Oral bacteria, oral health, and adverse pregnancy outcomes

Asociación de parto prematuro y enfermedad periodontal en Bolivia, Chile y Colombia

Introducción. El parto prematuro es un problema médico, social y económico importante, causa gran mortalidad y morbilidad neonatal, tiene un impacto importante en el sistema de salud y afecta la calidad de vida de las familias. El peso de los recién nacidos de madres con enfermedad periodontal es significativamente menor en comparación con los de madres no afectadas por esta enfermedad bucal. Este resultado adverso se considera un problema de salud pública global según los datos epidemiológicos. Objetivo. Determinar la asociación entre la prevalencia de parto prematuro y la enfermedad periodontal en Bolivia, Chile y Colombia entre el 2000 y el 2020. Materiales y métodos. Este estudio ecológico consideró las poblaciones de mujeres de Bolivia, Chile y Colombia, y la prevalencia de partos prematuros y enfermedad periodontal, discriminadas por grupos de edad. El estudio abarcó el período entre el 2000 y el 2020. La estrategia de búsqueda con la herramienta de investigación del Institute for Health Metrics and Evaluation incluyó prevalencia, grupos de edad, años entre 2000 y 2020, causas de parto prematuro y enfermedad periodontal, contexto y ubicaciones, mujeres y tasas. El análisis estadístico incluyó una regresión lineal simple entre parto prematuro y enfermedad periodontal para cada grupo de edad dentro de cada país. Resultados. Las tasas de partos prematuros fueron mayores en el grupo de 15 a 19 años (Bolivia: 697.563, Chile: 844.864, Colombia: 804.126). La prevalencia de la enfermedad periodontal aumentó con la edad, particularmente en el grupo de 45 a 49 años (Bolivia: 22'077.854, Chile: 34'297.901, Colombia: 32'032,830). Según los grupos de edad, la regresión lineal fue estadísticamente significativa (p < 0,001) para todos los grupos evaluados de la población boliviana, en los grupos mayores de 30 años para las colombianas y solo en el grupo de 15 a 19 años para las mujeres chilenas. Conclusión. Se encontró asociación entre el parto prematuro y la enfermedad periodontal en todos los grupos de edad en Bolivia, solo en el grupo de 15 a 19 años en Chile, y de 30 años y más en Colombia en el período evaluado de 20 años.

Are educational tools in oral health programs for pregnant women effective in improving the oral status of mothers and babies? A systematic review

OBJECTIVE

To analyze, through a systematic review, the effectiveness of educational tools (ETs) in Oral Health Programs (OHPs) for pregnant women in improving their oral status and that of their babies.

METHOD

Searches were carried out in 5 electronic databases. Randomized (RCTs) and non-randomized clinical trials (CTs) were selected that included pregnant women exposed or not to ETs in OHPs, whose oral health status, in the pre- or postnatal period, or of their babies were verified. The types of ETs, outcomes, and results were extracted. Bias risk was assessed by ROBINS-I and RoB 2.0; and the certainty of the evidence (CE) by GRADE.

RESULTS

A total of nine studies were included. Most used more than one ET (n = 8), with verbal guidance used in all (n = 9). Mothers showed a reduction in biofilm (n = 3), caries (n = 4) and periodontitis (n = 4). All studies with babies (n = 3) were successful in preventing caries. RCTs (n = 3) were classified as low risk of bias (n = 1), with concerns (n = 1) and high risk of bias (n = 1). CTs (n = 6) presented risk of bias as low (n = 2), serious (n = 1) and critical (n = 3). Studies about caries in babies showed high CE, and those who evaluated caries and periodontal parameters/biofilm in the mother had moderate and low CE, respectively.

CONCLUSION

ETs as a strategy of OHPs for pregnant women can be effective in preventing caries in themselves and in their babies. However, despite the improvement of the mothers' oral hygiene and gingival condition, the CE was low considering this parameter.

Changes in Use of Prenatal Dental Care After Brazil's Incentive Policy

In 2020, the Brazilian federal government launched the "Prevent Brazil" program to incentivize cities to improve their performance across 7 health care indicators, including prenatal dental care. Our study examines the impact of this policy on the use of oral health care among pregnant women in Brazil. We used a series of cross-sectional data from the Brazilian Public Health System from 2018 to 2023. We linked publicly available data from the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. Our outcome was the proportion of pregnant women receiving prenatal care who had at least 1 dental visit during the past year. Covariates included city-level socioeconomic (income and literacy), demographic (gender, race, and urban areas), and workforce variables (number of dentists working in the public health system per city/year). We estimated the impact of the policy on prenatal dental visits nationwide and stratified by geographic region using interrupted time-series analysis. Our analyses included 99.9% of all Brazilian cities (n = 5,562). The use of oral health care among pregnant women increased from 15% in 2018 to 69% in 2023. Adjusted estimates show that, after initiation of the Prevent Brazil, dental care use among pregnant women increased nationally at a rate of 4.6 percentage points per 4-mo period (95% confidence interval [CI] 4.5; 4.7). The policy's largest impact was in the North and Northeast regions, which have the lowest socioeconomic profiles (adjusted time-series rate 5.7 [95% CI 5.3; 6.1] and 5.2 [5.0; 5.4] percent points, respectively). Our findings support the positive impact of the Prevent Brazil policy on prenatal dental care in Brazil. The policy was associated with a countrywide improvement in prenatal dental care use, with a greater impact in socioeconomically disadvantaged regions.

Assessment of women's needs and wishes regarding interprofessional guidance on oral health in pregnancy - a qualitative study

BACKGROUND

Poor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women's positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy.

METHODS

Sources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz.

RESULTS

25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic.

CONCLUSION

Guidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

Nanoparticles in Periodontitis Therapy: A Review of the Current Situation

Periodontitis is a disease of inflammation that affects the tissues supporting the periodontium. It is triggered by an immunological reaction of the gums to plaque, which leads to the destruction of periodontal attachment structures. Periodontitis is one of the most commonly recognized dental disorders in the world and a major factor in the loss of adult teeth. Scaling and root planing remain crucial for managing patients with persistent periodontitis. Nevertheless, exclusive reliance on mechanical interventions like periodontal surgery, extractions, and root planning is insufficient to halt the progression of periodontitis. In response to the problem of bacterial resistance, some researchers are committed to finding alternative therapies to antibiotics. In addition, some scholars focus on finding new materials to provide a powerful microenvironment for periodontal tissue regeneration and promote osteogenic repair. Nanoparticles possess distinct therapeutic qualities, including exceptional antibacterial, anti-inflammatory, and antioxidant properties, immunomodulatory capacities, and the promotion of bone regeneration ability, which made them can be used for the treatment of periodontitis. However, there are many problems that limit the clinical translation of nanoparticles, such as toxic accumulation in cells, poor correlation between in vitro and in vivo, and poor animal-to-human transmissibility. In this paper, we review the present researches on nanoparticles in periodontitis treatment from the perspective of three main categories: inorganic nanoparticles, organic nanoparticles, and nanocomposites (including nanofibers, hydrogels, and membranes). The aim of this review is to provide a comprehensive and recent update on nanoparticles-based therapies for periodontitis. The conclusion section summarizes the opportunities and challenges in the design and clinical translation of nanoparticles for the treatment of periodontitis.

A prospective study on maternal periodontal diseases and neonatal adverse outcomes

OBJECTIVE

It is evident that periodontitis is linked to various adverse pregnancy outcomes. This prospective study explored the potential link of maternal periodontal diseases to neonatal adverse outcomes.

MATERIALS AND METHODS

A total of 193 generally healthy females in their third trimester (34-36 weeks) of pregnancy were enrolled. All subjects received full-mouth periodontal assessment, and the periodontal inflamed surface area (PISA) was calculated. Demographic data, lifestyles and anthropometric measurements of the neonates (e.g., body length and head circumference) were recorded. Herein, small-for-gestational age (SGA) referred to gender- and age-adjusted birth weight below the 10th percentile in line with the standard reference. Multivariable logistic regression analysis and restricted cubic spline were performed for examining the association of periodontal parameters with SGA.  Results: There were 8.3% (16/193) of neonates with SGA. Significantly positive correlation existed between the percentage of tooth sites with increased probing depth and an elevated risk of SGA (OR: 1.052; P < 0.05). Yet, the PISA was positively associated with the risk of SGA (OR: 1.002; P < 0.05) as well. No significant link occurred between maternal periodontal status and other neonatal outcome measures.

CONCLUSION

Within the limitations of this study, the findings suggest that there could be a link between maternal periodontal diseases and neonatal adverse outcomes like SGA. Further investigation is required to clarify the current findings and potential implications for promoting maternal oral/periodontal health and newborn health.

Adverse childhood experiences and dental cleaning during pregnancy: Findings from the North and South Dakota PRAMS, 2017-2021

OBJECTIVE

Research demonstrates that adverse childhood experiences (ACEs)-that is, experiences of abuse, neglect, and household dysfunction-are related to lower preventive dental care utilization in childhood and adolescence. However, limited research has explored the connection between ACEs and preventive dental care utilization in adulthood, and no research has examined this relationship during pregnancy. The current study extends existing research by investigating the relationship between ACEs and dental cleaning and dental care utilization during pregnancy among a sample of women who delivered live births in North Dakota and South Dakota.

METHODS

Data are from the 2017 to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS) in North Dakota and South Dakota (n = 7391). Multiple logistic regression is used to examine the relationship between the number of ACEs (0, 1, 2, 3 or 4 or more) and dental cleaning during pregnancy.

RESULTS

Relative to respondents with 0 ACEs, those with 4 or more ACEs were significantly less likely to report having dental care during pregnancy (OR = 0.757, 95% CI = 0.638, 0.898). By racial and ethnic background, the results showed that the significant associations are concentrated among White and Native American respondents.

CONCLUSIONS

The results suggest that exposure to 4 or more ACEs is associated with a significantly lower likelihood of dental cleaning during pregnancy among women who delivered a live birth in North Dakota and South Dakota. Further investigations are necessary to understand the mechanisms underlying the relationship between ACEs and dental cleaning during pregnancy and replicate the findings in other geographic contexts.

Association Between Periodontitis and Adverse Pregnancy Outcomes: Two-Sample Mendelian Randomisation Study

AIM

This Mendelian randomisation (MR) study endeavoured to delineate the causal relationship between periodontitis and adverse pregnancy outcomes (APOs), encompassing low birthweight (LBW), pre-term birth (PTB), stillbirth, miscarriage, and gestational hypertension (GH).

METHODS

Utilising genetic instruments for periodontitis (acute and chronic periodontitis) from the Genome-Wide Association Study (GWAS) database among individuals of European descent, this study explored the causal relationship with adverse pregnancy outcomes, and vice versa. The Inverse Variance Weighted (IVW) method was employed as the primary analytical approach to assess causality, with MR-Egger serving as a sensitivity analysis method.

RESULTS

The primary analytical method employed in this study, IVW, did not reveal any impact of periodontitis (acute and chronic periodontitis) on PTB, stillbirth, miscarriage, and gestational hypertension, and vice versa. Heterogeneity testing using the MR-Egger method confirmed the null causal hypothesis, with odds ratios (OR) approximating 1, and P-values exceeding 0.05. Notably, the results from the IVW analysis (OR 1.410, CI 1.039-1.915, P-value 0.028) indicate statistically significant evidence supporting a causal relationship between chronic periodontitis and LBW. However, caution is advised in interpreting the causal relationship, considering the non-significant P-values obtained from other methods.

CONCLUSION

Within the limitations of this MR study, the findings do not support the influence of periodontitis on LBW, PTB, stillbirth, miscarriage, and GH, nor vice versa.

Leveraging Dental Stem Cells for Oral Health during Pregnancy: A Concise Review

Pregnancy induces significant changes in oral health because of hormonal fluctuations, making it a crucial period for preventive measures. Dental stem cells (DSCs), particularly those derived from the dental pulp and periodontal ligaments, offer promising avenues for regenerative therapies and, possibly, preventive interventions. While the use of DSCs already includes various applications in regenerative dentistry in the general population, their use during pregnancy requires careful consideration. This review explores recent advancements, challenges, and prospects in using DSCs to address oral health issues, possibly during pregnancy. Critical aspects of the responsible use of DSCs in pregnant women are discussed, including safety, ethical issues, regulatory frameworks, and the need for interdisciplinary collaborations. We aimed to provide a comprehensive understanding of leveraging DSCs to improve maternal oral health.

Relationship between vaginal and oral microbiome in patients of human papillomavirus (HPV) infection and cervical cancer

BACKGROUND

The aim of this study was to assess the microbial variations and biomarkers in the vaginal and oral environments of patients with human papillomavirus (HPV) and cervical cancer (CC) and to develop novel prediction models.

MATERIALS AND METHODS

This study included 164 samples collected from both the vaginal tract and oral subgingival plaque of 82 women. The participants were divided into four distinct groups based on their vaginal and oral samples: the control group (Z/KZ, n = 22), abortion group (AB/KAB, n = 17), HPV-infected group (HP/KHP, n = 21), and cervical cancer group (CC/KCC, n = 22). Microbiota analysis was conducted using full-length 16S rDNA gene sequencing with the PacBio platform.

RESULTS

The vaginal bacterial community in the Z and AB groups exhibited a relatively simple structure predominantly dominated by Lactobacillus. However, CC group shows high abundances of anaerobic bacteria and alpha diversity. Biomarkers such as Bacteroides, Mycoplasma, Bacillus, Dialister, Porphyromonas, Anaerococcus, and Prevotella were identified as indicators of CC. Correlations were established between elevated blood C-reactive protein (CRP) levels and local/systemic inflammation, pregnancy, childbirth, and abortion, which contribute to unevenness in the vaginal microenvironment. The altered microbial diversity in the CC group was confirmed by amino acid metabolism. Oral microbial diversity exhibited an inverse pattern to that of the vaginal microbiome, indicating a unique relationship. The microbial diversity of the KCC group was significantly lower than that of the KZ group, indicating a link between oral health and cancer development. Several microbes, including Fusobacterium, Campylobacter, Capnocytophaga, Veillonella, Streptococcus, Lachnoanaerobaculum, Propionibacterium, Prevotella, Lactobacillus, and Neisseria, were identified as CC biomarkers. Moreover, periodontal pathogens were associated with blood CRP levels and oral hygiene conditions. Elevated oral microbial amino acid metabolism in the CC group was closely linked to the presence of pathogens. Positive correlations indicated a synergistic relationship between vaginal and oral bacteria.

CONCLUSION

HPV infection and CC impact both the vaginal and oral microenvironments, affecting systemic metabolism and the synergy between bacteria. This suggests that the use of oral flora markers is a potential screening tool for the diagnosis of CC.

Fusobacterium nucleatum: An Overview of Evidence, Demi-Decadal Trends, and Its Role in Adverse Pregnancy Outcomes and Various Gynecological Diseases, including Cancers

Gynecological and obstetric infectious diseases are crucial to women's health. There is growing evidence that links the presence of Fusobacterium nucleatum (F. nucleatum), an anaerobic oral commensal and potential periodontal pathogen, to the development and progression of various human diseases, including cancers. While the role of this opportunistic oral pathogen has been extensively studied in colorectal cancer in recent years, research on its epidemiological evidence and mechanistic link to gynecological diseases (GDs) is still ongoing. Thus, the present review, which is the first of its kind, aims to undertake a comprehensive and critical reappraisal of F. nucleatum, including the genetics and mechanistic role in promoting adverse pregnancy outcomes (APOs) and various GDs, including cancers. Additionally, this review discusses new conceptual advances that link the immunomodulatory role of F. nucleatum to the development and progression of breast, ovarian, endometrial, and cervical carcinomas through the activation of various direct and indirect signaling pathways. However, further studies are needed to explore and elucidate the highly dynamic process of host-F. nucleatum interactions and discover new pathways, which will pave the way for the development of better preventive and therapeutic strategies against this pathobiont.

Identifying the oral microbiome of adolescents with and without dental fluorosis based on full-length 16S rRNA gene sequencing

Dental fluorosis, resulting from long-term environmental exposure to fluoride, is prevalent among diverse populations worldwide. Severe fluorosis not only compromises the aesthetic appeal of teeth but also impairs their functionality. This study aims to investigate the oral microbiome in dental fluorosis and the health individuals of adolescents living in the endemic fluorosis area of Guizhou, China through full-length 16S rDNA sequencing. Fourty-six individuals meet the sampling criteria, and we divided these samples into the following groups: a healthy group (H = 23) and a dental fluorosis group (F = 23), and two subgroups of Miao ethnicity: a healthy Miao group (Hm = 13) and a dental fluorosis Miao group (Fm = 15). A total of 660,389 high-quality sequences were obtained, and 12,007 Amplicon Sequence Variants (ASVs) were identified, revealing significant variations in oral microbiome between Fm and Hm groups. The composition of oral microbiota was similar between the H and F groups. At the genus level, Pseudopropionibacterium and at the species level, Streptococcus oralis_subsp.dentisani_clade_058 were less abundant in group F than in group H (P < 0.05). Further analysis revealed that the abundance of Capnocytophaga gingivalis and Kingella denitrificans was significantly lower in Fm fluorosis patients than in the Hm group (P < 0.05). Based on the LEfSe analysis, the potential core biomarkers in the oral of Fm fluorosis patients were identified at different taxonomic levels, ranging from phylum to species. These include Gammaproteobacteria, Prevotella sp_HMT_304, Gemella sanguinis, and Gracilibacteria_(GN02). Network analysis revealed that the microbiota in the fluorosis group exhibited more complex interactions with each other than the healthy group. Notably, within the Hm group, the potential biomarkers Capnocytophaga gingivalis and Kingella denitrificans exhibited a positive correlation. Finally, we employed PICRUSt2 analysis to explore the abundance clustering of the top 30 functional units in each sample, and we found that the metabolic pathway compositions of the four groups were similar. In summary, our findings suggest that the microbial composition of plaque in Hm patients with dental fluorosis is significantly altered, and we identified the potential marker microorganisms that contribute to these changes.

The oral microbiome: diversity, biogeography and human health

The human oral microbiota is highly diverse and has a complex ecology, comprising bacteria, microeukaryotes, archaea and viruses. These communities have elaborate and highly structured biogeography that shapes metabolic exchange on a local scale and results from the diverse microenvironments present in the oral cavity. The oral microbiota also interfaces with the immune system of the human host and has an important role in not only the health of the oral cavity but also systemic health. In this Review, we highlight recent advances including novel insights into the biogeography of several oral niches at the species level, as well as the ecological role of candidate phyla radiation bacteria and non-bacterial members of the oral microbiome. In addition, we summarize the relationship between the oral microbiota and the pathology of oral diseases and systemic diseases. Together, these advances move the field towards a more holistic understanding of the oral microbiota and its role in health, which in turn opens the door to the study of novel preventive and therapeutic strategies.

Sol-Gel Technologies to Obtain Advanced Bioceramics for Dental Therapeutics

The aim of this work is to review the application of bioceramic materials in the context of current regenerative dentistry therapies, focusing on the latest advances in the synthesis of advanced materials using the sol-gel methodology. Chemical synthesis, processing and therapeutic possibilities are discussed in a structured way, according to the three main types of ceramic materials used in regenerative dentistry: bioactive glasses and glass ceramics, calcium phosphates and calcium silicates. The morphology and chemical composition of these bioceramics play a crucial role in their biological properties and effectiveness in dental therapeutics. The goal is to understand their chemical, surface, mechanical and biological properties better and develop strategies to control their pore structure, shape, size and compositions. Over the past decades, bioceramic materials have provided excellent results in a wide variety of clinical applications related to hard tissue repair and regeneration. Characteristics, such as their similarity to the chemical composition of the mineral phase of bones and teeth, as well as the possibilities offered by the advances in nanotechnology, are driving the development of new biomimetic materials that are required in regenerative dentistry. The sol-gel technique is a method for producing synthetic bioceramics with high purity and homogeneity at the molecular scale and to control the surfaces, interfaces and porosity at the nanometric scale. The intrinsic nanoporosity of materials produced by the sol-gel technique correlates with the high specific surface area, reactivity and bioactivity of advanced bioceramics.

Stressful life events, oral health, and barriers to dental care during pregnancy

OBJECTIVES

Poor oral health during pregnancy poses risks to maternal and infant well-being. However, limited research has documented how proximate stressful life events (SLEs) during the prenatal period are associated with oral health and patterns of dental care utilization.

METHODS

Data come from 13 states that included questions on SLEs, oral health, and dental care utilization in the Pregnancy Risk Assessment Monitoring System for the years 2016-2020 (n = 48,658). Multiple logistic regression analyses were used to assess the association between levels of SLE (0, 1-2, 3-5, or 6+) and a range of (1) oral health experiences and (2) barriers to dental care during pregnancy while controlling for socio-demographic and pregnancy-related characteristics.

RESULTS

Women with more SLEs in the 12 months before birth-especially six or more-reported worse oral health experiences, including not having dental insurance, not having a dental cleaning, not knowing the importance of caring for teeth and gums, needing to see a dentist for a problem, going to see a dentist for a problem, and unmet dental care needs. Higher levels of SLEs were also associated with elevated odds of reporting barriers to dental care.

CONCLUSIONS

SLEs are an essential but often understudied risk factor for poor oral health, unmet dental care needs, and barriers to dental care services. Future research is needed to understand better the mechanisms linking SLEs and oral health.

The association of employment status and unwanted job loss with maternal oral health experiences: findings from the pregnancy risk assessment monitoring system

BACKGROUND

Oral health is an essential component of a healthy pregnancy. While most women work full-time while pregnant, research has overlooked the impact of occupational status and job loss on oral health experiences during pregnancy. To examine the impact of employment status and job loss on oral health experiences during pregnancy in the United States.

DATA

Data are from eight sites (Georgia, Massachusetts, Minnesota, Missouri, North Carolina, New York State, New York City, and Wisconsin) of the Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2016-2020 (n = 31,362). Multiple logistic regression is used to assess the relationship between occupational status (including employment status and unwanted job loss) during pregnancy and oral health.

FINDINGS

Women who experienced an unwanted job loss in the prenatal period were at elevated risk of not having dental insurance, not receiving a dental cleaning during pregnancy, having an oral health problem, and having unmet dental care needs.

CONCLUSION

Experiencing unwanted job loss around the time of pregnancy is an important life event that corresponds to worse oral health experiences. There is a need for greater focus on adverse life events, such as job loss, especially during pregnancy, as a mechanism for oral health issues and challenges with proper access to dental health systems.

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

BACKGROUND

Although disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors' knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being.

METHODS

The authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy.

RESULTS

Women reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities.

CONCLUSIONS

Maternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy.

PRACTICAL IMPLICATIONS

Given the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.

Advances in the oral microbiota and rapid detection of oral infectious diseases

Several studies have shown that the dysregulation of the oral microbiota plays a crucial role in human health conditions, such as dental caries, periodontal disease, oral cancer, other oral infectious diseases, cardiovascular diseases, diabetes, bacteremia, and low birth weight. The use of traditional detection methods in conjunction with rapidly advancing molecular techniques in the diagnosis of harmful oral microorganisms has expanded our understanding of the diversity, location, and function of the microbiota associated with health and disease. This review aimed to highlight the latest knowledge in this field, including microbial colonization; the most modern detection methods; and interactions in disease progression. The next decade may achieve the rapid diagnosis and precise treatment of harmful oral microorganisms.

Knowledge, attitudes, and practices of prenatal care practitioners regarding oral health in pregnancy-A systematic review

BACKGROUND

Hormonal and behavioral changes during pregnancy may impact the oral health of women, which can influence the pregnancy course. Prenatal care practitioners (PCP) must be aware of this bidirectional relation in order to include an oral assessment in routine prenatal care.

OBJECTIVES

To characterize the knowledge and attitudes of PCP regarding oral health in pregnant women.

SEARCH STRATEGY

The search was carried out in PubMed, Web of Science, Lilacs, Scopus, and Embase on May 2022.

SELECTION CRITERIA

Peer-reviewed cross-sectional studies published in English within the last 5 years that assessed the knowledge, attitudes, and practices of PCP towards oral health in pregnancy were selected.

DATA COLLECTION AND ANALYSIS

Data were standardly extracted by the three reviewers from the selected articles and their bias was assessed.

MAIN RESULTS

From a total of 996 articles, 24 were selected. Overall, most PCP have an adequate level of knowledge regarding the importance of oral health during pregnancy. Although several professionals reported referring their patients to a dentist, the attitudes and practices of the majority of PCP were still inadequate.

CONCLUSIONS

PCP are aware of the importance of oral health during pregnancy but still lack translating this knowledge into clinical practice.

Physical intimate partner violence and oral health problems during pregnancy

BACKGROUND

The aim of this study was to assess the association between physical intimate partner violence (IPV) during pregnancy and reports of prenatal oral health problems among a sample of mothers in the United States.

METHODS

Data were obtained from the Pregnancy Risk Assessment Monitoring System from 7 sites (Kentucky, Mississippi, New Hampshire, New York, Puerto Rico, Utah, West Virginia) for 2016 through 2020. The authors used multivariable logistic regression to examine the relationship between physical IPV and respondent self-reports of whether they needed to see a dentist for several oral health problems during pregnancy: (1) needing to have a tooth restored; (2) painful, red, or swollen gingivae; (3) toothache; (4) needing to have a tooth extracted; (5) having an injury to the mouth, teeth, or gingivae; or (6) another problem with teeth or gingivae.

RESULTS

Women who experienced physical IPV during pregnancy had elevated rates of oral health problems during pregnancy compared with women who did not experience IPV. The findings detailed associations between physical IPV and oral health problems that may stem from physical violence, including painful, red, or swollen gingivae; toothache; and mouth, teeth, or gingivae injury.

CONCLUSIONS

The results of this study highlight a connection between physical IPV during pregnancy and oral health problems consistent with orofacial injuries.

PRACTICAL IMPLICATIONS

The association between physical IPV and elevated rates of oral health problems and orofacial injuries highlights the critical role of oral health care providers in screening for, detecting, and intervening in IPV among pregnant women.

Enhanced Fusobacterium nucleatum Genetics Using Host DNA Methyltransferases To Bypass Restriction-Modification Systems

Bacterial restriction-modification (R-M) systems are a first-line immune defense against foreign DNA from viruses and other bacteria. While R-M systems are critical in maintaining genome integrity, R-M nucleases unfortunately present significant barriers to targeted genetic modification. Bacteria of the genus Fusobacterium are oral, Gram-negative, anaerobic, opportunistic pathogens that are implicated in the progression and severity of multiple cancers and tissue infections, yet our understanding of their direct roles in disease have been severely hindered by their genetic recalcitrance. Here, we demonstrate a path to overcome these barriers in Fusobacterium by using native DNA methylation as a host mimicry strategy to bypass R-M system cleavage of transformed plasmid DNA. We report the identification, characterization, and successful use of Fusobacterium nucleatum type II and III DNA methyltransferase (MTase) enzymes to produce a multifold increase in gene knockout efficiency in the strain Fusobacterium nucleatum subsp. nucleatum 23726, as well as the first system for efficient gene knockouts and complementations in F. nucleatum subsp. nucleatum 25586. We show plasmid protection can be accomplished in vitro with purified enzymes, as well as in vivo in an Escherichia coli host that constitutively expresses F. nucleatum subsp. nucleatum MTase enzymes. In summary, this proof-of-concept study characterizes specific MTases that are critical for bypassing R-M systems and has enhanced our understanding of enzyme combinations that could be used to genetically modify clinical isolates of Fusobacterium that have thus far been inaccessible to molecular characterization. IMPORTANCE Fusobacterium nucleatum is an oral opportunistic pathogen associated with diseases that include cancer and preterm birth. Our understanding of how this bacterium modulates human disease has been hindered by a lack of genetic systems. Here, we show that F. nucleatum DNA methyltransferase-modified plasmid DNA overcomes the transformation barrier and has allowed the development of a genetic system in a previously inaccessible strain. We present a strategy that could potentially be expanded to enable the genetic modification of highly recalcitrant strains, thereby fostering investigational studies to uncover novel host-pathogen interactions in Fusobacterium.

Healthy microbiome – a mere idea or a sound concept?

Hundreds of studies in last decades have aimed to compare the microbiome of patients suffering from diverse diseases with that of healthy controls. The microbiome-related component was additionally identified in pathophysiology of many diseases formerly considered to depend only on the host physiology. This, however, opens important questions like: “What is the healthy microbiome?” or “Is it possible to define it unequivocally?”. In this review, we describe the main hindrances complicating the definition of “healthy microbiome” in terms of microbiota composition. We discuss the human microbiome from the perspective of classical ecology and we advocate for the shift from the stress on microbiota composition to the functions that microbiome ensures for the host. Finally, we propose to leave the concept of ideal healthy microbiome and replace it by focus on microbiome advantageous for the host, which always depends on the specific context like the age, genetics, dietary habits, body site or physiological state.

Gain a Baby Lose a Tooth-Is There an Association between Periodontitis and Preterm Birth?

Preterm birth serves as one of the leading causes of neonatal mortality worldwide. The underlying mechanisms that contribute to preterm birth are not yet fully understood. However, an association between periodontitis and preterm birth has been proposed. The periodontal status and presence of periodontal pathogens in women with different birth outcomes have been previously examined. However, varying definitions of periodontitis and different microbiological methods make their interpretation challenging. The aim of this case-control study on women with and without preterm birth was to investigate their periodontal status using the current classification system for periodontal diseases. Moreover, differences in the periodontal microbiome of the study participants were investigated. Therefore, we collected data on oral and periodontal parameters in 77 puerperal women divided into two groups based on gestational age at delivery: 33 patients with preterm birth (PTB, <37 weeks) and 44 patients with term birth (TB, >37 weeks). These data included pocket probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival-bleeding index, DMFT index, and gynecologic and dental history. In addition, their oral microbiome was explored. Median CAL and percentage PPD ≥ 4 mm were significantly higher in the PTB group than in the TB group (p = 0.0128 and p = 0.047, respectively). Birth weight was significantly higher in periodontally healthy women than in those with gingivitis (p = 0.0078) or periodontitis (p = 0.0127). The periodontal microbiome differed significantly between groups. Our results are underlining the possible association between periodontitis and preterm delivery. Women with periodontitis had babies with significantly lower birth weights. The microbiome varied between the groups.

Characterizing the supragingival microbiome of healthy pregnant women

The ecological characteristics and changes of the supragingival plaque microbial community during pregnancy are poorly understood. This study compared the microbial community characteristics of supragingival plaque in pregnant and non-pregnant women, with the aim of identifying specific microbial lineages and genera that may be associated with pregnancy. Thirty pregnant women were randomly selected from the First Affiliated Hospital of Xinjiang Medical University and divided into groups based on pregnancy trimester: first trimester (group P1, n=10, ≤12 weeks), second trimester (group P2, n=10, 13–27 weeks), and third trimester (group P3, n=10, 28–40 weeks). Ten healthy non-pregnant women (group N) were enrolled as the control group. Supragingival plaque samples of all subjects were collected and oral microbial composition was surveyed using a 16S rRNA gene sequencing approach. Statistical analysis was performed using a nonparametric test. The Chao 1 index of P3 was significantly lower compared with that of N, P1, and P2 (P&lt;0.05). The Simpson indices of P2 and P3 were significantly higher than that of N (P&lt;0.05). The Shannon index of P2 was significantly higher compared with that of N (P&lt;0.05). Principal coordinate analysis (PCoA) showed different clustering according to the pregnancy status. Linear discriminant analysis effect size (LEfSe) revealed that the microbial species in group N that were significantly different from those of other groups were concentrated in the genus Neisseria. Species in P1 that were significantly different from those of other groups were concentrated in the genus Tannerella, while those in P2 and P3 were concentrated in the genus Leptotrichia. A total of 172 functional pathways were predicted for the bacterial communities in this study using PICRUSt2. Principal Component Analysis (PCA) showed that most predicted functional pathways clustered together in N and P1 and in P2 and P3. LEfSe analysis revealed that 11 pathways played a discriminatory role in the four groups. This work suggests a potential role of pregnancy in the formation of supragingival plaque microbiota and indicates that physiological changes during pregnancy may convert supragingival plaque into entities that could cause harm, which may be a risk factor for maternal health. Furthermore, findings from the study provide a basis for etiological studies of pregnancy-associated oral ecological disorders.

Oral hygiene and oral health behavior, periodontal complaints and oral health-related quality of life in pregnant women

Objectives

This questionnaire-based cross-sectional study aimed in the evaluation of oral hygiene and oral health behavior, periodontal complaints and oral health-related quality of life (OHRQoL) in pregnant women in southwest-Saxony, Germany.

Materials and methods

Consecutive patients attending the clinics for Obstetrics and Gynecology, Heinrich-Braun-Klinikum Zwickau, Germany, were recruited in the years 2020 and 2021. The evaluation consisted of three parts: (I) dental and oral hygiene behavior, (II) periodontal complaints and (III) German short form of oral health impact profile (OHIP G14) to assess OHRQoL.

Results

853 out of 1056 participants were included in the study. The pregnant women reported that they have received information on oral health during pregnancy more often from gynecologists than from dentists. Slightly more than half of the participants (51.5%) rated to regularly undergo a professional tooth cleaning. Similarly, nearly half of the women stated to perform interdental cleaning (55.8%). The most common periodontal complaint was bleeding of the gums (45.4%). The OHIP G14 findings of all questions as well as sum scores showed a median of 0. Regression analysis revealed that regular professional tooth cleaning was a predictor of better OHRQoL (β – 0.698, CI95 0.049–1.299; p < 0.04).

Conclusion

Oral hygiene and oral health behavior of pregnant women in southwest-Saxony requires improvement. While the overall OHRQoL of the cohort was not reduced, professional tooth cleaning and thus professional preventive measures can support OHRQoL during pregnancy. Improved interdisciplinary oral health care concepts for pregnant women should be fostered. These concepts can also positively influence OHRQoL issues.

Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies

Periodontal disease is an inflammatory and destructive disease of tissues supporting the tooth. A large number of studies have confirmed that periodontal pathogens and their metabolites can lead to adverse pregnancy outcomes in direct or indirect ways. Adverse pregnancy outcomes, such as preterm birth, low birth weight, and pre-eclampsia, have a serious impact on human reproductive health. In recent years, although the level of global medical technology has gradually improved, the incidence of adverse pregnancy outcomes has not declined and is still a global public health problem. The purpose of this review is to summarize the current data on periodontal disease in pregnancy and adverse pregnancy outcomes, including the association between periodontal disease and adverse pregnancy outcomes, the pathogenic mechanism related to this association, the efficacy of different nutrition supplements for both periodontal disease and adverse pregnancy outcomes and the effect of providing periodontal treatment on the occurrence of adverse pregnancy outcomes, to provide guidance for the prevention and treatment of adverse pregnancy outcomes in clinical practice.

Oral Healthcare during Pregnancy: Its Importance and Challenges in Lower-Middle-Income Countries (LMICs)

Oral health is essential in general health and well-being to maintain overall quality of life [...].

Interconnection of periodontal disease and comorbidities: Evidence, mechanisms, and implications

Periodontitis, a microbiome-driven inflammatory disease of the tooth-attachment apparatus, is epidemiologically linked with other disorders, including cardio-metabolic, cognitive neurodegenerative and autoimmune diseases, respiratory infections, and certain cancers. These associations may, in part, be causal, as suggested by interventional studies showing that local treatment of periodontitis reduces systemic inflammation and surrogate markers of comorbid diseases. The potential cause-and-effect connection between periodontitis and comorbidities is corroborated by studies in preclinical models of disease, which additionally provided mechanistic insights into these associations. This overview discusses recent advances in our understanding of the periodontitis-systemic disease connection, which may potentially lead to innovative therapeutic options to reduce the risk of periodontitis-linked comorbidities.