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Wu J, Wu J, Tang B, Zhang Z, Wei F, Yu D, Li L, Zhao Y, Wang B, Wu W, Hong X. 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. Front Public Health 2024; 12:1373691. [PMID: 39371200 PMCID: PMC11449777 DOI: 10.3389/fpubh.2024.1373691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 09/03/2024] [Indexed: 10/08/2024] Open
Abstract
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.
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Affiliation(s)
- Jianru Wu
- Shenzhen Institute of Pharmacovigilance and Risk Management, Shenzhen, China
| | - Jingying Wu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Biyu Tang
- Shenzhen Institute of Pharmacovigilance and Risk Management, Shenzhen, China
| | - Ze Zhang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Fenfang Wei
- Shenzhen Institute of Pharmacovigilance and Risk Management, Shenzhen, China
| | - Dingbiao Yu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Limin Li
- Shenzhen Institute of Pharmacovigilance and Risk Management, Shenzhen, China
| | - Yue Zhao
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Bei Wang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Wenyu Wu
- Shenzhen Institute of Pharmacovigilance and Risk Management, Shenzhen, China
| | - Xiang Hong
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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Thayyil S, Bauserman M, Valentine G, Patterson JK, Hoffman M, Aagaard K, Ramji S, Lokangaka A, Mhango J, Bhutta ZA, Shankaran S. Design and Conduct of Global Health Research in Low- and Middle-Income Countries. J Pediatr 2024:114268. [PMID: 39216623 DOI: 10.1016/j.jpeds.2024.114268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/26/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Affiliation(s)
| | - Melissa Bauserman
- Gillings School of Global Public Health, University of North Carolina School of Medicine, USA
| | - Gregory Valentine
- Departments of Pediatrics, Oral Health Sciences & Mechanical Engineering, University of Washington & Seattle Children's Hospital, Seattle, WA, and Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Jackie K Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, USA
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA
| | - Kjersti Aagaard
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Siddarth Ramji
- Former Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | | | - Joseph Mhango
- Baylor College of Medicine Children's Foundation, Malawi
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Seetha Shankaran
- University of Texas at Austin, Austin, TX and Wayne State University, Detroit, MI, USA.
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Liu P, Wen W, Yu KF, Tong RWM, Gao X, Lo ECM, Wong MCM. Can oral microbiome predict low birth weight infant delivery? J Dent 2024; 146:105018. [PMID: 38679133 DOI: 10.1016/j.jdent.2024.105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024] Open
Abstract
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.
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Affiliation(s)
- Pei Liu
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Weiye Wen
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China; Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Ka Fung Yu
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Raymond Wai Man Tong
- Central Research Laboratories, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Xiaoli Gao
- Faculty of Dentistry & Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Edward Chin Man Lo
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - May Chun Mei Wong
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Arbildo-Vega HI, Padilla-Cáceres T, Caballero-Apaza L, Cruzado-Oliva FH, Mamani-Cori V, Cervantes-Alagón S, Vásquez-Rodrigo H, Coronel-Zubiate FT, Aguirre-Ipenza R, Meza-Málaga JM, Luján-Valencia SA, Castillo-Cornock TB, Serquen-Olano K. Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:943. [PMID: 38929560 PMCID: PMC11205593 DOI: 10.3390/medicina60060943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/25/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
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.
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Affiliation(s)
- Heber Isac Arbildo-Vega
- Department of General Dentistry, Dentistry School, San Martín de Porres University, Chiclayo 14012, Peru; (H.I.A.-V.); (H.V.-R.); (T.B.C.-C.); (K.S.-O.)
- Department of Human Medicine, School of Human Medicine, San Martín de Porres University, Chiclayo 14012, Peru
| | - Tania Padilla-Cáceres
- Department of General Dentistry, Dentistry School, University of the Altiplano, Puno 21001, Peru; (T.P.-C.); (L.C.-A.); (V.M.-C.); (S.C.-A.)
- Research Institute in Environmental Sciences, Health and Biodiversity—IICASB, University of the Altiplano, Puno 21001, Peru
| | - Luz Caballero-Apaza
- Department of General Dentistry, Dentistry School, University of the Altiplano, Puno 21001, Peru; (T.P.-C.); (L.C.-A.); (V.M.-C.); (S.C.-A.)
- Department of Nursing, School of Nursing, University of the Altiplano, Puno 21001, Peru
| | - Fredy Hugo Cruzado-Oliva
- Department of Stomatology, School of Stomatology, National University of Trujillo, Trujillo 13011, Peru;
| | - Vilma Mamani-Cori
- Department of General Dentistry, Dentistry School, University of the Altiplano, Puno 21001, Peru; (T.P.-C.); (L.C.-A.); (V.M.-C.); (S.C.-A.)
- Research Institute in Environmental Sciences, Health and Biodiversity—IICASB, University of the Altiplano, Puno 21001, Peru
| | - Sheyla Cervantes-Alagón
- Department of General Dentistry, Dentistry School, University of the Altiplano, Puno 21001, Peru; (T.P.-C.); (L.C.-A.); (V.M.-C.); (S.C.-A.)
- Amazonian Andean Research and Development Institute—IIDEAA, University of the Altiplano, Puno 21001, Peru
| | - Hernán Vásquez-Rodrigo
- Department of General Dentistry, Dentistry School, San Martín de Porres University, Chiclayo 14012, Peru; (H.I.A.-V.); (H.V.-R.); (T.B.C.-C.); (K.S.-O.)
- Department of Dentistry, Dentistry School, Norbert Wiener University, Lima 15046, Peru
| | - Franz Tito Coronel-Zubiate
- Faculty of Health Sciences, Stomatology School, Toribio Rodríguez of Mendoza National University of Amazonas, Chachapoyas 01001, Peru
| | | | - Joan Manuel Meza-Málaga
- Faculty of Dentistry, Dentistry School, Católica de Santa María University, Arequipa 04013, Peru; (J.M.M.-M.); (S.A.L.-V.)
- Faculty of Medicine, Medicine School, Católica de Santa María University, Arequipa 04013, Peru
| | - Sara Antonieta Luján-Valencia
- Faculty of Dentistry, Dentistry School, Católica de Santa María University, Arequipa 04013, Peru; (J.M.M.-M.); (S.A.L.-V.)
- Postgraduate School, Católica de Santa María University, Arequipa 04013, Peru
| | - Tania Belú Castillo-Cornock
- Department of General Dentistry, Dentistry School, San Martín de Porres University, Chiclayo 14012, Peru; (H.I.A.-V.); (H.V.-R.); (T.B.C.-C.); (K.S.-O.)
- Faculty of Health Sciences, Stomatology School, Señor de Sipán University, Chiclayo 14000, Peru
| | - Katherine Serquen-Olano
- Department of General Dentistry, Dentistry School, San Martín de Porres University, Chiclayo 14012, Peru; (H.I.A.-V.); (H.V.-R.); (T.B.C.-C.); (K.S.-O.)
- Faculty of Health Sciences, Stomatology School, Señor de Sipán University, Chiclayo 14000, Peru
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Zhang X, Liu X, Liu C, Hua C. Clinical considerations of emergent oral manifestations during pregnancy. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2024; 42:142-153. [PMID: 38597074 PMCID: PMC11034408 DOI: 10.7518/hxkq.2024.2023367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Indexed: 04/11/2024]
Abstract
Pregnancy is a special period for developing and treating oral diseases. Oral emergencies during pregnancy need to be handled appropriately. Changes in the physiological environments and personal habits of pregnant women increase susceptibility to some oral diseases. However, clinical treatment strategies are limited due to the need to ensure the safety of pregnant women and fetuses. Pregnant women should obtain oral health knowledge and enhance their awareness. Dentists should adhere to the principle of "prevention before pregnancy, controlling symptoms during pregnancy, and treating diseases after pregnancy" for different pregnancy periods. They should also formulate appropriate treatment plans to control emergencies, prevent disease progression, and avoid harmful effects on pregnant women by using the safest, simplest, and most effective strategies that avoid adverse effects on fetuses. Pregnant women and dentists should combine prevention and treatment while collaborating in maintaining oral health during pregnancy. This article focuses on the principles of treatment during pregnancy, and the treatment timing, clinical management, and treatment strategies of different diseases causing oral emergencies during pregnancy are reviewed.
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Affiliation(s)
- Xuefeng Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xian Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chang Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chengge Hua
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Raaj V, Bhardwaj A, Singh PK, Sinha K. Comparative Evaluation and Correlation of Periodontal Status With Inflammatory Markers in Pregnant Women With or Without Chronic Periodontitis: A Clinico-Hematological Study. Cureus 2024; 16:e55868. [PMID: 38595889 PMCID: PMC11002702 DOI: 10.7759/cureus.55868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Background The research delves into the intricate relationship between periodontal health and specific blood biomarkers in pregnant women during their second trimester. It specifically focuses on the levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), and C-reactive protein (CRP) in those suffering from chronic periodontitis compared to healthy controls. Methodology A detailed approach was taken involving 60 pregnant women categorized into two groups based on the presence or absence of chronic periodontitis. Out of 60 pregnant women, 30 had chronic periodontitis, while the other 30 served as controls selected from the regular patient population of the college. The study utilized blood sample analysis and advanced statistical tools for data analysis, ensuring precise and reliable results. Levels of IL-6, LDH, and CRP in those suffering from chronic periodontitis compared to healthy controls were checked. Results The findings revealed a notable variance in IL-6, LDH, and CRP levels between the two groups. Women with chronic periodontitis exhibited significantly higher levels of these biomarkers. The statistical analysis reinforced the validity of these differences, highlighting their significance. Conclusions The study underscored a clear link between higher levels of IL-6, LDH, and CRP and the presence of chronic periodontitis in pregnant women. These biomarkers emerge as potential indicators for early detection and monitoring of periodontal health in this demographic.
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Affiliation(s)
- Vaibhava Raaj
- Department of Periodontology, Faculty of Dental Sciences, Shree Guru Gobind Singh Tricentenary (SGT) University, Gurugram, IND
| | - Amit Bhardwaj
- Department of Periodontology, Faculty of Dental Sciences, Shree Guru Gobind Singh Tricentenary (SGT) University, Gurugram, IND
| | - Prabhat K Singh
- Department of Periodontology, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | - Kajal Sinha
- Department of Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Patna, IND
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Brame JL, Quinonez RB, Ciszek BP, Weintraub JA. Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned. Health Promot Pract 2023:15248399231207070. [PMID: 37904487 DOI: 10.1177/15248399231207070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
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.
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Affiliation(s)
- Jennifer L Brame
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rocio B Quinonez
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brittney P Ciszek
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- The University of Utah, Salt Lake City, UT, USA
| | - Jane A Weintraub
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Parry S, Jeffcoat M, Reddy MS, Doyle MJ, Grender JM, Gerlach RW, Tanna N, Geisinger ML, Geurs NC, Biggio J. Evaluation of an advanced oral hygiene regimen on maternity outcomes in a randomized multicenter clinical trial (Oral Hygiene and Maternity Outcomes Multicenter Study). Am J Obstet Gynecol MFM 2023; 5:100995. [PMID: 37127210 DOI: 10.1016/j.ajogmf.2023.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND During pregnancy, dental plaque-induced gingivitis prevalence and subsequent risk of periodontal disease increases substantially, as a consequence of both inadequate oral hygiene and changes in sex steroid hormone levels. Although maternal periodontal disease has been associated with adverse pregnancy outcomes, including spontaneous preterm birth, previous clinical trials involving mechanical debridement (eg, scaling and root planing) to remove plaque biofilm have not yielded decreased rates of preterm birth. OBJECTIVE We hypothesized that an advanced oral hygiene program, including an antibacterial regimen coupled with a power toothbrush and hygiene instruction, may improve the periodontal milieu and reduce the rate of spontaneous preterm birth. Therefore, we conducted a clinical trial of obstetrical patients with moderate-to-severe gingivitis who were randomized to an advanced oral hygiene program vs usual oral hygiene care, and the primary obstetrical outcome compared between the treatment groups was gestational age at delivery. STUDY DESIGN Obstetrical patients with singleton pregnancies between 8 and 24 weeks' gestation were screened by trained dentists at 2 clinical sites for moderate-to-severe gingivitis (>30 intraoral sites with gingival bleeding on probing). Eligible participants were randomized to an advanced oral hygiene regimen, including antibacterial mouth wash, dental floss, antibacterial toothpaste, a power toothbrush, and intensive oral hygiene education vs standard oral home care instructions and regimen. The primary obstetrical outcome assessed was gestational age at delivery. The overall primary (dental) outcomes were gingival index, bleeding sites, and pocket depth (reported elsewhere). Secondary obstetrical outcomes included birthweight and incidence of preterm birth at <37 weeks' gestation. Regression models were utilized and included factors such as treatment group, gestational age at enrollment, preterm birth history, and potential markers of health disparities (ie, education, employment status). RESULTS A total of 817 obstetrical patients underwent dental screening at the 2 sites, 789 were identified with moderate-to-severe gingivitis, 746 were randomized, and birth outcomes were available for 613 of the study participants. The gestational age at delivery was 2 days earlier in the control group (P=.040), but the clinical significance of this finding was limited (39.13 vs 38.85 weeks). Overall rates of spontaneous preterm birth <37 weeks and <34 weeks were not statistically different between the 2 treatment groups (7.0% advanced oral hygiene regimen vs 10.3% controls, OR=1.63 (0.90-3.00), P=.11; and 2.3% vs 3.9%, OR=1.88 (0.71-4.98), P=.20, respectively). However, we observed lower rates of spontaneous preterm birth among unemployed participants with less favorable socioeconomic status (4.7% advanced oral hygiene regimen vs 16.0% controls, OR=4.04 (1.34-15.12), P=.01). CONCLUSION An advanced oral hygiene program may reduce the risk of spontaneous preterm birth among pregnant patients with moderate-to-severe gingivitis and health disparities. This is the same group that may be at highest risk of poor dental hygiene and preterm birth.
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Affiliation(s)
- Samuel Parry
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Dr Parry).
| | - Marjorie Jeffcoat
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA (Drs Jeffcoat and Tanna)
| | - Michael S Reddy
- School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL (Drs Reddy, Geisinger, and Geurs); University of California San Francisco School of Dentistry, San Francisco, CA (Dr Reddy)
| | - Matthew J Doyle
- The Procter and Gamble Company, Cincinnati, OH (Drs Doyle, Grender, and Gerlach)
| | - Julie M Grender
- The Procter and Gamble Company, Cincinnati, OH (Drs Doyle, Grender, and Gerlach)
| | - Robert W Gerlach
- The Procter and Gamble Company, Cincinnati, OH (Drs Doyle, Grender, and Gerlach)
| | - Nipul Tanna
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA (Drs Jeffcoat and Tanna)
| | - Maria L Geisinger
- School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL (Drs Reddy, Geisinger, and Geurs)
| | - Nicolaas C Geurs
- School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL (Drs Reddy, Geisinger, and Geurs)
| | - Joseph Biggio
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Dr Biggio); Women's Services, Ochsner Health, New Orleans, LA (Dr Biggio)
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AlSharief M, Alabdurubalnabi E. Periodontal Pathogens and Adverse Pregnancy Outcomes: A Narrative Review. Life (Basel) 2023; 13:1559. [PMID: 37511934 PMCID: PMC10381683 DOI: 10.3390/life13071559] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Periodontal disease is a multi-microbial infection of the teeth-supporting apparatus that manifests as clinical attachment loss and alveolar bone loss. The association between periodontal disease and systemic diseases has been proposed in the literature owing to the former's chronic state of inflammation, and adverse pregnancy outcomes are no exception. As a result of periodontal pathogen invasion, a series of systemic inflammatory and immunologic events affecting the safety of the fetoplacental unit may unfold. This may be further exaggerated by physiologic hormonal and metabolic fluctuations during pregnancy. This can not only negatively affect the gestation period and consequently cause preterm low weight but also complicate the pregnancy via preeclampsia and gestational diabetes. This narrative review article aims to provide a summary of relevant available evidence pertinent to the relationship between periodontal diseases, associated periodontal pathogens and virulence mechanisms mediated by pro-inflammatory cytokines and prostaglandins, and adverse pregnancy outcomes. Furthermore, this article highlights some of the literature addressing the impact of periodontal therapy interventions and pregnancy outcomes.
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Affiliation(s)
- Mishali AlSharief
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Esraa Alabdurubalnabi
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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Geurs NC, Jeffcoat MK, Tanna N, Geisinger ML, Parry S, Biggio JR, Doyle MJ, Grender JM, Gerlach RW, Reddy MS. A Randomized Controlled Clinical Trial of Prenatal Oral Hygiene Education in Pregnancy-Associated Gingivitis. J Midwifery Womens Health 2023; 68:507-516. [PMID: 37026567 DOI: 10.1111/jmwh.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Research shows there is a significant increase in gingival inflammation during pregnancy. This study was conducted to determine if an oral health intervention (OHI), including oral hygiene education delivered by nurse-led staff and an advanced over-the-counter (OTC) oral home care regimen, improved gingival inflammation in pregnant women with moderate-to-severe gingivitis compared with a standard oral hygiene control group. METHODS This was a multicenter, randomized, controlled, single-masked, parallel group clinical trial conducted in obstetrics clinics of 2 medical centers. A total of 750 pregnant women between 8 and 24 weeks of pregnancy with at least 20 natural teeth and moderate-to-severe gingivitis (>30 intraoral bleeding sites) were enrolled. Participants were randomized to either the OHI group, which included oral hygiene instructions supplemented with an educational video and advanced OTC antibacterial/mechanical oral hygiene products, or the control group receiving oral hygiene instructions and standard products. Both groups received oral hygiene instructions from nurse-led staff. Experienced, masked examiners measured whole mouth gingival index (GI) and periodontal probing depths (PDs) at baseline and months 1, 2, and 3. RESULTS Participants enrolled in this study presented with moderate-to-severe gingivitis at baseline. Both the OHI and control groups exhibited significant reductions in GI (P < .001) and PD (P < .03) from baseline that persisted throughout the study period. The OHI group exhibited modest, yet statistically greater, reductions in GI (P ≤ .044) compared with the control at all time points. The reduction in PD directionally favored the OHI group, but between-group differences were small (<0.03 mm) and not statistically significant (P > .18). DISCUSSION Significant gingivitis was prevalent among participants in this study and identifies an opportunity to improve gingival health during pregnancy by providing oral health education during the course of prenatal care when coupled with an advanced OTC oral hygiene regimen.
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Affiliation(s)
- Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marjorie K Jeffcoat
- Department of Periodontics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nipul Tanna
- Department of Periodontics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, Ochsner Baptist, New Orleans, Louisiana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matthew J Doyle
- Research & Development, The Procter & Gamble Company, Cincinnati, Ohio
| | - Julie M Grender
- Research & Development, The Procter & Gamble Company, Cincinnati, Ohio
| | - Robert W Gerlach
- Research & Development, The Procter & Gamble Company, Cincinnati, Ohio
| | - Michael S Reddy
- School of Dentistry, University of California San Francisco, San Francisco, California
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11
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Mickenautsch S, Yengopal V. Allocation concealment appraisal of clinical therapy trials using the extended Composite Quality Score (CQS-2)-An empirically based update. Front Med (Lausanne) 2023; 10:1176219. [PMID: 37396894 PMCID: PMC10308079 DOI: 10.3389/fmed.2023.1176219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives The objective of this study was to revise CQS-2/Criterion II concerning allocation concealment appraisal for prospective, controlled clinical therapy trials. Methods Meta-analyses of trials with inadequate allocation concealment were tested for in-between trial heterogeneity (I2 > 0) due to imbalances in baseline variables. Meta-analyses with positive test results were used as a basis to deduce criteria for adequate allocation concealment. The CQS-2/Criterion II was reformulated in line with the findings. Result One suitable meta-analysis was identified. Two forest plots with data from five and four trials with inadequate/unclear allocation concealment were selected for testing. In addition, a total of five trials with adequate allocation concealment were identified. The meta-analysis test results were positive, and keywords for the judgment of adequate allocation concealment were extracted verbatim from the text of the meta-analysis. The extracted keywords indicated "central allocation" as the main criterion for adequate allocation concealment. Criterion II of the CQS-2 was revised accordingly. Conclusion Criterion II of the CQS-2 trial appraisal tool was revised. The revised appraisal tool was specified as version CQS-2B.
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Affiliation(s)
- Steffen Mickenautsch
- Review Centre for Health Science Research, Johannesburg, South Africa
- Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veerasamy Yengopal
- Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
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12
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Valentine GC, Perez K, Tsegaye AT, Enquobahrie DA, Couper D, Beck JD, Umoren R, Aagaard KM, McKinney CM. Nonsurgical periodontal treatment during pregnancy and rates of preterm birth. AJOG GLOBAL REPORTS 2023; 3:100167. [PMID: 36876161 PMCID: PMC9975275 DOI: 10.1016/j.xagr.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Periodontitis during pregnancy is associated with an increased risk of preterm birth (<37 weeks of gestation) or low birthweight (<2500 g) offspring. Beyond periodontal disease, the risk of preterm birth varies both by previous history of preterm birth and in association with social determinants prevalent among vulnerable and marginalized populations. This study hypothesized that the timing of periodontal treatment during pregnancy and/or social vulnerability measures modified the response to dental scaling and root planing for the treatment of periodontitis and prevention of preterm birth. OBJECTIVE This study aimed to determine the association of timing of dental scaling and root planing for gravidae with a diagnosed periodontal disease on the rates of preterm birth or low birthweight offspring among subgroups or strata of gravidae as part of the Maternal Oral Therapy to Reduce Obstetric Risk randomized controlled trial. All participants in the study had clinically diagnosed periodontal disease and differed by the timing of the periodontal treatment (dental scaling and root planing at <24 weeks [per protocol] or after delivery) or by baseline characteristics. Although all participants met the well-accepted clinical criteria for periodontitis, not all participants acknowledged a priori that they had periodontal disease. STUDY DESIGN This was a per-protocol analysis of data from 1455 participants of the Maternal Oral Therapy to Reduce Obstetric Risk trial evaluating dental scaling and root planing on the risk of preterm birth or low birthweight offspring. Adjusted multiple logistic regression to control for confounders was used to estimate associations comparing the timing of periodontal treatment in pregnancy to receiving treatment after pregnancy (referent control) on rates of preterm birth or low birthweight among subgroups of gravidae with known periodontal disease. Study analyses were stratified, and the associations with the following characteristics-body mass index, self-described race and ethnicity, household income, maternal education, recency of immigration, and self-acknowledgment of poor oral health, were explored. RESULTS Dental scaling and root planing during the second or third trimester of pregnancy were associated with an increased adjusted odds ratio of preterm birth among those at the lower body mass index strata (18.5 to <25.0 kg/m2) (adjusted odds ratio, 2.21; 95% confidence interval, 1.07-4.98), but not among individuals who were overweight (body mass index of 25.0 to <30.0 kg/m2; adjusted odds ratio, 0.68; 95% confidence interval, 0.29-1.59) or obese (body mass index of ≥30 kg/m2; adjusted odds ratio, 1.26; 95% confidence interval, 0.65-2.49). There was no significant difference in pregnancy outcomes related to the other evaluated variables: self-described race and ethnicity, household income, maternal education, immigration status, or self-acknowledgment of poor oral health. CONCLUSION In this per-protocol analysis of the Maternal Oral Therapy to Reduce Obstetric Risk trial, dental scaling and root planing had no preventive benefit against adverse obstetrical outcomes and were associated with increased odds of preterm birth among individuals at lower body mass index strata. There was no significant difference in the occurrence of preterm birth or low birthweight after dental scaling and root planing periodontitis treatment concerning other analyzed social determinants of preterm birth.
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Affiliation(s)
- Gregory C. Valentine
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA (Drs Valentine, Perez, and Umoren)
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Valentine and Aagaard)
- Corresponding author: Gregory C. Valentine, MD, MEd, FAAP.
| | - Krystle Perez
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA (Drs Valentine, Perez, and Umoren)
| | - Adino T. Tsegaye
- Department of Epidemiology, University of Washington, Seattle, WA (Mr Tsegaye and Dr Enquobahrie)
| | - Daniel A. Enquobahrie
- Department of Epidemiology, University of Washington, Seattle, WA (Mr Tsegaye and Dr Enquobahrie)
| | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC (Dr Couper)
| | - James D. Beck
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC (Dr Beck)
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA (Drs Valentine, Perez, and Umoren)
| | - Kjersti M. Aagaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Valentine and Aagaard)
| | - Christy M. McKinney
- Seattle Children's Research Institute, Seattle, WA (Dr McKinney)
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA (Dr McKinney)
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13
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Antepartum periodontitis treatment and risk of offspring screening positive for autism spectrum disorder. J Perinatol 2023; 43:470-476. [PMID: 36697694 DOI: 10.1038/s41372-023-01610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND To evaluate if treating maternal periodontal disease, a pro-inflammatory condition, during pregnancy (intervention) compared to after pregnancy (control) reduces the likelihood of offspring screening positive for autism spectrum disorder (ASD). METHODS In a follow-up study to the MOTOR randomized trial, we compared rates of positive screens on the Modified Checklist for Autism in Toddlers (M-CHAT) among n = 306 two-year-old toddlers and correlated findings to maternal and cord blood pro-inflammatory interleukin-6 (IL-6). RESULTS Toddlers in the intervention group had decreased risk of a positive M-CHAT screen (adjusted RR = 0.53, 95% CI 0.29-0.99). Toddlers screening positive compared to negative had higher mean IL-6 in cord blood (1.58 ± 1.14 vs. 1.09 ± 0.72 p = 0.001) and maternal IL-6 change from baseline (1.30 ± 0.61 vs 0.96 ± 0.62 p = 0.03). CONCLUSIONS Treating periodontal disease during pregnancy reduced risk of a positive ASD screen. M-CHAT positivity was associated with increased IL-6 in maternal and cord blood. CLINICAL TRIAL Trial Registration numbers: Clinicaltrials.gov NCT03423836.
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14
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Alnasser BH, Alkhaldi NK, Alghamdi WK, Alghamdi FT. The Potential Association Between Periodontal Diseases and Adverse Pregnancy Outcomes in Pregnant Women: A Systematic Review of Randomized Clinical Trials. Cureus 2023; 15:e33216. [PMID: 36733569 PMCID: PMC9888319 DOI: 10.7759/cureus.33216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
| | - Njoud K Alkhaldi
- General Medicine and Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Waad K Alghamdi
- General Medicine and Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Faisal T Alghamdi
- Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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15
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Merchant AT, Gupta RD, Akonde M, Reynolds M, Smith-Warner S, Liu J, Tarannum F, Beck J, Mattison D. Association of Chlorhexidine Use and Scaling and Root Planing With Birth Outcomes in Pregnant Individuals With Periodontitis: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2247632. [PMID: 36534397 PMCID: PMC9856591 DOI: 10.1001/jamanetworkopen.2022.47632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Chlorhexidine mouthwash enhances treatment effects of conventional periodontal treatment, but data on chlorhexidine as a source of heterogeneity in meta-analyses assessing the treatment of maternal periodontitis in association with birth outcomes are lacking. OBJECTIVE To assess possible heterogeneity by chlorhexidine use in randomized clinical trials (RCTs) evaluating the effect of periodontal treatment (ie, scaling and root planing [SRP]) vs no treatment on birth outcomes. DATA SOURCES Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database), US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), and the WHO International Clinical Trials Registry Platform were searched through March 2022. STUDY SELECTION RCTs were included if they were conducted among pregnant individuals with periodontitis, used interventions consisting of SRP vs no periodontal treatment, and assessed birth outcomes. DATA EXTRACTION AND SYNTHESIS Data were abstracted with consensus of 2 reviewers using Rayyan and assessed for bias with the Cochrane Risk of Bias 2 tool before random effects subgroup meta-analyses. Analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. MAIN OUTCOMES AND MEASURES Outcomes of interest were preterm birth (ie, <37 weeks' gestation) and low birth weight (ie, <2500 g). RESULTS There were 12 studies with a total of 5735 participants evaluating preterm birth. Control group participants did not receive any treatment or use chlorhexidine during pregnancy. All intervention group participants received SRP; in 5 of these studies (with 2570 participants), pregnant participants in the treatment group either received chlorhexidine mouthwash or advice to use it, but participants in the remaining 7 studies (with 3183 participants) did not. There were 8 studies with a total of 3510 participants evaluating low birth weight, including 3 studies with SRP plus chlorhexidine (with 594 participants) and 6 studies with SRP only (with 2916 participants). The SRP plus chlorhexidine groups had lower risk of preterm birth (relative risk [RR], 0.56; 95% CI, 0.34-0.93) and low birth weight (RR, 0.47; 95% CI, 0.32-0.68) but not the SRP-only groups (preterm birth: RR, 1.03; 95% CI, 0.82-1.29; low birth weight: RR, 0.82; 95% CI, 0.62-1.08). CONCLUSIONS AND RELEVANCE These findings suggest that treating maternal periodontitis with chlorhexidine mouthwash plus SRP was associated with reduced risk of preterm and low birth weight. Well-conducted RCTs are needed to test this hypothesis.
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Affiliation(s)
- Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Mark Reynolds
- School of Dentistry, University of Maryland Baltimore, Baltimore
| | - Stephanie Smith-Warner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Fouzia Tarannum
- M. R. Ambedkar Dental College and Hospital, Bangalore, India
| | - James Beck
- Division of Comprehensive Oral Health and Periodontology, University of North Carolina, Chapel Hill
| | - Donald Mattison
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
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16
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Ben David M, Callen Y, Eliasi H, Peretz B, Odeh-Natour R, Ben David Hadani M, Blumer S. Oral Health and Knowledge among Postpartum Women. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1449. [PMID: 36291384 PMCID: PMC9600570 DOI: 10.3390/children9101449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Oral health behavior and risks during pregnancy and after birth affect the oral health of babies and toddlers. We examined the oral and gingival health and caries prevalence of 150 postpartum women shortly after giving birth and assessed their knowledge of oral hygiene using a questionnaire. We also compared the oral health knowledge of nulliparous and multiparous women. Although most participants (98.0%) understood the importance of maintaining oral hygiene in children, their overall knowledge of oral health was medium-low, regardless of the number of previous pregnancies. Only 4.6% of women received oral health advice from their obstetrician during their pregnancy. Most participants had a high gingival index score, which correlated with dental pain during pregnancy. In contrast, the number of decayed, missing and filled teeth was significantly lower in first-time mothers. There was a statistically significant positive correlation between women who regularly visit their dentist and those who regularly take their children to the dentist. Expecting mothers should be educated about their own oral health and that of their developing fetus and children. Raising awareness among obstetricians with regards to this topic may be an effective way to achieve this.
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Affiliation(s)
- Mordechai Ben David
- Department of Obstetrics and Gynecology, Laniado Hospital, Netanya 42223, Israel
| | - Yaffa Callen
- Department of Paediatric Dentistry, The Maurice and Gabriela Goldshleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hila Eliasi
- Department of Paediatric Dentistry, The Maurice and Gabriela Goldshleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Benjamin Peretz
- Department of Paediatric Dentistry, The Maurice and Gabriela Goldshleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Rasha Odeh-Natour
- Department of Obstetrics and Gynecology, Laniado Hospital, Netanya 42223, Israel
| | | | - Sigalit Blumer
- Department of Paediatric Dentistry, The Maurice and Gabriela Goldshleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Starzyńska A, Wychowański P, Nowak M, Sobocki BK, Jereczek-Fossa BA, Słupecka-Ziemilska M. Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring. Int J Mol Sci 2022; 23:2473. [PMID: 35269617 PMCID: PMC8910384 DOI: 10.3390/ijms23052473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/24/2022] Open
Abstract
Periodontal disease (PD) is one of the most common oral conditions affecting both youths and adults. There are some research works suggesting a high incidence of PD in pregnant women. As an inflammatory disease of bacterial origin, PD may result in the activation of the pathways affecting the course and the pregnancy outcome. The authors, based on the literature review, try to answer the PICO question: Does maternal periodontitis (exposure) influence the incidence of complications rates in pregnancy and the development of systemic diseases in childhood and adult offspring (outcome) in the humans of any race (population) compared to the offspring of mothers with healthy periodontium (comparison)? The authors try to describe the molecular pathways and mechanisms of these interdependencies. There is some evidence that maternal periodontitis may affect the pregnancy course and outcome, resulting in preeclampsia, preterm delivery, vulvovaginitis and low birth weight. It can be suggested that maternal periodontitis may affect offspring epigenome and result in some health consequences in their adult life.
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Affiliation(s)
- Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Piotr Wychowański
- Department of Oral Surgery, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland;
- Specialized Private Implantology Clinic Wychowanski Stomatologia, 9/33 Rakowiecka Street, 02-517 Warsaw, Poland
| | - Maciej Nowak
- Department of Periodontology and Oral Diseases, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland;
| | - Bartosz Kamil Sobocki
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20-112 Milan, Italy;
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20-141 Milan, Italy
| | - Monika Słupecka-Ziemilska
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawińskiego Street, 02-106 Warsaw, Poland;
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18
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Orlandi M, Muñoz Aguilera E, Marletta D, Petrie A, Suvan J, D'Aiuto F. Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:314-327. [PMID: 34791686 DOI: 10.1111/jcpe.13554] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022]
Abstract
AIM To investigate the effect of treatment of periodontitis on systemic health outcomes, pregnancy complications, and associated quality of life. MATERIALS AND METHODS Systematic electronic searches were conducted to identify randomized controlled trials with minimum 6-month follow-up and reporting on the outcomes of interest. Qualitative and quantitative analyses were performed as deemed suitable. RESULTS Meta-analyses confirmed reductions of high-sensitivity C-reactive protein (hs-CRP) [0.56 mg/L, 95% confidence interval (CI) (-0.88, -0.25), p < .001]; interleukin (IL)-6 [0.48 pg/ml, 95% CI (-0.88, -0.08), p = .020], and plasma glucose [1.33 mmol/l, 95% CI (-2.41, -0.24), p = .016], and increase of flow-mediated dilation (FMD) [0.31%, 95% CI (0.07, 0.55), p = .012] and diastolic blood pressure [0.29 mmHg, 95% CI (0.10, 0.49), p = .003] 6 months after the treatment of periodontitis. A significant effect on preterm deliveries (<37 weeks) was observed [0.77 risk ratio, 95% CI (0.60, 0.98), p = .036]. Limited evidence was reported on quality-of-life (QoL) outcomes in the included studies. CONCLUSIONS Treatment of periodontitis results in systemic health improvements including improvement in cardiometabolic risk, reduction in systemic inflammation and the occurrence of preterm deliveries. Further research is however warranted to confirm whether these changes are sustained over time. Further, appropriate QoL outcomes should be included in the study designs of future clinical trials.
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | | | | | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, London, UK
| | - Jean Suvan
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
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Le QA, Eslick GD, Coulton KM, Akhter R, Lain S, Nassar N, Yaacoub A, Condous G, Leonardi M, Eberhard J, Nanan R. DIFFERENTIAL IMPACT OF PERIODONTAL TREATMENT STRATEGIES DURING PREGNANCY ON PERINATAL OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 22:101666. [DOI: 10.1016/j.jebdp.2021.101666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 10/12/2021] [Accepted: 11/06/2021] [Indexed: 01/12/2023]
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Raju K, Berens L. Periodontology and pregnancy: An overview of biomedical and epidemiological evidence. Periodontol 2000 2021; 87:132-142. [PMID: 34463990 DOI: 10.1111/prd.12394] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Women are particularly susceptible to developing gingival problems during pregnancy. In addition, periodontal disease in pregnant women may lead to adverse outcomes for both mother and infant, which have serious clinical and public health implications. Both scenarios have been extensively researched, helping to bring attention to pregnant women as an important and vulnerable population as it concerns periodontal health. The increase in gingival inflammation caused by hormonal changes in pregnant women is undisputed and has been studied and documented since the 1960s, although the exact etiology is not fully understood. The relationship between periodontal disease during pregnancy and adverse pregnancy outcomes is less substantiated, because of conflicting evidence. This review of the biomedical and epidemiologic literature provides an overview of both sides of this relationship and examines the potential mechanisms for developing periodontal disease during pregnancy and the proposed mechanisms by which periodontal disease leads to adverse pregnancy outcomes.
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Affiliation(s)
- Karen Raju
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Lisa Berens
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, USA
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21
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Luan X, Zhou X, Fallah P, Pandya M, Lyu H, Foyle D, Burch D, Diekwisch TGH. MicroRNAs: Harbingers and shapers of periodontal inflammation. Semin Cell Dev Biol 2021; 124:85-98. [PMID: 34120836 DOI: 10.1016/j.semcdb.2021.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
Periodontal disease is an inflammatory reaction of the periodontal tissues to oral pathogens. In the present review we discuss the intricate effects of a regulatory network of gene expression modulators, microRNAs (miRNAs), as they affect periodontal morphology, function and gene expression during periodontal disease. These miRNAs are small RNAs involved in RNA silencing and post-transcriptional regulation and affect all stages of periodontal disease, from the earliest signs of gingivitis to the regulation of periodontal homeostasis and immunity and to the involvement in periodontal tissue destruction. MiRNAs coordinate periodontal disease progression not only directly but also through long non-coding RNAs (lncRNAs), which have been demonstrated to act as endogenous sponges or decoys that regulate the expression and function of miRNAs, and which in turn suppress the targeting of mRNAs involved in the inflammatory response, cell proliferation, migration and differentiation. While the integrity of miRNA function is essential for periodontal health and immunity, miRNA sequence variations (genetic polymorphisms) contribute toward an enhanced risk for periodontal disease progression and severity. Several polymorphisms in miRNA genes have been linked to an increased risk of periodontitis, and among those, miR-146a, miR-196, and miR-499 polymorphisms have been identified as risk factors for periodontal disease. The role of miRNAs in periodontal disease progression is not limited to the host tissues but also extends to the viruses that reside in periodontal lesions, such as herpesviruses (human herpesvirus, HHV). In advanced periodontal lesions, HHV infections result in the release of cytokines from periodontal tissues and impair antibacterial immune mechanisms that promote bacterial overgrowth. In turn, controlling the exacerbation of periodontal disease by minimizing the effect of periodontal HHV in periodontal lesions may provide novel avenues for therapeutic intervention. In summary, this review highlights multiple levels of miRNA-mediated control of periodontal disease progression, (i) through their role in periodontal inflammation and the dysregulation of homeostasis, (ii) as a regulatory target of lncRNAs, (iii) by contributing toward periodontal disease susceptibility through miRNA polymorphism, and (iv) as periodontal microflora modulators via viral miRNAs.
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Affiliation(s)
- Xianghong Luan
- Texas A&M Center for Craniofacial Research and Diagnosis and Department of Periodontics, TAMU College of Dentistry, 75246 Dallas, TX USA
| | - Xiaofeng Zhou
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Chicago, IL 60612, USA
| | - Pooria Fallah
- Texas A&M Center for Craniofacial Research and Diagnosis and Department of Periodontics, TAMU College of Dentistry, 75246 Dallas, TX USA
| | - Mirali Pandya
- Texas A&M Center for Craniofacial Research and Diagnosis and Department of Periodontics, TAMU College of Dentistry, 75246 Dallas, TX USA
| | - Huling Lyu
- Texas A&M Center for Craniofacial Research and Diagnosis and Department of Periodontics, TAMU College of Dentistry, 75246 Dallas, TX USA; Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Deborah Foyle
- Texas A&M Center for Craniofacial Research and Diagnosis and Department of Periodontics, TAMU College of Dentistry, 75246 Dallas, TX USA
| | - Dan Burch
- Department of Pedodontics, TAMU College of Dentistry, 75246 Dallas, TX, USA
| | - Thomas G H Diekwisch
- Texas A&M Center for Craniofacial Research and Diagnosis and Department of Periodontics, TAMU College of Dentistry, 75246 Dallas, TX USA.
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Terzic M, Aimagambetova G, Terzic S, Radunovic M, Bapayeva G, Laganà AS. Periodontal Pathogens and Preterm Birth: Current Knowledge and Further Interventions. Pathogens 2021; 10:pathogens10060730. [PMID: 34207831 PMCID: PMC8227634 DOI: 10.3390/pathogens10060730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Preterm labor is defined as a birth before 37 weeks of gestation and occurs in 5–20% of pregnancies. Preterm labor, as multifactorial entity associated with a high risk of neonatal morbidity and mortality, is influenced by maternal, fetal and environmental factors. Microbiological studies suggest that infectious pathogens may account for 25–40% of preterm birth. Infections of different sites, like genital, urinary tract infections, and pneumonia, are linked to the preterm labor. The most recent epidemiological studies consistently report that maternal periodontal disease is associated with preterm delivery, as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes. On the other hand, some previously published papers found periodontal bacteria in placentas of term pregnancies. In spite of a huge research done on the topic, both experimental and clinical, there are many controversial opinions about the role of periodontal infections in preterm birth. Thus, this comprehensive review addresses this very important topic and evaluates novel strategies of preventive and therapeutic approaches.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
- Correspondence:
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
| | - Milena Radunovic
- Laboratory for Microbiology, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
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Favero V, Bacci C, Volpato A, Bandiera M, Favero L, Zanette G. Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures. Dent J (Basel) 2021; 9:dj9040046. [PMID: 33921608 PMCID: PMC8072957 DOI: 10.3390/dj9040046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.
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Affiliation(s)
- Vittorio Favero
- Unit of Maxillofacial Surgery and Dentistry, University of Verona, 37129 Verona, Italy;
| | - Christian Bacci
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Andrea Volpato
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
- Correspondence: or
| | - Michela Bandiera
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Lorenzo Favero
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Gastone Zanette
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
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24
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Rodrigues Amorim Adegboye A, Dias Santana D, Teixeira dos Santos PP, Guedes Cocate P, Benaim C, Trindade de Castro MB, Maia Schlüssel M, Kac G, Lilienthal Heitmann B. Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile. Nutrients 2021; 13:783. [PMID: 33673568 PMCID: PMC7997467 DOI: 10.3390/nu13030783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.
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Affiliation(s)
- Amanda Rodrigues Amorim Adegboye
- Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK
| | - Danilo Dias Santana
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Pedro Paulo Teixeira dos Santos
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Paula Guedes Cocate
- Department of Bioscience and Physical Activity, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, Brazil;
| | - Camila Benaim
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Michael Maia Schlüssel
- The EQUATOR Network—UK Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Road, Oxford OX3 7LD, UK;
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark;
- Section for General Practice, Institute of Public Health, Copenhagen University, 1014 Copenhagen, Denmark
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25
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Erchick DJ, Agrawal NK, Khatry SK, Katz J, LeClerq SC, Reynolds MA, Mullany LC. Adherence to and acceptability of three alcohol-free, antiseptic oral rinses: A community-based pilot randomized controlled trial among pregnant women in rural Nepal. Community Dent Oral Epidemiol 2020; 48:501-512. [PMID: 33070354 PMCID: PMC7689705 DOI: 10.1111/cdoe.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Antiseptic oral rinses have been evaluated as interventions to reduce the risk of adverse pregnancy outcomes associated with periodontal disease in pregnant women. Oral rinse use is not common in Nepal or other countries in South Asia, where the prevalence of adverse pregnancy outcomes is high. Understanding whether pregnant women in rural communities in this region would incorporate rinse use into their daily teeth cleaning routine is an important prerequisite to future research on this topic in South Asia. METHODS We conducted a community-based pilot randomized controlled trial of three alcohol-free, antiseptic oral rinses among pregnant women <22 weeks pregnant in rural Nepal with the aim of assessing rinse acceptability, adherence, and effect on clinical periodontal measures. At baseline, participants underwent a clinical periodontal examination, and then were classified as healthy or having at least mild gingivitis (≥1 site with probing depth (PD) 3 mm and bleeding on probing (BOP) or ≥4 mm (PD)). Participants were stratified by periodontal status and randomized within each exposure category to chlorhexidine (CHX) (0.12%), cetylpyridinium chloride (CPC) (0.05%), salt and water (NaCl), or control (no rinse). Rinse participants were followed weekly for 12 weeks, and all participants underwent a second periodontal examination and answered a questionnaire. RESULTS Pregnant women in the rural Terai region of Nepal showed high adherence to (mean weekly rinse use: 185 mL (standard deviation: 66 mL)) a recommended 210 mL and acceptability of all three rinses. Participants reported greater frequency of tooth brushing with toothpaste and improvements in other recommended oral hygiene behaviours. CHX significantly reduced rates of gingivitis (defined as a participant with BOP ≥ 10% of sites) and the extent of BOP (gingivitis at the end of follow-up for CHX vs control: RR 0.37, 95% CI: 0.16, 0.84). CPC and NaCl rinse groups had rates of gingivitis and extent of BOP similar to the control group (gingivitis at the end of follow-up for CPC: RR 0.81, 95% CI: 0.47, 1.38; NaCl: RR 0.92, 95% CI: 0.55, 1.56). CONCLUSIONS Adherence to and acceptability of three alcohol-free, antiseptic oral rinses were high among pregnant women in rural Nepal. Among participants with mild gingivitis at baseline, CHX rinse was most effective at reducing signs of disease compared to the control group. Oral rinse should be considered as a supplement to current oral self-care routines for pregnant women in settings where rinse use is uncommon and access to oral health services is limited.
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Affiliation(s)
- Daniel J. Erchick
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Nitin K. Agrawal
- Department of DentistryInstitute of MedicineTribhuhvan UniversityKathmanduNepal
| | - Subarna K. Khatry
- Nepal Nutrition Intervention Project – Sarlahi (NNIPS)KathmanduNepal
| | - Joanne Katz
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Steven C. LeClerq
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Nepal Nutrition Intervention Project – Sarlahi (NNIPS)KathmanduNepal
| | - Mark A. Reynolds
- Department of Advanced Oral Sciences and TherapeuticsUniversity of Maryland School of DentistryBaltimoreMDUSA
| | - Luke C. Mullany
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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26
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Akinkugbe AA, Papapanou PN. The "sufficient cause" model framework applied to the periodontitis-systemic diseases link. J Periodontol 2020; 92:343-347. [PMID: 32761817 DOI: 10.1002/jper.20-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
The premise for the oral-systemic diseases relationship dates to the early 20th century with the introduction of the focal infection theory that posited that oral disease affects overall health and wellbeing. While the biological plausibility for the link has been supported by experimental animal models and observational studies in humans, findings from interventional studies in which periodontal therapy failed to alleviate systemic health outcomes have often been interpreted as evidence against periodontitis contribution to the etiology of systemic health conditions. One concept of causation assumes a one-to-one correspondence between cause and effect. Nevertheless, common chronic diseases to which periodontitis is associated have multifactorial etiologies. This commentary provides an overview of Rothman's "sufficient cause" model as a framework for consideration of the oral-systemic diseases link.
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Affiliation(s)
- Aderonke A Akinkugbe
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Inquiry, Innovation and Inclusion, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, New York, USA
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27
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Erchick DJ, Khatry SK, Agrawal NK, Katz J, LeClerq SC, Rai B, Reynolds MA, Mullany LC. Risk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort study. BMJ Open 2020; 10:e036515. [PMID: 32819989 PMCID: PMC7443267 DOI: 10.1136/bmjopen-2019-036515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Observational studies have identified associations between periodontitis and adverse pregnancy outcomes, but randomised controlled trials evaluating the efficacy of periodontal therapy have yielded inconsistent results. Few studies have explored relationships between gingival inflammation and these outcomes or been conducted in rural, low-income communities, where confounding risk factors differ from other settings. METHODS We conducted a community-based, prospective cohort study with the aim of estimating associations between the extent of gingival inflammation in pregnant women and incidence of preterm birth in rural Nepal. Our primary exposure was gingival inflammation, defined as bleeding on probing (BOP) ≥10%, stratified by BOP <30% and BOP ≥30%. A secondary exposure, mild periodontitis, was defined as ≥2 interproximal sites with probing depth (PD) ≥4 mm (different teeth) or one site with PD ≥5 mm. Our primary outcome was preterm birth (<37 weeks gestation). We used Poisson regression to model this relationship, adjusting for potential confounders. RESULTS Of 1394 participants, 554 (39.7%) had gingival inflammation, 54 (3.9%) mild periodontitis and 197 (14.1%) delivered preterm. In the adjusted regression model, increasing extent of gingival inflammation was associated with a non-significant increase in risk of preterm birth (BOP ≥30% vs no BOP: adjusted relative risk (aRR) 1.37, 95% CI: 0.81 to 2.32). A secondary analysis, stratifying participants by when in pregnancy their oral health status was assessed, showed an association between gingival inflammation and preterm birth among women examined in their first trimester (BOP ≥30% vs no BOP: aRR 2.57, 95% CI: 1.11 to 5.95), but not later in pregnancy (BOP ≥30% vs no BOP: aRR 1.05, 95% CI: 0.52 to 2.11). CONCLUSIONS Gingival inflammation in women examined early in pregnancy and poor oral hygiene behaviours were risk factors for preterm birth. Future studies should evaluate community-based oral health interventions that specifically target gingival inflammation, delivered early in or before pregnancy, on preterm birth. TRIAL REGISTRATION NUMBER Nepal Oil Massage Study, NCT01177111.
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Affiliation(s)
- Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Nitin K Agrawal
- Department of Dentistry, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Bhola Rai
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Mark A Reynolds
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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28
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Boggess KA. Choosing the left fork: Steven Offenbacher and understanding maternal periodontal disease and adverse pregnancy outcomes. J Periodontol 2020; 91 Suppl 1:S40-S44. [PMID: 32614074 DOI: 10.1002/jper.20-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022]
Abstract
Steven Offenbacher was one of the first researchers to identify periodontal disease as a risk factor for various adverse pregnancy outcomes. Cohort and case-controlled studies of pregnant women have demonstrated periodontal disease as a risk factor for preterm birth, preeclampsia, and fetal growth restriction. Periodontal therapy during the second trimester improves maternal oral health but fails to reduce the risk of preterm birth. A possible association between periodontal disease and gestational diabetes has also been reported. In one model, periodontal bacteria gain access to the systemic circulation, and thereby the placenta, resulting in local inflammation, placental dysfunction, and, consequently, adverse pregnancy outcomes. It is crucial to increase awareness of the links between maternal periodontal and adverse pregnancy outcomes and to promote oral health prophylaxis during pregnancy.
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Affiliation(s)
- Kim A Boggess
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC
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29
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Bayar E, Bennett PR, Chan D, Sykes L, MacIntyre DA. The pregnancy microbiome and preterm birth. Semin Immunopathol 2020; 42:487-499. [PMID: 32797272 PMCID: PMC7508933 DOI: 10.1007/s00281-020-00817-w] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
Preterm birth is a global health concern and continues to contribute to substantial neonatal morbidity and mortality despite advances in obstetric and neonatal care. The underlying aetiology is multi-factorial and remains incompletely understood. In this review, the complex interplay between the vaginal microbiome in pregnancy and its association with preterm birth is discussed in depth. Advances in the study of bacteriology and an improved understanding of the human microbiome have seen an improved awareness of the vaginal microbiota in both health and in disease.
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Affiliation(s)
- Erna Bayar
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK.
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK.
| | - Denise Chan
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Lynne Sykes
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - David A MacIntyre
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
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30
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Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontol 2000 2020; 83:154-174. [PMID: 32385871 DOI: 10.1111/prd.12294] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Yiorgos A Bobetsis
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Filippo Graziani
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Mervi Gürsoy
- Department of Periodontology, University of Turku, Turku, Finland
| | - Phoebus N Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
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Beck JD, Papapanou PN, Philips KH, Offenbacher S. Periodontal Medicine: 100 Years of Progress. J Dent Res 2020; 98:1053-1062. [PMID: 31429666 DOI: 10.1177/0022034519846113] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research's Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the "first" of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease (n = 10), diabetes (n = 12), and adverse pregnancy outcomes (n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.
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Affiliation(s)
- J D Beck
- 1 Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - P N Papapanou
- 2 Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York City, NY, USA
| | - K H Philips
- 3 Department of Oral and Craniofacial Health Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - S Offenbacher
- 1 Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
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Chopra A, Radhakrishnan R, Sharma M. Porphyromonas gingivalis and adverse pregnancy outcomes: a review on its intricate pathogenic mechanisms. Crit Rev Microbiol 2020; 46:213-236. [PMID: 32267781 DOI: 10.1080/1040841x.2020.1747392] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Porphyromonas gingivalis (P. gingivalis), a Gram-negative facultative anaerobe of the oral cavity, is associated with the onset of various adverse pregnancy outcomes. P. gingivalis is linked with the development of preeclampsia, preterm labour, spontaneous abortion, gestational diabetes, foetal growth restriction, and misconception. The unique virulence factors, surface adhesions, enzymes of P. gingivalis can directly injure and alter the morphology, microbiome the foetal and maternal tissues. P. gingivalis can even exaggerate the production of cytokines, free radicals and acute-phase proteins in the uterine compartment that increases the risk of myometrial contraction and onset of preterm labour. Although evidence confirms the presence of P. gingivalis in the amniotic fluid and placenta of women with poor pregnancy outcomes, the intricate molecular mechanisms by which P. gingivalis initiates various antenatal and postnatal maternal and foetal complications are not well explained in the literature. Therefore, the present review aims to comprehensively summarise and highlight the recent and unique molecular pathogenic mechanisms of P. gingivalis associated with adverse pregnancy outcomes.
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Affiliation(s)
- Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Raghu Radhakrishnan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Mohit Sharma
- Department of Oral Pathology, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
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Taniguchi-Tabata A, Takeuchi N, Uchida Y, Ekuni D, Morita M. Association between maternal periodontal status and ultrasonographic measurement of fetal growth: A longitudinal study. Sci Rep 2020; 10:1402. [PMID: 31996751 PMCID: PMC6989493 DOI: 10.1038/s41598-020-58396-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of this prospective cohort study was to investigate the association between intrauterine fetal growth patterns and periodontal status in pregnant women. Fifty-three pregnant women were recruited. Periodontitis was diagnosed based on probing pocket depth and clinical attachment level. Maternal urinary 8-hydroxy-2’-deoxyguanosine levels and body mass index were recorded. Ultrasonographic measurements of the biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were recorded, and estimated fetal weight (EFW) was calculated. In addition, approximation spline curves of BPD, AC, FL, and EFW were obtained throughout the gestation period. Recorded delivery outcomes were gestational age (GA), birth weight and length, sex, placental weight, and umbilical cord length. Forty-four participants (34.1 ± 4.9 years) were analyzed. Mean neonatal birth weight was 2906.0 ± 544.4 g. On multiple regression analysis, birth weight was related with periodontitis (standardized β = −0.21, P = 0.001). For EFW and BPD, the curves of the periodontitis group were located lower than those of the non-periodontitis group, with significant differences after 32 weeks and 20 weeks of GA, respectively. In conclusion, periodontal treatment before conception may be recommended and a good periodontal condition in the early stage of pregnancy at the latest is desirable for infant growth.
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Affiliation(s)
| | - Noriko Takeuchi
- Department of Preventive Dentistry, Okayama University Hospital, Okayama, Japan.
| | - Yoko Uchida
- Department of Preventive Dentistry, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ekuni
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Manabu Morita
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Govindasamy R, Periyasamy S, Narayanan M, Balaji VR, Dhanasekaran M, Karthikeyan B. The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review of the current evidence. J Indian Soc Periodontol 2020; 24:7-14. [PMID: 31983838 PMCID: PMC6961443 DOI: 10.4103/jisp.jisp_228_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/13/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Rohini Govindasamy
- Department of Periodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Sugavanesh Periyasamy
- Department of Public Health Dentistry, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Mohan Narayanan
- Department of Oral Medicine and Radiology, Vinayaga Mission Dental College, Salem, Tamil Nadu, India
| | | | - Manikandan Dhanasekaran
- Department of Periodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Balakrishnan Karthikeyan
- Department of Periodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
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Bi WG, Emami E, Luo ZC, Santamaria C, Wei SQ. Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:3259-3268. [PMID: 31630597 DOI: 10.1080/14767058.2019.1678142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Wei Guang Bi
- CHU Sainte-Justine Research Center, Department of Obstetrics and Gynecology, University of Montreal, Montréal, Canada.,Faculty of Dentistry, University of Montreal, Montréal, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Prosserman Centre for Population Health Research, University of Toronto, Toronto, Canada
| | - Christina Santamaria
- CHU Sainte-Justine Research Center, Department of Obstetrics and Gynecology, University of Montreal, Montréal, Canada
| | - Shu Qin Wei
- CHU Sainte-Justine Research Center, Department of Obstetrics and Gynecology, University of Montreal, Montréal, Canada
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Caneiro-Queija L, López-Carral J, Martin-Lancharro P, Limeres-Posse J, Diz-Dios P, Blanco-Carrion J. Non-Surgical Treatment of Periodontal Disease in a Pregnant Caucasian Women Population: Adverse Pregnancy Outcomes of a Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3638. [PMID: 31569780 PMCID: PMC6801449 DOI: 10.3390/ijerph16193638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
AIM To analyze if non-surgical treatment of periodontitis in a pregnant Caucasian women population can reduce adverse pregnancy outcomes. METHODS AND RESULTS A parallel randomized clinical trial was designed and approved by the Ethical Committee of Sanitary Area Santiago-Lugo, Spain (registration number: 2016/451). Forty patients with periodontitis stage II grade B were randomly allocated to receive either comprehensive non-surgical periodontal therapy (test group; n = 20) or professional tooth cleaning (control group; n = 20) before 24 gestational weeks. Randomization was computer-generated by the statistic program Epidat v.4.1 and allocation was performed using sealed opaque envelopes. Clinical measurements and peripheral blood samples for biochemical variables were collected at baseline, in the middle of second trimester before non-surgical treatment, and in the third trimester. Microbiological samples were collected in the second and third trimester. A statistically significant reduction was verified in all clinical and microbiological parameters after periodontal treatment in the test group. No significant differences were observed for the rest of the variables, including preterm birth and/or low birth weight. No adverse events related to periodontal treatment were reported. CONCLUSIONS Non-surgical periodontal treatment in Caucasian patients with periodontitis stage II grade B did not significantly reduce the risk of adverse pregnancy outcomes.
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Affiliation(s)
- Leticia Caneiro-Queija
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Jose López-Carral
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Department of Obstetrics and Gynecology, Clinic University Hospital of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Pablo Martin-Lancharro
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Department of Obstetrics and Gynecology, Clinic University Hospital of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Jacobo Limeres-Posse
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, 15782 Santiago de Compostela, Spain.
| | - Pedro Diz-Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, 15782 Santiago de Compostela, Spain.
| | - Juan Blanco-Carrion
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
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Microorganisms in the Placenta: Links to Early-Life Inflammation and Neurodevelopment in Children. Clin Microbiol Rev 2019; 32:32/3/e00103-18. [PMID: 31043389 DOI: 10.1128/cmr.00103-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Prenatal exposure to various stressors can influence both early and later life childhood health. Microbial infection of the intrauterine environment, specifically within the placenta, has been associated with deleterious birth outcomes, such as preterm birth, as well as adverse neurological outcomes later in life. The relationships among microorganisms in the placenta, placental function, and fetal development are not well understood. Microorganisms have been associated with perinatal inflammatory responses that have the potential for disrupting fetal brain development. Microbial presence has also been associated with epigenetic modifications in the placenta, as well other tissues. Here we review research detailing the presence of microorganisms in the placenta and associations among such microorganisms, placental DNA methylation, perinatal inflammation, and neurodevelopmental outcomes.
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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). Pilot Feasibility Stud 2019; 5:38. [PMID: 30873290 PMCID: PMC6402123 DOI: 10.1186/s40814-019-0417-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/13/2019] [Indexed: 12/16/2022] Open
Abstract
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.
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Jia B, Zong L, Lee JY, Lei J, Zhu Y, Xie H, Clemens JL, Feller MC, Na Q, Dong J, McLane MW, Jones-Beatty K, Burd I. Maternal Supplementation of Low Dose Fluoride Alleviates Adverse Perinatal Outcomes Following Exposure to Intrauterine Inflammation. Sci Rep 2019; 9:2575. [PMID: 30796233 PMCID: PMC6385257 DOI: 10.1038/s41598-018-38241-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/12/2018] [Indexed: 11/09/2022] Open
Abstract
Maternal periodontal disease has been linked to adverse pregnancy sequelae, including preterm birth (PTB); yet, root planing and scaling in pregnancy has not been associated with improved perinatal outcomes. Fluoride, a cariostatic agent, has been added to drinking water and dental products to prevent caries and improve dental health. The objective of this study was to explore the effects of fluoride supplementation using a mouse model of preterm birth and perinatal sequalae. Pregnant mice were fed low dose fluoride (LF-) or high dose fluoride (HF-) and given intrauterine injections of lipopolysaccharide (LPS) or phosphate-buffered saline (PBS). We found that LPS + LF- significantly increased livebirths, pup survival, and litter size compared to LPS alone. Moreover, offspring from the LPS + LF- group exhibited significantly improved neuromotor performance and more neurons compared to those from the LPS group. Additionally, LF- treatment on human umbilical vein endothelial cells (HUVECs) increased cell viability and decreased oxidative stress after treatment with LPS. Collectively, our data demonstrates that maternal LF- supplementation during pregnancy postpones the onset of PTB, acts to increase the liveborn rate and survival time of newborns, and reduces perinatal brain injury in cases of intrauterine inflammation.
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Affiliation(s)
- Bei Jia
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Center for Prenatal and Hereditary Disease Diagnosis, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Lu Zong
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Ji Yeon Lee
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Jun Lei
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Yan Zhu
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Han Xie
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Julia L Clemens
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Mia C Feller
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Quan Na
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Jie Dong
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michael W McLane
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kimberly Jones-Beatty
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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Antony KM, Levison J, Suter MA, Raine S, Chiudzu G, Phiri H, Sclafani J, Belfort M, Kazembe P, Aagaard KM. Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years. Int J Womens Health 2019; 11:75-95. [PMID: 30774452 PMCID: PMC6361229 DOI: 10.2147/ijwh.s185199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Kathleen M Antony
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA, .,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Wisconsin-Madison, Madison, WI, USA,
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA,
| | - Melissa A Suter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA,
| | - Susan Raine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA,
| | - Grace Chiudzu
- Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Henry Phiri
- Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Joseph Sclafani
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA, .,Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi.,Baylor College of Medicine Children's Clinical Center of Excellence, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA,
| | - Peter Kazembe
- Baylor College of Medicine Children's Clinical Center of Excellence, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Kjersti M Aagaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA,
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Marchi KS, Rinki C, Shah M, Dove M, Terpak C, Curtis MP, Braveman P. Medical Provider Promotion of Oral Health and Women’s Receipt of Dental Care During Pregnancy. Matern Child Health J 2019; 23:890-902. [DOI: 10.1007/s10995-018-02714-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, Rasubala L, Malmstrom H, Ren Y, Eliav E. Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis. Caries Res 2019; 53:411-421. [PMID: 30630167 PMCID: PMC6554051 DOI: 10.1159/000495187] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA,
| | - Naemah Alkhers
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ronald J Billings
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Daniel A Castillo
- Miner Library, University of Rochester Medical Center, Rochester, New York, USA
| | - Linda Rasubala
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Hans Malmstrom
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
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43
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Selections from the current literature. J Am Dent Assoc 2019. [DOI: 10.1016/j.adaj.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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44
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Pihlstrom BL, Hodges JS, Michalowicz B, Wohlfahrt JC, Garcia RI. Authors' response. J Am Dent Assoc 2018; 149:751-752. [PMID: 30165973 DOI: 10.1016/j.adaj.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bruce L Pihlstrom
- Professor Emeritus, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN; Associate Editor, Research, The Journal of the American Dental Association, Independent Oral Health Research Consultant
| | - James S Hodges
- Professor, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Bryan Michalowicz
- Adjunct Professor, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - J Caspar Wohlfahrt
- Assistant Professor, Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Raul I Garcia
- Professor and Chair, Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
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45
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Komine-Aizawa S, Aizawa S, Hayakawa S. Periodontal diseases and adverse pregnancy outcomes. J Obstet Gynaecol Res 2018; 45:5-12. [PMID: 30094895 DOI: 10.1111/jog.13782] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
From last decade of the 20th century, numerous epidemiological studies and intervention trials have attempted to prove the relationships between maternal periodontal diseases and adverse pregnancy outcomes (APO). Periodontal diseases are considered a risk factor for APO, including preterm birth, fetal growth restriction, low birthweight, pre-eclampsia and gestational diabetes. However, the efficacy of periodontal treatment during pregnancy is controversial. Two pathogenic mechanisms might explain the potential effect of periodontal diseases on pregnancy outcomes. First, periodontal bacteria originating in the gingival biofilm directly affect the feto-placental unit subsequent to bacteremia. Second, inflammatory mediators secreted by the subgingival inflammatory site are carried to the feto-placental unit, where they then cause an inflammatory response. To elucidate these mechanisms, many researchers have been investigating the use of experimental animal models and in vitro models. In the present review, we summarize the current literature on the relationship between periodontal diseases and APO from epidemiological studies, animal models studies and in vitro studies, and speculate on the possible mechanism of periodontal diseases affecting pregnancy outcomes.
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Affiliation(s)
- Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Sohichi Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.,Department of Oral Surgery, JCHO Yokohama Chuo Hospital, Kanagawa, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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Abstract
Oral health is a fundamental component of health and physical and mental well-being. Oral health is influenced by an individual's physiologic and psychosocial attributes and cumulative oral health experiences. The perinatal period is a critical time when health and oral health determinants set in and thus an important time for intervention. Recognition of the importance of oral health intervention during pregnancy and oral health infrastructures have substantially grown over the last several years. This article reviews the current state of knowledge and practice of oral health intervention during pregnancy with a focus on individual- and population-based strategies, and summarizes key agendas for advancing prenatal oral health.
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Affiliation(s)
- Hiroko Iida
- New York State Oral Health Center of Excellence, 259 Monroe Avenue, Rochester, NY 14607, USA.
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47
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Uwitonze AM, Uwambaye P, Isyagi M, Mumena CH, Hudder A, Haq A, Nessa K, Razzaque MS. Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D? J Steroid Biochem Mol Biol 2018; 180:65-72. [PMID: 29341890 DOI: 10.1016/j.jsbmb.2018.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/06/2017] [Accepted: 01/12/2018] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Anne Marie Uwitonze
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Peace Uwambaye
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Moses Isyagi
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Chrispinus H Mumena
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Alice Hudder
- Department of Biochemistry, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Afrozul Haq
- Department of Food Technology, School of Interdisciplinary Sciences & Technology, Jamia Hamdard, New Delhi, India
| | - Kamrun Nessa
- Department of Obstetrics & Gynaecology, Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Mohammed S Razzaque
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda; Department of Applied Oral Sciences, Forsyth Institute, Harvard School of Dental Medicine Affiliate, Cambridge, MA, USA; Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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48
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Chu DM, Seferovic M, Pace RM, Aagaard KM. The microbiome in preterm birth. Best Pract Res Clin Obstet Gynaecol 2018; 52:103-113. [PMID: 29753695 DOI: 10.1016/j.bpobgyn.2018.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
The microbiome is thought to play a role in the maintenance of a healthy pregnancy and thus may either contribute to or protect from preterm birth. Study of the human microbiome has been aided by metagenomic sequencing approaches, providing greater insight into the commensal bacteria that coexist in and on our bodies. The vaginal microbiome has been the most widely studied, though there have been recent efforts to explore the gut, cervical-vaginal, placental and oral microbiomes in the further search of etiologies of preterm birth. To date, a specific microbiome community or microorganism has yet to be reliably associated with preterm birth. This is partly due to the fact that the 'normal' constituents' microbiome can vary widely between healthy individuals. Before our knowledge of the microbiome can be utilized and applied in clinical practice, a greater understanding of the 'healthy' microbiome must be achieved. In particular, we must first appreciate how our microbes influence our biology to promote a healthy pregnancy or alternately render preterm birth.
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Affiliation(s)
- Derrick M Chu
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; Interdepartmental Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Maxim Seferovic
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Ryan M Pace
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Kjersti M Aagaard
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; Interdepartmental Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA; Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA.
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49
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An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes. J Evid Based Dent Pract 2017; 18:218-239. [PMID: 30077375 DOI: 10.1016/j.jebdp.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022]
Abstract
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.
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Deavenport-Saman A, Britt A, Smith K, Jacobs RA. Milestones and controversies in maternal and child health: examining a brief history of micronutrient fortification in the US. J Perinatol 2017; 37:1180-1184. [PMID: 28749486 DOI: 10.1038/jp.2017.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/26/2017] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
Abstract
Fortification of our food and drinking supply has decreased morbidity rates related to micronutrient deficiencies among mothers and their children, particularly during the perinatal and neonatal periods of development. The purpose of this historical review is to examine the impact of public policy changes related to micronutrient fortification. We provide a historical investigation of achievements and controversies related to iodine, vitamin D, fluoride and folic acid fortifications in our food and drinking supply. We also discuss the current status of fortification recommendations and their significance to maternal and child health.
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Affiliation(s)
- A Deavenport-Saman
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
| | - A Britt
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
| | - K Smith
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
| | - R A Jacobs
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
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