Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial

Evaluation of the Effect of Supragingival Scaling on Periodontal Parameters in Pregnant Women with Metabolic Syndrome

Background

Although there are quite a number of studies on the impacts of periodontal therapeutic management on pregnant females, literature on the impact of supragingival scaling on pregnant females with metabolic syndrome (MS) is wanting. The present investigation was meticulously formulated to ascertain the clinical ramifications of supragingival scaling in pregnant individuals diagnosed with MS.

Material and Methods

An intervention study was conducted on 47 pregnant females. The gingival index (GI), plaque index, bleeding on probing, probing depth, and clinical attachment level were among the periodontal parameters evaluated. By the end of 20-21 weeks of pregnancy, all participants had received scaling and polishing at the baseline appointment, along with advice on dental hygiene. Periodontal parameters were gathered again during a follow-up appointment 8 weeks post treatment. A 5% threshold for statistical significance was set, and paired t-test and chi-square test were applied for comparison.

Results

Lower levels of PI, GI, and BOP 8 weeks post supragingival scaling were noted than at the baseline. The results obtained were statistically significant (P < 0.001) All patients with severe periodontitis (n = 14) before supragingival scaling shifted to milder forms of the disease. Similarly, moderate periodontitis was seen in 20 patients before the start of the study, and after the intervention, it was reduced to 16 patients.

Conclusion

In summary, supragingival scaling lowers the incidence of periodontal disease in pregnant MS females. High-risk pregnant women who receive scaling treatment and instruction on oral hygiene on a regular basis have better oral health, which in turn improves the health of their unborn child.

Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review

Background: The aim of this review was to evaluate the effects of periodontal disease (PD) treatment in pregnant women to reduce the risk of preterm birth (PB) and low birth weight (LBW) by conducting an umbrella review. Methods: A comprehensive search for the literature up to April 2024 was conducted across multiple databases including PubMed, Cochrane Library, Scopus, EMBASE, Scielo, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We specifically targeted systematic reviews (SRs) with or without meta-analyses, irrespective of language or time constraints, focusing on primary studies examining the effect of PD treatment in pregnant women to reduce the risk of PB and LBW. Various types of non-systematic reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded from consideration. The quality and overall confidence of the included studies were assessed using the AMSTAR-2 tool. Results: After the initial search, 232 articles were identified, of which only 24 met the selection criteria after exclusion. The majority of these studies indicated that periodontal treatment reduces the risk of PB and LBW. Conclusions: According to the findings and conclusions drawn from the SRs with a high overall confidence level, PD treatment in pregnant women reduces the risk of PB and LBW.

From Oral Health to Obstetric Outcomes: A Comprehensive Review of Periodontal Disease and Its Implications for Preeclampsia

Periodontal disease and preeclampsia (PE) are both significant health concerns with implications for maternal and fetal well-being. Emerging evidence suggests a potential association between these two conditions, prompting increased interest in understanding their relationship and clinical implications. This comprehensive review examines the current literature on periodontal disease and PE, focusing on epidemiological evidence, proposed mechanistic pathways, and clinical implications. Epidemiological studies consistently demonstrate an increased risk of PE among pregnant individuals with periodontal disease, independent of traditional risk factors. Proposed mechanisms linking periodontal disease to PE include systemic inflammation, endothelial dysfunction, and immune dysregulation. The implications for research include the need for well-designed prospective studies and randomized controlled trials to elucidate further the mechanisms underlying the association and evaluate the effectiveness of periodontal interventions in preventing PE. Clinicians should be aware of the potential link between periodontal disease and PE and consider screening pregnant individuals for periodontal disease as part of routine prenatal care. Interdisciplinary collaboration between obstetricians and periodontists may be beneficial in managing pregnant individuals with periodontal disease to mitigate the risk of PE. By addressing these research gaps, we can further understand the relationship between oral health and obstetric outcomes and develop evidence-based strategies to improve maternal and fetal health.

Awareness of Periodontal Health among Pregnant Females in Government Setting in United Arab Emirates

OBJECTIVE

 Periodontal disease is one of the most common infectious diseases. Several factors are associated with increased susceptibility of periodontal disease such as hormonal changes during pregnancy. Although pregnancy does not directly cause gingivitis, it can aggravate preexisting periodontal disease. This study aimed to evaluate knowledge of the association between periodontal disease and pregnancy in pregnant females.

MATERIALS AND METHODS

 A convenience sample of pregnant females attending two United Arab Emirates government hospitals was recruited for this study. A 23-item questionnaire was developed with four sections, covering sociodemographic details, oral hygiene, oral symptoms during pregnancy, and knowledge of periodontal health during pregnancy. The study was conducted between April and October 2017. All participants consented to the survey.

RESULTS

 A total of 100 participants with a mean age of 31 years (± 5.9) completed the survey. Most respondents brushed their teeth 2 to 3 times a day (65%), used a manual toothbrush (93%) but only visited the dentist when in pain (62%). Few respondents self-reported any gingival signs and symptoms during pregnancy; 38% had bleeding gums, 27% had no gum swelling, and 34% had bad odor/taste/smell. Only 21% of pregnant females lost a tooth/teeth during pregnancy, 15% believed that pregnancy increased the likelihood of gum disease, and 66% of gynecologists did not advise a visit to the dentist.Housewives were significantly less knowledgeable about periodontal health than students/employed respondents (p = 0.01). Quality of knowledge was not associated with educational attainment (< 0.06). Respondents > 30 years of age were more likely to believe in "a tooth for a baby" than younger participants aged < 30 years (p < 0.05). A logistic regression model showed that educational attainment was not a predictor for the belief in "a tooth for a baby" but age was a significant predictor (odds ratio = 2.0).

CONCLUSION

 Protocols should be developed in antenatal clinics in order to improve periodontal health in pregnant females and to prevent complications that can result in adverse pregnancy outcomes.

Periodontitis in Pregnant Women: A Possible Link to Adverse Pregnancy Outcomes

BACKGROUND

Periodontitis develops in 11% of pregnant women, and it is independently linked to severe complications during pregnancy such as preterm birth, low birth weight, and gestational diabetes.

METHODS

A literature search (Pubmed/MEDLINE, and Scopus) from 2003 to 2023 was conducted to analyze studies focused on periodontitis and adverse pregnancy outcomes.

RESULTS

16 articles have been included. Most of the studies showed adverse outcomes, like preterm birth and the low weight of the unborn child, are among the most frequent consequences (respectively 62.5% and 68.7% of articles); pre-eclampsia is also linked to this condition (12.5% of articles); and perinatal mortality (12.5% of articles).

CONCLUSIONS

Periodontal disease appears to be associated with adverse events in pregnancy due to the transport of biofilm bacteria into the bloodstream and into placental tissue; what would cause adverse events is the body's immune response to infection.

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.

Antibiotic use in endodontic treatment during pregnancy: A narrative review

More than half of pregnant women are usually affected by odontogenic pain affects. Pain often accompanies periapical or pulp infections and increases the risks to pregnant patients and their fetuses. The American Dental Association, in partnership with the American College of Obstetricians and Gynecologists, has offered a strong declaration reaffirming the significance of suitable and timely oral health care as an indispensable constituent of a healthy pregnancy. However, there is lack of knowledge about the use of antibiotics in endodontic treatment. Therefore, the present study would review the researches done in this area and tries to provide comprehensive and complete information about the use of antibiotics in endodontic treatment during pregnancy. Based on the results, it can be said that using antibiotics during pregnancy are allowed, and they can be used normally and safely by pregnant women.

Periodontal Diseases and Adverse Pregnancy Outcomes: Review of Two Decades of Clinical Research

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected.

Periodontal disease and adverse pregnancy outcomes

Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.

The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review of the current evidence

BACKGROUND AND OBJECTIVES

The poor maternal oral health in the pregnancy has an impact on the fetus through the oral-systemic link. Various studies have proven the relationship between poor maternal oral health and the occurrence of adverse pregnancy outcomes. Hence, periodontal therapy becomes indispensable during pregnancy. Previous systematic reviews and meta-analysis conducted to assess the influence of periodontal therapy on the occurrence of adverse pregnancy outcomes have shown inconsistent results. Hence, we conducted the present review to assess the influence of periodontal therapy on the occurrence of adverse pregnancy outcomes including the studies published till date.

MATERIALS AND METHODS

We searched for the relevant studies using the databases PUBMED, MEDLINE, CINAHL, and EMBASE on the randomized controlled trials evaluating the influence of periodontal treatment on adverse pregnancy outcomes from 2000 to 2018. Nineteen studies were considered for the present review based on the predetermined criteria. The risk of bias tool by Cochrane was used to evaluate the risk of bias among the studies.

RESULTS

Among the studies included for the present review, the occurrence of preterm birth among the pregnant mothers who received periodontal therapy ranged from 0% to 53.5%, while in the control group, the range was 6.38%-72%. The rate of LBW among the mothers treated for periodontal disease ranged from 0% to 36%, and in the control group, it varied from 1.15% to 53.9%.

CONCLUSION

With best possible evidence, it can be inferred that nonsurgical periodontal therapy is safe during pregnancy. Even though it does not completely avert the occurrence of adverse pregnancy outcomes, it can be recommended as a part of antenatal care.

Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis

OBJECTIVE

To assess the effect of periodontal treatment during pregnancy on maternal, fetal and neonatal outcomes.

METHODS

This is a systematic review and meta-analysis of randomized controlled trials that evaluated the effect of treatment of periodontal diseases on pregnancy outcomes. Primary outcome was perinatal mortality. Secondary outcomes were maternal and neonatal morbidity. Outcomes were pooled using fix-effect or random effects models and presented as risk ratio (RR), or mean difference (MD), and 95% confidence interval (CI).

RESULTS

Twenty randomized controlled trials involving 8171 participants were included in this study. Periodontal treatment during pregnancy was associated with significantly decreased risk of perinatal mortality [N = 5942; RR = 0.53 (0.30-0.93); p = .03; heterogeneity (I²) = 0%, Number needed to treat (NNT): 162]. Periodontal treatment during pregnancy reduced risks of preterm birth [N = 7335; RR = 0.78 (0.62-0.98); p = .03; I² = 72%, NNT = 37]. Periodontal treatment during pregnancy significantly increased birthweight (gram) [N = 4708; MD = 200.79 (63.34-337.24); p = .004; I² = 93%]. Periodontal treatment during pregnancy was not associated with preeclampsia, gestational diabetes, cesarean section, small for gestational age, or congenital malformations.

CONCLUSION

Periodontal treatment during pregnancy reduces the risks of perinatal mortality and preterm birth, and improves birth weight.

Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial)

Background

Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis.

Methods

The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18–40 years and with < 20 gestational weeks (n = 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6–8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence.

Discussion

Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes.

Trial registration

NCT, NCT03148483. Registered on May 11, 2017.

Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years

Background

In 2012, we performed a needs assessment and gap analysis to qualitatively assess providers’ and patients’ knowledge and perceptions regarding preterm birth (PTB). During the study, we identified knowledge gaps surrounding methods to reduce the risk of occurrence of PTB and management options if preterm labor/birth occur. We targeted health messages toward these gaps. The objective of the present study was to assess the impact of our community health worker-based patient education program 3 years after it was implemented.

Methods

Fifteen focus groups including 70 participants were included in the study. The groups comprised either patients/patient couples or health providers. A minimum of two facilitators led each group using 22 a priori designed and standardized lead-in prompts for participants with four additional prompts for providers only. A single researcher recorded responses, and transcript notes were reviewed by the facilitators and interpreters immediately following each group discussion to ensure accuracy.

Results

The understanding of term vs preterm gestation was generally accurate. Every participant knew of women who had experienced PTB, and the general perception was that two to three women out of every ten had this experience. The majority of respondents thought that women should present to their local health clinic if they experience preterm contractions; few were aware of the use of antenatal steroids for promoting fetal lung maturity, but many acknowledged that the neonate may be able to receive life-sustaining treatment if born at a higher level of care facility. The majority of participants were aware that PTB could recur in subsequent pregnancies. All respondents were able to list ways that women could potentially reduce the risk of PTB.

Conclusion

After employing targeted health messages, the majority of participants expressed improved understanding of the definition of PTB, methods to prevent risk of PTB, and management options for preterm labor or PTB.

Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis

Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.

Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D?

Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required.

An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes

OBJECTIVE

In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature.

METHODS

A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed.

RESULTS

A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions.

CONCLUSIONS

Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.

The effects of periodontal treatment on pregnancy outcomes

BACKGROUND

Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity.

AIM

To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight.

METHODS

Search of databases including PubMed, ISI Web of Science and Cochrane Library.

RESULTS

The single RCT identified showed no significant effect of periodontal treatment on birth outcomes.

DISCUSSION

All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials--also judged to be high-quality and at low risk of bias--have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes.

CONCLUSION

Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.

The effects of periodontal treatment on pregnancy outcomes

BACKGROUND

Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity.

AIM

To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight.

METHODS

Search of databases including PubMed, ISI Web of Science and Cochrane Library.

RESULTS

The single RCT identified showed no significant effect of periodontal treatment on birth outcomes.

DISCUSSION

All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials - also judged to be high-quality and at low risk of bias - have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes.

CONCLUSION

Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.

Periodontal Status and Some Variables among Pregnant Women in a Nigeria Tertiary Institution

Background:

Gingival changes during pregnancy have been well-documented. The prevalence of gingivitis in pregnant women has reportedly ranged from 30% to 100%. Increase in both the rate of estrogen metabolism and synthesis of prostaglandins by the gingiva contributed to the gingival changes observed during pregnancy. In effect increased prevalence of dental caries, gingivitis, periodontitis and tooth mobility may be encountered in pregnancy.

Aim:

The purpose of the study was to determine the association of some variables and the periodontal status in a sample of pregnant women attending the Ante Natal Clinic (ANC) of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos.

Subjects and Methods:

Women at various stages of pregnancy, attending the ANC of LASUTH, constituted the target population. The questionnaire was administered on each patient followed by dental examinations. Periodontal status was assessed using the community periodontal index (CPI) of treatment needs. Oral hygiene status was evaluated according to Green and Vermilion simplified oral hygiene index (OHI-S).

Results:

The association between the CPI scores; OHI-S scores and variables such as trimester and dental visits were statistically significant.

Conclusion:

This study indicated that the gestational age of pregnancy and dental visits have a definite impact on the periodontal status. Oral health education should be included as an integral part of antenatal care to increase the women awareness. This would improve the mothers’ dental care-seeking behavior.

Periodontal disease awareness among pregnant women in the central and eastern regions of Saudi Arabia

AIM

The purpose of this study was to assess the knowledge and awareness regarding periodontal disease and its effects on pregnancy among pregnant women in the central and eastern regions of Saudi Arabia.

METHODS

In this cross-sectional survey, self-administered, structured questionnaires were distributed to 300 pregnant women who were chosen randomly from attendees of maternity health care centers in the central and eastern regions of Saudi Arabia. The questions were developed from literature reviews of articles. The questionnaire addressed personal and sociodemographic variables, periodontal health awareness, and knowledge of pregnant women. The questionnaire was translated into Arabic and was pretested during the pilot study on a random sample of 50 pregnant women. Data were analyzed by χ(2) -tests, with the level of significance set at P < 0.05.

RESULTS

An overall response rate of 81% was obtained. Approximately 53% had a higher level of education, but only 21% knew how to define dental plaque and 30% knew its harmful effects. Almost 73% stated that gum disease could be prevented through toothbrushing and flossing. Approximately 97% of the respondents knew the negative effect of smoking, while only 12% knew there was a possible relationship between periodontal disease and adverse pregnancy outcomes.

CONCLUSION

The results of this cross-sectional study found that there is limited knowledge and awareness about periodontal disease and its possible effects on pregnancy among pregnant women attending maternal health care centers in the central and eastern regions of Saudi Arabia.

Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: a systematic review

OBJECTIVE

To confirm effectiveness of nonsurgical periodontal treatment during pregnancy on pregnancy outcome in terms of preterm birth and low birth weight (LBW).

METHOD

We searched for Randomized controlled trials in MEDLINE, CINAHL and EMBASE. from January 2000 to October 2012. References of included studies were hand searched. Studies which measured incidence of either preterm labor (PTL), LBW or both were included. Information on study design, population, risk of bias, periodontal parameters, time and type of periodontal treatment given and pregnancy outcome were abstracted independently by three reviewers.

RESULTS

Total thirteen studies were included. Five studies had low risk of bias. Conclusive results could not be obtained for incidence of PTL or LBW because of heterogeneity in results due to various reasons, but all studies which assessed PTL and LBW combined showed significant difference in incidence of same in group which received non surgical periodontal treatment.

CONCLUSION

Our study suggests that treatment of periodontitis during gestation improves pregnancy outcome in terms of PTLBW, a fact which may be used for health and economical benefits but better RCTs with adequate sample size are required for conclusive evidence.

Intrapregnancy non-surgical periodontal treatment and pregnancy outcome: a randomized controlled trial

BACKGROUND

The purpose of the present study is to investigate the potential link between maternal periodontitis and pregnancy outcomes, including preterm birth (<37 weeks) and low birth weight (<2,500 g).

METHODS

Ninety nine pregnant females with mild/moderate periodontitis were randomly allocated to a control (n = 50) or test (n = 49) group. Test group participants received intrapregnancy non-surgical periodontal treatment, whereas this was deferred until after delivery for controls. Demographic and baseline clinical data were obtained for all participants at initial assessment pretreatment. Clinical data were rerecorded for test participants at review 8 weeks after treatment. Birth outcomes were completed at delivery by midwives who also collected cord blood samples when possible; the latter were analyzed to determine the presence/levels of cytokines interleukin (IL)-1β, IL-6, and IL-8. All data were analyzed on an intention-to-treat basis using appropriate statistical tests.

RESULTS

Random allocation of participants resulted in well-balanced control and test groups. All test group participants and all but one control participant gave birth to a live infant. No significant differences were detected between control and test groups with regard to birth outcome measures of birth weight and gestational age or in relation to cytokine prevalence/levels.

CONCLUSION

Intrapregnancy non-surgical periodontal treatment, completed at 20 to 24 weeks, did not reduce the risk of preterm, low-birth-weight delivery in this population.

Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis

The events leading to preterm birth are still not completely understood. A quantitative systematic review was performed to estimate the effects of periodontal care during pregnancy on preventing preterm birth and low birth weight. The meta-analysis included randomized trials with pregnant women with a diagnosis of periodontal disease before 20 weeks of gestation. Relative risk (RR) with 95% confidence intervals (95%CI) was calculated. We evaluated the reduction in preterm and low birth weight. Thirteen trials were included, comparing 3,576 women in intervention groups with 3,412 women receiving usual care. The meta-analysis of the effects of periodontal disease treatment during pregnancy indicated a non-significant reduction in preterm births (RR = 0.90; 95%CI: 0.68-1.19) and low birth weights (RR = 0.92; 95%CI: 0.71-1.20). The creation and examination of a funnel plot revealed clear evidence of publication bias. In summary, primary periodontal care during pregnancy cannot be considered an efficient way of reducing the incidence of preterm birth.