A pilot study of the association between cariogenic oral bacteria and preterm birth

Oral Pathogens' Substantial Burden on Cancer, Cardiovascular Diseases, Alzheimer's, Diabetes, and Other Systemic Diseases: A Public Health Crisis-A Comprehensive Review

This review synthesizes the findings from 252 studies to explore the relationship between the oral pathogens associated with periodontitis, dental caries, and systemic diseases. Individuals with oral diseases, such as periodontitis, are between 1.7 and 7.5 times (average 3.3 times) more likely to develop systemic diseases or suffer adverse pregnancy outcomes, underscoring the critical connection between dental and overall health. Oral conditions such as periodontitis and dental caries represent a significant health burden, affecting 26-47% of Americans. The most important oral pathogens, ranked by publication frequency, include the herpes virus, C. albicans, S. mutans, P. gingivalis, F. nucleatum, A. actinomycetemcomitans, P. intermedia, T. denticola, and T. forsythia. The systemic diseases and disorders linked to oral infections, ranked similarly, include cancer, respiratory, liver, bowel, fever, kidney, complications in pregnancy, cardiovascular bacteremia, diabetes, arthritis, autoimmune, bladder, dementia, lupus, and Alzheimer's diseases. Evidence supports the efficacy of dental and periodontal treatments in eliminating oral infections and reducing the severity of systemic diseases. The substantial burden that oral pathogens have on cancer, cardiovascular diseases, Alzheimer's, diabetes, and other systemic diseases poses a significant public health crisis.

Oral Microbiome and Alzheimer's Disease

The accumulation of amyloid-beta plaques in the brain is a central pathological feature of Alzheimer's disease. It is believed that amyloid responses may be a result of the host immune response to pathogens in both the central nervous system and peripheral systems. Oral microbial dysbiosis is a chronic condition affecting more than 50% of older adults. Recent studies have linked oral microbial dysbiosis to a higher brain Aβ load and the development of Alzheimer's disease in humans. Moreover, the presence of an oral-derived and predominant microbiome has been identified in the brains of patients with Alzheimer's disease and other neurodegenerative diseases. Therefore, in this opinion article, we aim to provide a summary of studies on oral microbiomes that may contribute to the pathogenesis of the central nervous system in Alzheimer's disease.

Periodontal disease and systemic health: An update for medical practitioners

INTRODUCTION

Chronic periodontal disease is a highly prevalent dental condition affecting tooth-supporting tissues. Scientific evidence is accumulating on links between periodontal disease and various systemic conditions. This narrative review provides a holistic yet succinct overview that would assist medical practitioners to deliver integrated care for better clinical outcomes.

METHOD

Scientific evidence on associations between periodontal disease and systemic conditions was synthesised and critically appraised. Key findings of latest prospective cohort studies, randomised clinical trials, and meta-analysis were closely assessed and compiled.

RESULTS

A bidirectional relationship has been established, indicating that diabetes and periodontal disease are closely linked and amplify one another, if not successfully controlled. Existing evidence also supports the associations of periodontal disease with cardiovascular diseases and adverse pregnancy outcomes. Successful treatment of periodontal disease and dental prophylaxis has been shown to improve clinical outcomes in these systemic conditions. Other systemic conditions associated with periodontal disease include respiratory diseases, Alzheimer's disease, rheumatoid arthritis and chronic kidney disease. Although the underlying mechanisms remain to be fully elucidated, it is generally accepted that the inflammatory burden of chronic periodontal disease has an important systemic impact.

CONCLUSION

Oral-systemic links are multifaceted and complex. While evidence linking periodontal disease with a variety of systemic conditions is still emerging, the nature of the relationship is becoming clearer. The updated understanding of these associations warrants the attention of medical experts and policymakers for a concerted effort to develop a patient-centric, integrated model for the treatment of comorbid dental and medical conditions.

Oral microflora and pregnancy: a systematic review and meta-analysis

Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.

Oral, systemic and socioeconomic factors associated with preterm birth

BACKGROUND

The rates of preterm births have been increasing worldwide. Complications related to preterm births are associated with increased costs of care, and have a direct impact on the health system of the countries. Therefore, it is important to address factors associated with preterm birth in order to provide prevention strategies.

OBJECTIVE

This case-control study investigated oral, systemic, and socioeconomic factors associated with preterm birth in postpartum women. Participants were 279 postpartum women that gave birth to a singleton live-born infant. Cases were women giving birth before 37 completed weeks of gestation (preterm birth). Controls were women giving birth at term (≥37weeks). Data were collected through questionnaires, medical records and intra-oral clinical examinations, which included dental caries registration according to World Health Organization criteria and oral biofilm evaluation through visible plaque index.

RESULTS

Ninety-one women had preterm birth (cases) and 188 women had birth at term (controls), ratio 1:2. Caries lesions were present in 62.3% of the cases and in 62.5% of the controls. The univariate analysis showed no association between dental caries and preterm birth (Odds Ratio=1.08, p=0.90). The multivariate analysis showed that maternal educational level (Odds Ratio=2.56, p=0.01) and arterial hypertension (Odds Ratio=2.32, p=0.01) were associated with prematurity.

CONCLUSION

This study demonstrated that dental caries is frequent in postpartum women, but it does not appear to be associated with preterm birth. Meanwhile, maternal education level and arterial hypertension were associated with prematurity in this population.

Dental caries and preterm birth: a systematic review and meta-analysis

OBJECTIVES

The primary objective of this systematic review was to evaluate the association between dental caries and preterm birth (PTB). The secondary objective was ascertaining the difference between women with dental caries who experienced PTB and those who did not with regard to decayed, missing and filled teeth (DMFT), and decayed, missing and filled surfaces (DMFS) indices.

METHODS

MEDLINE, Embase, CINAHL and Cochrane databases were searched initially in November 2015 and repeated in December 2016. We included observational cohort and case-control studies. Only studies reporting the risk of PTB in women affected compared with those not affected by dental caries in pregnancy were included. Random-effect meta-analyses were used to compute the summary OR of PTB among women with caries versus women without caries, and the mean difference in either DMFT or DMFS indices between women experiencing PTB and those without PTB.

RESULTS

Nine observational studies (4826 pregnancies) were included. Women affected by dental caries during pregnancy did not show a significantly higher risk of PTB (OR: 1.16, 95% CI 0.90 to 1.49, P=0.25, I2=35%). Also, the women with PTB did not show significantly higher DMFT or DMFS indices (summary mean differences: 1.56, P=0.10; I2=92% and -0.15, P=0.9, I2=89%, respectively).

CONCLUSION

Dental caries does not appear to be a substantial risk factor for PTB.

TRIAL REGISTRATION NUMBER

NCT01675180; Pre-results.

Probiotics in early life: a preventative and treatment approach

Microbial colonization of the infant gut plays a key role in immunological and metabolic pathways impacting human health. Since the maturation of the gut microbiota coincides with early life development, failure to develop a health compatible microbiota composition may result in pathology and disease in later life. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Maternal transfer of microorganisms is possible during pregnancy and lactation, and the mother's diet and microbiota can influence that of her offspring. Furthermore, pre-term birth, Caesarean section birth, formula feeding, antibiotic use, and malnutrition have been linked to dysbiosis, which in turn is associated with several pathologies such as necrotizing enterocolitis, inflammatory bowel diseases, antibiotic associated diarrhea, colic, and allergies. Thus, early life should represent a preferred stage of life for probiotic interventions. In this context, they could be regarded as a means to 'program' the individual for health maintenance, in order to prevent pathologies associated with dysbiosis. In order to elucidate the mechanisms underlying the benefits of probiotic administration, pre-clinical studies have been conducted and found an array of positive results such as improved microbial composition, intestinal maturation, decreased pathogenic load and infections, and improved immune response. Moreover, specific probiotic strains administered during the perinatal period have shown promise in attenuating severity of necrotizing enterocolitis. The mechanisms elucidated suggest that probiotic interventions in early life can be envisaged for disease prevention in both healthy offspring and offspring at risk of chronic disease.

Can nutritional modulation of maternal intestinal microbiota influence the development of the infant gastrointestinal tract?

The gastrointestinal microbiota plays an important role in maintaining host health by preventing the colonization of pathogens, fermenting dietary compounds, and maintaining normal mucosal immunity. Particularly in early life, the composition of the microbiota profoundly influences the development and maturation of the gastrointestinal tract (GIT) mucosa, which may affect health in later life. Therefore, strategies to manipulate the microbiota during infancy may prevent the development of some diseases later in adult life. Earlier research suggested that term fetuses are sterile and that the initial bacterial colonization of the newborn GIT occurs only after the baby transits through the birth canal. However, recent studies have demonstrated that the colonization and/or contact of the fetus with the maternal GIT microbiota may start in utero. After vaginal birth, the colonization of the neonate GIT continues through contact with maternal feces and vaginal bacteria, leading to a relatively simple microbial community that is influenced by feeding type (breast vs. formula feeding). Maternal GIT microbiota, vaginal microbiota, and breast milk composition are influenced by maternal diet. Alterations of the maternal GIT microbiota composition via supplementation with probiotics and prebiotics have been shown; however, transfer of these benefits to the offspring remains to be demonstrated. This review focuses on the influence of maternal GIT microbiota during the pre- and postpartum periods on the colonization of the infant GIT. In particular, it examines the manipulation of the maternal GIT microbiota composition through the use of probiotics and/or prebiotics and subsequent consequences for the health of the offspring.

Maternal dental caries and pre-term birth: results from the EPIPAP study

OBJECTIVE. The aim of this study was to analyse the association between maternal dental caries and pre-term birth (PTB), with a particular focus on the infection-suspected causes of pre-term births. MATERIALS AND METHODS. A secondary analysis was performed on data from the EPIPAP study, a French multi-centre case-control study. Cases were 1107 women giving birth to a singleton live-born infant before 37 weeks of gestation and controls were 1094 women delivering at 37 weeks or more. A sub-group of cases was defined as women with spontaneous labour and/or pre-term premature rupture of membranes (PPROM, n = 620). A full-mouth dental examination was performed after delivery. The main factor of interest was the presence of decay on at least one tooth. RESULTS. Crude associations between presence of tooth decay and PTB or spontaneous PTB/PPROM were significant (OR = 1.21 [1.01-1.45] and OR = 1.25 [1.01-1.55], respectively). After adjustment for two sets of potential confounders (four pre-term birth risk factors and four social characteristics), for periodontitis status and for inter-examiner variability, tooth decay was not significantly associated with either PTB or spontaneous PTB/PPROM (aOR = 1.10 [0.91-1.32] and aOR = 1.14 [0.91-1.42], respectively). CONCLUSIONS. This study failed to demonstrate a significant association between tooth decay and pre-term birth. However, future well-designed studies are needed to further assess the link between dental caries and adverse pregnancy outcomes.

Oral health and adverse pregnancy outcomes - what's next?

Studies on the link between periodontal disease and adverse pregnancy outcome have gone through several phases. The epidemiological studies predominantly support a positive association between these wide-affecting diseases. During the intervention phase, a few small-scale, single-center studies reported improvement of birth outcome following periodontal treatment, whereas the large-scale multi-center studies did not demonstrate efficacy. Many questions arise with regard to patient population, disease type, and therapy. In addressing these questions, it is crucial that one understands the mechanism underlying the link between these diseases. Two non-mutually exclusive hypotheses exist. In the first, periodontal disease is believed to affect the maternal and fetal immune responses systemically, leading to premature labor. Alternatively, evidence is accumulating that oral bacteria may translocate directly into the pregnant uterus, causing localized inflammation and adverse pregnancy outcome in the presence or absence of clinical periodontitis. The oral-uterine transmission is not limited to the well-recognized periodontal pathogens, but instead may also involve the commensal species. Future studies should investigate these mechanisms, to understand the host susceptibility to oral-uterine transmission. Only when a thorough understanding of the mechanism is achieved can meaningful intervention studies be designed utilizing effective therapies, targeting appropriate populations, and measuring relevant outcomes.

Periodontal infection and preterm birth: successful periodontal therapy reduces the risk of preterm birth

OBJECTIVE

This study tested the hypothesis that successful periodontal treatment was associated with a reduction in the incidence of spontaneous preterm birth (PTB).

DESIGN

This was a randomised, controlled, blinded clinical trial.

SETTING

Hospital outpatient clinic.

POPULATION

Pregnant women of 6-20 weeks of gestation were eligible.

METHODS

Of 322 pregnant women with periodontal disease, 160 were randomly assigned to receive scaling and root planing (SRP, cleaning above and below the gum line), plus oral hygiene instruction, whereas the remaining 162 received only oral hygiene instruction and served as an untreated control group. Subjects received periodontal examinations before and 20 weeks after SRP, and were classified blindly according to the results of treatment into two groups: successful ('non-exposure') and unsuccessful ('exposure') treatment. Groups were compared using standard inferential statistics; dichotomous variables were compared using the chi-square test or logistic regression. Results are presented in terms of odds ratios.

MAIN OUTCOME MEASURE

The main outcome measure was spontaneous preterm birth before 35 weeks of gestation.

RESULTS

No significant difference was found between the incidence of PTB in the control group (52.4%; n = 162) and the periodontal treatment group (45.6%; n = 160) (P < 0.13, Fisher's exact test). The incidence of PTB was compared within the periodontal treatment group, considering the success of therapy. A logistic regression analysis showed a strong and significant relationship between successful periodontal treatment and full-term birth (adjusted odds ratio 6.02; 95% CI 2.57-14.03). Subjects refractory to periodontal treatment were significantly more likely to have PTB.

CONCLUSIONS

A beneficial effect on PTB may be dependent on the success of periodontal treatment.