Maternal periodontal disease and preterm low birthweight: case-control study

Doença periodontal materna como fator associado ao baixo peso ao nascer

OBJETIVO: Estudos recentes têm apresentado evidências de que a doença periodontal em gestantes pode ser um dos determinantes do baixo peso ao nascer. Realizou-se estudo para verificar a existência de associação entre doença periodontal materna e baixo peso ao nascer. MÉTODOS: Estudo do tipo caso-controle com 302 mulheres, sendo 102 mães de nascidos vivos de baixo peso (grupo caso) e 200 mães de nascidos vivos com peso normal (grupo controle). A existência de associação entre doença periodontal e baixo peso ao nascer foi avaliada mediante modelo multivariado de regressão logística, considerando outros fatores de risco para o baixo peso. RESULTADOS: Ambos os grupos de mães eram comparáveis no que se refere a idade, altura, peso pré-gestacional, tabagismo, alcoolismo, doenças prévias, estado civil, situação socioeconômica, número de escovações e uso de fio dental, número de refeições diárias, e visitas ao dentista. A doença periodontal foi diagnosticada em 57,8% das mães do grupo caso e 39,0% do grupo controle. A análise de regressão logística indicou associação positiva entre doença periodontal e baixo peso ao nascer (ORbruto=2,15; IC 95%: 1,32-3,48), especialmente entre as mães com escolaridade menor ou igual a quatro anos (ORajustada=3,98; IC 95%: 1,58-10,10). CONCLUSÕES: A doença periodontal é um possível fator de risco para o baixo peso ao nascer.

Distribution of anaerobic bacteria among pregnant periodontitis patients who experience preterm delivery

The preterm delivery of low-birth-weight (PLBW) infants remains a significant public health issue and a leading cause of neonatal death and of long-term neurodevelopmental disturbances and health problems. Epidemiological and immunological studies have suggested that periodontal disease may be an independent risk factor for PLBW. The incidence of periodontal disease during pregnancy has been found to be associated with a significantly lower birth weight for gestational age after adjustment for race, parity and baby gender. The present case-control study, carried out to examine the distribution of anaerobes in pregnant women with periodontitis who experienced preterm delivery, provides microbial evidence that maternal periodontal disease and the presence of key pathogens are significant contributors to the obstetric risk of preterm delivery.

Factors related to utilization of dental services during pregnancy

OBJECTIVES

The purposes of this study were to investigate factors related to utilization of dental services during pregnancy and to assess the extent of mothers' knowledge regarding oral health during pregnancy and its effect on pregnancy outcomes.

MATERIALS AND METHODS

Cross-sectional data were collected from 625 women using a structured questionnaire mailed to mothers who had given birth in Johnson County, Iowa from August 2001 to March 2002. The survey assessed knowledge, behaviours, attitudes toward dental care during pregnancy, and personal, demographic and pregnancy-related factors. Variables which showed associations in bivariate analysis (p< or =0.1) were considered as candidates for building logistic regression models separately by domain (demographics, dental health care behaviours, lifestyle, financial variables, pregnancy-related variables, and knowledge of the possible association between oral health and pregnancy). Significant domain-specific regression results (p< or =0.05) were used to develop a final model using forward stepwise logistic regression analyses.

RESULTS

The overall response rate was 69%. Dental visits during pregnancy were reported by 49% of respondents. Forty-three percent were aware of the possible connection between oral health and pregnancy outcomes. In the final logistic regression analysis, factors significantly associated with reporting dental visits during pregnancy were: (1) personal factors (being married, greater frequency of visiting the dentist when not pregnant and use of inter-proximal cleaning aids); (2) financial factors (dental insurance); and (3) knowledge of the possible connection between oral health and pregnancy outcomes.

CONCLUSIONS

There was limited knowledge of the possible relationships between oral health and pregnancy outcomes in a fairly homogeneous population of women who were of relatively high socioeconomic standing. This study suggests that better education of the importance of dental care before and during pregnancy is needed.

Is there an association between periodontal disease, prematurity and low birth weight? A population-based study

BACKGROUND

The relationship between periodontal diseases in pregnancy and children born prematurely or with low birth weight has been increasingly investigated, showing inconclusive results.

OBJECTIVES

To test the link between periodontal disease in pregnant women and low birth weight or prematurity.

METHODS

A population-based, cross-sectional study was carried out in Southern Brazil. The sample consisted of 449 parturients who were interviewed and examined up to 48 h post-partum. Three outcomes were investigated: low birth weight, prematurity and prematurity and/or birth weight. Periodontal disease, the exposure, was defined as (i) at least one site with a periodontal pocket; (ii) the presence of pockets at four or more sites. Socio-demographic information relating to health and maternal habits was collected through a questionnaire and by hospital medical records. Simple and multiple regression analysis was performed.

FINDINGS

There was no statistically significant association between periodontal disease and low birth weight. Periodontal pocket was not associated with low birth weight and/or pre-term birth after being adjusted. A periodontal pocket in at least one site was associated with prematurity (odds ratio=2.6; 95% confidence interval 1.0-6.9) even after adjusting for maternal schooling, parity, number of previous children of low birth weight, number of pre-natal consultations and body mass index. After the introduction of variables relating to maternal health during pregnancy, this association disappeared.

CONCLUSIONS

No association was found between periodontal disease in the mother and the low birth weight. An association between prematurity and periodontal pockets was found but it was confounded by maternal health variables.

Pathophysiology of preterm birth: emerging concepts of maternal infection

Preterm birth remains a significant health concern. Maternal reproductive infections such as bacterial vaginosis pose increased risk for preterm birth, although treatment of bacterial vaginosis has not proven to be universally effective in preterm birth prevention. Maternal oral infection such as clinical periodontal disease has also been identified as a risk factor for preterm birth, and pilot data suggest that oral treatment interventions undertaken during pregnancy may reduce preterm birth risk.

The National Institute of Dental and Craniofacial Research: research for the practicing dentist

BACKGROUND AND OVERVIEW

Established in 1948, the National Institute of Dental and Craniofacial Research (NIDCR) has helped transform dentistry into a profession that is based firmly in prevention and technological innovation. This article introduces the new NIDCR initiative in general dentistry practice-based research. It also highlights research supported by the NIDCR and its implications for dental practice in restorative dentistry, oral and systemic disease, stem cell research, salivary diagnostics, gene transfer therapy and pain.

CLINICAL IMPLICATIONS

The NIDCR supports research that will help guide the practitioner in the delivery of patient care and have a direct impact on the practice of dentistry.

Association between periodontitis and low birth weight: a case-control study

OBJECTIVE

To verify a possible association between periodontitis and low-birth-weight babies.

MATERIAL AND METHODS

One hundred and fifty-one mothers were examined. The case group included 76 mothers (mean age 25.6 years), whose babies at birth weighed <2500 g and had a gestational age (GA) <37 weeks, while 75 mothers (mean age 24.4 years), whose babies were born with a weight of >2500 g and with a GA>37 weeks, were the control group. Data from the mothers and the babies were collected from the Hospital registration records and during an interview with the mother. The periodontal examination included measurements of probing pocket depth (PPD) and clinical attachment loss (CAL) in six sites from all existing teeth, except for third molars. Mothers with periodontitis had at least four sites with PPD> or =4 and CAL> or =3 mm, while healthy mothers had PPD< or =3 mm and CAL< or =1 mm.

RESULTS

The median number of sites with PPD> or =4 and CAL> or =3 mm was eight in the case group, and four in the control group. The significant associations with low birth weight (LBW) babies were periodontitis (odds ratio (OR)=3.48, 95% confidence interval (CI): 1.17; 10.36), arterial hypertension (OR=9.65, 95% CI: 2.22; 41.91), haemorrhage during pregnancy (OR=10.88, 95% CI: 1.95; 60.53), number of pre-natal examinations (OR=0.10, 95% CI: 0.02; 0.43) and genitourinary infection (OR=3.21, 95% CI: 1.25; 8.20).

CONCLUSION

Periodontitis was considered a risk indicator for LBW in this sample, similar to other risk factors already recognized by obstetricians.

Periodontal status and preterm low birth weight: a case control study

BACKGROUND

Previous studies have suggested that periodontal disease may be an important risk factor for preterm low birth weight. However, the link between periodontal health status of pregnant women and preterm low birth weight is contentious, as recent studies found no association between periodontitis and pregnancy outcome.

OBJECTIVE

The aim of this study was to investigate this potential link in a German Caucasian population.

METHODS

Fifty-nine pregnant women with a high risk for a preterm low birth weight infant (suffering from preterm contractions, cases, group 1) as well as 42 control women with no preterm contractions during pregnancy and having an infant appropriate for date and weight (>or= 37 weeks gestation, >or= 2500 g, group 2) were examined. Clinical periodontal status was recorded on a full mouth basis. Subgingival plaque samples were taken and periodontal pathogens were identified by polymerase chain reaction. Additionally, interleukin-1 beta level in gingival crevicular fluid was analysed.

RESULTS

The mean percentage of sites showing moderate to advanced attachment loss (>or=3 mm) was low in all study groups (group 1: 9.9 +/- 11.2%; group 2:10.6 +/- 14.1%, respectively). No significant differences between the groups in any aspects of the studied periodontitis parameters could be detected. Using a logistic regression model controlling for known preterm low birth weight risk factors, no periodontitis-associated factors increased risk for preterm contractions or preterm low birth weight. The odds ratio (OR) was 1.19 for preterm contractions, the 95% confidence interval (CI) 0.46; 3.11 and 0.73 for preterm low birth weight; 95% CI: 0.13; 4.19, respectively.

CONCLUSION

In this population, periodontitis was not a detectable risk factor for preterm low birth weight in pregnant women.

Clinical risk factors associated with incidence and progression of periodontal conditions in pregnant women

OBJECTIVES

Few large studies have investigated the progression of periodontal conditions during pregnancy in a comprehensive manner. This study aimed to identify clinical factors that were predictive of incidence/progression of periodontal measures in pregnant women adjusting for relevant predictors.

MATERIAL AND METHODS

Periodontal examinations were conducted on 891 pregnant women prior to 26 weeks gestational age and within 48 h after delivery. Gingivitis/periodontitis incidence/progression (GPIP) was defined as four plus sites with 2+ mm increase in probing depth (PD) that resulted in PD of at least 4 mm at delivery. Multivariable models including relevant clinical variables and significant covariates were developed.

RESULTS

While several clinical measures were significantly associated with the outcome, having >/=10% of sites with bleeding on probing (BOP) and four plus sites with PD >/=4 mm (PD4) were the best two predictors of GPIP (odds ratio (OR)=2.8, 95% confidence interval (CI)=1.8-4.2; OR=2.0, 95% CI=1.4-2.9, respectively), adjusting for maternal race, age, enrollment weight, smoking during pregnancy, marital status, food stamp eligibility, and private health insurance. Multivariable models assessed the impact of BOP on the PD4-GPIP relationship. PD4 was significant in the presence of BOP (low BOP OR=1.3, 95% CI=0.5-3.3; high BOP OR=3.0, 95% CI=2.2-4.3).

CONCLUSIONS

Enrollment BOP and PD4 were significant predictors of PD in pregnant women, however; PD4 is only a predictor with BOP.

Correlation between infant birth weight and mother's periodontal status

OBJECTIVES

Recent studies have suggested that periodontal disease is a risk factor for low birth weight (LBW) with other multiple factors. A cross-sectional study was undertaken to help further evaluate the proposed association between periodontal disease and infant birth weight.

MATERIAL AND METHODS

Caucasian pregnant women (n=152), aged 14-39 years, were enrolled while receiving prenatal care. Dental plaque, probing depth, bleeding on probing and clinical attachment level were recorded and three groups were made: healthy group (HG) (n=38), gingivitis group (GG) (n=71) and periodontitis group (PG) (n=43). At delivery, birth weight was recorded.

RESULTS

Infant mean weight at delivery was 3293.9+/-508.1 g. The total incidence of preterm birth and LBW infants was 5.3% and 4.6%, respectively. The incidence of LBW infants was 3.5% in term gestations and 25% in preterm gestations. Mothers height correlated with infant birth weight (p=0.03). Significant difference in birth weight existed between mothers with <1.55 m (3229.23+/-462.57) and those with > or =1.65 m (3475.55+/-505.07). In the group of women >25 years old infant mean weight in HG was 3588.33+/-531.83, being lower in GG (3466.75+/-334.45) and even lower (3092.60+/-592.94) in PG (p=0.0198). Bleeding on probing was significantly greater in women with <2500 g infants (40.2+/-21.8%) compared with 2500-3499 g (18.6+/-15.1%) and > or =3500 g (17.1+/-16.1%) (p=0.009).

CONCLUSIONS

Periodontal disease in normal Caucasian pregnant women, older than 25 years, is statistically associated with a reduction in the infant birth weight. These data provide new evidence on the relationship between periodontal disease and birth weight.

Periodontal infections and pre-term low birth weight: a case-control study

OBJECTIVE

Pre-term delivery of low-birth-weight infants [pre-term low birth weight (PLBW)] remains a significant public health issue and a major cause of neonatal death and long-term health problems. There is a growing consensus that infections remote from fetal-placental unit may influence PLBW infants. Recent studies have suggested that maternal periodontal disease may be an independent risk factor for PLBW. The purpose of the present study was to evaluate the possible link between periodontal infections and PLBW by means of clinical and microbiological data in post-partum women with low socioeconomic level.

METHODS

Clinical periodontal recordings comprising dental plaque, bleeding on probing, probing pocket depth and gingival recession were performed (six sites/tooth) in a total number of 181 women (53 cases and 128 controls) within 3 days post-partum. Subgingival plaque samples from mesio-or disto-buccal aspect of randomly selected one first molar and one incisor tooth have been obtained by paperpoints and were analysed by checkerboard DNA-DNA hybridization with respect to 12 bacterial species. In all analyses, the individual subject was the computational unit. Thus, mean values for all clinical parameters were calculated and bacterial scores from each individual sample were averaged. Statistical methods included Student's t-test, Fisher's exact test/chi(2) test, and multiple logistic regression analysis.

RESULTS

The cases have gained significantly less weight during the pregnancy than did the controls (p<0.05). There were no statistically significant differences between the cases and controls with regard to the dental and periodontal parameters and the values of clinical periodontal recordings were found to be very similar (p>0.05). Mean and median scores (bacterial loads) of Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Actinobacillus actinomycetemcomitans, and Streptococcus intermedius in the subgingival plaque sampling sites were significantly higher in the controls than in the cases (p<0.05). The occurrence rates of P. intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, Campylobacter rectus, Eikenella corrodens, Selenomonas noxia and S. intermedius were higher in the cases compared with the controls, but the differences were not statistically significant (p>0.05). According to the model created by the multiple logistic regression analysis, P. micros and C. rectus were found to significantly increase the risk of PLBW (p<0.01 and p<0.05 respectively), while P. nigrescens and A. actinomycetemcomitans decreased this risk (p<0.01).

CONCLUSION

The present findings indicated that when subgingival bacteria were evaluated together, P. micros and C. rectus may have a role in increasing the risk for PLBW, although no single bacteria exhibited any relation with the risk of PLBW. Further studies are required to better clarify the possible relationship between periodontal diseases and PLBW.

Markers of periodontal infection and preterm birth

OBJECTIVE

This study was undertaken to explore the relationship between clinical, microbiologic, and serologic markers of periodontitis and preterm birth (PTB).

STUDY DESIGN

We compared women with a singleton gestation giving birth before the 37th week (cases, n = 83) with term delivery controls (n = 120). Periodontal examination and collection of dental plaque and blood samples were performed within 48 hours after delivery. Microbial levels and maternal immunoglobulin G titers to oral bacteria were analyzed. Multivariate regression models were fitted controlling for common covariates.

RESULTS

Cases showed greater mean attachment loss (1.7 vs 1.5 mm, P = .003) and higher prevalence of periodontitis (30.1% vs 17.5%, P = .027). No differences in microbial or serum antibody levels were detected between the groups. Logistic regression revealed that PTB was associated with attachment loss (adjusted odds ratio: 2.75, 95% CI: 1.01-7.54). Linear regression indicated a significant ( P = .04) association between attachment loss and low birth weight (LBW).

CONCLUSION

The data support the notion that periodontitis is independently associated with PTB and LBW.

Periodontal Diseases and the Risk of Preterm Birth and Low Birth Weight: A Meta-Analysis

BACKGROUND

This meta-analysis of periodontal disease in relation to the risk of preterm birth/low birth weight (PTB/ LBW) is based on two case-control studies and three prospective cohort studies that met pre-stated inclusion criteria.

METHODS

Information on the designs of the studies, characteristics of the study population, exposure and outcome measures, control for confounders, and risk estimates were abstracted independently by two investigators using a standard protocol.

RESULTS

Pregnant women with periodontal disease had an overall adjusted risk of preterm birth that was 4.28 (95% confidence interval [CI], 2.62 to 6.99; P <0.005) times that risk for healthy subjects. The overall adjusted odds ratio of preterm low birth weight was 5.28 (95% CI, 2.21 to 12.62; P <0.005), while the overall adjusted odds ratio of a delivery of either PTB or LBW was 2.30 (95% CI, 1.21 to 4.38; P <0.005).

CONCLUSIONS

Our findings indicate that periodontal diseases in the pregnant mother significantly increase the risk of subsequent preterm birth or low birth weight. While it remains important to promote good oral hygiene during routine prenatal visits, there is no convincing evidence, on the basis of existing case control and prospective studies, that treatment of periodontal disease will reduce the risk of preterm birth. Consequently, large randomized, placebo-controlled, masked clinical trials are required.

SalivaryActinomyces naeslundiiGenospecies 2 andLactobacillus caseiLevels Predict Pregnancy Outcomes

BACKGROUND

Gravida's poor periodontal health is emerging as a modifiable independent risk factor for preterm delivery and low birth weight.

METHODS

To test the hypothesis that oral bacteria other than periodontal pathogens are also associated with pregnancy outcomes, specific oral bacterial levels measured during pregnancy were evaluated in relation to gestational age and birth weight while controlling for demographic, medical, and dental variables. The study population consisted of 297 predominantly African- American women who were pregnant for the first time. The salivary bacterial levels evaluated were Streptococcus mutans, Streptococcus sobrinus, Streptococcus sanguinus, Lactobacillus acidophilus, Lactobacillus casei, Actinomyces naeslundii genospecies (gsp) 1 and 2, total streptococci, and total cultivable organisms.

RESULTS

For 1 unit increase in log(10) A. naeslundii gsp 2 levels, there was a 60 gm decrease in birth weight (beta = -59.7 g; SE = 29.1; P = 0.04), and a 0.17 week decrease in gestational age (beta = -0.17 wk; SE = 0.09; P = 0.05). In contrast, per 1 unit increase in log(10) L. casei levels, there was a 42 gm increase in birth weight (beta = 42.2 g; SE = 19.3; P = 0.03), and a 0.13 week increase in gestational age (beta = 0.13 week; SE = 0.06; P = 0.04).

CONCLUSIONS

We conclude that other oral bacterial species can also be related to pregnancy outcomes in addition to previously reported periodontal pathogens. These organism levels may not only predict poor pregnancy outcomes, but also be used as modifiable risk factors in reducing prematurity and low birth weight.

A case-control study to investigate an association between adverse pregnancy outcome and periodontal disease

OBJECTIVES

The aim of this case-control study was to ascertain if women who experienced a preterm (or premature) birth had any differences in periodontal disease severity compared with women who delivered at term.

MATERIAL AND METHODS

Subjects were recruited postpartum. Case subjects delivered a baby before 37 weeks of gestation whereas control subjects gave birth at or around term. A questionnaire was administered by a Research Midwife, designed to collect demographic information, pregnancy outcome variables and information on other factors which may influence health in pregnancy. A periodontal examination was then performed at the bedside.

RESULTS

Demographic variables were similar between case and control subjects. There was a higher proportion of case subjects who reported smoking. There were no differences in oral hygiene, bleeding on probing or loss of attachment; however, control subjects had a higher proportion of periodontal pockets probing 5 mm or greater.

CONCLUSIONS

There was no association between the severity of periodontal disease and pregnancy outcome in this population.

Periodontitis, a marker of risk in pregnancy for preterm birth

BACKGROUND

Why chronic periodontitis may induce an inflammatory response with premature pregnancy termination is unclear.

AIMS

(1) To assess if periodontitis predicts premature gestation; (2) to study amniotic fluid cytokines and periodontitis variables in early-stage pregnancy.

MATERIAL AND METHODS

A periodontal examination and collection of amniotic fluid was performed (weeks 15-20) of pregnancy in 36 women at risk for pregnancy complications. Amniotic fluid (bacteria), vaginal smears and intra-oral plaque samples were studied. Cytokine levels in amniotic fluid were studied in relation to other study variables.

RESULTS

Periodontitis was diagnosed in 20% of normal and in 83% of preterm birth cases (p<0.01). Bacteria were never found in the amniotic fluids studied. Sub-gingival plaque samples including bacteria in the orange and red complexes were found in 18% of full-term 100% of preterm cases (p<0.001) and total colony-forming units (CFUs) were higher in preterm birth (p<0.01). Amniotic levels of interleukin (IL)-6 and prostaglandin-E2 (PGE2) were higher in preterm cases (p<0.001). Amniotic IL-6 (r=0.56, p<0.01) and PGE2 (r=0.50, p<0.01) cytokine levels were correlated with CFU from sub-gingival plaque samples (r2=0.44). The odds ratio of preterm delivery and having periodontitis was 20.0 (95% confidence interval (CI): 2.0-201.7, p<0.01). The odds of >60 CFU in sub-gingival plaque and preterm birth was 32.5:1 (95% CI: 3.0-335.1, p<01).

CONCLUSIONS

Pregnant women with findings of elevated amniotic fluid levels of PGE2, IL-6 and IL-8 in the 15-20 weeks of pregnancy and with periodontitis are at high risk for premature birth. The implication of this is that periodontitis can induce a primary host response in the chorioamnion leading to preterm birth.

A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome

OBJECTIVE

This study aimed to investigate a relationship between maternal periodontal disease and preterm birth, low birth weight and late miscarriage.

DESIGN

Prospective study in a single centre.

SETTING

Guy's and St Thomas' Hospital Trust, London, UK between August 1998 and July 2001.

SUBJECTS AND METHODS

Pregnant women were recruited on attending an ultrasound scan at approximately 12 weeks of pregnancy. Subjects completed a questionnaire and underwent periodontal examination.

MAIN OUTCOME MEASURES

Plaque and bleeding scores, pocket probing depth and loss of attachment. Pregnancy outcome data was collected retrospectively, including gestational age and birth weight at delivery.

RESULTS

Data were collected for 3,738 subjects. Regression analysis indicated that there were no significant relationships between the severity of periodontal disease and either preterm birth (PTB) or low birth weight (LBW). In contrast, there did appear to be a correlation between poorer periodontal health and those that experienced a late miscarriage.

CONCLUSIONS

There was no association between either preterm birth or low birth weight and periodontal disease in this population. There is evidence of a correlation between markers of poorer periodontal health and late miscarriage.

A possible association between preterm birth and early periodontitis. Pilot study

According to many studies, generalised periodontitis can be a risk factor for preterm birth (PB). A case-control study was carried out to examine if early localised periodontitis could be a risk factor for adverse pregnancy outcome.

MATERIAL AND METHODS

Postpartum women without any systemic disease were included into the study. Similar numbers of patients belonged to the case (41) and to the control (44) groups. A PB case was defined if a patient had a threatening premature labour during pregnancy, preterm premature rupture of membranes, or spontaneous preterm labour, and/or the weight of the newborn was < or = 2499 g. Control women had delivery after the 37th gestational week and the newborn's weight was > or = 2500 g. Known risk factors like smoking, alcohol, drug consumption, socio-economic status and the periodontal status were recorded.

RESULTS

A significant association was found between PB and early localised periodontitis of the patient with the following criterion having bleeding at > or = 50% of the examined sites (6 at each tooth) and having at least at one site > or = 4 mm probing depth (p = 0.001). The odds ratio was 5.46 at the 95% confidence interval. The average weight of the newborns in the periodontitis group was less than in the control group, the difference is significant (p = 0.047).

CONCLUSION

The results indicate that early localised periodontitis of the patient during pregnancy can be regarded as an important risk factor for PB.

The effects of diet, breast-feeding and weaning on caries risk for pre-term and low birth weight children

OBJECTIVES

The aims of this study were to determine the prevalence of dental disease in 3-4-year-old children born pre-term and low birth weight (PLBW) in East London, UK, to make comparisons with normal birth weight children (NBW), and to investigate the impact of dietary habits on the development of dental caries in primary teeth.

DESIGN

This was a cross-sectional study.

SUBJECTS AND METHODS

The subjects were 100 children (54 boys and 46 girls) with a mean age (+/- SD) of 41.70 +/- 5.11 months. The children were resident within walking distance of the dental hospital and were invited to attend with their parents. Demographic data and information about feeding practices from infancy to the present were ascertained by structured questionnaire. Dental caries status was determined, and height, weight and head circumference were also measured.

RESULTS

Sixty children had experienced dental caries with a mean (+/- SD) dmft of 2.98 +/- 3.93, 25 of whom had a dmft greater than 5. Normal birth weight children (3.00 +/- 4.18) and boys (3.55 +/- 4.48) had a significantly increased dmft over PLBW children (2.95 +/- 3.35) and girls (2.29 +/- 3.04). The PLBW children were more likely to have used a bottle from birth and one in four children were still using a bottle at the time of the dental examination. The PLBW children were significantly more likely to eat sugar than NBW children, scoring 5.53 +/- 2.10 and 4.61 +/- 1.94, respectively.

CONCLUSIONS

A clear relationship exists between poor diet and PLBW in a group of children resident in the East End of London. Targeted infant feeding programmes, education and support for families with regard to dental care is of importance to avoid an unnecessary amount of dental disease in young children.

Maternal LPS induces cytokines in the amniotic fluid and corticotropin releasing hormone in the fetal rat brain

Perinatal infections are a risk factor for fetal neurological pathologies, including cerebral palsy and schizophrenia. Cytokines that are produced as part of the inflammatory response are proposed to partially mediate the neurological injury. This study investigated the effects of intraperitoneal injections of lipopolysaccharide (LPS) to pregnant rats on the production of cytokines and stress markers in the fetal environment. Gestation day 18 pregnant rats were treated with LPS (100 μg/kg body wt ip), and maternal serum, amniotic fluid, placenta, chorioamnion, and fetal brain were harvested at 1, 6, 12, and 24 h posttreatment to assay for LPS-induced changes in cytokine protein (ELISA) and mRNA (real-time RT-PCR) levels. We observed induction of proinflammatory cytokines interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) as well as the anti-inflammatory cytokine IL-10 in the maternal serum within 6 h of LPS exposure. Similarly, proinflammatory cytokines were induced in the amniotic fluid in response to LPS; however, no significant induction of IL-10 was observed in the amniotic fluid. LPS-induced mRNA changes included upregulation of the stress-related peptide corticotropin-releasing factor in the fetal whole brain, TNF-α, IL-6, and IL-10 in the chorioamnion, and TNF-α, IL-1β, and IL-6 in the placenta. These findings suggest that maternal infections may lead to an unbalanced inflammatory reaction in the fetal environment that activates the fetal stress axis.

Associations between systemic status, periodontal status, serum cytokine levels, and delivery outcomes in pregnant women with a diagnosis of threatened premature labor

BACKGROUND

Threatened premature labor (TPL) often results in preterm birth (PB). The aim of the present study was to evaluate the associations of periodontal and general health conditions with TPL and PB in relation to serum cytokine levels and the composition of subgingival plaque.

METHODS

Eighty-eight women were enrolled in the study. Systemic conditions were assessed, and subgingival plaque samples obtained for bacterial analysis. Periodontal examinations included assessments of plaque, gingivitis, clinical attachment level, probing depth, and bleeding on probing. Serum cytokine levels also were analyzed. Gestational age at delivery was recorded, and the mothers were divided into a TPL or non-TPL group, and into a non-TPL-TB (term birth), non-TPL-PB, TPL-TB, or TPL-PB group, accordingly.

RESULTS

Forty subjects were classified as TPL and 18 as TPL-PB. There were significant differences between the TPL and non-TPL subjects in several of the systemic and periodontal parameters and serum cytokine levels. Significant differences were observed between the TPL-TB and TPL-PB groups in the percentage of Tannerella forsythensis (Tf, formerly Bacteroides forsythus), and the serum interleukin (IL)-8 and IL-1beta levels. Significant negative correlations between the gestational age at delivery and several periodontal parameters and serum IL-8 and IL-1beta levels, and significant positive correlations between periodontal status and serum IL-8 and IL-1beta levels, were observed.

CONCLUSIONS

The TPL women revealed worsened periodontal conditions and elevated serum IL-8 and IL-1beta levels compared to the non-TPL women. The elevated levels of serum IL-8 and IL-1beta could have affected the maintenance of the proper uterine-fetus relationship, resulting in premature uterine contractions.

Periodontal Disease as a Risk Factor for Adverse Pregnancy Outcomes. A Systematic Review

BACKGROUND

Recent studies have implicated a variety of infections, including periodontal diseases, as risk factors for adverse pregnancy outcomes such as prematurity and low birth weight.

RATIONALE

A number of studies have shown that bacterial vaginosis is related to preterm and/or low birth weight (PT/LBW), which continues to be a significant cause of infant morbidity and mortality. It is also possible that other infectious processes, including periodontal diseases, contribute to PT/LBW. This systematic review examines the literature to determine the possible relationship between PT/LBW and periodontal diseases.

FOCUSED QUESTION

Does prevention/control of periodontal disease as compared to controls have an impact on the initiation/progression of adverse pregnancy outcomes?

SEARCH PROTOCOL

MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Oral Controlled Trials Register were searched to identify published studies that related variables associated with PT/LBW and periodontal disease. Searches were performed for articles published through October 2002.

INCLUSION CRITERIA

Randomized controlled clinical trials (RCTs), case-control, and cohort studies were included. Study populations included mothers, with or without periodontal disease, who gave birth to preterm and/or mature infants. The interventions considered included all forms of periodontal therapy.

EXCLUSION CRITERIA

Only studies on humans were included.

DATA COLLECTION AND ANALYSIS

Due to study heterogeneity, meta-analysis was not possible.

MAIN RESULTS

1. Of the over 660 studies identified, 12 (6 case-control, 3 cross-sectional and longitudinal, and 3 intervention) met inclusion and exclusion criteria and were included in the analysis. 2. While several studies implicated periodontal disease as a risk factor for PT/LBW, few assessed the impact of the prevention and treatment of periodontal disease on outcomes. 3. Several epidemiologic studies did not support periodontal disease as a risk factor for PT/LBW.

REVIEWERS' CONCLUSIONS

1. Periodontal disease may be a risk factor for PT/LBW. 2. Additional longitudinal, epidemiologic, and interventional studies are needed to validate this association and to determine whether it is causal. 3. It is not yet clear whether periodontal diseases play a causal role in adverse pregnancy outcomes. 4. Preliminary evidence to date suggests that periodontal intervention may reduce adverse pregnancy outcomes.

Common oral manifestations during pregnancy: a review

Pregnancy has far-reaching systemic effects extending beyond the reproductive system. Oral and masticatory changes during pregnancy have been documented for many years; however, their magnitude and frequency have not been stressed. This review highlights the major oral complications during pregnancy. Pregnancy gingivitis and pregnancy tumor are described and presented, and possible preventive strategies are suggested.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader will be able to summarize the major oral complications during pregnancy, to outline the etiologic factors associated with each of these conditions, and to explain the role of dental treatment during pregnancy.

Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study

BACKGROUND

Previous case-control and prospective studies have shown an association between the presence of periodontitis and the risk of preterm birth (PTB). The goal of this pilot trial was to determine the feasibility of conducting a trial to determine whether treatment of periodontitis reduces the risk of spontaneous preterm birth (SPTB).

METHODS

Three hundred sixty-six (366) women with periodontitis between 21 and 25 weeks' gestation were recruited and randomized to one of three treatment groups with stratification on the following two factors: 1) previous SPTB at <35 weeks and 2) body mass index <19.8 or bacterial vaginosis as assessed by Gram stain. The treatment groups consisted of: 1) dental prophylaxis plus placebo capsule; 2) scaling and root planing (SRP) plus placebo capsule; and 3) SRP plus metronidazole capsule (250 mg t.i.d. for one week). An additional group of 723 pregnant women meeting the same criteria for periodontitis and enrolled in a prospective study served as an untreated reference group.

RESULTS

The rate of PTB at <35 weeks was 4.9% in the prophylaxis group, compared to 3.3% in the SRP plus metronidazole group and 0.8% in the SRP plus placebo group (P = 0.75 and 0.12, respectively). The rate of PTB at <35 weeks was 6.3% in the reference group.

CONCLUSIONS

This trial indicates that performing SRP in pregnant women with periodontitis may reduce PTB in this population. Adjunctive metronidazole therapy did not improve pregnancy outcome. Larger trials will be needed to achieve statistical significance, especially at less than 35 weeks gestational age.

Oral infections and systemic diseases

An association between periodontal infection and CVD has been revealed in some epidemiologic studies, whereas other studies were unable to demonstrate such an association. A link between the two diseases may be explained by shared established or nonestablished risk factors. Future studies with extended control of confounding factors and intervention studies may add to the understanding of a possible relationship between the diseases. In some cases, IE is caused by dental plaque bacteria. Several studies are suggestive of oral bacteria causing respiratory infection. The pathogenesis and course of a number of other diseases including DM and rheumatoid arthritis have been associated wish periodontitis, but more research is necessary to elucidate possible pathogenic interactions.

Preterm low birth weight and periodontal disease among African Americans

African Americans consistently experience higher rates of preterm and low birth weight (LBW) deliveries than do whites. LBW and preterm infants are more likely to die before their first birthday and survivors may suffer from a number of health problems. Therefore, identification of modifiable risk factors for preterm deliveries and LBW has considerable public health significance. Pregnant women's poor periodontal healtlh is emerging as one such factor. Maternal clinical periodontal status and bacteriologic and immunologic profiles related to periodontal disease have been associateted with risk of fetal growth and preterm LBW, and periodontal treatment during pregnancy has reduced the incidence of preterm deliveries. This article reviews the literature on the above association and presents data from a previously published prospective study of predominantly African Americans to show that preterm LBW deliveries are associated with higher midtrimester maternal serum antibody levels against Porphyromonas gingivalis.