32, P > 0.05, respectively). Within groups, the decrease in CAT scores was significant (2.43 ± 0.44 vs 1.74 ± 0.47 vs 0.53 ± 0.50, P < 0.0001) for only the high-risk experimental group.

CONCLUSION

Personalized oral hygiene management is effective in improving the oral health of pregnant women and can improve pregnancy outcomes and the oral health of the general population.

Application of zero-inflated Poisson model with heterogeneous random effects to evaluate the effect of oral health education on pregnant women's dental caries: A longitudinal experimental study

Background

Pregnant women have poor knowledge of oral hygiene during pregnancy. One problem with the follow-up of dental caries in this group is zero accumulation in the decayed, missing, and filled teeth (DMFT) index, for which some models must be used to achieve valid results. The studied population may be heterogeneous in longitudinal studies, leading to biased estimates. We aimed to assess the impact of oral health education on dental caries in pregnant women using a suitable model in a longitudinal experimental study with heterogeneous random effects.

Materials and Methods

This longitudinal, experimental research was carried out on pregnant women who visited medical centers in Tehran. The educational group (236 cases) received education for three sessions. The control group (200 cases) received only standard training. The DMFT index assessed oral and dental health at baseline, 6 months, and 24 months after delivery. The Chi-square test was used for comparing nominal variables and the Mann-Whitney U test for ordinal variables. The zero-inflated Poisson (ZIP) model was applied under heterogeneous and homogeneous random effects using R 4.2.1, SPSS 26, and SAS 9.4. The level of significance was set at 0.05.

Results

Data from 436 women aged 15 years and older were analyzed. Zero accumulation in the DMFT was mainly related to the filled teeth (51%). The heterogeneous ZIP model fitted better to the data. On average, the intervention group exhibited a higher rate of change in filled teeth over time than the control group (P = 0.021).

Conclusion

The proposed ZIP model is a suitable model for predicting filled teeth in pregnant women. An educational intervention during pregnancy can improve oral health in the long-term follow-up.

Association between dietary patterns and periodontal disease: The OsteoPerio cohort study

AIM

To examine the association of dietary patterns with periodontal disease (PD) and its progression over 5 years.

MATERIALS AND METHODS

Analyses involved 1197 post-menopausal women from the OsteoPerio cohort. Dietary patterns assessed include Healthy Eating Index-2015 (HEI), Alternative HEI (AHEI), Dietary Approaches to Stop Hypertension (DASH) and alternate Mediterranean Diet (aMed) at baseline (the average of two food frequency questionnaires administered between 1993 and 2001). At baseline and the 5-year follow-up, periodontal assessments evaluated alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of gingival sites bleeding on probing (%BOP) and missing teeth due to PD. Linear and logistic regression were used to examine the associations.

RESULTS

Cross-sectionally, HEI and aMed were associated with smaller CAL and %BOP; along with DASH, they were associated with a decreased odds of teeth missing due to PD. AHEI and aMed were associated with a decreased odds of severe PD. Prospectively, AHEI was associated with greater ACH progression. This association was attenuated to the null after loss of ACH was imputed for teeth lost due to PD over follow-up, or after excluding participants with diabetes, osteoporosis, hypertension or heart disease at baseline.

CONCLUSIONS

Better adherence to healthy dietary patterns was associated with better PD measures cross-sectionally but greater progression of ACH over 5 years. The latter might be explained by incident tooth loss due to PD and pre-existing comorbidities.

Can oral microbiome predict low birth weight infant delivery?

OBJECTIVES

This study aimed to identify the oral microbiota factors contributing to low birth weight (LBW) in Chinese pregnant women and develop a prediction model using machine learning.

METHODS

A nested case-control study was conducted in a prospective cohort of 580 Chinese pregnant women, with 23 LBW cases and 23 healthy delivery controls matched for age and smoking habit. Saliva samples were collected at early and late pregnancy, and microbiome profiles were analyzed through 16S rRNA gene sequencing.

RESULTS

The relative abundance of Streptococcus was over-represented (median 0.259 vs. 0.116) and Saccharibacteria_TM7 was under-represented (median 0.033 vs. 0.068) in the LBW case group than in controls (p < 0.001, p = 0.015 respectively). Ten species were identified as microbiome biomarkers of LBW by LEfSe analysis, which included 7 species within the genus of Streptococcus or as part of 'nutritionally variant streptococci' (NVS), 2 species of opportunistic pathogen Leptotrichia buccalis and Gemella sanguinis (all LDA score>3.5) as risk biomarkers, and one species of Saccharibacteria TM7 as a beneficial biomarker (LDA= -4.5). The machine-learning model based on these 10 distinguished oral microbiota species could predict LBW, with an accuracy of 82 %, sensitivity of 91 %, and specificity of 73 % (AUC-ROC score 0.89, 95 % CI: 0.75-1.0). Results of α-diversity showed that mothers who delivered LBW infants had less stable salivary microbiota construction throughout pregnancy than the control group (measured by Shannon, p = 0.048; and Pielou's, p = 0.021), however the microbiome diversity did not improve the prediction accuracy of LBW.

CONCLUSIONS

A machine-learning oral microbiome model shows promise in predicting low-birth-weight delivery. Even in cases where oral health is not significantly compromised, opportunistic pathogens or rarer taxa associated with adverse pregnancy outcomes can still be identified in the oral cavity.

CLINICAL SIGNIFICANCE

This study highlights the potential complexity of the relationship between oral microbiome and pregnancy outcomes, indicating that mechanisms underlying the association between oral microbiota and adverse pregnancy outcomes may involve complex interactions between host factors, microbiota, and systemic conditions. Using machine learning to develop a predictive model based on specific oral microbiota biomarkers provides a potential for personalized medicine approaches. Future prediction models should incorporate clinical metadata to be clinically useful for improving maternal and child health.

Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand

BACKGROUND

Pregnancy is a unique period of women's lives, and oral health is an important public health indicator during this period. Pregnant women have increased vulnerability to oral health problems. The study aimed to describe oral health knowledge, literacy and behavior of pregnant women in a northeastern province of Thailand.

METHODS

A descriptive study was used. Twenty pregnant women who attended antenatal care clinics of eight public hospitals in the province were recruited by use of purposive sampling. They participated voluntarily in individual interview. The Health Belief Model was used as conception framework. All data were transcribed and subjected to content analysis.

RESULTS

Five categories emerged: Misbelief and lack of knowledge, Oral health problems and dental care seeking, Oral health information from different persons, Self-care management of oral health, and Fear of and anxiety towards dental treatment. The findings showed that low knowledge of need for treatment, little importance to oral health and low priority of dental needs affect the demand for dental care. Fear of and anxiety towards dental treatment were the results of negative past experiences of neglecting dental care. Some women perceived health benefits of practicing self-care of oral health during pregnancy.

CONCLUSION

The findings help to better understand the oral health issues of pregnant women and provide baseline information for oral health promotion. Such promotion and culturally appropriate care should be integrated in maternal health education classes.

Pregnancy Outcomes and Maternal Periodontal Diseases: The Unexplored Connection

In the early 20th century, numerous in-vitro studies, animal studies, epidemiological studies, and human trials have attempted to demonstrate the interrelationship between pregnancy outcomes and maternal periodontal disease. This review aims to shed light on the unexplored connections between pregnancy outcomes and maternal periodontal diseases. A literature search was conducted using electronic databases such as PubMed, Scopus, Google Scholar, Web of Science, and Embase. Our research focuses on the role of epigenetics, maternal vitamin D status, stress levels, genetic factors, innate immunity, pattern recognition receptors, and any potential paternal influence, and their possible connections to maternal periodontal disease. Although the precise etiologies and pathogenic mechanisms of the adverse pregnancy outcomes remain obscure, substantial affirmation of the inter-relationship between maternal periodontal diseases and adverse pregnancy outcomes may prove to be of public health relevance as periodontitis can certainly be prevented and treated. Maternal periodontal disease may augment the probability of jeopardizing maternal health causing adverse effects on the pregnancy and neonatal morbidity. Hence, emphasis should be placed on an early diagnosis and management of periodontal diseases. Routine oral health evaluation during prenatal care should be encouraged to combat complications. Ensuing endeavors should be undertaken to help find plausible mechanisms keeping in view the future research domains and new pathways.

Assessment of Oral Health Status and Pregnancy Outcomes Among Women in Saudi Arabia

Purpose

Pregnant women witness many changes in the body as well as in the oral cavity with many factors influencing these changes. This study evaluated the relationship between oral health status, perceptions, and pregnancy outcomes.

Methods

A cross sectional study design was implemented to recruit a convenience sample of women attending Obstetrics and gynecology department in public hospitals in East and capital city of Saudi Arabia. To collect data, a validated self-administered questionnaire in English and Arabic was used. The questionnaire covered background information, perceived oral health status, and dental visits.

Results

About 64.4% of the 481 women recruited had dental problems, 49.7% reported deterioration in their oral health during pregnancy, and 17.5% reported adverse pregnancy outcomes. Only 40.7% of pregnant women rated their oral health as good, and only 22% visited a dentist during their pregnancy. Dentists were the most common source of oral health information (44.1%), followed by social media (38.9%). Dental problems during pregnancy were significantly associated with adverse outcomes (P=0.007). Oral health perceptions of pregnant women, not visiting the dentist during pregnancy, and gingival problems were also significantly associated with adverse pregnancy outcomes (P=0.001). Those with fair to poor oral health were twice as likely to experience adverse pregnancy outcome. Those who intended to visit the dentist during their pregnancy but did not do so, as well as those who did not visit the dentist at all were 12 and 9 times more likely to experience adverse pregnancy outcomes respectively.

Conclusion

Dental complaints during pregnancy, oral health perceptions, and a lack of dental visits were all linked to increased likelihood of adverse pregnancy outcomes. There is a need for interprofessional collaboration to dispel myths and encourage oral health care and regular dental visits during pregnancy.

Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study

Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2-3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value < 0.01, 95% CI: 1.3-5.1). There is insignificant association found between the prevalence ratio of GDM in women with periodontal disease in our setting. Women who are overweight or tend to gain weight should be closely monitored and guided to take dietary measures.

Barriers for why pregnant women do not visit a dentist on a regular basis: using group concept mapping methodology

OBJECTIVES

Periodontitis in pregnancy represents a significant, but often overlooked challenge due to its association to adverse pregnancy (preeclampsia and gestational diabetes) and birth related outcomes (preterm birth and low birth weight). The overall study aim was to identify, organize, and prioritize barriers influencing dental visits among Danish pregnant women not seeing a dentist on a regularly basis.

MATERIALS AND METHODS

Participants were pregnant women screened at weeks 11-13 of gestation, and were recruited if they were not seeing a dentist regularly. The study was conducted at Holbæk and Nykøbing Falster Hospital in Region Zealand, Denmark. The Group Concept Mapping (GCM) approach was applied. The pregnant women participated in brainstorming (n = 18), sorting (n = 20), and rating (n = 17) the seating question 'Thinking as broadly as you can, please list all barriers of importance to you for not seeing a dentist on a regular basis'.

RESULTS

A total of 38 unique barriers were identified, organized, and prioritized online. The multidimensional scaling analysis involved 10 iterations and revealed a low stress value of 0.21. A cluster solution with five clusters including 'economic reasons', 'lack of priority', 'lack of time and energy', 'no problems with teeth', and 'dental fear', was discussed and interpreted at a validation meeting.

CONCLUSIONS

Five overall clusters explaining barriers for not seeing a dentist regularly were revealed. Of the five clusters, 'economic reasons' and 'lack of priority' were rated as the most important clusters. Accordingly, such barriers should be considered in the planning of future strategies of dental care during pregnancy.

Oral microbiota-host interaction: the chief culprit of alveolar bone resorption

There exists a bidirectional relationship between oral health and general well-being, with an imbalance in oral symbiotic flora posing a threat to overall human health. Disruptions in the commensal flora can lead to oral diseases, while systemic illnesses can also impact the oral cavity, resulting in the development of oral diseases and disorders. Porphyromonas gingivalis and Fusobacterium nucleatum, known as pathogenic bacteria associated with periodontitis, play a crucial role in linking periodontitis to accompanying systemic diseases. In periodontal tissues, these bacteria, along with their virulence factors, can excessively activate the host immune system through local diffusion, lymphatic circulation, and blood transmission. This immune response disruption contributes to an imbalance in osteoimmune mechanisms, alveolar bone resorption, and potential systemic inflammation. To restore local homeostasis, a deeper understanding of microbiota-host interactions and the immune network phenotype in local tissues is imperative. Defining the immune network phenotype in periodontal tissues offers a promising avenue for investigating the complex characteristics of oral plaque biofilms and exploring the potential relationship between periodontitis and associated systemic diseases. This review aims to provide an overview of the mechanisms underlying Porphyromonas gingivalis- and Fusobacterium nucleatum-induced alveolar bone resorption, as well as the immunophenotypes observed in host periodontal tissues during pathological conditions.

Oral health status and barriers to utilization of dental services among pregnant women in Sunsari, Nepal: A cross-sectional study

OBJECTIVES

This study was conducted to assess oral hygiene practices, oral health status and barriers to utilization of oral health care services among pregnant mothers attending two family health care clinics in Sunsari, Nepal.

METHODS

A cross-sectional study was conducted among 139 women using a purposive sampling technique. The data collection was done using a pretested standard semi-structured questionnaire. Face-to-face interviews of the participants were done by a single investigator in the local language (Nepali). The examination was done using a mouth mirror and CPI probe for periodontal status, loss of attachment and dentition status, and treatment needs.

RESULTS

The majority of pregnant mothers brushed their teeth once a day or less than once a day (n = 106, 76.3%) and self-reported perceived oral health status was poor/fair (n = 93, 66.9%). The prevalence of dental caries was found to be 69.8%. Bleeding on probing was present in all participants. DMFT, presence of bleeding on probing and increased periodontal pocket was significantly high among women who had self-reported their oral health problems in comparison to those who had not reported any problem. The most common barriers reported by the participants were a lack of knowledge of dental checkups and a lack of perceived need for dental care during pregnancy.

CONCLUSIONS

There was a high prevalence of dental caries and periodontal disease. Lack of knowledge and perceived need for dental care were the major barriers found in this study. Hence, this directs towards the utmost need for improvement in awareness level as well as oral hygiene practices.

The associations of two novel inflammation indexes, systemic immune-inflammation index (SII) and system inflammation response index (SIRI), with periodontitis: evidence from NHANES 2009-2014

OBJECTIVES

The research's goal is to look for any potential relationships between the systemic immune-inflammation index (SII) and the system inflammation response index (SIRI), along with inflammation indicators and the likelihood of periodontitis.

METHODS

Ten thousand two hundred eighty-two individuals in sum were determined to be eligible for this cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2014. Multiple logistic regression, generalized additive model, smooth curve fitting, subgroup analysis, and interaction tests were done for analyzing the association between periodontitis and SII, SIRI, and other inflammatory indicators.

RESULTS

The analysis, adjusted for population weighting, revealed that individuals with moderate/severe periodontitis had SII levels of 545.46 (95% CI (529.10, 561.82), P = 0.0044) and SIRI levels of 1.33 (95% CI (1.29, 1.37), P < 0.0001). In a fully adjusted multivariate logistic regression model, SII was not sensibly associated with moderate/severe periodontitis among the continuous and quartile Q1-Q4 groups (OR = 0.97, 95% CI (0.91, 1.02)). The continuous variable of SIRI (OR = 1.11, 95% CI (1.06, 1.17)) and the quartile Q4 group (OR = 1.58, 95% CI (1.28, 1.94)) had a deemed significant positive association with moderate to severe periodontitis. In addition, other inflammatory indicators, especially NLR, PPN, PLR, MLR, PC, NC, and MC were observed to be notably involved moderate/severe periodontist in this research.

CONCLUSION

We explored the association between periodontitis and two novel comprehensive markers of inflammation (SII and SIRI).

CLINICAL RELEVANCE

These inflammatory markers are expected to serve as tools to assist clinicians in diagnosing periodontitis.

The impact of DNA methylation as a factor of Adverse Pregnancy and Birth Outcomes (APBOs): a systematic review protocol

BACKGROUND

Deoxyribonucleic acid (DNA) methylation is one of the epigenetic modifications that has gained a lot of interest as a factor influencing fetal programming and as a biomarker for adverse pregnancy and birth outcomes (APBOs). Epidemiological studies have demonstrated that DNA methylation can result in adverse pregnancy and birth outcomes (APBOs) including miscarriage, intrauterine growth restriction (IUGR), low birth weight (LBW), sepsis, and preterm birth (PTB), which may later result in diseases in adulthood. However, the mechanism by which DNA methylation influences these APBOs remains unclear. The systematic review will assess the association between global and gene-specific DNA methylation with adverse pregnancy outcomes.

METHOD

The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist will be followed when conducting this systematic review. To develop the search strategy the PI(E)COS (population, intervention/exposure, comparator/control, outcome, and study designs) framework will be followed. Thus far, the research team has retrieved 4721 from Cochrane Library, PubMed, Web of Sciences, and MEDLINE. Out of these, 584 studies have been screened for eligibility, and approximately 124 studies meet the inclusion criteria. Pending the search results identified from the grey literature. For identification of unpublished studies in journals indexed in electronic databases, Google Scholar will be used. I.M and A.S will separately extract data from the articles and screen them, if there are any disagreements between I.M and A.S, then the L.M will resolve them. The methodological quality and bias risk of the included studies will be evaluated using the Critical Appraisal Skill Programme CASP) checklist. [Formula: see text] and [Formula: see text] alpha = 0.10 statistic will be used for assessing statistical heterogeneity between studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess and grade the overall quality of extracted data.

ETHICS AND DISSEMINATION

Ethical approval is not required. The systematic review will assess available literature on possible associations between DNA methylation with adverse pregnancy and birth outcomes (APBOs) including LBW, IUGR, miscarriage, sepsis, and PTB. The findings could help guide future research assessing DNA methylation and other APBOs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRCRD42022370647.

Exploring the Perception and Awareness of Dental Students and Interns in Managing and Treating Pregnant Patients

Background Undergraduate dental students and interns express reluctance to deal with pregnant women in the dental office due to the fear of medical consequences on the fetus. This study aims to explore the knowledge, attitudes, and practices of dental students and interns regarding the dental considerations of pregnant women in three dental schools in Saudi Arabia. Methodology This cross-sectional study was performed between October and December 2023 and targeted the clinical academic years of dental students and interns at three dental schools in Saudi Arabia, namely, Taibah University, Umm Al-Qura University, and Qassim University. Using the convenience sampling method, 223 students were invited to respond to a questionnaire constructed from previously published studies and reviewed by experts in the field. It consisted of 15 questions divided into four sections. Descriptive analysis and chi-square test were conducted to assess the difference between the different sociodemographic groups and students' educational levels with the significance level set at p-values <0.05. Results Overall, 223 complete responses were received, with a response rate of 97%. Demographics included 99 (44.40%) males and 124 (55.60%) females, with a reasonable distribution across academic years. Knowledge assessment findings revealed that 114 (51%) participants acquired adequate knowledge. Regarding participants' attitudes, 112 (50%) found the curriculum-centered information sufficient. In addition, 173 (77.6%) participants chose lectures/books as their preferred source of information. Almost 138 (61.9%) participants did not feel confident in managing pregnant women. The chi-square test revealed that educational level significantly impacts the knowledge and practice of the participants, regardless of their gender (p < 0.05). Conclusions Both students and dental interns showed adequate-to-good levels of knowledge and attitude. Both need more exposure to clinical situations with pregnant women during their undergraduate dental training programs to boost their confidence level and enhance their readiness to practice dental procedures with such a group of patients after graduation.

[Knowledge level of periodontal health in students of health sciences. a cross-sectional study]

Introduction

Periodontal disease is a multifactorial chronic inflammatory disease, so knowledge about this disease is important for health professionals for an assertive and early diagnosis.

Objective

Determine the level of knowledge about periodontal health in Health Sciences students at a private university in Lima-Perú.

Materials and Methods

Through a descriptive and cross-sectional study, 200 students from the Faculty of Health Sciences were evaluated. The sample size was obtained using a proportion estimation formula. The level of knowledge about periodontal health was measured using a specific virtual and self-applicable questionnaire, which was fully validated. University students of legal age and who signed the informed consent were included. This consisted of 16 questions about the causes, signs, prevention habits and relationship with systemic diseases related to periodontal disease. The data were analyzed using descriptive statistics (absolute and relative frequencies) and means and averages for age.

Results

The level of knowledge was medium in 38%, high in 32.5% and low in 29.5% of the students surveyed. 96.5% knew that periodontal disease is preventable; However, 91.5% do not know what its main clinical sign is.

Conclusions

The use of a self-applicable and specific questionnaire is beneficial to evaluate and measure knowledge about periodontal health, and the Health Sciences students evaluated have a medium level of knowledge about periodontal health.

Oral Inflammation and Human Papilloma Virus Association among Hispanics

Background

Identifying factors related to persistent human papillomavirus (HPV) infection is essential to reduce the incidence of HPV-related cancers.

Objective

To evaluate whether gingival/periodontal inflammation is associated with oral HPV infection.

Methods

This cross-sectional study (n = 740) uses data from the follow-up visit of the San Juan Overweight Adults Longitudinal Study, which recruited overweight/obese adults aged 40-65 from Puerto Rico. Participants completed a dental examination and two interviews (face-to-face/ACASI) and provided oral rinse samples for HPV detection. Oral inflammation was assessed using two definitions: (1) the number of sites with bleeding on probing (BOP), and (2) the number of teeth with probing pocket depths (PPD) ≥ 4 mm and BOP. Multivariate logistic regression was used to assess the association between oral inflammation and oral HPV.

Results

Nearly three-quarters (72%) of participants were female, and 68% had 50 years or older. Participants with HPV had a higher mean number of sites with BOP (15.5 vs. 10.1) and teeth with PPD ≥ 4 mm and BOP (8.5 vs. 3.2) than participants without HPV (p < 0.05). After adjusting for sex, age, income, and the number of oral sex partners, the odds of having an oral HPV infection increased by 3% (95% confidence interval (CI): 1.00-1.06) for any additional sites with BOP and 5% (95% CI: 1.02-1.09) for any other teeth with PPD ≥ 4 mm and BOP.

Conclusions

We found that oral inflammation was associated with oral HPV infection among adults in Puerto Rico. Future studies need to further investigate the underlying mechanisms.

Interleukin 1 beta and its association with the periodontal health of pregnant women

Objectives

In this study, we measured and compared serum and gingival crevicular fluid (GCF) levels of interleukin 1 beta (IL-1β) in pregnant women with periodontitis and pregnant women with a healthy periodontium. We also determined the prevalence of periodontitis among pregnant women attending Omdurman Midwifery Hospital.

Materials

This was a hospital-based clinical study and laboratory investigation using ELISA tests of 80 pregnant women in the third trimester conducted at the Omdurman Midwifery Hospital in Khartoum, Sudan. The study group consisted of 50 women while the control group consisted of 30 women.

Results

Independent samples t-tests were used to compare serum and GCF levels of IL-1β between the study and control groups. Pearson's correlation analysis was also used to compare gingival parameters and IL-1β levels in the GCF. For each comparison, the p-value was fixed at 0.05. The GCF in the research group showed a considerable increase in IL-1β levels. There was also a strong positive association between high IL-1β levels in the research group's GCF and probing pocket depth (PPD) and clinical attachment level (CAL) levels.

Conclusions

Our study provides further evidence that periodontitis, as measured by a PD ≥4 mm and a CAL ≥3 mm, is associated with an increased level of IL-1β in the GCF of pregnant women with active periodontal disease during pregnancy and may include the transient translocation of oral organisms to the utero-placental unit, inciting placental inflammation or oxidative stress early in pregnancy, ultimately resulting in placental damage and clinical manifestations.

Porphyromonas gingivalis outer membrane vesicles shape trophoblast cell metabolism impairing functions associated to adverse pregnancy outcome

Periodontitis is proposed as a risk factor for preterm delivery, fetal growth restriction, and preeclampsia with severe consequences for maternal and neonatal health, but the biological mechanisms involved are elusive. Porphyromonas gingivalis gain access to the placental bed and impair trophoblast cell function, as assessed in murine and human pregnancy, suggesting a pathogenic role in adverse pregnancy and neonatal outcomes. P. gingivalis releases outer membrane vesicles (P. gingivalis OMV) during growth that spread to distant tissues and are internalized in host cells as described in metabolic, neurological, and vascular systemic diseases. Here we tested the hypothesis that P. gingivalis OMV internalized in trophoblast cells disrupt their metabolism leading to trophoblast and placenta dysfunction and adverse pregnancy outcomes. An in vitro design with human trophoblast cells incubated with P. gingivalis OMV was used together with ex vivo and in vivo approaches in pregnant mice treated with P. gingivalis OMV. P. gingivalis OMV modulated human trophoblast cell metabolism by reducing glycolytic pathways and decreasing total reactive oxygen species with sustained mitochondrial activity. Metabolic changes induced by P. gingivalis OMV did not compromise cell viability; instead, it turned trophoblast cells into a metabolic resting state where central functions such as migration and invasion were reduced. The effects of P. gingivalis OMV on human trophoblast cells were corroborated ex vivo in mouse whole placenta and in vivo in pregnant mice: P. gingivalis OMV reduced glycolytic pathways in the placenta and led to lower placental and fetal weight gain in vivo with reduced placental expression of the glucose transporter GLUT1. The present results point to OMV as a key component of P. gingivalis involved in adverse pregnancy outcomes, and even more, unveil a metabolic cue in the deleterious effect of P. gingivalis OMV on trophoblast cells and mouse pregnancy, providing new clues to understand pathogenic mechanisms in pregnancy complications and other systemic diseases.

Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned

The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.

Influence of maternal oral microbiome on newborn oral microbiome in healthy pregnancies

BACKGROUND

Periodontal disease and its bacteria can be responsible for pregnancy complications and transmission of periodontal bacteria from mother to newborn.

METHODS

A salivary swab to 60 healthy, full-term newborns and their mothers was taken immediately after birth. The test was performed with Real Time PCR method to evaluate the expression of the gene through DNA amplification. The species considered were: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum ssp.

RESULTS

The newborn oral microbiome was composed primarily by saprophytes (98.38 + 4.88%), just like the mothers (98.8 + 3.69%). There was a statistically significant difference of the total microbiological density in newborns and mothers (p = 0.0001). Maternal and neonatal oral microbiome had a correlated total microbiological density only in 33.3% (N = 20/60) of cases. The analysis of the oral microbiome showed a pathological composition only in 12/60 babies (20%). The most frequent detected specie in newborns was Fusobacterium nucleatum (9/12 babies, 75%), as well as for the mothers (53.3%). However, the pathogen was present both in baby and his mother only in 3 dyads. Porphyromonas gingivalis showed the highest association mother-baby (4/12 dyads, 33%). Porphyromonas gingivalis was the pathogen with the highest bacterial load in the 12 mothers. We found a statistically significant difference in the total load of Porphyromonas gingivalis in mothers and babies (p = 0.02).

CONCLUSIONS

There was a statistically significant difference in the richness of the microbiome from newborns and mothers. Even comparing the microbiological density in the oral cavity of the individual mother-child pairs, we did not find a significant concordance. These results seem to suggest a low influence of maternal oral microbiome on the richness of the oral neonatal one. We didn't find mother-child concordance (p = 0.0001) in the presence of pathogenic periodontal micro-organisms. Fusobacterium nucleatum was the most frequent specie detected. Porphyromonas gingivalis instead was the bacteria with the higher possibility of transmission. In conclusion in our study maternal oral health doesn't affect healthy, full-term newborns' oral microbiome. Further studies are needed to understand the maternal influence on newborn's oral microbiome and its effects on babies long-term health.

Predictors of oral health literacy in pregnant women

We determined factors associate with oral health literacy of pregnant women. A total of 203 pregnant women attending Hospital Universiti Sains Malaysia (USM) for antenatal care participated in this cross-sectional study. The Malay version of Oral Health Literacy Instrument (OHLI-M) and a structured self-administered questionnaire were used to obtain variables of interest. The mean OHLI-M score was 73.6 (SD 12.59). Only slightly more than half of our participants had adequate oral health literacy (54.2%), while others were marginal (31.0%) and inadequate (14.8%). Our findings revealed that women with adequate oral health literacy were more likely to be those with higher education qualification and were very satisfied or satisfied with their oral health status. The identification of these predictors highlighted the importance to keep oral health education messages simple and clear for the benefit of individuals with low educational attainment.

Factors associated with access to dental care among refugees: A systematic review of quantitative studies

OBJECTIVES

To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide.

METHODS

A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted.

RESULTS

The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]).

CONCLUSIONS

Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.

Extracellular Vesicles of Porphyromonas gingivalis Disrupt Trophoblast Cell Interaction with Vascular and Immune Cells in an In Vitro Model of Early Placentation

Extracellular vesicles released by the primary pathogen of periodontal disease Porphyromonas gingivalis (Pg), referred to as outer membrane vesicles (OMVs), have been associated with the pathogenesis of systemic diseases like cardiovascular disease, rheumatoid arthritis, and Alzheimer's disease. A pathogenic role for Pg by disrupting placental homeostasis was proposed in the association between periodontal disease and adverse pregnancy outcomes. On the basis that trophoblast-derived factors modulate endothelial and immune cell profiles in normal pregnancy and the scarce presence of Pg in placenta, we hypothesized that OMVs from Pg affect trophoblast cell phenotype, impairing trophoblast-endothelium and trophoblast-neutrophil interactions. By means of in vitro designs with first-trimester human trophoblast cells, endothelial cells, and freshly isolated neutrophils, we showed that Pg OMVs are internalized by trophoblast cells and modulate the activity and expression of functional markers. Trophoblast cells primed with Pg OMVs enhanced neutrophil chemoattraction and lost their anti-inflammatory effect. In addition, reduced migration with enhanced adhesion of monocytes was found in endothelial cells upon incubation with the media from trophoblast cells pretreated with Pg OMVs. Taken together, the results support a pathogenic role of Pg OMVs at early stages of pregnancy and placentation through disruption of trophoblast contribution to vascular transformation and immune homeostasis maintenance.

Preconception Periodontitis and Risk of Spontaneous Abortion in a Prospective Cohort Study

Few studies have evaluated the association between periodontitis and spontaneous abortion (SAB), and all had limitations. We used data from the Pregnancy Study Online (PRESTO), a prospective preconception cohort study of 3,444 pregnancy planners in the United States and Canada (2019-2022), to address this question. Participants provided self-reported data on periodontitis diagnosis, treatment, and symptoms of severity (i.e., loose teeth) via the enrollment questionnaire. SAB (pregnancy loss at <20 weeks' gestation) was assessed via bimonthly follow-up questionnaires. Participants contributed person-time from the date of a positive pregnancy test to the gestational week of SAB, loss to follow-up, or 20 weeks' gestation, whichever came first. We fitted Cox regression models with weeks of gestation as the time scale to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs), and we used inverse probability of treatment weighting to account for differential loss to follow-up. We used probabilistic quantitative bias analysis to estimate the magnitude and direction of the effect of exposure misclassification bias on results. In weighted multivariable models, we saw no appreciable association between preconception periodontitis diagnosis (HR = 0.97, 95% CI: 0.76, 1.23) or treatment (HR = 1.01, 95% CI: 0.79, 1.27) and SAB. A history of loose teeth was positively associated with SAB (HR = 1.38, 95% CI: 0.88, 2.14). Quantitative bias analysis indicated that our findings were biased towards the null but with considerable uncertainty in the bias-adjusted results.

A Bibliometric Perspective on the Relationship between Periodontal Disease and Gestational Diabetes

AIM

To analyze the bibliometric indicators of the world scientific production on periodontal disease and gestational diabetes.

MATERIALS AND METHODS

Bibliometric study in which a search strategy was designed with logical operators and MESH terms. After the search and application of selection criteria, 83 articles were included. SciVal, VOSviewer, and the Bibliometrix module of R Studio were used to analyze the metadata.

RESULTS

From 2012 to 2021, there is evidence of an increase in scientific dissemination on gestational diabetes and periodontal disease, especially in high-impact journals (79.2%). SUNY Buffalo (6), United State University, and Ege University, Turkey (5) are the most productive; however, the one that received more citations than the global average was the University of Birmingham (FWCI: 5.59). In addition, the United States, Brazil, and India were the most influential countries; while, Graziani F, Akcali A, and Buduneli N, were the most representative authors. The Journal of Periodontology and the Journal of Clinical Periodontology published the most articles, with 13 and 6, respectively.

CONCLUSIONS

The scientific production on periodontal disease and gestational diabetes is higher in recent years, with a better proportion of articles in high-impact journals. In addition, the United States concentrates many publications, and the activity of Chilean institutions stands out.

CLINICAL SIGNIFICANCE

The clinical significance of this study lies in its capacity to synthesize the currently available published information regarding the correlation between periodontal disease and gestational diabetes. This study enables researchers and clinicians to ascertain the current level of knowledge on this subject.

An Overview of the Systematic Evidence on the Adjunctive Use of Laser Therapy in Non-surgical Periodontal Treatment

This overview aimed to recapitulate the evidence related to laser application in non-surgical periodontal treatment along with conventional periodontal treatment for optimum clinical practice based on the available systematic reviews (SRs). An advanced literature search in the English language was conducted in the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), ScienceDirect, and Scopus databases from January 2000 to October 2022. Two independent reviewers screened all the databases and extracted the data in duplicate. The risk of bias in the selected studies was assessed with the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) guideline for SRs. Cohen's kappa statistics were performed to assess the level of agreement for the assessment of the risk of bias. A total of 556 studies (PubMed = 115, Scopus = 66, ScienceDirect = 298, and MEDLINE = 77) were identified after the initial search using the keywords from different databases. After removing the duplicates and assessing the full manuscripts, a total of 24 studies were selected based on the inclusion criteria for the current overview. A total of three, four, 12, and five systematic reviews were classified as high, moderate, low, and critically low-quality SRs as per the AMSTAR 2 quality assessment tool. Cohen's Kappa statistics showed perfect (𝛋 =1.000) agreement between the two reviewers. Adjunctive laser therapy along with conventional non-surgical periodontal treatment might be effective in short-term treatment outcomes; however, evidence of long-term effects is still lacking.

The potential role of the gingival crevicular fluid biomarkers in the prediction of pregnancy complications

Early and minimally invasive methods are required to predict the risk of multiple adverse pregnancy outcomes. A potential technique with growing interest utilizes the gingival crevicular fluid (GCF), a physiological serum exudate found in the healthy gingival sulcus and in the periodontal pocket in inflammatory conditions. Analysis of biomarkers in the GCF is a minimally invasive method that can be feasible and cost-effective. The potential use of GCF biomarkers along with other clinical indicators in early pregnancy may provide reliable predictors of several adverse pregnancy outcomes, therefore, reducing both maternal and fetal morbidities. Various studies have reported that increased or decreased concentrations of different biomarkers in GCF are associated with a high risk of developing pregnancy complications. In particular, such associations have been commonly demonstrated with gestational diabetes, pre-eclampsia, and pre-term birth. However, limited evidence is available regarding other pregnancy complications such as preterm premature rupture of membranes, recurrent miscarriage, small for gestational age, and hyperemesis gravidarum. In this review, we discuss the reported association between individual GCF biomarkers and common pregnancy complications. Future research is required to provide more solid evidence of the predictive value of those biomarkers in estimating women's risk for each disorder.

Antenatal interventions to reduce risk of low birth weight related to maternal infections during pregnancy

BACKGROUND

Maternal infections during pregnancy have been linked to increased risk of adverse birth outcomes, including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and stillbirth (SB).

OBJECTIVES

The purpose of this article was to summarize evidence from published literature on the effect of key interventions targeting maternal infections on adverse birth outcomes.

METHODS

We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL Complete between March 2020 and May 2020 with an update to cover until August 2022. We included randomized controlled trials (RCTs) and reviews of RCTs of 15 antenatal interventions for pregnant women reporting LBW, PTB, SGA, or SB as outcomes.

RESULTS

Of the 15 reviewed interventions, the administration of 3 or more doses of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine [IPTp-SP; RR: 0.80 (95% CI: 0.69, 0.94)] can reduce risk of LBW compared with 2 doses. The provision of insecticide-treated bed nets, periodontal treatment, and screening and treatment of asymptomatic bacteriuria may reduce risk of LBW. Maternal viral influenza vaccination, treatment of bacterial vaginosis, intermittent preventive treatment with dihydroartemisinin-piperaquine compared with IPTp-SP, and intermittent screening and treatment of malaria during pregnancy compared with IPTp were deemed unlikely to reduce the prevalence of adverse birth outcomes.

CONCLUSIONS

At present, there is limited evidence from RCTs available for some potentially relevant interventions targeting maternal infections, which could be prioritized for future research.

Promoting Oral Health Behavior During Pregnancy: A Randomized Controlled Trial

BACKGROUND

Pregnant women are vulnerable to oral disease due to physiological, hormonal, and dietary alterations. The aim of the present study was to evaluate the impact of the educational program according to the Health Promotion Model (HPM) on the oral health prevention behavior of pregnant women.

STUDY DESIGN

A randomized controlled trial.

METHODS

This study was performed on 105 pregnant women visiting health centers located in Arak from February to November 2022. The subjects were randomly assigned to intervention (n=54) and control (n=51) groups. A reliable and valid questionnaire according to HPM constructs was used to collect the data. The pre-test was conducted in the groups. The intervention group received the educational program in 9 educational sessions (from 12 to 24 weeks of pregnancy). Then, the post-test was conducted in the 36th week of pregnancy in the groups. Finally, the data were analyzed by SPSS software (version 18) and using independent t-test, paired t-test, and Chi-square test.

RESULTS

There were statistically significant differences between the intervention and control groups regarding perceived benefits (24.68±3.63 vs. 26.57±3.67, P=0.009), perceived barriers (7.31±3.14 vs. 5.81±3.59, P=0.025), positive affect (10.50±1.66 vs. 11.29±1.34, P=0.009), negative affect (1.59±0.223 vs. 1.40±1.51, P=0.006), commitment to the action plan (4.05±1.92 vs. 4.77±1.50, P=0.034), and tooth brushing time (2.29±0.72 vs. 2.74±0.48, P<0.001). However, no significant difference was observed regarding the tooth brushing frequency (2.05±0.58 vs. 2.07±0.66, P=0.901) after the intervention. The brushing time for 2-3 minutes in the intervention group increased from 51.85% to 75.92% after the intervention.

CONCLUSION

HPM-based education was effective in promoting the duration of tooth brushing in pregnant women. However, it had no effect on the tooth brushing frequency.

How much do pregnant women know about the importance of oral health in pregnancy? Questionnaire-based survey

BACKGROUND

Although pregnancy is a physiological process it causes hormonal changes that can also affect the oral cavity. Pregnancy increases the risk of gum disease inflammation and tooth caries which could affect the health of the developing baby. Proper oral health is crucial both for mother and her babies and is related with mothers' awareness of this connection. The aim of this study was the self-assessment of women's both oral health and oral health literacy as well as mothers' awareness of the connection of oral health and pregnancy.

MATERIAL AND METHODS

In the study anonymous questionnaire was prepared and provided to be filled in by 200 mothers at the age from 19 to 44 y.o. who gave birth in the gynecological clinic. The questionnaire included demographic, and concerning the areas of oral health before and during pregnancy and after the childbirth questions.

RESULTS

Only 20% of the investigated women underwent the oral examination before the pregnancy and the next 38.5% underwent it intentionally when the pregnancy had been confirmed. As much as 24% of women pointed out lack of awareness of the importance of proper oral hygiene during pregnancy. 41.5% of investigated women declared complaints during the pregnancy concerning teeth or gums and 30.5% underwent dental treatment; 68%, brushed their teeth properly-twice a day; 32% of women observed deterioration of oral health state during the pregnancy. The knowledge of the importance of oral health during pregnancy presented by the majority of mothers was relatively proper, which was strongly connected with higher education status and living in big cities. A significant correlation between higher birth weight and more frequent daily tooth brushing was observed. Both higher frequency of problems concerning the oral cavity and dental treatment during pregnancy were significantly related to the younger age of mothers.

CONCLUSIONS

The knowledge of women concerning of oral health on the management of pregnancy and development of fetus is still insufficient. Gynecologists should inquire pregnant women if they have done dental examination, and provide wider education about importance of oral health in pregnancy.

Association between the Risk of Preterm Birth and Low Birth Weight with Periodontal Disease in Pregnant Women: An Umbrella Review

Background: The purpose of this review is to determine the association between the risk of preterm birth and low birth weight in newborns and periodontal disease in pregnant women. Methods: A bibliographic search was carried out until November 2021 in the following biomedical databases: PubMed/Medline, Cochrane Library, Scopus, EMBASE, Web of Science, Scielo, LILACS and Google Scholar. Studies reporting the association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women, which were systematic reviews, in English and without time limits were included. AMSTAR-2 was used to assess the risk of the included studies, and the GRADEPro GDT tool was used to assess the quality of the evidence and the strength of the recommendation of the results. Results: The preliminary search yielded a total of 161 articles, discarding those that did not meet the selection criteria, leaving only 15 articles. Seven articles were entered into a meta-analysis, and it was found that there is an association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women. Conclusions: There is an association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women.

[Pathways and Mechanisms of Periodontitis Contributing to Adverse Pregnancy Outcomes]

Periodontitis is a chronic oral inflammatory disease with a high incidence in the global population. Periodontal pathogens can colonize and infect multiple human tissues and organs through blood transmission, which is an important risk factor of many systemic diseases. Recently, the correlation between periodontitis and adverse pregnancy outcomes (APOs) has attracted growing research interest. Herein, we systematically reviewed the research progress in the relationship between periodontitis and APOs and summarized reported findings on the pathways and mechanisms by which periodontitis contributes to APOs. We also clarified that intrauterine infection caused by oral pathogens transmitted through blood is an important pathway by which periodontitis interferes with pregnancy. In addition, further research focused on the discovery of more APOs-related oral pathogenic bacteria and their virulence factors, analysis of the interaction between pathogenic bacteria and placental tissue, and pathogenic pathways of oral bacterial invasion of the fetus will promote thorough analysis of the specific molecular mechanism of how periodontitis affects APOs. Furthermore, the validation of the results of human population-based studies through animal/cell experiments and the translation into effective intervention strategies are of great clinical significance to the prevention and control of the occurrence and development of APOs.

The Potential Association Between Periodontal Diseases and Adverse Pregnancy Outcomes in Pregnant Women: A Systematic Review of Randomized Clinical Trials

Preceding studies have demonstrated that periodontitis might increase the liability of adverse pregnancy outcomes such as preterm birth, preeclampsia, low birth weight, and perinatal fatality in pregnant women. Nonetheless, there is no convincing testimony that periodontitis is related directly to adverse pregnancy outcomes in pregnant women. This systematic review intended to assess and review all the available randomized clinical trials that concentrated on the association between periodontal diseases and adverse pregnancy outcomes, and the impact of periodontal disease therapy on adverse pregnancy outcomes. The databases like Scopus, PubMed, Google Scholar, and Web of Science were consumed to explore relevant and suitable studies after adopting the inclusion and exclusion criteria. The search included articles with no time restrictions and certain keywords were utilized in the databases. The investigation was done through four independent reviewers employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-three studies fulfilled the exclusion and inclusion criteria and were used and included in this systematic review. The above-mentioned studies assessed the association between periodontal diseases and adverse pregnancy outcomes and the effect of periodontal disease treatment in reducing the influence of adverse pregnancy outcomes. This systematic review revealed that there is a relationship between periodontitis and adverse pregnancy outcomes, and periodontal treatment has a reducing impact on adverse pregnancy outcomes in pregnant women with periodontitis. Prospect studies are warranted to investigate the relationship between periodontitis and different adverse pregnancy outcomes and to decide the best type and the most effective therapy to treat periodontitis in pregnant women.

The Association between Maternal Oral Inflammation and Neutrophil Phenotypes and Poly-Unsaturated Fatty Acids Composition in Human Milk: A Prospective Cohort Study

This prospective cohort study aimed to investigate the impact of maternal oral inflammation on human milk composition including neutrophil counts, activation state (based on cluster of differentiation (CD) markers expression), and fatty acid levels. Fifty mothers were recruited from St. Michael's hospital, Toronto, and followed up from 2-4 weeks until 4 months postpartum. Oral rinse and human milk samples were collected at both timepoints. Oral polymorphonuclear neutrophils (oPMNs) within the rinses were quantified using flow cytometry and the participants' oral health state was categorized into three groups (i.e., healthy, moderate, and severe) based on the oPMNs counts. Fatty acids were identified and quantified using a gas chromatography-flame ionization detector (GC-FID). Compared to mothers with a healthy oral health state, mothers with moderate to severe oral inflammation had a statistically significant decrease in the expression of CD64 biomarker, an increase in the expression of CD14 biomarker on human milk neutrophils and a decrease in the levels of eicosapentaenoic acid (C20:5n-3) in their human milk at follow-up compared to baseline. This study demonstrates for the first time that maternal oral inflammation can affect human milk composition. The mechanism by which these alterations can affect infant health outcomes in the long term critically needs to be considered.

Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review

Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.

Characterizing the supragingival microbiome of healthy pregnant women

The ecological characteristics and changes of the supragingival plaque microbial community during pregnancy are poorly understood. This study compared the microbial community characteristics of supragingival plaque in pregnant and non-pregnant women, with the aim of identifying specific microbial lineages and genera that may be associated with pregnancy. Thirty pregnant women were randomly selected from the First Affiliated Hospital of Xinjiang Medical University and divided into groups based on pregnancy trimester: first trimester (group P1, n=10, ≤12 weeks), second trimester (group P2, n=10, 13–27 weeks), and third trimester (group P3, n=10, 28–40 weeks). Ten healthy non-pregnant women (group N) were enrolled as the control group. Supragingival plaque samples of all subjects were collected and oral microbial composition was surveyed using a 16S rRNA gene sequencing approach. Statistical analysis was performed using a nonparametric test. The Chao 1 index of P3 was significantly lower compared with that of N, P1, and P2 (P&lt;0.05). The Simpson indices of P2 and P3 were significantly higher than that of N (P&lt;0.05). The Shannon index of P2 was significantly higher compared with that of N (P&lt;0.05). Principal coordinate analysis (PCoA) showed different clustering according to the pregnancy status. Linear discriminant analysis effect size (LEfSe) revealed that the microbial species in group N that were significantly different from those of other groups were concentrated in the genus Neisseria. Species in P1 that were significantly different from those of other groups were concentrated in the genus Tannerella, while those in P2 and P3 were concentrated in the genus Leptotrichia. A total of 172 functional pathways were predicted for the bacterial communities in this study using PICRUSt2. Principal Component Analysis (PCA) showed that most predicted functional pathways clustered together in N and P1 and in P2 and P3. LEfSe analysis revealed that 11 pathways played a discriminatory role in the four groups. This work suggests a potential role of pregnancy in the formation of supragingival plaque microbiota and indicates that physiological changes during pregnancy may convert supragingival plaque into entities that could cause harm, which may be a risk factor for maternal health. Furthermore, findings from the study provide a basis for etiological studies of pregnancy-associated oral ecological disorders.

Physicians' awareness of oral-systemic links and its association with physician-reported patient referral to dentists

INTRODUCTION

Physicians promote oral health by screening for oral pathologies, providing emergency help, and referring patients to dentists. The literature consistently reports a robust association between periodontal disease and systemic diseases. However, it is not fully known if physicians in Saudi Arabia are aware of the oral-systemic disease links. Therefore, the study aimed to evaluate physicians' awareness of the oral-systemic disease links and their association with patients' referral to dentists and patients' access to oral care.

METHODS

This cross-sectional study was conducted (June 2019-January 2020) on physicians working in private and public hospitals in the Eastern province of Saudi Arabia. The physicians (n = 333) responded to a paper-based self-administered and pilot-tested questionnaire which inquired about their awareness of oral-systemic disease links and patient referral to dentists. The reliability of items of oral-systemic disease links was evaluated by calculating Cronbach's alpha (0.84).

RESULTS

Most participants (92.8%) agreed/strongly agreed that oral health is associated with systemic health. Half of the sample (50.8%) referred patients to dentists during the last month. Almost 80.5% believed that more patients will be referred to the dentists because of their awareness of the oral-systemic disease links and 84% believed that more patients will access oral care services if patients were aware of the oral-systemic disease links. The participants who referred patients to the dentists during the last month (P = 0.038), believed that more patients will be referred (P = 0.001), and believed that more patients will access oral care (P = 0.003) demonstrated significantly higher oral-systemic disease links awareness score. The adjusted model showed patients' referral to dentist (OR = 1.96.10, P = 0.006) and believing in more patients accessing oral care (OR = 2.05, P = 0.044) were associated with significantly increased awareness of the oral-systemic disease links.

CONCLUSION

Most physicians in the study were aware of the oral-systemic disease links. Increased awareness of the oral-systemic disease links was significantly associated with the referral of patients to dentists and belief in improved patients' access to oral care services.

Prevalence of periodontal disease in pregnancy: A systematic review and meta-analysis

OBJECTIVES

The purpose of this study was to systematically assess the epidemic trend of periodontal disease in pregnancy.

DATA

Eligibility criteria comprised studies that reported periodontitis and the periodontal indicators of BOP (+) or CAL≥4 mm or PD≥4 mm among pregnant women. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias was assessed using the Critical Appraisal Checklist for prevalence studies proposed by The Joanna Briggs Institute (JBI). Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I2 statistic, subgroup and sensitivity analyses assessed study heterogeneity.

SOURCES

Electronic search of articles was conducted using PubMed, Web of Science, EMBASE, Scopus, and Ovid from January 2000 to January 2022.

RESULTS

A total of 20 studies were included in the meta-analysis. The prevalence of periodontitis among pregnancy was 40% (95% Confidence Interval (CI): [0.15, 1.00]). The prevalence rates were 67% (CI [0.56, 0.80]), 42% (CI [0.27, 0.57]) and 24% (CI [0.12, 0.37]) for BOP (+), PD≥4 mm and CAL≥4 mm respectively. Regarding subgroup meta-analyses, the prevalence rates of BOP (+) and PD≥4 mm presented a gradual increase throughout pregnancy, while the highest prevalence rate of CAL≥4 mm was in the 2nd trimester.

CONCLUSIONS

It was observed a high prevalence of periodontal disease in pregnancy. However, heterogeneity was high among included studies. More high-quality epidemiologic investigations on periodontal disease in pregnancy are still needed.

CLINICAL SIGNIFICANCE

Periodontal disease in pregnancy is highly prevalent which results in a reduced quality of life, frequent systemic pathologies and adverse pregnancy outcomes. Given the unhealthy consequences, public health impact, and expansive disease burden, it is worthwhile to investigate more aspects of periodontal disease during pregnancy.