Treatment of periodontitis reduces the risk of spontaneous preterm birth

Periodontal status and associated risk factors among childbearing age women in Cixi City of China

OBJECTIVE

To investigate the periodontal status and associated risk factors among women of childbearing age to increase the awareness of oral health.

METHODS

The study was conducted on childbearing age women in Cixi, a city in Zhejiang Province in the southeast of China. A total of 754 women participated in periodontal examination while receiving prenatal care. Data of the women were collected from the Cixi Family Planning Commission and during an interview. Clinical periodontal indices, such as bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured during the examination. Statistical analysis on subject-based data was performed.

RESULTS

The prevalence of periodontal disease among childbearing age women in Cixi was high (84.7%). A significant association was found between the disease and educational level, pregnancy, taking oral contraceptives, stress, alcohol consumption, overweight, dental visit, and teeth brushing (P<0.05). Women who suffered periodontal disease showed deep PD, obvious BOP, and clinical attachment loss. Among this population, pregnancy was closely associated with higher BOP percentage; teeth brushing no more than once per day or brushing for less than 1 min (P<0.001) after adjusting for age and stress.

CONCLUSIONS

The periodontal status of childbearing age women in Cixi needs to be improved urgently. Attention towards the periodontal health should be warranted, especially for those in special statuses and with poor awareness.

Periodontal treatment in pregnant women improves periodontal disease but does not alter rates of preterm birth

DESIGN

This was a multicentre randomised controlled trial (RCT).

INTERVENTION

Pregnant women were divided into two groups. Those to whom dental treatment was given had up to four visits of periodontal scaling and root planing using ultrasonic and hand instruments, with local anaesthesia as needed. Treatment recipients were also given instruction in oral hygiene and monthly tooth polishing and re-instruction in oral hygiene, with scaling and planing as needed. Control patients received only a brief oral examination at monthly follow-ups but attended the same number of visits as the treatment group. Patients in the control group were offered the same periodontal therapy after delivery.

OUTCOME MEASURE

The primary outcome was gestational age at delivery. Secondary outcomes included birth weight, the proportion of infants who were small for gestational age, Apgar scores, and admissions to a neonatal intensive care unit.

RESULTS

Preterm birth (before 37 weeks of gestation) occurred in 49 out of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 out of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery [P 0.70; hazard ratio for treatment group versus control group, 0.93; 95% confidence interval (CI), 0.63-1.37]. There were no significant differences between the treatment and control groups in mean babies' birth weights (3239 g versus 3258 g; P 0.64) or in the rate of delivery of infants who were small for gestational age (12.7% versus 12.3%; odds ratio, 1.04; 95% CI, 0.68-1.58). There were five spontaneous abortions or stillbirths in the treatment group, compared with 14 in the control group (P 0.08).

CONCLUSIONS

Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight or foetal growth restriction.