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Butera A, Maiorani C, Morandini A, Trombini J, Simonini M, Ogliari C, Scribante A. Periodontitis in Pregnant Women: A Possible Link to Adverse Pregnancy Outcomes. Healthcare (Basel) 2023; 11:healthcare11101372. [PMID: 37239657 DOI: 10.3390/healthcare11101372] [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: 01/30/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Periodontitis develops in 11% of pregnant women, and it is independently linked to severe complications during pregnancy such as preterm birth, low birth weight, and gestational diabetes. METHODS A literature search (Pubmed/MEDLINE, and Scopus) from 2003 to 2023 was conducted to analyze studies focused on periodontitis and adverse pregnancy outcomes. RESULTS 16 articles have been included. Most of the studies showed adverse outcomes, like preterm birth and the low weight of the unborn child, are among the most frequent consequences (respectively 62.5% and 68.7% of articles); pre-eclampsia is also linked to this condition (12.5% of articles); and perinatal mortality (12.5% of articles). CONCLUSIONS Periodontal disease appears to be associated with adverse events in pregnancy due to the transport of biofilm bacteria into the bloodstream and into placental tissue; what would cause adverse events is the body's immune response to infection.
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Affiliation(s)
- Andrea Butera
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Carolina Maiorani
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Julia Trombini
- Member Association: "Mamme & Igieniste", 24125 Bergamo, Italy
| | | | | | - Andrea Scribante
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Gazala MP, Gupta V, Mishra S, Vandana K, Ratre M. Serum Vitamin D level and its association with red blood cell indices in patients with periodontitis. J Indian Soc Periodontol 2022; 26:446-450. [PMID: 36339383 PMCID: PMC9626783 DOI: 10.4103/jisp.jisp_443_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Research of late has brought to light a connect between Vitamin D and anemia. The level of 25hydroxyvitamin D (25(OH) D) is decreased in periodontitis subjects as against subjects without periodontitis and this reduced level could be related to more risk for anemia in periodontitis patients. Objective: This study aimed to evaluate the serum 25(OH) D levels and red blood cell indices in patients affected by generalized Stage III Grade B periodontitis and healthy controls and to assess the association between level of Vitamin D and red cell indices in periodontitis patients. Materials and Methods: The subjects were categorized into (i) case and (ii) control group of 30 each. Clinical parameters including oral hygiene index simplified, mean ratio of sites that bled on probing, gingival index, probing pocket depth, and the clinical attachment loss were assessed in both the groups. Subjects' blood samples (venous) were taken for the biochemical analysis. Results: In contradiction to healthy subjects, periodontitis subjects had significantly diminished 25(OH) D levels, hemoglobin (Hb), hematocrit, and mean corpuscular hemoglobin concentration (MCHC). 25(OH) D was moderately correlated with MCHC (r = 0.53) and it was statistically significant (P = 0.002). Conclusion: Periodontitis impacts Vitamin D status which further causes anemia. It suggests that effective management of periodontitis can help maintain sufficient Vitamin D status and may be vital in preventing anemia.
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Periodontal Disease and Vitamin D Deficiency in Pregnant Women: Which Correlation with Preterm and Low-Weight Birth? J Clin Med 2021; 10:jcm10194578. [PMID: 34640596 PMCID: PMC8509337 DOI: 10.3390/jcm10194578] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023] Open
Abstract
Periodontal disease seems to be correlated with low vitamin D serum levels, preterm birth (PTB) and low birth weight (LBW), although the literature still lacks a consensus. This study aimed to investigate this correlation in a cohort of pregnant women over 20 weeks of gestation from the University Hospital “Maggiore della Carità”, Novara, Italy. We assessed serum levels of vitamin D and oral health status through the following indexes: Oral Hygiene Index (OHI), Plaque Control Record (PCR), Gingival Bleeding Index (GBI), and Community Periodontal Index of Treatment Needs (CPTIN). Moreover, we assessed the number of PTB and LBW among the newborns. Out of 121 pregnant women recruited, 72 (mean age 29.91 ± 3.64 years) were included. There was a statistically significant correlation between preterm and OHI > 3 (p = 0.033), and between LBW and OHI > 3 (p = 0.005) and CPITN = 3 (p = 0.027). Both pregnant women with vitamin D deficiency ((25-hydroxy-vitamin D) < 30 ng/mL) and PTB plus LBW newborns were significantly correlated (p < 0.05) with poor levels of all oral health status indexes during pregnancy. Furthermore, these conditions (women with hypovitaminosis D and combination of PTB and LBW) were shown to be significantly correlated (p < 0.001). Taken together, our findings reported a high prevalence of PTB and LBW with poor oral health and vitamin D deficiency in pregnant women.
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Kc S, Wang XZ, Gallagher JE. Diagnostic sensitivity and specificity of host-derived salivary biomarkers in periodontal disease amongst adults: Systematic review. J Clin Periodontol 2019; 47:289-308. [PMID: 31701554 DOI: 10.1111/jcpe.13218] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/03/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To systematically assess the diagnostic value of host-derived salivary biomarkers based on their reported sensitivity and specificity in relation to clinical parameters of periodontal disease diagnosis in adults. MATERIALS AND METHODS Comprehensive search of PubMed, Nature, Cochrane and OVID (Embase, MEDLINE [R] and PsycINFO) was conducted up to 1 August 2018, using key terms relevant to the research questions and Cochrane methodology, supplemented by a grey literature search. The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS- 2) tool was used to assess the methodological quality of all included studies. RESULTS Seven studies were included in the review. Macrophage inflammatory protein-1αlpha (MIP-1α), interleukin-1beta (IL-1β), interleukin-6 (IL-6) and matrix metalloproteinase-8 (MMP-8) were identified as diagnostically acceptable biomarkers for periodontal disease. Overall, the combination of IL-6 and MMP-8 showed best diagnostic performance. Also, a combination of the four key biomarkers (IL-1β, IL-6, MMP-8 and MIP-1α) showed promising results for distinction between gingivitis and periodontitis, as well as for periodontitis compared with gingival health. Results are interpreted with caution due to limitations in the number of studies included and their quality. CONCLUSION Certain salivary biomarkers can potentially be useful in combination and singularly for the diagnosis of periodontal disease. However, further methodically robust research is required to validate these biomarkers.
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Affiliation(s)
- Sukriti Kc
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Xiaozhe Z Wang
- Kings College London Dental Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London, UK
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Preterm birth and oral infections interplay. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.24.2.2019.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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6
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Preeclampsia and maternal periodontal disease. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.25.3.2019.2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Gerber FA, Sahrmann P, Schmidlin OA, Heumann C, Beer JH, Schmidlin PR. Influence of obesity on the outcome of non-surgical periodontal therapy - a systematic review. BMC Oral Health 2016; 16:90. [PMID: 27590050 PMCID: PMC5010690 DOI: 10.1186/s12903-016-0272-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/11/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obesity and periodontitis are important chronic health problems. Obesity is associated with an increased prevalence of periodontitis. Whether obesity also affects the outcome of non-surgical periodontal therapy is to date still unclear. METHODS A systematic review of studies referenced in SCOPUS, MEDLINE, PubMed, Cochrane, CINAHL, Biosis and Web of Science was performed. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. Probing pocket depth reduction was analyzed as primary surrogate parameter for therapeutic success after non-surgical periodontal therapy. RESULTS One-hundred-and-fifty-nine potentially qualifying studies were screened. Eight studies fulfilled the inclusion criteria and were analyzed. Three of eight studies failed to show an influence of obesity on pocket depth reduction after non-surgical therapy. The remaining five studies documented a clear negative effect on the outcome of non-surgical periodontal therapy. The finally included studies did not correspond to the highest level of quality (RCTs). Due to the heterogeneity of the data a meta-analysis was not possible. CONCLUSION The literature on the effect of obesity on the treatment outcome of non-surgical periodontal therapy remains controversial. The data, however, support that obesity is not only a factor associated with poorer periodontal health but might also result in inferior response to non-surgical treatment of periodontitis.
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Affiliation(s)
- Fabienne A. Gerber
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Oliver A. Schmidlin
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Christian Heumann
- Department of Statistics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jürg Hans Beer
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Patrick R. Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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Khan NS, Luke R, Soman RR, Krishna PM, Safar IP, Swaminathan SK. Qualitative assessment of red blood cell parameters for signs of anemia in patients with chronic periodontitis. J Int Soc Prev Community Dent 2015; 5:476-81. [PMID: 26759801 PMCID: PMC4697232 DOI: 10.4103/2231-0762.167726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM Anemia of chronic disease is defined as anemia occurring in chronic infections and inflammatory conditions that is not caused by marrow deficiencies or other diseases and in the presence of adequate iron stores and vitamins. The present case control study was aimed to assess the red blood cell parameters for signs of anemia in patients with mild, moderate, and severe chronic periodontitis. MATERIALS AND METHODS A simple random sampling method was used to select 80 healthy male patients, who were divided into four groups based on full mouth periodontal examination as follows: group I patients comprised the control group (n = 20), which included patients with a clinically healthy periodontium, group II patients (n = 20) were diagnosed with mild chronic periodontitis, group III (n = 20) included moderate chronic periodontitis patients, and patients with severe chronic periodontitis formed group IV (n = 20). Laboratory blood investigations included total number of erythrocytes, hemoglobin concentration, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. RESULTS Data analysis showed a statistically significant decrease in red blood cell parameters with increase in different grades of periodontitis. CONCLUSION Results of the present study show a substantial decrease in red blood cell parameters with increase in the severity of periodontal destruction.
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Affiliation(s)
- Nubesh S. Khan
- Department of Periodontics, Sri Sankara Dental College, Trivandrum, Kerala, India
| | - Roji Luke
- Department of Periodontics, Educare Institute of Dental Sciences, Malappuram, Kerala, India
| | - Rino Roopak Soman
- Department of Periodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Praveen M. Krishna
- Department of Periodontics, SRI Ramakrishna Dental College and Hospital, Coimbatore, India
| | - Iqbal P. Safar
- Department of Periodontics, Malabar Dental College, Edappal, Kerala, India
| | - Senthil Kumar Swaminathan
- Department of Periodontics, Rajah Muthiah Dental College and Hospital, Chidambaram, Tamil Nadu, India
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Jitprasertwong P, Charadram N, Kumphune S, Pongcharoen S, Sirisinha S. Female sex hormones modulate Porphyromonas gingivalis
lipopolysaccharide-induced Toll-like receptor signaling in primary human monocytes. J Periodontal Res 2015; 51:395-406. [DOI: 10.1111/jre.12320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 02/02/2023]
Affiliation(s)
- P. Jitprasertwong
- Department of Preventive Dentistry; Faculty of Dentistry; Naresuan University; Phitsanulok Thailand
| | - N. Charadram
- Department of Restorative Dentistry; Faculty of Dentistry; Naresuan University; Phitsanulok Thailand
| | - S. Kumphune
- Faculty of Allied Health Science; Biomedical Research Unit in Cardiovascular Sciences; Naresuan University; Phitsanulok Thailand
| | - S. Pongcharoen
- Department of Medicine; Faculty of Medicine; Naresuan University; Phitsanulok Thailand
- Centre of Excellence in Medical Biotechnology (CEMB); Faculty of Medical Science; Naresuan University; Phitsanulok Thailand
| | - S. Sirisinha
- Department of Microbiology; Faculty of Science; Mahidol University; Bangkok Thailand
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Mesa F, Pozo E, O'Valle F, Puertas A, Magan-Fernandez A, Rosel E, Bravo M. Relationship between periodontal parameters and plasma cytokine profiles in pregnant woman with preterm birth or low birth weight. Clin Oral Investig 2015; 20:669-74. [PMID: 26245274 DOI: 10.1007/s00784-015-1553-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 07/28/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim was to determine whether clinical periodontal parameters are associated with plasma anti- and/or pro-inflammatory cytokines in pregnant woman with preterm birth (PB) or low birth weight (LBW) neonates. MATERIALS AND METHODS An observational case-control study was performed in 131 puerperal women: mothers of PB/LBW neonates (cases, n = 67) and mothers of full-term normal-weight neonates (controls, n = 64). Sociodemographic and periodontal data was gathered from all participants, and interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17, IL-23, and tumor necrosis factor alpha (TNF-α) were determined in plasma. RESULTS In multiple linear regression models, clinical attachment loss was associated with TNF-α (0.28 ± 0.14; 95% confidence interval (CI) [0.006, 0.553]) and IL-1β (0.43 ± 0.21; 95%CI [0.018, 0.842]), independent of group membership. IL-1β (-1.67 ± 0.27, 95%CI [-2.199, -1.141]), IL-6 (-0.86 ± 0.27; 95%CI [-1.389, -0.331]), and IL-8 (-3.84 ± 0.50, 95%CI [-4.820, -2.860]) were lower, and IL-10 (0.86 ± 0.26; 95%CI [0.350, 1.370]) was higher in cases versus controls after adjusting for potential confounders. CONCLUSIONS Clinical attachment loss was associated with plasma TNF-α and IL-1β levels. No plasma cytokine profiles suggestive of systemic inflammatory response were observed in the pregnant women with PB/LBW neonates. CLINICAL RELEVANCE Clinical attachment loss, as the main periodontal measure, is associated with TNF-α and IL-1β plasma levels in pregnant women. No relationship was found between PB/LBW and the markers of systemic inflammatory response assessed in this study.
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Affiliation(s)
- Francisco Mesa
- Periodontology Department, School of Dentistry, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain.
| | - Elena Pozo
- Periodontology Department, School of Dentistry, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Francisco O'Valle
- Pathology Department, School of Medicine, University of Granada, Avda. De Madrid s/n, 18012, Granada, Spain
| | - Alberto Puertas
- Department of Obstetrics and Gynecology, Virgen de las Nieves University Hospital, Avda. Fuerzas Armadas 2, 18014, Granada, Spain
| | - Antonio Magan-Fernandez
- Periodontology Department, School of Dentistry, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Eva Rosel
- Department of Preventive Dentistry and Epidemiology, School of Dentistry, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Manuel Bravo
- Department of Preventive Dentistry and Epidemiology, School of Dentistry, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain
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Souza LM, Cruz SSD, Gomes-Filho IS, Barreto ML, Passos-Soares JS, Trindade SC, Figueiredo ACMG, Alves CMC, Coelho JMF, Vianna MIP. Effect of maternal periodontitis and low birth weight--a case control study. Acta Odontol Scand 2015; 74:73-80. [PMID: 26018844 DOI: 10.3109/00016357.2015.1049374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Since the 1990s, evidence has been raised that there is an association between maternal periodontal disease and undesirable gestational events, for example low birth weight; this issue is controversial. OBJECTIVE To evaluate whether there is an association between maternal periodontitis and low birth weight (LBW). METHODS A case-control study was carried out on 951 mothers that had been cared for by the Brazilian Unified Health System in Petrolina-PE and Juazeiro-BA, Brazil. The case group (n = 269) consisted of mothers of newborns with birth weight <2500 g and a control group (n = 682) of mothers of newborns with birth weight ≥2500 g. An interview was realized, using a questionnaire as well as a full mouth examination to diagnose the periodontal condition. Women who had at least four teeth with probing depth ≥4 mm and clinical attachment loss ≥3 mm, with bleeding on probing at the same site, were diagnosed with periodontitis. The birth weight was obtained through the hospital book record. The main association was evaluated using the multivariate regression model, considering confounders. RESULTS The frequency of periodontitis was 16.4% (case group) and 17.4% (control group). Periodontitis did not show an association with LBW (ORcrude = 0.92; 95% CI = 0.63-1.35), even after adjustment for the following confounders: maternal age, pre-gestational body mass index, number of pre-natal consultations, number of pregnancies, maternal schooling level, smoking habit during pregnancy and hypertension (ORadjusted = 1.00; 95% CI = 0.61-1.68). CONCLUSION The findings of this study showed no association between maternal periodontal disease and low birth weight, even after appropriate adjustments for confounding factors.
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Affiliation(s)
- Luise Maria Souza
- a 1 Department of Periodontics, Feira de Santana State University , Bahia, Brazil
| | - Simone Seixas da Cruz
- b 2 Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus , Bahia, Brazil
| | | | - Mauricio Lima Barreto
- c 3 Collective Health Institute, Federal University of Bahia , Salvador, Bahia, Brazil
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Heilbrunn-Lang AY, de Silva AM, Lang G, George A, Ridge A, Johnson M, Bhole S, Gilmour C. Midwives' perspectives of their ability to promote the oral health of pregnant women in Victoria, Australia. BMC Pregnancy Childbirth 2015; 15:110. [PMID: 25943399 PMCID: PMC4490712 DOI: 10.1186/s12884-015-0536-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/17/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Midwives have a potential role in promoting the oral health of pregnant women although they have little formal training in this area. The aim of this study was to explore the perspectives of midwives in Victoria towards incorporating oral health promotion into their antenatal practice after undergoing training through the Midwifery Initiated Oral Health (MIOH) online education program. METHODS A purposive sample of thirty-nine midwives from maternity services across Victoria, Australia were invited to participate in an online MIOH education program in October 2012. The program included three self-paced modules covering oral health screening, referral processes, and theoretical and practical skill assessments. A mixed methods design was used to capture midwives perspectives. Evaluation questionnaires, completed pre- and post-training, captured knowledge and confidence (confidence likert scale), and also included five opened-ended questions post-training. Open-ended questions, feedback forms and unsolicited emails formed the data for qualitative analysis. Data were analysed using content and thematic analysis and descriptive statistics. RESULTS Thirty-three midwives completed the MIOH education program and demonstrated a significant increase (51.5%) in their confidence to promote oral health. All participants viewed the program as suitable, acceptable and useful for their practice and were happy to recommend the course to other Victorian midwives. Participants indicated that it would be feasible to incorporate oral health into the first antenatal booking visit and recognised that oral health promotion was within their scope of practice. CONCLUSIONS This study has shown that the MIOH education program is a valued resource that can assist midwives to increase their confidence and skills to incorporate oral health promotion into their practice. A key barrier identified was time constraints during antenatal care booking visits. However, it is evident that with relevant training it would be feasible and acceptable for Victorian midwives to incorporate oral health promotion within their practice. The current engagement with midwives in Victoria and other parts of Australia provides an opportunity to continue to explore and define the role of antenatal health care professionals in oral health promotion at a state and national level.
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Affiliation(s)
- Adina Y Heilbrunn-Lang
- Centre for Applied Oral Health Research, Dental Health Services Victoria, Melbourne, Australia.
| | - Andrea M de Silva
- Centre for Applied Oral Health Research, Dental Health Services Victoria, Melbourne, Australia.
| | - Gillian Lang
- Health Promotion, Dental Health Services Victoria, Melbourne, Australia.
| | - Ajesh George
- Centre for Applied Nursing Research, University of Western Sydney/ South Western Sydney Local Health District, Sydney, Australia. .,Ingham Institute Applied Medical Research, Sydney, Australia. .,Faculty of Dentistry, University of Sydney, Sydney, Australia.
| | - Allison Ridge
- Health Promotion, Dental Health Services Victoria, Melbourne, Australia.
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.
| | - Sameer Bhole
- Faculty of Dentistry, University of Sydney, Sydney, Australia. .,Sydney Local Health District Oral Health Services and Sydney Dental Hospital, Sydney, Australia.
| | - Carole Gilmour
- Australian College of Midwifery Victorian Branch, Melbourne, Australia. .,Monash University, Melbourne, Australia.
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López NJ, Uribe S, Martinez B. Effect of periodontal treatment on preterm birth rate: a systematic review of meta-analyses. Periodontol 2000 2014; 67:87-130. [DOI: 10.1111/prd.12073] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 01/08/2023]
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Abstract
Introduction Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from sexually transmitted infections (STIs) to TORCHS infections to periodontal disease to systemic infections and may be transmitted to the fetus during pregnancy, labor, delivery or breastfeeding. Methods A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. Results Preconception behavioral interventions significantly declines re-infection or new STI rates by 35% (95% CI: 20-47%). Further, condom use has been shown to be the most effective way to prevent HIV infection (85% protection in prospective studies) through sexual intercourse. Intervention trials showed that preconception vaccination against tetanus averted a significant number of neonatal deaths (including those specifically due to tetanus) when compared to placebo in women receiving more than 1 dose of the vaccine (OR 0.28; 95% CI: 0.15-0.52); (OR 0.02; 95% CI: 0.00-0.28) respectively. Conclusion Preconception counseling should be offered to women of reproductive age as soon as they test HIV-positive, and conversely women of reproductive age should be screened with their partners before pregnancy. Risk assessment, screening, and treatment for specific infections should be a component of preconception care because there is convincing evidence that treatment of these infections before pregnancy prevents neonatal infections.
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15
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Dawson DR, Branch-Mays G, Gonzalez OA, Ebersole JL. Dietary modulation of the inflammatory cascade. Periodontol 2000 2013; 64:161-97. [DOI: 10.1111/j.1600-0757.2012.00458.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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16
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Geisinger ML, Geurs NC, Bain JL, Kaur M, Vassilopoulos PJ, Cliver SP, Hauth JC, Reddy MS. Oral health education and therapy reduces gingivitis during pregnancy. J Clin Periodontol 2013; 41:141-8. [PMID: 24164645 DOI: 10.1111/jcpe.12188] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pregnant women demonstrate increases in gingivitis despite similar plaque levels to non-pregnant counterparts. AIM To evaluate an intensive protocol aimed at reducing gingivitis in pregnant women and provide pilot data for large-scale randomized controlled trials investigating oral hygiene measures to reduce pregnancy gingivitis and alter maternity outcomes. MATERIALS AND METHODS One hundred and twenty participants between 16 and 24 weeks gestation with Gingival Index (GI) scores ≥2 at ≥50% of tooth sites were enrolled. Plaque index (PI), gingival inflammation (GI), probing depth (PD), and clinical attachment levels (CAL) were recorded at baseline and 8 weeks. Dental prophylaxis was performed at baseline and oral hygiene instructions at baseline, 4 and 8 weeks. Pregnancy outcomes were recorded at parturition. Mixed-model analysis of variance was used to compare clinical measurements at baseline and 8 weeks. RESULTS Statistically significant reductions in PI, GI, PD, and CAL occurred over the study period. Mean whole mouth PI and GI scores decreased approximately 50% and the percentage of sites with PI and GI ≥2 decreased from 40% to 17% and 53% to 21.8%, respectively. Mean decreases in whole mouth PD and CAL of 0.45 and 0.24 mm, respectively, were seen. CONCLUSIONS Intensive oral hygiene regimen decreased gingivitis in pregnant patients.
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Affiliation(s)
- Maria L Geisinger
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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DeBate R, Daley EM, Vamos CA, Kline N, Marsh L, Smith S. Transdisciplinary Women's Health: A Call to Action. Health Care Women Int 2013; 35:1113-32. [DOI: 10.1080/07399332.2013.840636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Wu YM, Liu J, Sun WL, Chen LL, Chai LG, Xiao X, Cao Z. Periodontal status and associated risk factors among childbearing age women in Cixi City of China. J Zhejiang Univ Sci B 2013; 14:231-9. [PMID: 23463766 DOI: 10.1631/jzus.b1200034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the periodontal status and associated risk factors among women of childbearing age to increase the awareness of oral health. METHODS The study was conducted on childbearing age women in Cixi, a city in Zhejiang Province in the southeast of China. A total of 754 women participated in periodontal examination while receiving prenatal care. Data of the women were collected from the Cixi Family Planning Commission and during an interview. Clinical periodontal indices, such as bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured during the examination. Statistical analysis on subject-based data was performed. RESULTS The prevalence of periodontal disease among childbearing age women in Cixi was high (84.7%). A significant association was found between the disease and educational level, pregnancy, taking oral contraceptives, stress, alcohol consumption, overweight, dental visit, and teeth brushing (P<0.05). Women who suffered periodontal disease showed deep PD, obvious BOP, and clinical attachment loss. Among this population, pregnancy was closely associated with higher BOP percentage; teeth brushing no more than once per day or brushing for less than 1 min (P<0.001) after adjusting for age and stress. CONCLUSIONS The periodontal status of childbearing age women in Cixi needs to be improved urgently. Attention towards the periodontal health should be warranted, especially for those in special statuses and with poor awareness.
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Affiliation(s)
- Yan-min Wu
- Department of Oral Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.
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Affiliation(s)
- Juhee Kim
- Department of Public Health, Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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20
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Cullinan MP, Seymour GJ. Periodontal disease and systemic illness: will the evidence ever be enough? Periodontol 2000 2013; 62:271-86. [DOI: 10.1111/prd.12007] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Boland MR, Hripcsak G, Albers DJ, Wei Y, Wilcox AB, Wei J, Li J, Lin S, Breene M, Myers R, Zimmerman J, Papapanou PN, Weng C. Discovering medical conditions associated with periodontitis using linked electronic health records. J Clin Periodontol 2013; 40:474-82. [PMID: 23495669 DOI: 10.1111/jcpe.12086] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 12/12/2022]
Abstract
AIM To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses. MATERIALS AND METHODS This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders. RESULTS Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I (OR = 1.6, 95% CI 1.30-1.99, p < 0.001) and type II (OR = 1.4, 95% CI 1.22-1.67, p < 0.001), hypertension (OR = 1.2, 95% CI 1.10-1.37, p < 0.001), hypercholesterolaemia (OR = 1.2, 95% CI 1.07-1.38, p = 0.004), hyperlipidaemia (OR = 1.2, 95% CI 1.06-1.43, p = 0.008) and conditions pertaining to pregnancy and childbirth (OR = 2.9, 95% CI: 1.32-7.21, p = 0.014). We also found a previously unreported association with benign prostatic hyperplasia (OR = 1.5, 95% CI 1.05-2.10, p = 0.026) after adjusting for age, gender, ethnicity, hypertension, diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse. CONCLUSIONS This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records.
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Affiliation(s)
- Mary Regina Boland
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA.
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Stadelmann P, Alessandri R, Eick S, Salvi GE, Surbek D, Sculean A. The potential association between gingival crevicular fluid inflammatory mediators and adverse pregnancy outcomes: a systematic review. Clin Oral Investig 2013; 17:1453-63. [PMID: 23468255 DOI: 10.1007/s00784-013-0952-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 02/13/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The association between periodontal disease and adverse pregnancy outcomes (APO), primarily preterm birth (PTB), is still controversially discussed in the literature. Therefore, the aim of the present systematic review was to analyze the existing literature on the potential association between inflammatory mediators detected in gingival crevicular fluid (GCF) and APO. MATERIALS AND METHODS MEDLINE (PubMed) and EMBASE databases were searched for entries up to April 2012 and studies were selected by two independent reviewers. RESULTS The majority of the eight studies included confirmed a positive association between GCF mediators, such as interleukin-1β, prostaglandin E2, and tumor necrosis factor-alpha, and APO. Due to the heterogeneity and variability of the available studies, no meta-analysis could be performed. CONCLUSIONS A positive association between GCF inflammatory mediator levels and APO/PTB might be present but the results need to be considered with great caution because of the heterogeneity and variability among the studies. Further studies with an adequate number of patients allowing for an appropriate analysis are warranted to definitely confirm this association. CLINICAL RELEVANCE The present findings suggest that an association between GCF inflammatory mediator levels and APO might exist.
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Affiliation(s)
- Pascale Stadelmann
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Pirie M, Linden G, Irwin C. Intrapregnancy non-surgical periodontal treatment and pregnancy outcome: a randomized controlled trial. J Periodontol 2012; 84:1391-400. [PMID: 23237583 DOI: 10.1902/jop.2012.120572] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of the present study is to investigate the potential link between maternal periodontitis and pregnancy outcomes, including preterm birth (<37 weeks) and low birth weight (<2,500 g). METHODS Ninety nine pregnant females with mild/moderate periodontitis were randomly allocated to a control (n = 50) or test (n = 49) group. Test group participants received intrapregnancy non-surgical periodontal treatment, whereas this was deferred until after delivery for controls. Demographic and baseline clinical data were obtained for all participants at initial assessment pretreatment. Clinical data were rerecorded for test participants at review 8 weeks after treatment. Birth outcomes were completed at delivery by midwives who also collected cord blood samples when possible; the latter were analyzed to determine the presence/levels of cytokines interleukin (IL)-1β, IL-6, and IL-8. All data were analyzed on an intention-to-treat basis using appropriate statistical tests. RESULTS Random allocation of participants resulted in well-balanced control and test groups. All test group participants and all but one control participant gave birth to a live infant. No significant differences were detected between control and test groups with regard to birth outcome measures of birth weight and gestational age or in relation to cytokine prevalence/levels. CONCLUSION Intrapregnancy non-surgical periodontal treatment, completed at 20 to 24 weeks, did not reduce the risk of preterm, low-birth-weight delivery in this population.
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Affiliation(s)
- Martina Pirie
- Centre for Dental Education, School of Medicine, Dentistry, and Biomedical Sciences, Queens University, Belfast, Northern Ireland
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24
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Relationship between periodontal inflammation and fetal growth in pregnant women: a cross-sectional study. Arch Gynecol Obstet 2012; 287:951-7. [DOI: 10.1007/s00404-012-2660-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
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25
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Skaleric E, Petelin M, Gaspirc B, Skaleric U. Periodontal inflammatory burden correlates with C-reactive protein serum level. Acta Odontol Scand 2012; 70:520-8. [PMID: 22329625 DOI: 10.3109/00016357.2011.640284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of study was to present a new method for evaluation of the periodontal inflammatory burden, to apply the method to the adult population and to correlate it with serum levels of C-reactive protein (CRP). MATERIALS AND METHODS On 515 extracted teeth was measured the neck circumferences (NC). The average values of the NC were obtained for 16 male and 16 female individual tooth types. In the clinical part of this study 238 dentate subjects were included. The subgingival area, inflamed area and periodontal wound size were calculated from NC, probing depth and BOP. The sum of the inflamed and ulcerated subgingival areas of all teeth represented the total periodontal inflammatory burden of an individual. Serum levels of CRP were measured by immunochemical method. RESULTS The average subgingival area in 238 subjects was calculated to be 13.11 ± 6.35 cm(2) and inflammatory burden area 9.25 ± 5.57 cm(2). The periodontal bleeding wound (p < 0.05) was significantly larger in men. The increased serum levels of CRP correlated with periodontal inflammatory burden (p < 0.05). CONCLUSIONS This new method quantifies the inflammatory burden caused by periodontal disease. The size of the inflammatory burden is correlated with increased serum levels of CRP.
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Affiliation(s)
- Eva Skaleric
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Slovenia.
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26
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Kim AJ, Lo AJ, Pullin DA, Thornton-Johnson DS, Karimbux NY. Scaling and Root Planing Treatment for Periodontitis to Reduce Preterm Birth and Low Birth Weight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Periodontol 2012; 83:1508-19. [DOI: 10.1902/jop.2012.110636] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Santa Cruz I, Herrera D, Martin C, Herrero A, Sanz M. Association between periodontal status and pre-term and/or low-birth weight in Spain: clinical and microbiological parameters. J Periodontal Res 2012; 48:443-51. [DOI: 10.1111/jre.12024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2012] [Indexed: 11/28/2022]
Affiliation(s)
- I. Santa Cruz
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - D. Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - C. Martin
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - A. Herrero
- Section of Periodontology; School of Dentistry; University Complutense; Madrid Spain
| | - M. Sanz
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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Guimarães AN, Silva-Mato A, Siqueira FM, Cyrino RM, Cota LOM, Costa FO. Very low and low birth weight associated with maternal periodontitis. J Clin Periodontol 2012; 39:1024-31. [PMID: 22994882 DOI: 10.1111/jcpe.12000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the association of very low and low birth weight (VLBW and LBW) with maternal periodontitis. MATERIAL AND METHODS Overall, 1206 women were examined at post-partum and two alternative criteria for periodontitis definition were used: (1) four or more teeth with at least one site with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 3 mm; and (2) at least one site with PD and CAL ≥ 4 mm. For each definition, two multivariate analyses were performed: (1) linear regression for birth weight; (2) ordinal logistic regression for birth weight, categorized as adequate (n = 1046), LBW (n = 145) and VLBW (n = 15). RESULTS Linear regression showed that maternal periodontitis was associated with a decrease in mean birth weight (periodontitis definition 1: p = 0.027; periodontitis definition 2: p = 0.003). Ordinal logistic regression showed that maternal periodontitis was associated with LBW and VLBW [odds ratio (OR) = 2.0; 95% confidence interval (CI) 1.39-2.90, when considering periodontitis definition 2]; and with LBW (OR = 1.65; 95% CI 1.15-2.36, when considering periodontitis definition 1). CONCLUSION Maternal periodontitis was associated with a decrease in mean birth weight, as well as with LBW and VLBW.
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Affiliation(s)
- Alessandra N Guimarães
- Department of Health and Socio-Medical Sciences, Biostatistics Unit, Faculty of Medicine, Alcalá University, Madrid, Spain
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Corbella S, Del Fabbro M, Taschieri S, Francetti L. Periodontal disease and adverse pregnancy outcomes: a systematic review. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.ios.2011.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Schillinger C, Petrich A, Lux R, Riep B, Kikhney J, Friedmann A, Wolinsky LE, Göbel UB, Daims H, Moter A. Co-localized or randomly distributed? Pair cross correlation of in vivo grown subgingival biofilm bacteria quantified by digital image analysis. PLoS One 2012; 7:e37583. [PMID: 22655057 PMCID: PMC3360060 DOI: 10.1371/journal.pone.0037583] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 04/22/2012] [Indexed: 11/18/2022] Open
Abstract
The polymicrobial nature of periodontal diseases is reflected by the diversity of phylotypes detected in subgingival plaque and the finding that consortia of suspected pathogens rather than single species are associated with disease development. A number of these microorganisms have been demonstrated in vitro to interact and enhance biofilm integration, survival or even pathogenic features. To examine the in vivo relevance of these proposed interactions, we extended the spatial arrangement analysis tool of the software daime (digital image analysis in microbial ecology). This modification enabled the quantitative analysis of microbial co-localization in images of subgingival biofilm species, where the biomass was confined to fractions of the whole-image area, a situation common for medical samples. Selected representatives of the disease-associated red and orange complexes that were previously suggested to interact with each other in vitro (Tannerella forsythia with Fusobacterium nucleatum and Porphyromonas gingivalis with Prevotella intermedia) were chosen for analysis and labeled with specific fluorescent probes via fluorescence in situ hybridization. Pair cross-correlation analysis of in vivo grown biofilms revealed tight clustering of F. nucleatum/periodonticum and T. forsythia at short distances (up to 6 µm) with a pronounced peak at 1.5 µm. While these results confirmed previous in vitro observations for F. nucleatum and T. forsythia, random spatial distribution was detected between P. gingivalis and P. intermedia in the in vivo samples. In conclusion, we successfully employed spatial arrangement analysis on the single cell level in clinically relevant medical samples and demonstrated the utility of this approach for the in vivo validation of in vitro observations by analyzing statistically relevant numbers of different patients. More importantly, the culture-independent nature of this approach enables similar quantitative analyses for “as-yet-uncultured” phylotypes which cannot be characterized in vitro.
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Affiliation(s)
- Claudia Schillinger
- Institut für Mikrobiologie und Hygiene, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Annett Petrich
- Institut für Mikrobiologie und Hygiene, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Renate Lux
- UCLA School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Birgit Riep
- Abteilung für Parodontologie und Synoptische Zahnmedizin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Kikhney
- Institut für Mikrobiologie und Hygiene, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anton Friedmann
- School of Dentistry, Faculty of Health, University of Witten, Witten, Germany
| | - Lawrence E. Wolinsky
- Texas A&M Health Science Center, Baylor College of Dentistry, Dallas, Texas, United States of America
| | - Ulf B. Göbel
- Institut für Mikrobiologie und Hygiene, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Holger Daims
- Department of Microbial Ecology, Ecology Center, University of Vienna, Vienna, Austria
- * E-mail: (AM); (HD)
| | - Annette Moter
- Institut für Mikrobiologie und Hygiene, Charité – Universitätsmedizin Berlin, Berlin, Germany
- * E-mail: (AM); (HD)
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Prediction of Preterm and Low Birth Weight Delivery by Maternal Periodontal Parameters: Receiver Operating Characteristic (ROC) Curve Analysis. Matern Child Health J 2012; 17:299-306. [DOI: 10.1007/s10995-012-0974-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kaneto C, Toyokawa S, Inoue K, Inoue M, Senba T, Suyama Y, Miyoshi Y, Kobayashi Y. Association between periodontal disease and peptic ulcers among Japanese workers: MY health up study. Glob J Health Sci 2012; 4:42-9. [PMID: 22980150 PMCID: PMC4777052 DOI: 10.5539/gjhs.v4n2p42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/28/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the association between periodontal disease and peptic ulcers in a working population. METHODS Self-administered questionnaires were distributed to all employees of a large insurance company in Japan. The questionnaire asked about their health status and lifestyle habits. Peptic ulcer was defined as either stomach ulcer, duodenal ulcer, or both. For the evaluation of periodontal disease, three indices were used: (a) loss of five or more teeth, (b) having been told of having periodontitis, and (c) periodontal risk score. RESULTS Of the eligible 28 765 subjects analyzed, peptic ulcer was present in 397 (1.4%). The results of bivariate analyses showed that a significantly higher proportion of subjects with peptic ulcer reported that they lost five or more teeth (35.3 vs. 17.4%, p<0.001) or that they were told they had periodontitis (33.5 vs. 20.7%, p<0.001). Moreover, the periodontal risk score was higher for those with peptic ulcer than those without (mean 0.83 vs. 0.59, p<0.001). In multivariate logistic regression analyses, statistical associations were found between the presence of peptic ulcer and loss of five or more teeth (odds ratio (OR): 1.41, 95% confidence interval (CI): 1.13-1.76, p<0.01), having been told of having periodontitis (OR: 1.28, 95% CI: 1.03-1.59, p<0.05), and a 1-point increase in the periodontal risk score (OR: 1.17, 95% CI: 1.04-1.30, p<0.01), respectively. CONCLUSION Modest but statistically significant associations were found between the self-reported measures of periodontal disease and peptic ulcers.
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Affiliation(s)
- Chie Kaneto
- Department of Public Health, Graduate School of Medicine, University of Tokyo, Bunkyoku, Japan.
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Tateishi F, Hasegawa-Nakamura K, Nakamura T, Oogai Y, Komatsuzawa H, Kawamata K, Douchi T, Hatae M, Noguchi K. Detection of Fusobacterium nucleatum in chorionic tissues of high-risk pregnant women. J Clin Periodontol 2012; 39:417-24. [PMID: 22304677 DOI: 10.1111/j.1600-051x.2012.01855.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2011] [Indexed: 10/14/2022]
Abstract
AIM This study was undertaken to investigate the existence of a periodontopathic bacterium, Fusobacterium nucleatum, in chorionic tissues of pregnant women, and the effects of F. nucleatum on human chorion-derived cells. MATERIALS AND METHODS Oral and chorionic tissue samples were collected from 24 high-risk pregnant women and 15 normal pregnant women. The presence of F. nucleatum in the samples was detected using polymerase chain reaction. Chorion-derived cells and Toll-like receptor (TLR)-2 or TLR-4 gene-silenced chorion-derived cells were stimulated with F. nucleatum lipopolysaccharide (LPS). Interleukin (IL)-6 and corticotrophin-releasing hormone (CRH) levels in the culture supernatants were measured using ELISA. RESULTS F. nucleatum was detected in all oral samples and seven chorionic tissues from the high-risk pregnant women, but was not detected in chorionic tissues from the normal pregnant women. F. nucleatum LPS significantly increased IL-6 and CRH secretion by chorion-derived cells. The F. nucleatum LPS-induced IL-6 and CRH levels were significantly reduced in TLR-2 or TLR-4 gene-silenced chorion-derived cells. CONCLUSIONS We suggest that F. nucleatum is detected in chorionic tissues of high-risk pregnant women, but not in chorionic tissues of normal pregnant women, and that F. nucleatum induces IL-6 and CRH production via both TLR-2 and TLR-4 in chorion-derived cells.
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Affiliation(s)
- Fumi Tateishi
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Hirano E, Sugita N, Kikuchi A, Shimada Y, Sasahara J, Iwanaga R, Tanaka K, Yoshie H. The association of Aggregatibacter actinomycetemcomitans with preeclampsia in a subset of Japanese pregnant women. J Clin Periodontol 2012; 39:229-38. [DOI: 10.1111/j.1600-051x.2011.01845.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emi Hirano
- Division of Periodontology; Department of Oral Biological Science; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Noriko Sugita
- Division of Periodontology; Department of Oral Biological Science; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Akira Kikuchi
- Department of Obstetrics and Gynecology; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Yasuko Shimada
- Division of Periodontology; Department of Oral Biological Science; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Jun Sasahara
- Department of Obstetrics and Gynecology; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Ruriko Iwanaga
- Division of Periodontology; Department of Oral Biological Science; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Kenichi Tanaka
- Department of Obstetrics and Gynecology; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Hiromasa Yoshie
- Division of Periodontology; Department of Oral Biological Science; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
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Relationship between periodontal diseases and preterm birth: recent epidemiological and biological data. J Pregnancy 2011; 2011:164654. [PMID: 22132334 PMCID: PMC3205685 DOI: 10.1155/2011/164654] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 10/03/2011] [Indexed: 01/02/2023] Open
Abstract
For ten years, the incidence of preterm birth does not decrease in developed countries despite the promotion of public health programs. Many risk factors have been identified including ethnicity, age, tobacco, and infection. However, almost 50% of preterm birth causes remain unknown. The periodontal diseases are highly prevalent inflammatory and infectious diseases of tooth supporting tissues leading to an oral disability. They influence negatively general health worsening cardiovascular diseases and diabetes. Periodontal diseases have been also suspected to increase the rate of preterm birth, but data remain contradictory. The objective of this review is to present the principal results of epidemiological, biological, and interventional studies on the link between periodontal diseases and preterm birth. The conclusions of this work underline the importance for the physician/obstetrician to identify women at risk for preterm birth and to address these patients to dentist for periodontal examination and treatment in order to limit adverse pregnancy outcomes.
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Schenkein HA, Koertge TE, Sabatini R, Brooks CN, Gunsolley JC. Birth weight of infants of mothers with aggressive periodontitis. J Periodontol 2011; 83:279-86. [PMID: 21819247 DOI: 10.1902/jop.2011.110192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It was hypothesized that if periodontal infections predispose low birth weights and premature birth, then such outcomes should be apparent when the mother has aggressive periodontitis (AgP). METHODS Birth weight data were collected by questionnaire from females with AgP, their periodontally healthy siblings, and unrelated periodontally healthy women. Both prospective and retrospective birth outcome data were used. Because many of the periodontal evaluations were performed after the births, there were incomplete data regarding most of the risk factors for low birth weight. We determined associations between mothers' periodontal diagnoses and clinical variables and the reported birth weights. RESULTS There were no significant differences in mean birth weights of babies born to control subjects or AgP patients. This was true whether all the births were considered or only those reported <1 or 2 years before periodontal examination. For periodontally healthy controls, 13.2% of babies born to siblings of AgP patients and 12.8% of babies born to unrelated mothers weighed <2,500 g, whereas 9.9% of those born to mothers with generalized AgP and 10.3% of those born to mothers with localized AgP weighed <2,500 g. CONCLUSIONS Because of the relative rarity of AgP in the population, and attendant difficulties in performing a prospective study of its association with pregnancy outcomes, we used a compromised approach using prospective data as well as weaker retrospective data assuming that disease onset was likely before the births. Our results, within the limitations of this approach, indicate no evidence that AgP in the mother predisposes low birth weights. AgP has many unique biologic characteristics that differentiate it from chronic forms of periodontal disease, and the possible lack of its association with birth weight may be another such characteristic.
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Affiliation(s)
- Harvey A Schenkein
- Department of Periodontics, Virginia Commonwealth University, School of Dentistry, Richmond, VA 23298-0566, USA.
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Boillot A, El Halabi B, Batty GD, Rangé H, Czernichow S, Bouchard P. Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies. PLoS One 2011; 6:e21508. [PMID: 21814546 PMCID: PMC3140980 DOI: 10.1371/journal.pone.0021508] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 06/02/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population. METHODS The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest. RESULTS Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66-2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30-1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35). CONCLUSIONS In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.
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Affiliation(s)
- Adrien Boillot
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
| | - Bechara El Halabi
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
| | - George David Batty
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Hélène Rangé
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
| | - Sébastien Czernichow
- Department of Nutrition, Ambroise Paré Hospital, University Versailles St-Quentin, Boulogne-Billancourt, France
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
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Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case–control studies. Odontology 2011; 100:232-40. [DOI: 10.1007/s10266-011-0036-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 06/09/2011] [Indexed: 11/26/2022]
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Hasegawa-Nakamura K, Tateishi F, Nakamura T, Nakajima Y, Kawamata K, Douchi T, Hatae M, Noguchi K. The possible mechanism of preterm birth associated with periodontopathic Porphyromonas gingivalis. J Periodontal Res 2011; 46:497-504. [DOI: 10.1111/j.1600-0765.2011.01366.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shearer DM, Thomson WM, Caspi A, Moffitt TE, Broadbent JM, Poulton R. Inter-generational continuity in periodontal health: findings from the Dunedin family history study. J Clin Periodontol 2011; 38:301-9. [PMID: 21281332 PMCID: PMC3071145 DOI: 10.1111/j.1600-051x.2011.01704.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether parental periodontal disease history is a risk factor for periodontal disease in adult offspring. METHODS Proband periodontal examination [combined attachment loss (CAL) at age 32, and incidence of CAL from ages 26 to 32] and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected. The sample was divided into two familial-risk groups for periodontal disease (high- and low-risk) based on parents' self-reported periodontal disease. RESULTS Periodontal risk analysis involved 625 proband-parent(s) groups. After controlling for confounding factors, the high-familial-risk periodontal group was more likely to have 1+ sites with 4+mm CAL [relative risk (RR) 1.45; 95% confidence interval (CI) 1.11-1.88], 2+ sites with 4+mm CAL (RR 1.45; 95% CI 1.03-2.05), 1+ sites with 5+mm CAL (RR 1.60; 95% CI 1.02-2.50), and 1+ sites with 3+mm incident CAL (RR 1.64; 95% CI 1.01-2.66) than the low-familial-risk group. Predictive validity was enhanced when information was available from both parents. CONCLUSIONS Parents with poor periodontal health tend to have offspring with poor periodontal health. Family/parental history of oral health is a valid representation of the shared genetic and environmental factors that contribute to an individual's periodontal status, and may help to predict patient prognosis and preventive treatment need.
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Affiliation(s)
- Dara M Shearer
- Department of Oral Sciences, School of Dentistry, Dunedin, New Zealand Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, England.
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Beikler T, Flemmig TF. Oral biofilm-associated diseases: trends and implications for quality of life, systemic health and expenditures. Periodontol 2000 2011; 55:87-103. [PMID: 21134230 DOI: 10.1111/j.1600-0757.2010.00360.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Avula H, Avula J. Periodontal Infections and Adverse Pregnancy Outcomes: The Oral Health—Fetal Connection. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2009.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haritha Avula
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Andhra Pradesh, India
| | - Jayakumar Avula
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Andhra Pradesh, India
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Wisanskoonwong P, Fahy K, Hastie C. The effectiveness of medical interventions aimed at preventing preterm birth: a literature review. Women Birth 2011; 24:141-7. [PMID: 21277271 DOI: 10.1016/j.wombi.2010.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth? METHODS A systematic search was carried out in CINAHL, Cochrane, Medline and Embase in relation to following medical treatments aimed at preventing preterm births: anti-infective medications, tocolytics, progesterone and cervical cerclage. The research underpinning each type of intervention is critically analysed in order to establish the validity of knowledge claims that are made for each type of intervention. FINDINGS In relation to reducing the rates of preterm births, anti-infectives are only effective in the presence of known infection. Screening for infections during pregnancy is ineffective. Tocolytic agents are not effective in decreasing the preterm birth rates. Progesterone seems to be effective in a select group of pregnant women at higher risk of preterm birth. Cervical cerclage plays a small and an occasional role in preventing some preterm births. CONCLUSIONS This literature review demonstrates that medical interventions aimed at preventing, not just delaying, preterm birth, are not effective at a population level. Providing holistic, antenatal midwifery care for women living in socio-economic disadvantage and/or with an increased risk of preterm birth seems to be a promising strategy to address the negative effects of the social determinants of disease and thus to reduce the rate of preterm births at an individual and a population level.
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Affiliation(s)
- Peeranan Wisanskoonwong
- School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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Ramchandani M, Siddiqui M, Kanwar R, Lakha M, Phi L, Giacomelli L, Chiappelli F. Proteomic signature of periodontal disease in pregnancy: Predictive validity for adverse outcomes. Bioinformation 2011; 5:300-3. [PMID: 21364839 PMCID: PMC3043352 DOI: 10.6026/97320630005300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/17/2010] [Indexed: 11/23/2022] Open
Abstract
The rate of preterm birth is a public health concern worldwide because it is increasing and efforts to prevent it have failed. We report a Clinically Relevant Complex Systematic Review (CSCSR) designed to identify and evaluate the best available evidence in support of the association between periodontal status in women and pregnancy outcome of preterm low birth weight. We hypothesize that the traditional limits of research synthesis must be expanded to incorporate a translational component. As a proof-of-concept model, we propose that this CSCSR can yield greater validity of efficacy and effectiveness through supplementing its recommendations with data of the proteomic signature of periodontal disease in pregnancy, which can contribute to addressing specifically the predictive validity for adverse outcomes. For this CRCSR, systematic reviews were identified through The National Library of MedicinePubmed, The Cochrane library, CINAHL, Google Scholar, Web of Science, and the American Dental Association web library. Independent reviewers quantified the relevance and quality of this literature with R-AMSTAR. Homogeneity and inter-rater reliability testing were supplemented with acceptable sampling analysis. Research synthesis outcomes were analyzed qualitatively toward a Bayesian inference, and converge to demonstrate a definite association between maternal periodontal disease and pregnancy outcome. This CRCSR limits heterogeneity in terms of periodontal disease, outcome measure, selection bias, uncontrolled confounders and effect modifiers. Taken together, the translational CRCSR model we propose suggests that further research is advocated to explore the fundamental mechanisms underlying this association, from a molecular and proteomic perspective.
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Affiliation(s)
- Manisha Ramchandani
- Division of Oral Biology & Medicine, UCLA School of Dentistry, CHS 63-090, Los Angeles, CA 90095-1668
| | - Muniza Siddiqui
- Division of Oral Biology & Medicine, UCLA School of Dentistry, CHS 63-090, Los Angeles, CA 90095-1668
| | - Raveena Kanwar
- Division of Oral Biology & Medicine, UCLA School of Dentistry, CHS 63-090, Los Angeles, CA 90095-1668
| | - Manwinder Lakha
- Division of Oral Biology & Medicine, UCLA School of Dentistry, CHS 63-090, Los Angeles, CA 90095-1668
| | - Linda Phi
- Division of Oral Biology & Medicine, UCLA School of Dentistry, CHS 63-090, Los Angeles, CA 90095-1668
| | | | - Francesco Chiappelli
- Division of Oral Biology & Medicine, UCLA School of Dentistry, CHS 63-090, Los Angeles, CA 90095-1668
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Abstract
Preterm and low birthweight (PTLBW) continues to be a major cause of mortality and morbidity across the world. In recent years, maternal periodontal disease has been implicated as a risk factor for adverse pregnancy outcomes. There is conflicting evidence to support such an outcome as illustrated by descriptive, case control and randomised controlled trials involving pregnant women from across the world, using different measurement tools to determine the level of periodontal disease. Whilst considering the literature, there is evidence for both arguments, based on the effect of periodontal inflammatory by products. Bacteria associated with periodontal disease are not dissimilar to those known to be associated with genito-urinary bacterial infections and adverse pregnancy outcomes. Several groups have demonstrated the apparent translocation of Fusobacterium nucleatum, Prevotella nigrescens, Prevotella intermedia, Porphyromonus gingivalis, Treponema denticola to the foetal placental unit whereby a maternal or foetal response has been detected resulting in premature birth or low birthweight. The normal process of parturition involves a cascade of events including a build-up of inflammatory mediators as linked to inflammation, whereby the maternal environment becomes hostile and threatens the well-being of the infant, and the foetus expelled. The question remains therefore, is there a greater risk of delivering a PTLBW infant when the mother has detectable periodontal disease, or is the release of inflammatory mediators and their translocation via the haematogenous route sufficient to induce a poor pregnancy outcome? The data investigated would suggest that there is a positive outcome when certain oral gram-negative bacteria create a cumulative effect sufficient to trigger early delivery, which represents the final straw to result in preterm or low birthweight delivery. There is equally sufficient epidemiological evidence that does not support this outcome, but it is agreed that maintaining oral health during pregnancy is beneficial to the mother and her infant.
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Affiliation(s)
- Elizabeth Shira Davenport
- Centre of Oral Growth and Development, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, London, UK
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Gomes-Filho IS, Cruz SS, Costa MDCN, Passos JS, Cerqueira EM, Sampaio FP, Pereira EC, Miranda LF. Periodontal Therapy and Low Birth Weight: Preliminary Results From an Alternative Methodologic Strategy. J Periodontol 2010; 81:1725-33. [DOI: 10.1902/jop.2010.100041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Matevosyan NR. Periodontal disease and perinatal outcomes. Arch Gynecol Obstet 2010; 283:675-86. [DOI: 10.1007/s00404-010-1774-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/09/2010] [Indexed: 11/28/2022]
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Chaffee BW, Weston SJ. Association between chronic periodontal disease and obesity: a systematic review and meta-analysis. J Periodontol 2010; 81:1708-24. [PMID: 20722533 DOI: 10.1902/jop.2010.100321] [Citation(s) in RCA: 311] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Obesity is increasing in prevalence and is a major contributor to worldwide morbidity. One consequence of obesity might be an increased risk for periodontal disease, although periodontal inflammation might, in turn, exacerbate the metabolic syndrome, of which obesity is one component. This review aims to systematically compile the evidence of an obesity-periodontal disease relationship from epidemiologic studies and to derive a quantitative summary of the association between these disease states. METHODS Systematic searches of the MEDLINE, SCOPUS, BIOSIS, LILACS, Cochrane Library, and Brazilian Bibliography of Dentistry databases were conducted with the results and characteristics of relevant studies abstracted to standardized forms. A meta-analysis was performed to obtain a summary measure of association. RESULTS The electronic search identified 554 unique citations, and 70 studies met a priori inclusion criteria, representing 57 independent populations. Nearly all studies matching inclusion criteria were cross-sectional in design with the results of 41 studies suggesting a positive association. The fixed-effects summary odds ratio was 1.35 (Shore-corrected 95% confidence interval: 1.23 to 1.47), with some evidence of a stronger association found among younger adults, women, and non-smokers. Additional summary estimates suggested a greater mean clinical attachment loss among obese individuals, a higher mean body mass index (BMI) among periodontal patients, and a trend of increasing odds of prevalent periodontal disease with increasing BMI. Although these results are highly unlikely to be chance findings, unmeasured confounding had a credible but unknown influence on these estimates. CONCLUSIONS This positive association was consistent and coherent with a biologically plausible role for obesity in the development of periodontal disease. However, with few quality longitudinal studies, there is an inability to distinguish the temporal ordering of events, thus limiting the evidence that obesity is a risk factor for periodontal disease or that periodontitis might increase the risk of weight gain. In clinical practice, a higher prevalence of periodontal disease should be expected among obese adults.
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Affiliation(s)
- Benjamin W Chaffee
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA 94720-7358, USA.
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Abstract
Randomized controlled clinical trials offer the best evidence for changing clinical practice and informing public health policy. Using examples from the literature, this paper reviews clinical trials for those who may be unfamiliar with their design, operation, and interpretation. In the design of a clinical trial, the question to be answered and a clinically meaningful outcome must be clearly defined. Ethics must be considered, sample size carefully estimated, and use of biomarkers and surrogate outcomes understood. Prominent issues in trial implementation include developing a manual of operations, trial registration, subject recruitment and retention, use of a data coordinating center, and data and safety monitoring. Interpretation of clinical trials requires understanding differences between efficacy and effectiveness; superiority, equivalence, and non-inferiority; intent-to-treat; primary and secondary analyses; and limitations of unregistered small clinical trials compared with large multi-center Phase III trials that are more likely to be representative of a population and change clinical practice or public health policy.
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Affiliation(s)
- B.L. Pihlstrom
- Professor Emeritus, School of Dentistry, University of Minnesota and Independent Oral Health Research Consultant, Bethesda, MD 20814, and formerly Director, Division of Clinical Research and Health Promotion, National Institute of Dental and Craniofacial Research, National Institutes of Health
| | - M.L. Barnett
- Clinical Professor, School of Dental Medicine, University at Buffalo and Independent Oral Care Industry Consultant, Princeton, NJ 08540 USA, and formerly Senior Director of Dental Affairs and Technology Development for a major multinational consumer products company
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