Benefits of Periodontal Therapy When Preterm Birth Threatens

Allocation concealment appraisal of clinical therapy trials using the extended Composite Quality Score (CQS-2)-An empirically based update

Objectives

The objective of this study was to revise CQS-2/Criterion II concerning allocation concealment appraisal for prospective, controlled clinical therapy trials.

Methods

Meta-analyses of trials with inadequate allocation concealment were tested for in-between trial heterogeneity (I² > 0) due to imbalances in baseline variables. Meta-analyses with positive test results were used as a basis to deduce criteria for adequate allocation concealment. The CQS-2/Criterion II was reformulated in line with the findings.

Result

One suitable meta-analysis was identified. Two forest plots with data from five and four trials with inadequate/unclear allocation concealment were selected for testing. In addition, a total of five trials with adequate allocation concealment were identified. The meta-analysis test results were positive, and keywords for the judgment of adequate allocation concealment were extracted verbatim from the text of the meta-analysis. The extracted keywords indicated "central allocation" as the main criterion for adequate allocation concealment. Criterion II of the CQS-2 was revised accordingly.

Conclusion

Criterion II of the CQS-2 trial appraisal tool was revised. The revised appraisal tool was specified as version CQS-2B.

Maternal Periodontal Status as a Factor Influencing Obstetrical Outcomes

Background and Objectives: Preterm birth as a complex phenomenon is influenced by numerous endogenic and exogenic factors, although its exact cause often remains obscure. According to epidemiological studies, maternal periodontal diseases, in addition to affecting general health, can also cause adverse pregnancy outcomes. Nonetheless, the existing results in the literature regarding this topic remain controversial. Consequently, our study aimed to determine the connection between poor maternal periodontal status and neonatal birth weight. Materials and Methods: A total of 111 primigravida-primiparous pregnant, healthy women underwent a periodontal examination in the second trimester of their pregnancies. Probing depth (PD) and bleeding on probing (BOP) were determined, and based on these diagnostic measurements, the patients were divided into three subgroups according to their dental status: healthy (H, n = 17), gingivitis (G, n = 67), and periodontitis (P, n = 27). Results: Considering that poor maternal oral status is an influencing factor for obstetrical outcomes, the presence of PD and BOP (characterized by the sulcus bleeding index, SBI) was evaluated. In the case of P, defined as PD ≥ 4 mm in at least one site and BOP ≥ 50% of the teeth, a significant correlation between BOP and a low neonatal birth weight at delivery (p = 0.001) was found. An analysis of the relationship between SBI and gestational age (GA) at the time of the periodontal examination in the different dental status groups showed a significant correlation between these parameters in the G group (p = 0.04). Conclusions: Our results suggest that a worse periodontal status during pregnancy may negatively affect obstetrical outcomes, especially the prematurity rate and newborn weight. Therefore, the importance of periodontal screening to prevent these complications is undeniable.

The Potential Association Between Periodontal Diseases and Adverse Pregnancy Outcomes in Pregnant Women: A Systematic Review of Randomized Clinical Trials

Preceding studies have demonstrated that periodontitis might increase the liability of adverse pregnancy outcomes such as preterm birth, preeclampsia, low birth weight, and perinatal fatality in pregnant women. Nonetheless, there is no convincing testimony that periodontitis is related directly to adverse pregnancy outcomes in pregnant women. This systematic review intended to assess and review all the available randomized clinical trials that concentrated on the association between periodontal diseases and adverse pregnancy outcomes, and the impact of periodontal disease therapy on adverse pregnancy outcomes. The databases like Scopus, PubMed, Google Scholar, and Web of Science were consumed to explore relevant and suitable studies after adopting the inclusion and exclusion criteria. The search included articles with no time restrictions and certain keywords were utilized in the databases. The investigation was done through four independent reviewers employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-three studies fulfilled the exclusion and inclusion criteria and were used and included in this systematic review. The above-mentioned studies assessed the association between periodontal diseases and adverse pregnancy outcomes and the effect of periodontal disease treatment in reducing the influence of adverse pregnancy outcomes. This systematic review revealed that there is a relationship between periodontitis and adverse pregnancy outcomes, and periodontal treatment has a reducing impact on adverse pregnancy outcomes in pregnant women with periodontitis. Prospect studies are warranted to investigate the relationship between periodontitis and different adverse pregnancy outcomes and to decide the best type and the most effective therapy to treat periodontitis in pregnant women.

Association of Chlorhexidine Use and Scaling and Root Planing With Birth Outcomes in Pregnant Individuals With Periodontitis: A Systematic Review and Meta-analysis

IMPORTANCE

Chlorhexidine mouthwash enhances treatment effects of conventional periodontal treatment, but data on chlorhexidine as a source of heterogeneity in meta-analyses assessing the treatment of maternal periodontitis in association with birth outcomes are lacking.

OBJECTIVE

To assess possible heterogeneity by chlorhexidine use in randomized clinical trials (RCTs) evaluating the effect of periodontal treatment (ie, scaling and root planing [SRP]) vs no treatment on birth outcomes.

DATA SOURCES

Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database), US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), and the WHO International Clinical Trials Registry Platform were searched through March 2022.

STUDY SELECTION

RCTs were included if they were conducted among pregnant individuals with periodontitis, used interventions consisting of SRP vs no periodontal treatment, and assessed birth outcomes.

DATA EXTRACTION AND SYNTHESIS

Data were abstracted with consensus of 2 reviewers using Rayyan and assessed for bias with the Cochrane Risk of Bias 2 tool before random effects subgroup meta-analyses. Analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.

MAIN OUTCOMES AND MEASURES

Outcomes of interest were preterm birth (ie, <37 weeks' gestation) and low birth weight (ie, <2500 g).

RESULTS

There were 12 studies with a total of 5735 participants evaluating preterm birth. Control group participants did not receive any treatment or use chlorhexidine during pregnancy. All intervention group participants received SRP; in 5 of these studies (with 2570 participants), pregnant participants in the treatment group either received chlorhexidine mouthwash or advice to use it, but participants in the remaining 7 studies (with 3183 participants) did not. There were 8 studies with a total of 3510 participants evaluating low birth weight, including 3 studies with SRP plus chlorhexidine (with 594 participants) and 6 studies with SRP only (with 2916 participants). The SRP plus chlorhexidine groups had lower risk of preterm birth (relative risk [RR], 0.56; 95% CI, 0.34-0.93) and low birth weight (RR, 0.47; 95% CI, 0.32-0.68) but not the SRP-only groups (preterm birth: RR, 1.03; 95% CI, 0.82-1.29; low birth weight: RR, 0.82; 95% CI, 0.62-1.08).

CONCLUSIONS AND RELEVANCE

These findings suggest that treating maternal periodontitis with chlorhexidine mouthwash plus SRP was associated with reduced risk of preterm and low birth weight. Well-conducted RCTs are needed to test this hypothesis.

Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review

AIM

To investigate the effect of treatment of periodontitis on systemic health outcomes, pregnancy complications, and associated quality of life.

MATERIALS AND METHODS

Systematic electronic searches were conducted to identify randomized controlled trials with minimum 6-month follow-up and reporting on the outcomes of interest. Qualitative and quantitative analyses were performed as deemed suitable.

RESULTS

Meta-analyses confirmed reductions of high-sensitivity C-reactive protein (hs-CRP) [0.56 mg/L, 95% confidence interval (CI) (-0.88, -0.25), p < .001]; interleukin (IL)-6 [0.48 pg/ml, 95% CI (-0.88, -0.08), p = .020], and plasma glucose [1.33 mmol/l, 95% CI (-2.41, -0.24), p = .016], and increase of flow-mediated dilation (FMD) [0.31%, 95% CI (0.07, 0.55), p = .012] and diastolic blood pressure [0.29 mmHg, 95% CI (0.10, 0.49), p = .003] 6 months after the treatment of periodontitis. A significant effect on preterm deliveries (<37 weeks) was observed [0.77 risk ratio, 95% CI (0.60, 0.98), p = .036]. Limited evidence was reported on quality-of-life (QoL) outcomes in the included studies.

CONCLUSIONS

Treatment of periodontitis results in systemic health improvements including improvement in cardiometabolic risk, reduction in systemic inflammation and the occurrence of preterm deliveries. Further research is however warranted to confirm whether these changes are sustained over time. Further, appropriate QoL outcomes should be included in the study designs of future clinical trials.

Periodontal disease and adverse pregnancy outcomes

Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.

The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review of the current evidence

Background and Objectives:

The poor maternal oral health in the pregnancy has an impact on the fetus through the oral-systemic link. Various studies have proven the relationship between poor maternal oral health and the occurrence of adverse pregnancy outcomes. Hence, periodontal therapy becomes indispensable during pregnancy. Previous systematic reviews and meta-analysis conducted to assess the influence of periodontal therapy on the occurrence of adverse pregnancy outcomes have shown inconsistent results. Hence, we conducted the present review to assess the influence of periodontal therapy on the occurrence of adverse pregnancy outcomes including the studies published till date.

Materials and Methods:

We searched for the relevant studies using the databases PUBMED, MEDLINE, CINAHL, and EMBASE on the randomized controlled trials evaluating the influence of periodontal treatment on adverse pregnancy outcomes from 2000 to 2018. Nineteen studies were considered for the present review based on the predetermined criteria. The risk of bias tool by Cochrane was used to evaluate the risk of bias among the studies.

Results:

Among the studies included for the present review, the occurrence of preterm birth among the pregnant mothers who received periodontal therapy ranged from 0% to 53.5%, while in the control group, the range was 6.38%–72%. The rate of LBW among the mothers treated for periodontal disease ranged from 0% to 36%, and in the control group, it varied from 1.15% to 53.9%.

Conclusion:

With best possible evidence, it can be inferred that nonsurgical periodontal therapy is safe during pregnancy. Even though it does not completely avert the occurrence of adverse pregnancy outcomes, it can be recommended as a part of antenatal care.

Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis

OBJECTIVE

To assess the effect of periodontal treatment during pregnancy on maternal, fetal and neonatal outcomes.

METHODS

This is a systematic review and meta-analysis of randomized controlled trials that evaluated the effect of treatment of periodontal diseases on pregnancy outcomes. Primary outcome was perinatal mortality. Secondary outcomes were maternal and neonatal morbidity. Outcomes were pooled using fix-effect or random effects models and presented as risk ratio (RR), or mean difference (MD), and 95% confidence interval (CI).

RESULTS

Twenty randomized controlled trials involving 8171 participants were included in this study. Periodontal treatment during pregnancy was associated with significantly decreased risk of perinatal mortality [N = 5942; RR = 0.53 (0.30-0.93); p = .03; heterogeneity (I²) = 0%, Number needed to treat (NNT): 162]. Periodontal treatment during pregnancy reduced risks of preterm birth [N = 7335; RR = 0.78 (0.62-0.98); p = .03; I² = 72%, NNT = 37]. Periodontal treatment during pregnancy significantly increased birthweight (gram) [N = 4708; MD = 200.79 (63.34-337.24); p = .004; I² = 93%]. Periodontal treatment during pregnancy was not associated with preeclampsia, gestational diabetes, cesarean section, small for gestational age, or congenital malformations.

CONCLUSION

Periodontal treatment during pregnancy reduces the risks of perinatal mortality and preterm birth, and improves birth weight.

The Interprofessional Role in Dental Caries Management: Ways Medical Providers Can Support Oral Health (Perspectives from a Physician)

Medical providers are important allies in the prevention of dental caries. Through raising the issue by asking about risks and strengths, offering anticipatory guidance and counseling, encouraging and following up on referrals, and applying preventive fluoride, medical providers can have a direct, positive impact on oral health. Further, improving communication with referrals, bidirectionally, benefits patient care as well as provider satisfaction. By collaborating on advocacy efforts, medical and dental providers can broaden their impact while building relationships, with the end goal of improved health for patients throughout their lifetime. Reintegrating the mouth into the body and oral health into systemic health has benefits for patients and providers alike, and can and should be accomplished in the medical home.

Non-Surgical Treatment of Periodontal Disease in a Pregnant Caucasian Women Population: Adverse Pregnancy Outcomes of a Randomized Clinical Trial

Aim: To analyze if non-surgical treatment of periodontitis in a pregnant Caucasian women population can reduce adverse pregnancy outcomes. Methods and results: A parallel randomized clinical trial was designed and approved by the Ethical Committee of Sanitary Area Santiago-Lugo, Spain (registration number: 2016/451). Forty patients with periodontitis stage II grade B were randomly allocated to receive either comprehensive non-surgical periodontal therapy (test group; n = 20) or professional tooth cleaning (control group; n = 20) before 24 gestational weeks. Randomization was computer-generated by the statistic program Epidat v.4.1 and allocation was performed using sealed opaque envelopes. Clinical measurements and peripheral blood samples for biochemical variables were collected at baseline, in the middle of second trimester before non-surgical treatment, and in the third trimester. Microbiological samples were collected in the second and third trimester. A statistically significant reduction was verified in all clinical and microbiological parameters after periodontal treatment in the test group. No significant differences were observed for the rest of the variables, including preterm birth and/or low birth weight. No adverse events related to periodontal treatment were reported. Conclusions: Non-surgical periodontal treatment in Caucasian patients with periodontitis stage II grade B did not significantly reduce the risk of adverse pregnancy outcomes.

An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes

OBJECTIVE

In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature.

METHODS

A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed.

RESULTS

A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions.

CONCLUSIONS

Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.

Treating periodontal disease for preventing adverse birth outcomes in pregnant women

BACKGROUND

Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health.

OBJECTIVES

To assess the effects of treating periodontal disease in pregnant women in order to prevent or reduce perinatal and maternal morbidity and mortality.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), Cochrane Pregnancy and Childbirth's Trials Register (to 7 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 9) in the Cochrane Library, MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 6 October 2016). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 6 October 2016. We placed no restrictions on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) investigating the effects of periodontal treatment in preventing or reducing perinatal and maternal morbidity and mortality. We excluded studies where obstetric outcomes were not reported.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts and extracted data using a prepiloted data extraction form. Missing data were obtained by contacting authors and risk of bias was assessed using Cochrane's 'Risk of bias' tool. Where appropriate, results of comparable trials were pooled and expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) . The random-effects model was used for pooling except where there was an insufficient number of studies. We assessed the quality of the evidence using GRADE.

MAIN RESULTS

There were 15 RCTs (n = 7161 participants) meeting our inclusion criteria. All the included studies were at high risk of bias mostly due to lack of blinding and imbalance in baseline characteristics of participants. The studies recruited pregnant women from prenatal care facilities who had periodontitis (14 studies) or gingivitis (1 study).The two main comparisons were: periodontal treatment versus no treatment during pregnancy and periodontal treatment versus alternative periodontal treatment. The head-to-head comparison between periodontal treatments assessed a more intensive treatment versus a less intensive one.Eleven studies compared periodontal treatment with no treatment during pregnancy. The meta-analysis shows no clear difference in preterm birth < 37 weeks (RR 0.87, 95% CI 0.70 to 1.10; 5671 participants; 11 studies; low-quality evidence) between periodontal treatment and no treatment. There is low-quality evidence that periodontal treatment may reduce low birth weight < 2500 g (9.70% with periodontal treatment versus 12.60% without treatment; RR 0.67, 95% CI 0.48 to 0.95; 3470 participants; 7 studies).It is unclear whether periodontal treatment leads to a difference in preterm birth < 35 weeks (RR 1.19, 95% CI 0.81 to 1.76; 2557 participants; 2 studies; ) and < 32 weeks (RR 1.35, 95% CI 0.78 to 2.32; 2755 participants; 3 studies), low birth weight < 1500 g (RR 0.80, 95% CI 0.38 to 1.70; 2550 participants; 2 studies), perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth) (RR 0.85, 95% CI 0.51 to 1.43; 5320 participants; 7 studies; very low-quality evidence), and pre-eclampsia (RR 1.10, 95% CI 0.74 to 1.62; 2946 participants; 3 studies; very low-quality evidence). There is no evidence of a difference in small for gestational age (RR 0.97, 95% CI 0.81 to 1.16; 3610 participants; 3 studies; low-quality evidence) when periodontal treatment is compared with no treatment.Four studies compared periodontal treatment with alternative periodontal treatment. Data pooling was not possible due to clinical heterogeneity. The outcomes reported were preterm birth < 37 weeks, preterm birth < 35 weeks, birth weight < 2500 g, birth weight < 1500 g and perinatal mortality (very low-quality evidence). It is unclear whether there is a difference in < 37 weeks, preterm birth < 35 weeks, birth weight < 2500 g, birth weight < 1500 g and perinatal mortality when different periodontal treatments are compared because the quality of evidence is very low.Maternal mortality and adverse effects of the intervention did not occur in any of the studies that reported on either of the outcomes.

AUTHORS' CONCLUSIONS

It is not clear if periodontal treatment during pregnancy has an impact on preterm birth (low-quality evidence). There is low-quality evidence that periodontal treatment may reduce low birth weight (< 2500 g), however, our confidence in the effect estimate is limited. There is insufficient evidence to determine which periodontal treatment is better in preventing adverse obstetric outcomes. Future research should aim to report periodontal outcomes alongside obstetric outcomes.

Influence of obesity on the outcome of non-surgical periodontal therapy - a systematic review

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.

The effects of periodontal treatment on pregnancy outcomes

BACKGROUND

Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity.

AIM

To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight.

METHODS

Search of databases including PubMed, ISI Web of Science and Cochrane Library.

RESULTS

The single RCT identified showed no significant effect of periodontal treatment on birth outcomes.

DISCUSSION

All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials--also judged to be high-quality and at low risk of bias--have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes.

CONCLUSION

Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.

The effects of periodontal treatment on pregnancy outcomes

BACKGROUND

Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity.

AIM

To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight.

METHODS

Search of databases including PubMed, ISI Web of Science and Cochrane Library.

RESULTS

The single RCT identified showed no significant effect of periodontal treatment on birth outcomes.

DISCUSSION

All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials - also judged to be high-quality and at low risk of bias - have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes.

CONCLUSION

Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.

Comparative Evaluation of Oral Health Knowledge, Practices and Attitude of Pregnant and Non-Pregnant Women, and Their Awareness Regarding Adverse Pregnancy Outcomes

BACKGROUND

Adverse pregnancy outcomes are undesirable events occurring during pregnancy and childbirth in mother or child, such as Preterm Low Birth Weight (PLBW) and preeclampsia. There is growing evidence that periodontitis may be a risk factor for preterm birth even after adjusting for known risk factors.

AIM

1. To determine the knowledge and attitude of pregnant females about oral health. 2. To evaluate the oral hygiene practices of pregnant females. 3. To evaluate their awareness regarding effect of oral health on adverse pregnancy outcomes. 4. To assess whether there was any significant difference from their non pregnant counter parts. 5. To evaluate whether their awareness towards dental treatment had increased after conceiving.

MATERIALS AND METHODS

200 pregnant and 200 non-pregnant women filled up a validated questionnaire which comprised of questions on personal data, oral hygiene knowledge, attitude, oral hygiene practices and their awareness regarding the correlation of oral health to adverse pregnancy outcomes.

STATISTICAL ANALYSIS

Analyses were conducted using SPSS for Windows (version 15.0; SPSS Inc., Chicago, IL, USA).

RESULTS

The results indicate no statistically significant differences in the variables assessed in both the groups, indicating that no further knowledge had been imparted to the women after they conceived. 96% women of both groups (p>0.05) had received no knowledge from the gynaecologist regarding the impact of oral health on pregnancy outcomes. 93.9% of pregnant women, and 89.5% of non pregnant women (p>0.05) did not go for routine dental check-ups. Only 3% of pregnant women were aware of oral health having a correlation with adverse pregnancy outcomes.

CONCLUSION

In our study, pregnancy did little to change future attitudes to dental care. To provide better oral health care, more knowledge needs to be made available to the pregnant women and the medical community.

Relationship Among Mothers' Glycemic Level, Periodontitis, and Birth Weight

BACKGROUND

The aim of this study is to determine the influence of glycemic level on the relationship between periodontitis and low birth weight (LBW).

METHODS

A case-control study was conducted with 372 females divided into cases (109 mothers of newborns with birth weight < 2,500 g) and controls (263 mothers of newborns with birth weight ≥ 2,500 g). The birth weight of children was obtained from medical records, whereas information on sociodemographic, lifestyle, and health characteristics of the participants was obtained through an interview. Glycated hemoglobin (HbA1c) levels were measured, and probing depth, clinical attachment levels, and bleeding on probing were used to determine the periodontal status. Results were analyzed using logistic regression.

RESULTS

The likelihood of having children with LBW among the mothers with periodontitis was six times greater than that observed among mothers without periodontitis (adjusted odds ratio [OR adjusted] = 6.02, 95% confidence interval [CI] = 2.47 to 15.17), even after adjustment. There was also a strong, statistically significant relationship between periodontitis and LBW in both the normal glycemic-level group (HbA1c levels < 5.6%, unadjusted odds ratio [OR unadjusted] = 8.30, 95% CI = 3.56 to 19.35) and the high glycemic-level group (HbA1c levels ≥ 5.6% and < 6.5%, OR unadjusted = 5.73, 95% CI = 1.75 to 18.70). After adjustment for confounders, the magnitude of the association continued to be strong in the normal glycemic-level group (OR adjusted = 7.59, 95% CI = 2.7 to 24.28), an increase of 25% when compared to the main association measurement. In those with high glycemic levels (OR adjusted = 4.03, 95% CI = 0.81 to 19.96), the OR decreased almost 50%, and the association lost statistical significance.

CONCLUSION

Periodontitis and glycemic levels appeared to have opposing influences on birth weight, with periodontitis being associated with LBW and the magnitude of the association being altered depending on maternal blood glucose level.

Periodontal treatment for preventing adverse pregnancy outcomes: a meta- and trial sequential analysis

OBJECTIVES

Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis.

METHODS

An existing systematic review was updated and meta-analyses performed. Risk of bias, heterogeneity, and publication bias were evaluated, and meta-regression performed. Subgroup analysis was used to compare different studies with low and high risk of bias and different populations, i.e., risk groups. Trial sequential analysis was used to assess risk of random errors.

RESULTS

Thirteen randomized clinical trials evaluating 6283 pregnant women were meta-analyzed. Four and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant effect on preterm birth (odds ratio [95% confidence interval] 0.79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (< 20%) of preterm birth or low birth weight, periodontal treatment was not efficacious for any of the outcomes, and trial sequential analyses indicated that further trials might be futile. For populations with high occurrence (≥ 20%) of preterm birth and low birth weight, periodontal treatment seemed to reduce the risk of preterm birth (0.42 [0.24-0.73]) and low birth weight (0.32 [0.15-0.67]), but trial sequential analyses showed that firm evidence was not reached. Periodontal treatment did not significantly affect perinatal mortality, and firm evidence was not reached. Risk of bias, but not publication bias or patients' age modified the effect estimates.

CONCLUSIONS

Providing periodontal treatment to pregnant women could potentially reduce the risks of perinatal outcomes, especially in mothers with high risks. Conclusive evidence could not be reached due to risks of bias, risks of random errors, and unclear effects of confounding. Further randomized clinical trials are required.

Effect of maternal periodontitis and low birth weight--a case control study

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.

Fusobacterium nucleatum: a commensal-turned pathogen

Fusobacterium nucleatum is an anaerobic oral commensal and a periodontal pathogen associated with a wide spectrum of human diseases. This article reviews its implication in adverse pregnancy outcomes (chorioamnionitis, preterm birth, stillbirth, neonatal sepsis, preeclampsia), GI disorders (colorectal cancer, inflammatory bowel disease, appendicitis), cardiovascular disease, rheumatoid arthritis, respiratory tract infections, Lemierre's syndrome and Alzheimer's disease. The virulence mechanisms involved in the diseases are discussed, with emphasis on its colonization, systemic dissemination, and induction of host inflammatory and tumorigenic responses. The FadA adhesin/invasin conserved in F. nucleatum is a key virulence factor and a potential diagnostic marker for F. nucleatum-associated diseases.

Microorganisms in the female genital tract during pregnancy: tolerance versus pathogenesis

Microorganisms in the pregnant female genital tract are not always associated with pathology. The factors that influence the maternal response to microorganisms remain ill defined. We review the state of knowledge of microbe-host interactions in gestational tissues and highlight mechanisms that promote tolerance or pathogenesis. Tolerance to microorganisms is promoted during pregnancy by several mechanisms including upregulation of anti-inflammatory mediators, induction of endotoxin tolerance, and possibly by regulation of autophagy. Conversely, an altered vaginal microbiota or a pre-existing viral presence may result in induction of excessive inflammation and preterm labor. Although infections play a prevalent role in preterm birth, microbes are present in gestational tissues of women with healthy outcomes and may provide beneficial functions. The complex interactions between different microbial species and the maternal immune system during gestation remain incompletely elucidated.

The routine utilization of dental care during pregnancy in eastern China and the key underlying factors: a Hangzhou City study

OBJECTIVES

Oral diseases are associated with adverse pregnancy outcomes. The routine utilization of dental care (RUDC) during pregnancy is an effective way to improve pregnant women's oral health, and thus safeguard the health of their babies. As China has one fifth of the world's population, it is especially meaningful to encourage RUDC there. However, the status of RUDC in China and the key underlying factors are largely unknown.

METHODS

This cross-sectional survey investigated the current status of RUDC during pregnancy and the key underlying factors in Hangzhou City, Zhejiang Province, eastern China. We collected participants' demographics, individual oral-hygiene behaviors, individual lifestyle, oral-health conditions and attitudes, and also their RUDC during pregnancy. Binary Logistic Regression Analysis was used to analyze the key underlying factors.

RESULTS

Only 16.70% of the participants reported RUDC during pregnancy. The percentage of RUDC was significantly lower among pregnant women with the following characteristics: aged 30 or less, an annual household income under $8,000, brushing once a day or less, never flossing or rinsing the mouth, paying no attention to pregnancy-related oral-health knowledge, and being dissatisfied with one's individual dental hygiene behavior.

CONCLUSIONS

RUDC during pregnancy is very low in eastern China and is greatly influenced not only by a woman's age, annual income, individual hygiene behavior, but also by her attention and attitudes to oral health. To improve this population's access to and use of dental care during pregnancy, appropriate programs and policies are urgently needed.

Association of a common genetic factor, PTGER3, with outcome of periodontal therapy and preterm birth

BACKGROUND

Clinical evidence suggests an association between preterm birth and periodontal disease. This study explores whether specific genetic polymorphisms are associated with success of periodontal therapy in pregnant women with periodontal disease and, further, whether any of these same polymorphisms are also associated with spontaneous preterm birth (sPTB).

METHODS

One hundred sixty high-risk pregnant women (6 to 20 weeks of gestation) with periodontal disease (≥ 3 sites with attachment loss ≥ 4 mm) were studied. All women received scaling and root planing plus oral hygiene instruction. Periodontal examinations were performed before treatment and 20 weeks later. Participants were classified according to two study outcomes: 1) success or failure of periodontal treatment; and 2) presence or absence of sPTB. Maternal DNA samples from mucosal swabs were characterized using a 1536-SNP (single-nucleotide polymorphism) custom polymerase chain reaction chip. A probabilistic model of each dichotomous outcome, derived using a stepwise Bayesian procedure, was compared to respective null hypotheses on the basis of Monte Carlo simulations and significance estimates obtained using three measures (z-test, Welch t-test, and probability convolution). The models were further confirmed by logistic regression analyses.

RESULTS

The models revealed a significant relation between a specific polymorphism of prostaglandin E receptor 3 (a gene associated with inflammatory response) and both periodontal treatment failure (odds ratio 11.09, P <0.0002) and sPTB (odds ratio 6.89, P < 0.0032).

CONCLUSIONS

These results demonstrate that the risk of unsuccessful periodontal treatment is associated with tag SNPs in specific genes that regulate the inflammatory response, one of which is also associated with sPTB.

Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: a systematic review

OBJECTIVE

To confirm effectiveness of nonsurgical periodontal treatment during pregnancy on pregnancy outcome in terms of preterm birth and low birth weight (LBW).

METHOD

We searched for Randomized controlled trials in MEDLINE, CINAHL and EMBASE. from January 2000 to October 2012. References of included studies were hand searched. Studies which measured incidence of either preterm labor (PTL), LBW or both were included. Information on study design, population, risk of bias, periodontal parameters, time and type of periodontal treatment given and pregnancy outcome were abstracted independently by three reviewers.

RESULTS

Total thirteen studies were included. Five studies had low risk of bias. Conclusive results could not be obtained for incidence of PTL or LBW because of heterogeneity in results due to various reasons, but all studies which assessed PTL and LBW combined showed significant difference in incidence of same in group which received non surgical periodontal treatment.

CONCLUSION

Our study suggests that treatment of periodontitis during gestation improves pregnancy outcome in terms of PTLBW, a fact which may be used for health and economical benefits but better RCTs with adequate sample size are required for conclusive evidence.

Intrapregnancy non-surgical periodontal treatment and pregnancy outcome: a randomized controlled trial

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.

Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis

The events leading to preterm birth are still not completely understood. A quantitative systematic review was performed to estimate the effects of periodontal care during pregnancy on preventing preterm birth and low birth weight. The meta-analysis included randomized trials with pregnant women with a diagnosis of periodontal disease before 20 weeks of gestation. Relative risk (RR) with 95% confidence intervals (95%CI) was calculated. We evaluated the reduction in preterm and low birth weight. Thirteen trials were included, comparing 3,576 women in intervention groups with 3,412 women receiving usual care. The meta-analysis of the effects of periodontal disease treatment during pregnancy indicated a non-significant reduction in preterm births (RR = 0.90; 95%CI: 0.68-1.19) and low birth weights (RR = 0.92; 95%CI: 0.71-1.20). The creation and examination of a funnel plot revealed clear evidence of publication bias. In summary, primary periodontal care during pregnancy cannot be considered an efficient way of reducing the incidence of preterm birth.

[Interest of periodontitis screening and treatment in pregnancy: systematic review]

For 15 years, the investigation of a relationship between periodontal diseases and complications of pregnancy is explored, and allowed the publication of conflicting results. This work is a literature review of articles of high level of evidence, which aims to clarify the impact of treatment of periodontal disease on pregnancy. Among the 15 selected randomized controlled trials (RCT), nine concluded a significant reduction in pregnancy complications between the "experimental" group treated and "control" group. However, six other RCT concluded that the lack of a significant difference between the two groups has higher levels and a more robust methodology. In 2006, a RCT, published in an influent medical journal, announced that there would be no significant benefit to treat pregnant women to reduce the complications of pregnancy. The contradictions found in the different studies have led some authors of meta-analysis to allocate the RCT per groups of power, based on their methodology. Meta-analysis using this methodology concluded that there is no benefit for periodontal treatment to reduce complications of pregnancy. In conclusion, the next RCT conducted should standardize their methodological criteria, and preferably multicenter, including a large number of participants. In addition, a more precise definition of periodontal diseases for the purpose of research is necessary. Finally, the notion of success or failure of periodontal treatment must be considered.

Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes

In the last 2 decades, a large proportion of studies have focused on the relationship between maternal periodontal disease and poor obstetric outcomes. The aim of the present review is to summarize the current knowledge about human studies on the pathogenetic mechanisms linking periodontal diseases with adverse pregnancy outcomes. A search of the medical literature was conducted using NIH (National Institute of Health) Pubmed through April 2011. Articles were identified with the Medical Subject Heading (MeSH) and free text terms "small for gestational age (SGA)," "preeclampsia," "preterm labor," and "periodontal disease." Experimental human studies have shown that periodontal pathogens may disseminate toward placental and fetal tissues accompanied by an increase in inflammatory mediators in the placenta. As such, new inflammatory reactions within the placental tissues of the pregnant woman may occur, the physiological levels of prostaglandin E(2) (PGE(2)) and tumor necrosis factor-α (TNF-α) in the amniotic fluid may increase and eventually lead to premature delivery. Although many data from clinical trials suggest that periodontal disease may increase the adverse pregnancy outcome, the exact pathogenetic mechanism involved remains controversial. The findings explain the potential link between periodontal infections and adverse pregnancy outcomes. First, periodontal bacteria can directly cause infections both of the uteroplacenta and the fetus; second, systemic inflammatory changes induced by periodontal diseases can activate responses at the maternal-fetal interface. Of note, associative studies have produced different results in different population groups and no conclusive evidence has still been produced for the potential role of preventive periodontal care to reduce the risk factors of preterm birth.

Interaction between Chronic Inflammation and Oral HPV Infection in the Etiology of Head and Neck Cancers

Incidences of oral tongue, base of the tongue, and tonsil cancers have been increasing steadily in many parts of the world in spite of declining rates of tobacco use over the last four decades. A better understanding of the etiology, interactions between risk factors, and new approaches to prevention and treatment are necessary to change this course. This paper will present evidence supporting a potential role of chronic inflammation in the etiologies of oral human papillomavirus infection and head and neck squamous cell carcinoma, and it will discuss the implications for prevention and treatment.

Use of alcohol-free antimicrobial mouth rinse is associated with decreased incidence of preterm birth in a high-risk population

OBJECTIVE

We sought to determine if treatment of periodontal disease during pregnancy with an alcohol-free antimicrobial mouth rinse containing cetylpyridinium chloride impacts the incidence of preterm birth (PTB) in a high-risk population.

STUDY DESIGN

This single-blind clinical trial studied pregnant women (6-20 weeks' gestation) with periodontal disease who refused dental care. Subjects receiving mouth rinse were compared to designated controls who did not receive rinse (1 rinse:2 controls), balanced on prior PTB and smoking. Primary outcome was PTB <35 weeks.

RESULTS

In all, 226 women were included in the analysis (71 mouth rinse subjects, 155 controls). Incidence of PTB <35 weeks was lower in the rinse group compared to controls (5.6% and 21.9% respectively, P < .01); relative risk was 0.26 (95% confidence interval, 0.096-0.70). Gestational age and birthweight were significantly higher in the rinse group (P < .01).

CONCLUSION

A nonalcohol antimicrobial mouth rinse containing cetylpyridinium chloride was associated with decreased incidence of PTB <35 weeks.

Periodontal disease in pregnancy: review of the evidence and prevention strategies

This article reviews the current research on periodontal disease and treatment and its potential impact on maternal and newborn outcomes and provides recommendations for care management and prevention. These guidelines will be helpful for nurse professionals who are in a unique position to counsel pregnant women to improve the oral health of expectant mothers.

Periodontal treatment during pregnancy and birth outcomes: a meta-analysis of randomised trials

OBJECTIVE

The objective of this review was to conduct a meta-analysis of all up-to-date randomised control trials to determine whether periodontal treatment during pregnancy has the potential of reducing preterm birth and low birth weight incidence.

METHODS

Bibliographic databases MEDLINE (1966-present), EMBASE (1980-present), CINAHL (1982-present) and the Cochrane library up to and including 2010 Issue 10 were searched. The reference list of included studies and reviews were also searched for additional literature. Eligible studies were, published and ongoing randomised control trials that compared pregnancy outcomes for pregnant women who received periodontal treatment during the prenatal period. Two of the investigators independently assessed the studies and then extracted and summarised data from eligible trials. Extracted data were entered into Review Manager software and analysed.

RESULTS

A total of 5645 pregnant women participated in the 10 eligible trials. Meta-analysis found that periodontal treatment significantly lowered preterm birth (odd ratio 0.65; 95% confidence interval, 0.45-0.93; P = 0.02) and low birth weight (odd ratio 0.53; 95% confidence interval, 0.31-0.92; P = 0.02) rates while no significant difference was found for spontaneous abortion/stillbirth (odd ratio 0.71; 95% confidence interval, 0.43-1.16; P = 0.17). Moderate heterogeneity was observed among the studies for preterm birth and low birth weight. Subgroup analysis showed significant effect of periodontal treatment in pregnant women with low rate of previous preterm birth/low birth weight (odd ratio 0.35; 95% confidence interval, 017-0.70; P = 0.003) and less severe periodontal disease (odd ratio 0.49; confidence interval, 028-0.87; P = 0.01) as defined by probing depth.

CONCLUSION

The cumulative evidence suggests that periodontal treatment during pregnancy may reduce preterm birth and low birth weight incidence. However, these findings need to be further validated through larger more targeted randomised control trials.

Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy?

Several large randomized controlled clinical trials failed to find that standard periodontal therapy during pregnancy reduces the incidence of adverse pregnancy outcomes (eg, preterm birth and low birthweight). However, treating periodontal disease during pregnancy may be too late to reduce the inflammation that is related to the adverse pregnancy outcomes. Moreover, periodontal treatment during pregnancy can cause bacteremia, which itself may initiate the pathway leading to the adverse pregnancy outcomes. Finally, the periodontal treatments provided during pregnancy are not always effective in preventing the progression of periodontal disease during pregnancy. Pregnancy may not be an appropriate period for periodontal intervention(s). We hypothesize that periodontal treatment before pregnancy may reduce the rates of adverse pregnancy outcomes. Future randomized controlled trials are needed to test if treating periodontal disease in the prepregnancy period reduces the rate of adverse pregnancy outcomes.

Evidence grade associating periodontitis with preterm birth and/or low birth weight: II: a systematic review of randomized trials evaluating the effects of periodontal treatment

AIM

The aim of this systematic review was to evaluate whether maternal periodontal disease treatment (MPDT) can reduce the incidence of preterm birth (PB) and/or low birth weight (LBW).

METHODS

The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched for entries up to October 2010 without restrictions regarding the language of publication. Only randomized-controlled clinical trials (RCTs) that evaluated the effect of MPDT on birth term and birth weight were included. The search was conducted by two independent reviewers and random-effects meta-analyses were conducted methodically.

RESULTS

Thirteen RCTs provided data, but only five trials were considered to be at a low risk of bias. The results of eight studies (61.5%) showed that MPDT may reduce the incidence of PB and/or LBW. However, the results of all meta-analyses showed contrasting results for PB [RR: 0.88 (95% CI: 0.72, 1.09)], LBW [RR: 0.78 (95% CI: 0.53, 1.17)] and PB/LBW [RR: 0.52 (95% CI: 0.08, 3.31)].

CONCLUSION

The results of this review show that MPDT did not decrease the risk of PB and/or LBW; however, the influence of specific aspects that were not investigated (disease diagnosis, extension and severity and the success of MPDT) should be evaluated by future RCTs.

Comparison of different tissue-derived stem cell sheets for periodontal regeneration in a canine 1-wall defect model

Cytotherapeutic approaches have been investigated to overcome the limitations of existing procedures for periodontal regeneration. In this study, cell sheet transplantation was performed using three kinds of mesenchymal tissue (periodontal ligament, alveolar periosteum, and bone marrow)-derived cells to compare the differences between cell sources in a canine severe defect model (one-wall intrabony defect). Periodontal ligament cells (PDLCs), iliac bone marrow mesenchymal stromal cells (BMMSCs), and alveolar periosteal cells (APCs) were obtained from each dog; a total of four dogs were used. Three-layered cell sheets of each cell source supported with woven polyglycolic acid were autologously transplanted to the denuded root surface. One-wall intrabony defects were filled with a mixture of β-tricalcium phosphate (β-TCP) and collagen. Eight weeks after the transplantation, periodontal regeneration was significantly observed with both newly formed cementum and well-oriented PDL fibers more in the PDLC group than in the other groups. In addition, nerve filament was observed in the regenerated PDL tissue only in the PDLC group. The amount of alveolar bone regeneration was highest in the PDLC group, although it did not reach statistical significance among the groups. These results indicate that PDLC sheets combined with β-TCP/collagen scaffold serve as a promising tool for periodontal regeneration.

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.

Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis

OBJECTIVE

To examine whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Cochrane Central Trials Registry, ISI Web of Science, Medline, and reference lists of relevant studies to July 2010; hand searches in key journals.

STUDY SELECTION

Randomised controlled trials including pregnant women with documented periodontal disease randomised to either treatment with scaling and root planing or no treatment.

DATA EXTRACTION

Data were extracted by two independent investigators, and a consensus was reached with the involvement a third. Methodological quality of the studies was assessed with the Cochrane's risk of bias tool, and trials were considered either high or low quality. The primary outcome was preterm birth (<37 weeks). Secondary outcomes were low birthweight infants (<2500 g), spontaneous abortions/stillbirths, and overall adverse pregnancy outcome (preterm birth <37 weeks and spontaneous abortions/stillbirths).

RESULTS

11 trials (with 6558 women) were included. Five trials were considered to be of high methodological quality (low risk of bias), whereas the rest were low quality (high or unclear risk of bias). Results among low and high quality trials were consistently diverse; low quality trials supported a beneficial effect of treatment, and high quality trials provided clear evidence that no such effect exists. Among high quality studies, treatment had no significant effect on the overall rate of preterm birth (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15). Furthermore, treatment did not reduce the rate of low birthweight infants (odds ratio 1.07, 0.85 to 1.36; P=0.55), spontaneous abortions/stillbirths (0.79, 0.51 to 1.22; P=0.28), or overall adverse pregnancy outcome (preterm births <37 weeks and spontaneous abortions/stillbirths) (1.09, 0.91 to 1.30; P=0.34).

CONCLUSION

Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.