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Meriç P, Silbereisen A, Emingil G, Öztürk VÖ, Bostanci N. Clinical, oral immunological and microbiological shifts during and after pregnancy. Clin Oral Investig 2023; 28:60. [PMID: 38157038 PMCID: PMC10756889 DOI: 10.1007/s00784-023-05408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Physiological changes and shifts in the oral microbiota composition during pregnancy may affect the maternal immune system. Uncomplicated pregnancy is associated with a T-helper (Th) 2 predominant cytokine regulation (anti-inflammatory), while oral health deterioration during pregnancy is reflected by severe gingival inflammation, a primarily Th1 cytokine phenotype (pro-inflammatory), and oral microbiome alterations. This prospective observational study aimed to evaluate Th cytokine shifts and changes in the oral microbiota composition in saliva of women before and after birth. MATERIAL AND METHODS Saliva (n = 96) was collected before and 6 months after birth, and medical, oral health, and periodontal status were assessed. In a multiplex immunoassay, 10 cytokines were simultaneously analyzed and cumulative Th1 and Th2 cytokine levels and Th1/Th2 ratio were calculated for all groups. Putative periodontal pathogens (n = 6) were evaluated by quantitative real-time polymerase chain reaction. RESULTS Th2 cytokine levels were significantly lower (p = 0.014) while pro-inflammatory cytokine levels were significantly higher (p < 0.01) during pregnancy than postpartum. Similar Th1 levels were found between the groups (p = 0.143). Th1 and Th2 cytokines positively correlated with periodontal parameters (p < 0.001) and levels of studied bacteria during pregnancy (p < 0.05). CONCLUSIONS This study identified a significantly increased Th1/Th2 cytokine ratio during pregnancy and a positive association with putative periodontal pathogens. This immunological and microbiological deregulation in the oral milieu during pregnancy is suggestive of a destructive inflammatory periodontal profile. STUDY REGISTRATION Clinical Trials.gov (Record BAP-2015). CLINICAL RELEVANCE Understanding altered oral immunological and microbiological regulation patterns during pregnancy may help improve the inflammatory periodontal profile in pregnant women.
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Affiliation(s)
- Pınar Meriç
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Angelika Silbereisen
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 14104, Stockholm, Sweden
| | - Gülnur Emingil
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Veli-Özgen Öztürk
- Department of Periodontology, School of Dentistry, Adnan Menderes University, Aydın, Turkey
| | - Nagihan Bostanci
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 14104, Stockholm, Sweden.
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2
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AlSharief M, Alabdurubalnabi E. Periodontal Pathogens and Adverse Pregnancy Outcomes: A Narrative Review. Life (Basel) 2023; 13:1559. [PMID: 37511934 PMCID: PMC10381683 DOI: 10.3390/life13071559] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Periodontal disease is a multi-microbial infection of the teeth-supporting apparatus that manifests as clinical attachment loss and alveolar bone loss. The association between periodontal disease and systemic diseases has been proposed in the literature owing to the former's chronic state of inflammation, and adverse pregnancy outcomes are no exception. As a result of periodontal pathogen invasion, a series of systemic inflammatory and immunologic events affecting the safety of the fetoplacental unit may unfold. This may be further exaggerated by physiologic hormonal and metabolic fluctuations during pregnancy. This can not only negatively affect the gestation period and consequently cause preterm low weight but also complicate the pregnancy via preeclampsia and gestational diabetes. This narrative review article aims to provide a summary of relevant available evidence pertinent to the relationship between periodontal diseases, associated periodontal pathogens and virulence mechanisms mediated by pro-inflammatory cytokines and prostaglandins, and adverse pregnancy outcomes. Furthermore, this article highlights some of the literature addressing the impact of periodontal therapy interventions and pregnancy outcomes.
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Affiliation(s)
- Mishali AlSharief
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Esraa Alabdurubalnabi
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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3
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Gain a Baby Lose a Tooth-Is There an Association between Periodontitis and Preterm Birth? J Clin Med 2022; 11:jcm11237183. [PMID: 36498757 PMCID: PMC9739114 DOI: 10.3390/jcm11237183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Sinha A, Singh N, Gupta A, Bhargava T, P. C. M, Kumar P. Relationship Between the Periodontal Status of Pregnant Women and the Incidence and Severity of Pre-term and/or Low Birth Weight Deliveries: A Retrospective Observational Case-Control Study. Cureus 2022. [DOI: 10.7759/cureus.31735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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5
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Teraoka Y, Sugimoto J, Konishi H, Miyoshi H, Furusho H, Miyauchi M, Kajioka S, Koh I, Kudo Y. Progesterone Suppresses Uterine Contraction by Reducing Odontogenic Porphyromonas gingivalis Induced Chronic Inflammation in Mice. Biomolecules 2022; 12:biom12081029. [PMID: 35892338 PMCID: PMC9332501 DOI: 10.3390/biom12081029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
Preterm birth is one of the most significant obstetric complications. Inflammation reportedly promotes uterine contraction and weakening of the fetal membrane, which induces preterm birth. Previous studies using animal models of lipopolysaccharide-induced acute inflammation have shown that progesterone (P4) promotes uterine quiescence. However, this effect is not fully understood in chronic inflammation. This study aimed to investigate the effects of P4 on uterine contractility and inflammation of the fetal membrane in mice infected with Porphyromonas gingivalis (P.g.), a major periodontal pathogen as a model of preterm birth caused by chronic inflammation. Mice were injected with 1 mg of P4 from day 15.5 to 17.5. P4 prolonged the mean gestation period of P.g mice from 18.3 to 20.4 days, and no reduction in the gestation period was observed. P4 treatment suppressed spontaneous uterine contractility and decreased oxytocin sensitivity. In addition, the expression of inflammatory cytokines in the fetal membrane was significantly reduced. Thus, P4 prevented preterm birth by suppressing enhanced uterine contractility induced by chronic inflammation in this model. This result describes the effects of P4 in a chronic inflammation model, which may lead to a better understanding of the efficacy of P4 in preventing preterm birth in humans.
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Affiliation(s)
- Yuko Teraoka
- Department of Obstetrics and Gynecology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (J.S.); (I.K.); (Y.K.)
- Correspondence:
| | - Jun Sugimoto
- Department of Obstetrics and Gynecology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (J.S.); (I.K.); (Y.K.)
| | - Haruhisa Konishi
- Department of Obstetrics and Gynecology, Miyoshi Central Hospital, Miyoshi 728-8502, Japan;
| | - Hiroshi Miyoshi
- Department of Obstetrics and Gynecology, Hiroshima Prefectural Hospital, Hiroshima 734-0004, Japan;
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (H.F.); (M.M.)
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (H.F.); (M.M.)
| | - Shunichi Kajioka
- Department of Pharmaceutical Sciences, School of Pharmacy at Fukuoka, International University of Health Welfare, Fukuoka 812-8582, Japan;
| | - Iemasa Koh
- Department of Obstetrics and Gynecology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (J.S.); (I.K.); (Y.K.)
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (J.S.); (I.K.); (Y.K.)
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6
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Lee YL, Hu HY, Chou SY, Lin CL, Cheng FS, Yu CY, Chu D. Periodontal disease and preterm delivery: a nationwide population-based cohort study of Taiwan. Sci Rep 2022; 12:3297. [PMID: 35228672 PMCID: PMC8885688 DOI: 10.1038/s41598-022-07425-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/17/2022] [Indexed: 12/30/2022] Open
Abstract
Preterm delivery of low-birth weight infants is considered a leading cause of morbidity and mortality among neonates. Various studies have reported a positive correlation between periodontal disease (PD) and premature birth (PB) and yet no population-based study has assessed the impact of PD severity and treatments on premature birth. This cohort study used Taiwan’s national medical records (1999–2012, included 1,757,774 pregnant women) to investigate the association between PD severity and PB. Women with PD during the 2-year period prior for giving birth were more likely to have PB (11.38%) than those without PD (10.56%; p < 0.001). After variables adjustment, the advanced PD group had OR of 1.09 (95% CI 1.07–1.11) for PB, the mild PD group had OR of 1.05 (95% CI 1.04–1.06), while no-PD group had OR of 1. Increased PD severity was related to higher risk of PB. When stratified by age, the highest ORs for PB were those aged from 31 to 35 years in both mild PD group (OR = 1.09, 95% CI 1.07–1.11) and advanced PD group (OR = 1.13, 95% CI 1.09–1.17). Improving periodontal health before or during pregnancy may prevent or reduce the occurrence of adverse pregnancy outcomes and therefore maternal and perinatal morbidity and mortality.
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Affiliation(s)
- Ya-Ling Lee
- Department of Dentistry, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., Taipei City, 10341, Taiwan, ROC. .,Department of Dentistry, School of Dentistry, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC. .,University of Taipei, Taipei, Taiwan, ROC.
| | - Hsiao-Yun Hu
- University of Taipei, Taipei, Taiwan, ROC.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan, ROC.,Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Sin-Yi Chou
- Department of Dentistry, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., Taipei City, 10341, Taiwan, ROC
| | - Chen-Li Lin
- Department of Obstetrics and Gynecology, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Chia-Yi Yu
- Department of Dentistry, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., Taipei City, 10341, Taiwan, ROC
| | - Dachen Chu
- Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Hospital and Health Care Administration, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC.,Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan, ROC
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7
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Choi SE, Choudhary A, Ahern JM, Palmer N, Barrow JR. Association between maternal periodontal disease and adverse pregnancy outcomes: an analysis of claims data. Fam Pract 2021; 38:718-723. [PMID: 34173655 DOI: 10.1093/fampra/cmab037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While a number of studies have explored the link between periodontal disease and adverse pregnancy outcomes, both epidemiological studies and intervention trials have reached contradictory results with relatively small sample sizes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. OBJECTIVE Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. METHODS Using de-identified claims data from a national commercial insurer in the USA, records of all observed pregnancies from 2015 to 2019 were included in this retrospective cohort study. Adverse pregnancy outcomes, including low birthweight (LBW) of the newborn, preterm birth (PTB) and spontaneous abortion, were primary outcomes. To evaluate the association between periodontal disease and pregnancy outcomes, logistic mixed-effect model was estimated with periodontal disease status, age, existing clinical conditions of mothers and geographic location as covariates. RESULTS Out of 748 792 observed pregnancy records, 18.66% resulted in adverse pregnancy outcomes; 5.92% in LBW, 14.46% in PTB and 2.22 % in spontaneous abortion. Adjusting for individual-level risk factors, periodontal disease was significantly associated with maternal complications with odds ratios of 1.19 (95% CI:1.15, 1.24) for any adverse pregnancy outcomes, 1.10 (95% CI:1.03, 1.17) for LBW, 1.15 (95% CI:1.10, 1.19) for PTB and 1.34 (95% CI:1.23, 1.46) for spontaneous abortions. CONCLUSIONS Maternal periodontal disease may be associated with an increased risk of maternal complications and neonatal morbidity. A timely diagnosis and treatment of periodontal disease during pregnancy should be encouraged by considering oral health as part of routine prenatal care.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, USA
| | - Abhishek Choudhary
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, USA
| | - John M Ahern
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, USA
| | - Nathan Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Jane R Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, USA
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8
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Fischer RG, Gomes Filho IS, Cruz SSD, Oliveira VB, Lira-Junior R, Scannapieco FA, Rego RO. What is the future of Periodontal Medicine? Braz Oral Res 2021; 35:e102. [PMID: 34586216 DOI: 10.1590/1807-3107bor-2021.vol35.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 01/14/2023] Open
Abstract
In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.
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Affiliation(s)
- Ricardo Guimarães Fischer
- Universidade do Estado do Rio de Janeiro - UERJ, Department of Periodontology, Rio de Janeiro, RJ, Brazil
| | - Isaac Suzart Gomes Filho
- Universidade Estadual de Feira de Santana - UEFS, Department of Health, Feira de Santana, BA, Brazil
| | - Simone Seixas da Cruz
- Universidade Federal do Recôncavo da Bahia - UFRB, Health Sciences Center, Santo Antônio de Jesus, BA, Brazil
| | - Victor Bento Oliveira
- Universidade Federal do Ceará - UFC, Faculty of Pharmacy, Dentistry and Nursing, Graduate Program in Dentistry, Fortaleza, CE, Brazil
| | | | - Frank Andrew Scannapieco
- The State University of New York, Univeristy at Buffalo, School of Dental Medicine, Department of Oral Biology, Buffalo, NY, USA
| | - Rodrigo Otávio Rego
- Universidade Federal do Ceará - UFC, School of Dentistry, Department of Dentistry, Sobral, CE, Brazil
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9
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Jang H, Patoine A, Wu TT, Castillo DA, Xiao J. Oral microflora and pregnancy: a systematic review and meta-analysis. Sci Rep 2021; 11:16870. [PMID: 34413437 PMCID: PMC8377136 DOI: 10.1038/s41598-021-96495-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.
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Affiliation(s)
- Hoonji Jang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Alexa Patoine
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, USA
| | - Daniel A Castillo
- Miner Library, University of Rochester Medical Center, Rochester, NY, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
- Perinatal Oral Health, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, 14620, USA.
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10
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Favero V, Bacci C, Volpato A, Bandiera M, Favero L, Zanette G. Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures. Dent J (Basel) 2021; 9:dj9040046. [PMID: 33921608 PMCID: PMC8072957 DOI: 10.3390/dj9040046] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.
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Affiliation(s)
- Vittorio Favero
- Unit of Maxillofacial Surgery and Dentistry, University of Verona, 37129 Verona, Italy;
| | - Christian Bacci
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Andrea Volpato
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
- Correspondence: or
| | - Michela Bandiera
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Lorenzo Favero
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Gastone Zanette
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
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11
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Uwambaye P, Munyanshongore C, Rulisa S, Shiau H, Nuhu A, Kerr MS. Assessing the association between periodontitis and premature birth: a case-control study. BMC Pregnancy Childbirth 2021; 21:204. [PMID: 33711951 PMCID: PMC7953642 DOI: 10.1186/s12884-021-03700-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Premature delivery is among the leading causes of perinatal mortality and morbidity in developed societies, which is an important obstetrics problem. Maternal periodontitis is a prevalent condition that has been suspected to be associated with adverse pregnancy outcomes such as premature birth. However, there are still conflicting results about this possible relationship, therefore this study was designed to test the association between maternal periodontitis and premature birth. This study also provides information about a new screening tool recommended for use by nurses and midwives to screen for periodontal diseases during antenatal consultations in order to improve the health of mothers and children. METHODS A retrospective case-control study was conducted at 12 health facilities in the Southern Province of Rwanda from February to August, 2018. A total of 555 women in the postpartum period were enrolled in the study. Cases and controls were enrolled in a ratio of 1:2; each enrolled case of preterm birth was followed by 2 unmatched control subjects that were next on the register and who delivered at term gestation. A total of 185 cases of preterm deliveries and 370 controls of term delivery were enrolled in the study. Multivariate regression analysis was used and the independent variables were hierarchically entered in three groups: The first group involved demographic variables that were put in the regression model as Step 1. The second group was made up of other potential risk factors that were placed in the regression model as the second step. Periodontitis was entered in the final regression step, as it was hypothesized as the main predictor variable. RESULTS A statistically significant association was found between periodontitis and premature birth. Women who had periodontitis had 6 times the odds of giving birth to premature birth infants compared to women who had no periodontitis (OR: 6.360, 95% CI 3.9, 10.4). CONCLUSION The study results indicate that periodontitis is strongly associated with premature birth. Preventive solutions including the use of a periodontitis screening tool for nurses and midwives during antenatal care consultations, are highly recommended.
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Affiliation(s)
- Peace Uwambaye
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine and Health Sciences, School of Dentistry, Kigali, Rwanda.
| | - Cyprien Munyanshongore
- Department of Community Health, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Stephen Rulisa
- Department of Obstetrics & Gynecology, University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Harlan Shiau
- Department of Periodontology, University of Maryland, College Park, USA
| | - Assuman Nuhu
- Department of Physiotherapy, University of Rwanda College of Medicine and Health Sciences, School of Health Sciences, Kigali, Rwanda
| | - Michael S Kerr
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
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12
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Jyotirmay, Kumar A, Gulati S, Kumari S, Nazeer J, Singh P. Association of maternal periodontal health with preterm birth and a low birth weight among newborns: A cross-sectional study. Natl J Maxillofac Surg 2021; 12:67-71. [PMID: 34188403 PMCID: PMC8191548 DOI: 10.4103/njms.njms_135_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/10/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite numerous advancements in prenatal and natal care, complications arising in pregnancy and related to child-birth are major concerns in public health. Various risk factors responsible for poor outcomes include - life-style, biological, social, infectious, hormonal, and metabolic conditions. Oral diseases have been identified as a risk factor for low birth weight both under preterm and at-term states. AIM The aim of this study was to find an association of maternal periodontal health with preterm births and low birth weight among newborn infants. MATERIALS AND METHODS This was a cross-sectional observational study comprising of 300 pregnant females who had underwent child deliveries within the past 24 h with an age range of 21-30 years. Study participants were selected after interviewing for gestational history and obtaining prior informed consent. Postpartum female subjects following delivery within a time period of 24 h were included in the study. Gingival index (by Loe and Silness) was calculated for the evaluation of bleeding from gingival tooth surfaces. All data tabulations were done by performing statistical analysis into Microsoft Excel Worksheet 2007. RESULTS Mean age group of study participants was calculated to be 25 years. On analyzing brushing frequency, it was observed that approximately 40% brushed three times daily whereas 35% used to brush twice daily while the remaining, 25% brushed only once daily. No statistical significance was obtained on comparing brushing frequency with gingival health (P = 0.8). Similarly, no association was found between periodontal health and preterm low weight child births. CONCLUSION This study found no association between maternal periodontal health and preterm and low-birth weight births among newborns.
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Affiliation(s)
- Jyotirmay
- Department of Orthodontics, Patna Dental College and Hospital, Patna, Bihar, India
| | - Amit Kumar
- Dental Officer, Sub Divisional Hospital, Forbesganj, Araria, Bihar, India
| | - Saakshi Gulati
- Department of Oral Medicine and Radiology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Stuti Kumari
- Department of Dentistry, SKMCH, Muzaffarpur, Bihar, India
| | - Jazib Nazeer
- Department of Oral Pathology and Microbiology, Patna Dental College and Hospital, Patna, Bihar, India
| | - Pankaj Singh
- Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
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Konishi H, Urabe S, Teraoka Y, Morishita Y, Koh I, Sugimoto J, Sakamoto S, Miyoshi H, Miyauchi M, Takata T, Kajioka S, Kudo Y. Porphyromonas gingivalis, a cause of preterm birth in mice, induces an inflammatory response in human amnion mesenchymal cells but not epithelial cells. Placenta 2020; 99:21-26. [PMID: 32738645 DOI: 10.1016/j.placenta.2020.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Inflammation and infection, including dental infectious diseases, are factors that can induce preterm birth. We previously reported that mice with dental Porphyromonas gingivalis infection could be used as a model of preterm birth. In this model, cyclooxygenase (COX)-2 and interleukin (IL)-1β levels are increased, and P. gingivalis colonies are observed in the fetal membrane. However, the mechanism underlying fetal membrane inflammation remains unknown. Therefore, we investigated the immune responses of human amnion to P. gingivalis in vitro. METHODS Epithelial and mesenchymal cells were isolated from human amnion using trypsin and collagenase, and primary cell cultures were obtained. Confluent cells were stimulated with P. gingivalis lipopolysaccharide (P.g-LPS) or P. gingivalis. mRNA expressions of IL-1β, IL-8, IL-6 and COX-2, protein expressions of nuclear factor (NF)-κB pathway components and culture medium levels of prostaglandin E2 were evaluated. RESULTS Following stimulation with 1 μg/mL P.g-LPS, the mRNA expression levels of IL-1β, IL-8, IL-6 and COX-2 in mesenchymal cells were increased 5.9-, 3.3-, 4.2- and 3.1-fold, respectively. Similarly, the expression levels of IL-1β, IL-8, IL-6 and COX-2 in mesenchymal cells were increased by 7.6-, 8.2-, 13.4- and 9.3-fold, respectively, after coculture with P. gingivalis. Additionally, stimulation with P.g-LPS or P. gingivalis resulted in the activation of NF-κB signaling and increased production of IL-1β and prostaglandin E2. In contrast, no significant changes were observed in epithelial cells. DISCUSSION Our findings suggest that mesenchymal cells might mediate the inflammatory responses to P. gingivalis and P.g-LPS, thereby producing inflammation that contributes to the induction of preterm birth.
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Affiliation(s)
- Haruhisa Konishi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Satoshi Urabe
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yuko Teraoka
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yoshito Morishita
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Iemasa Koh
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Jun Sugimoto
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shinnichi Sakamoto
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Hiroshi Miyoshi
- Department of Obstetrics and Gynecology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Tokuyama University, Yamaguchi, Japan.
| | - Shunichi Kajioka
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Beck JD, Papapanou PN, Philips KH, Offenbacher S. Periodontal Medicine: 100 Years of Progress. J Dent Res 2020; 98:1053-1062. [PMID: 31429666 DOI: 10.1177/0022034519846113] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research's Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the "first" of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease (n = 10), diabetes (n = 12), and adverse pregnancy outcomes (n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.
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Affiliation(s)
- J D Beck
- 1 Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - P N Papapanou
- 2 Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York City, NY, USA
| | - K H Philips
- 3 Department of Oral and Craniofacial Health Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - S Offenbacher
- 1 Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
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Golofast B, Vales K. The connection between microbiome and schizophrenia. Neurosci Biobehav Rev 2019; 108:712-731. [PMID: 31821833 DOI: 10.1016/j.neubiorev.2019.12.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022]
Abstract
There has been an accumulation of knowledge about the human microbiome, some detailed investigations of the gastrointestinal microbiota and its functions, and the highlighting of complex interactions between the gut, the gut microbiota, and the central nervous system. That assumes the involvement of the microbiome in the pathogenesis of various CNS diseases, including schizophrenia. Given this information and the fact, that the gut microbiota is sensitive to internal and environmental influences, we have speculated that among the factors that influence the formation and composition of gut microbiota during life, possible key elements in the schizophrenia development chain are hidden where gut microbiota is a linking component. This article aims to describe and understand the developmental relationships between intestinal microbiota and the risk of developing schizophrenia.
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Affiliation(s)
- Bogdana Golofast
- National Institute of Mental Health, Topolova 748, 250 67 Klecany, Prague East, Czech Republic; Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic.
| | - Karel Vales
- National Institute of Mental Health, Topolova 748, 250 67 Klecany, Prague East, Czech Republic
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Makeeva IM, Ignatko AA, Churganova AA, Lebedev VA, Makeeva MK. [Periodontal diseases and complicated pregnancy]. STOMATOLOGII︠A︡ 2019; 98:70-73. [PMID: 30830097 DOI: 10.17116/stomat20199801170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Based on the datas available in the modern literature, to conduct a study on the effect of dental diseases on the course of pregnancy and outcome; mainly, the impact of periodontal disease on the low birth weight of the newborn and premature birth. MATERIAL AND METHODS This article is based on the study of materials from foreign and domestic studies found in the databases Pubmed and Elibrary. Literature data were used for the last 15 years. RESULTS The majority of pregnant women who are not receiving due dental examination and suffering with those or other diseases of the oral cavity have an unfavorable outcome of pregnancy, including premature births and low weight of the premature newborn. The role of the chronic effect of oral microorganisms Porphyromonas gingivalis (P. gingivalis) and Fusobacterium nudeatum, as well as local increase in prostaglandin E2 (PGE2) and tumor necrosis factor (TNF-α), in the implementation of the inflammatory reaction leading to a decrease in the weight of the fetus by 15-18%. CONCLUSION Due to the conducted research it was established that periodontal diseases and other infectious diseases of the oral cavity negatively affect the course of pregnancy and its outcome. The main problems were the lack of women's health education in terms of preparing for pregnancy and sanitation of foci of infection in the oral cavity both before pregnancy and at the time, as well as poor access to the dentist and not receiving proper prevention and, if necessary, treatment of oral diseases.
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Affiliation(s)
- I M Makeeva
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A A Ignatko
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A A Churganova
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia
| | - V A Lebedev
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia
| | - M K Makeeva
- People Friendship University of Russia, Moscow, Russia
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Association of periodontal disease with depression and adverse birth outcomes: Results from the Perinatal database; Finger Lakes region, New York State. PLoS One 2019; 14:e0215440. [PMID: 30998794 PMCID: PMC6472778 DOI: 10.1371/journal.pone.0215440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Preterm and low birth weight infants are at greater risk for mortality and a variety of health and developmental problems. Data from the Finger Lakes Perinatal Data System database on 316,956 deliveries occurring between 2004–2014 and pregnancy outcomes were analyzed to assess the association of periodontal (gum) disease with depression, other maternal factors and adverse birth outcomes. Adjusted effects of periodontal disease and depression on adverse birth outcomes were estimated using multiple logistic regression models and path analysis. Having preterm delivery was associated significantly with depression (OR = 1.177; 95% CI: [1.146, 1.208]), having adequate health care (OR = 1.638; 95% CI: [1.589, 1.689]), smoking during pregnancy (OR = 1.259; 95% CI: [1.220, 1.300]), and being less educated (OR = 1.214; 95% CI: [1.174, 1.256]). Having low birth weight was significantly associated with depression (OR = 1.206; 95% CI: [1.170, 1.208]), smoking during pregnancy (OR = 1.855; 95% CI: [1.793, 1.919]), and being less educated (OR = 1.322; 95% CI: [1.275, 1.370]). Periodontal disease was significantly associated with alcohol use during pregnancy (OR = 1.314; 95% CI: [1.227, 1.407]) and white race (OR = 1.192; 95% CI: [1.167, 1.217]). Depression was significantly associated with periodontal disease (OR = 1.762; 95% CI: [1.727, 1.797]) and alcohol use during pregnancy (OR = 1.470; 95% CI: [1.377, 1.570]). We concluded that a positive association existed between depression during pregnancy and adverse birth outcomes, and that depression served as a mediator in the association of periodontal disease with adverse birth outcomes.
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Wanhong W, Changchang Y, Ping H. [Research progress on the relationship and mechanisms between periodontal disease and preterm birth and low-birth-weight infants]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 35:527-532. [PMID: 29188651 DOI: 10.7518/hxkq.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Preterm birth (PB) is defined as the birth of a baby less than 37 weeks of gestational age. Low birth weight (LBW) is defined as a newborn baby's weight of less than 2 500 g. PB is often accompanied by LBW. Preterm low birth weight (PLBW) is the leading cause of newborn deaths. Periodontal disease (PD) is a chronic oral infectious disease, and it is closely related with general health. Epidemiological data show that PD is a risk factor for PLBW and other adverse pregnancy outcomes. The possible mechanisms include the direct effects of periodontal bacteria, inflammatory reactions, and immune response; however, the exact pathogenetic mechanism involved remains controversial. This article aims to review the research progress on the relationship between PD and PLBW and their underlying mechanisms, as well as the effects of periodontal treatment on PLBW incidence.
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Affiliation(s)
- Wu Wanhong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ye Changchang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Huang Ping
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Mattera MSDLC, Chiba FY, Lopes FL, Tsosura TVS, Peres MA, Brito VGB, Oliveira SHP, Pereira RF, Marani F, dos Santos RM, Belardi BE, Tessarin GWL, Benites ML, Ervolino E, Heimann JC, Sumida DH. Effect of maternal periodontitis on GLUT4 and inflammatory pathway in adult offspring. J Periodontol 2019; 90:884-893. [DOI: 10.1002/jper.18-0568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Maria Sara de Lima Coutinho Mattera
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Fernando Yamamoto Chiba
- Department of Child and Social DentistrySchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | | | - Thaís Verônica Saori Tsosura
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Maria Angelica Peres
- Department of Internal MedicineLaboratory of Experimental Hypertension, School of Medicine, University of São Paulo São Paulo Brazil
| | - Victor Gustavo Balera Brito
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Sandra Helena Penha Oliveira
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Renato Felipe Pereira
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Fernando Marani
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Rodrigo Martins dos Santos
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Bianca Elvira Belardi
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Gestter Willian Lattari Tessarin
- Institute of BiosciencesSão Paulo State University (UNESP) Botucatu Brazil
- Department of Basic SciencesDivision of HistologyDental School of AracatubaUNESP‐Univ Estadual Paulista Araçatuba Brazil
| | - Mariana Lopes Benites
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
| | - Edilson Ervolino
- Institute of BiosciencesSão Paulo State University (UNESP) Botucatu Brazil
- Department of Basic SciencesDivision of HistologyDental School of AracatubaUNESP‐Univ Estadual Paulista Araçatuba Brazil
| | - Joel Claudio Heimann
- Department of Internal MedicineLaboratory of Experimental Hypertension, School of Medicine, University of São Paulo São Paulo Brazil
| | - Doris Hissako Sumida
- Multicenter Post‐Graduate Program in Physiological Sciences (SBFis)Department of Basic SciencesSchool of DentistrySão Paulo State University (UNESP) Araçatuba Brazil
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Soltani M, Tabatabaee HR, Saeidinejat S, Eslahi M, Yaghoobi H, Mazloumi E, Rajabi A, Ghasemi A, Keyghobadi N, Enayatrad M, Noori A, Hashemi SA, Zolfizadeh F, Mahdavi S, Valadbeigi T, Etemad K, Taghipour A, Salehnasab C, Hajipour M. Assessing the risk factors before pregnancy of preterm births in Iran: a population-based case-control study. BMC Pregnancy Childbirth 2019; 19:57. [PMID: 30727983 PMCID: PMC6364407 DOI: 10.1186/s12884-019-2183-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/08/2019] [Indexed: 12/04/2022] Open
Abstract
Background Preterm birth is a major cause of prenatal and postnatal mortality particularly in developing countries. This study investigated the maternal risk factors associated with the risk of preterm birth. Methods A population-based case-control study was conducted in several provinces of Iran on 2463 mothers referred to health care centers. Appropriate descriptive and analytical statistical methods were used to evaluate the association between maternal risk factors and the risk of preterm birth. All tests were two-sided, and P values < 0.05 were considered to be statistically significant. Results The mean gestational age was 31.5 ± 4.03 vs. 38.8 ± 1.06 weeks in the case and control groups, respectively. Multivariate regression analysis showed a statistically significant association between preterm birth and mother’s age and ethnicity. Women of Balooch ethnicity and age ≥ 35 years were significantly more likely to develop preterm birth (OR: 1.64; 95% CI: 1.01–-2.44 and OR: 9.72; 95% CI: 3.07–30.78, respectively). However, no statistically significant association was observed between preterm birth and mother’s place of residence, level of education, past history of cesarean section, and BMI. Conclusion Despite technological advances in the health care system, preterm birth still remains a major concern for health officials. Providing appropriate perinatal health care services as well as raising the awareness of pregnant women, especially for high-risk groups, can reduce the proportion of preventable preterm births.
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Affiliation(s)
- Maryam Soltani
- Razi Clinical Research Development Unit(RCRDU), Birjand University of Medical Sciences(BUMS), Birjand, Iran
| | - Hamid Reza Tabatabaee
- Research Center for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahin Saeidinejat
- Department of Health Education and Health Promotion, School of Health Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Eslahi
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Halime Yaghoobi
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ehsan Mazloumi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdolhalim Rajabi
- Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Ghasemi
- Birjand University of Medical Sciences, Birjand, Iran
| | - Naeimeh Keyghobadi
- Department of Biostatistics Epidemiology, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mostafa Enayatrad
- Epidemiology Department, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abed Noori
- Medical Education, Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Seyyed Aliasghar Hashemi
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Zolfizadeh
- Health Care Management, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sepideh Mahdavi
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Tannaz Valadbeigi
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Koorosh Etemad
- Department of Epidemiology, Environmental and Occupational Hazards Control Research Center, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Taghipour
- Health Sciences Research Centre, Cancer Research Center, Department of Biostatistics and Epidemiology, School of Health, Faculty of Mashhad University of Medical Sciences, Mashhad, Iran
| | - Cirruse Salehnasab
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mahmoud Hajipour
- Student Research Committee, Epidemiology Department, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Silva CBD, Mendes MM, Rodrigues BR, Pereira TL, Rodrigues DBR, Rodrigues Junior V, Ferriani VPL, Geraldo-Martins VR, Nogueira RD. Streptococcus mutans detection in saliva and colostrum samples. EINSTEIN-SAO PAULO 2019; 17:eAO4515. [PMID: 30726310 PMCID: PMC6438671 DOI: 10.31744/einstein_journal/2019ao4515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/17/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To detect Streptococcus mutans in colostrum and saliva of neonates and compare with its detection in saliva of mothers. Methods Forty-three healthy women, full-term gestations with no complications, submitted to elective Cesarean section, and their newborns were included in the study. Samples were investigated by polymerase chain reaction to detect S. mutans in genetic material from the samples. Results Approximately 16% of colostrum samples showed S. mutans , but not correlated with the presence of the bacteria in both samples of saliva. S. mutans was detected in 49 and 30% of saliva samples of mothers and neonates, respectively. There was a positive correlation in S. mutans detection between types of saliva. The number of maternal samples of saliva with detectable S. mutans was smaller in women receiving dental treatment during pregnancy. Tooth brushing, three times a day, influenced the detection of S. mutans in both the saliva and the colostrum. Conclusion Although maternal saliva may present S. mutans , few samples of colostrum present the bacteria. The presence of bacteria in neonate saliva may be related to contact before birth. Dental treatment and hygiene habits seem to influence the detection of S. mutans in samples of maternal saliva and colostrum.
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Affiliation(s)
| | | | | | | | | | | | - Virginia Paes Leme Ferriani
- Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Ruchele Dias Nogueira
- Universidade de Uberaba, Uberaba, MG, Brazil.,Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Preterm birth and oral infections interplay. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.24.2.2019.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
About one in two adults in the United States has periodontal disease. Chronic periodontitis is an oral disease affecting the supporting structures of the teeth leading to progressive loss of the attachment apparatus and bone around teeth. It is characterized by gingival pocket formation and/or gingival recession. The disease is initiated by bacteria and their components like lipopolysaccharide and causes a heightened host inflammatory response. This cascade of inflammatory response ultimately leads to an increased osteoclastic activity and bone loss. Individuals with periodontitis have increased systemic levels of acute phase proteins, plasma antibody levels, coagulation factor, total white blood cell count, neutrophils, C reactive protein (CRP), and cytokines such as INF- gamma (Interferon gamma), TNF-α (Tumor necrosis Factor- Alpha), IL (Interleukin)-1β, IL-2 and IL-6. As periodontitis works on the same chronic inflammation model seen in systemic diseases, there is sufficient evidence to suggest a bi-directional link between the two. This article summarizes the established associations between periodontal disease and systemic health.
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Konishi H, Urabe S, Miyoshi H, Teraoka Y, Maki T, Furusho H, Miyauchi M, Takata T, Kudo Y, Kajioka S. Fetal Membrane Inflammation Induces Preterm Birth Via Toll-Like Receptor 2 in Mice With Chronic Gingivitis. Reprod Sci 2018; 26:869-878. [PMID: 30223727 DOI: 10.1177/1933719118792097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inflammation is associated with preterm birth. We previously described a mouse model of chronic inflammation-induced preterm birth after dental Porphyromonas gingivalis infection. The aim of this study was to employ this model system to investigate the mechanisms through which enhanced uterine contractility induces preterm birth. Messenger RNA (mRNA) encoding contraction-associated proteins, such as oxytocin receptors, was measured at various gestational time points by real-time polymerase chain reaction (PCR). Spontaneous and oxytocin-induced uterine contractile activity at gestational day 18 was assessed using a tissue organ bath. The expression levels of Toll-like receptor 2 (TLR2), TLR4, cyclooxygenase (COX)-2, nuclear factor-kappa B (NF-κB) p65, and p38 mitogen-activated protein kinase (MAPK) on gestational day 18 were also determined by real-time PCR or Western blotting. Messenger RNA encoding contraction-associated proteins was increased at gestational day 18, and the spontaneous contractile activity (1.6-fold greater area under the contraction curve) and sensitivity to oxytocin (EC50: 8.8 nM vs 2.2 nM) were enhanced in the P gingivalis group compared to those in the control group. In the P gingivalis group, COX-2 mRNA expression was not elevated in the placenta or myometrium but was upregulated 2.3-fold in the fetal membrane. The TLR2 mRNA levels in the fetal membrane were 2.7-fold higher in the P gingivalis group, whereas TLR4 levels were not elevated. Activation of the NF-κB p65 and p38 MAPK pathways was enhanced in the fetal membrane of the P gingivalis group. Thus, in mice with chronic dental P gingivalis infection, TLR2-induced inflammation in the fetal membrane leads to upregulation of uterine contractility, leading to preterm birth.
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Affiliation(s)
- Haruhisa Konishi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Urabe
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Miyoshi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Obstetrics and Gynecology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yuko Teraoka
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoko Maki
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Applied Urology and Molecular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunichi Kajioka
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Applied Urology and Molecular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
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Vivares-Builes AM, Rangel-Rincón LJ, Botero JE, Agudelo-Suárez AA. Gaps in Knowledge About the Association Between Maternal Periodontitis and Adverse Obstetric Outcomes: An Umbrella Review. J Evid Based Dent Pract 2018; 18:1-27. [DOI: 10.1016/j.jebdp.2017.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 01/01/2023]
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Iheozor‐Ejiofor Z, Middleton P, Esposito M, Glenny A. Treating periodontal disease for preventing adverse birth outcomes in pregnant women. Cochrane Database Syst Rev 2017; 6:CD005297. [PMID: 28605006 PMCID: PMC6481493 DOI: 10.1002/14651858.cd005297.pub3] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Zipporah Iheozor‐Ejiofor
- The University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Marco Esposito
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore Building, Oxford RoadManchesterUKM13 9PL
| | - Anne‐Marie Glenny
- The University of ManchesterDivision of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
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Meqa K, Dragidella F, Disha M, Sllamniku-Dalipi Z. The Association between Periodontal Disease and Preterm Low Birthweight in Kosovo. Acta Stomatol Croat 2017; 51:33-40. [PMID: 28740268 PMCID: PMC5506254 DOI: 10.15644/asc51/1/4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/04/2017] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Periodontal diseases have a high prevalence worldwide. Existing evidence support the concept that gingivitis and periodontitis are potentially infectious and they present inflammatory reservoirs that can be threatening to the fetoplacental unit. The objective of this study was to compare the periodontal status between women with normal delivery and those with preterm low-birthweight delivery. MATERIALS AND METHODS This study included 200 postpartum women whose periodontal and obstetrical parameters were taken. The periodontal condition was assessed bedside according to the modified criteria established by Machtei, while the birthweight and gestational age were assessed according to the World Health Organization criteria. RESULTS Women with periodontitis are statistically at 3.2 times higher risk to deliver a child with low weight, and at 3.4 times higher risk to deliver preterm, compared to women without periodontitis. The women with preterm low-birthweight babies had deeper periodontal pockets (2.49mm ± 0.49mm) than women with normal delivery (2.26mm ± 0.49mm). CONCLUSIONS Periodontal disease in pregnant women with a reservoir of organisms and their products can be considered a risk factor for adverse pregnancy outcome.
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Affiliation(s)
- Kastriot Meqa
- University of Pristina, Dentistry School, Department of Periodontology and Oral Medicine, Pristina, Republic of Kosovo
| | - Fatmir Dragidella
- University of Pristina, Dentistry School, Department of Periodontology and Oral Medicine, Pristina, Republic of Kosovo
| | - Metush Disha
- University of Pristina, Dentistry School, Department of Periodontology and Oral Medicine, Pristina, Republic of Kosovo
| | - Zana Sllamniku-Dalipi
- University of Pristina, Dentistry School, Department of Periodontology and Oral Medicine, Pristina, Republic of Kosovo
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Turton M, Africa CWJ. Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes. Int Dent J 2016; 67:148-156. [PMID: 27988930 DOI: 10.1111/idj.12274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. STUDY OBJECTIVE This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. MATERIALS AND METHODS The study sample comprised 443 pregnant women with a mean (± standard deviation) age of 24.13 (±5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. RESULTS While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. CONCLUSION This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes.
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Affiliation(s)
- Mervyn Turton
- Department of Medical Biosciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Charlene W J Africa
- Department of Medical Biosciences, University of the Western Cape, Bellville, Cape Town, South Africa
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Rajapakse PS, Nagarathne M, Chandrasekra KB, Dasanayake AP. Periodontal Disease and Prematurity among Non-smoking Sri Lankan Women. J Dent Res 2016; 84:274-7. [PMID: 15723870 DOI: 10.1177/154405910508400313] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The hypothesis that periodontal disease is associated with pre-term low birthweight was tested in a prospective follow-up study of rural prima-gravida women (N = 227) who were free of tobacco, alcohol, and drug use. Women with 3rd trimester mean probing pocket depths, plaque, and bleeding scores that were greater than the median value in the cohort were defined as ‘exposed’. There were 17 (7.5%) preterm low birthweight singleton deliveries in the cohort (among ‘exposed’ = 12%; among ‘unexposed’ = 5.6%; Odds Ratio = 2.3; 95% CI = 0.9−6.3). After adjustment for the independent variables, the OR for preterm low birthweight in relation to ‘exposure’ was 1.9 (95% CI = 0.7−5.4). Our results are only suggestive of an association between periodontal disease and preterm low birthweight, perhaps indicating that previously reported associations may have been subjected to residual confounding due to tobacco, alcohol, and drug use.
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Affiliation(s)
- P S Rajapakse
- Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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30
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Periodontitis, cardiovascular disease and pregnancy outcome--focal infection revisited? Br Dent J 2016; 217:467-74. [PMID: 25342358 DOI: 10.1038/sj.bdj.2014.903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 01/17/2023]
Abstract
Over the last two decades there has been a renewed interest around the possible effects of periodontal disease on both cardiovascular health and pregnancy outcome (among other diseases), a topic which has interested science for hundreds of years. These have led to a range of studies, workshops and consensus documents being published, with corresponding coverage in general and professional media. In this article the authors summarise the history and supporting theories behind such associations, whether clinical studies have been able to confirm these and what this might mean for general practitioners who are questioned on this topic by patients.
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Teshome A, Yitayeh A. Relationship between periodontal disease and preterm low birth weight: systematic review. Pan Afr Med J 2016; 24:215. [PMID: 27800070 PMCID: PMC5075444 DOI: 10.11604/pamj.2016.24.215.8727] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 06/19/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction Periodontal disease is a neglected bacterial infection that causes destruction of the periodontium in pregnant women. Yet its impact on the occurrence of adverse pregnancy outcomes has not systematically evaluated and there is no clear statement on the relationship between periodontal disease and preterm low birth weight. The objective of this study was to summarize the evidence on the impact of periodontal disease on preterm low birth weight. Methods We searched the following data bases from January 2005 to December 2015: CINAHL (cumulative index to nursing and allied health literature), MEDLINE, AMED, EMBASE (excerpta medica database), Cochrane library and Google scholar. Only case-control studies with full text in English were eligible. Critical appraisal of the identified articles was done by two authors independently to provide the possible relevance of the papers for inclusion in the review process. The selected Case control studies were critically appraised with 12 items structured checklist adapted from national institute of health (NIH). Odds ratio (OR) or risk ratios (RR) were extracted from the selected studies. The two reviewers who selected the appropriate studies also extracted the data and evaluated the risk of bias. Results Of 229 articles, ten studies with a total of 2423 participants with a mean age ranged from 13 to 49 years were met the inclusion criteria. The studies focused on preterm birth, low birth weight and /or preterm low birth weight and periodontitis. Of the selected studies, 9 implied an association between periodontal disease and increased risk of preterm birth, low birth weight and /or preterm low birth weight outcome (ORs ranging from 2.04 to 4.19) and only one study found no evidence of association. Conclusion Periodontal disease may be one of the possible risk factor for preterm low birth weight infant. However, more precise studies with randomized clinical trial with sufficient follow-up period must be done to confirm the association.
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Affiliation(s)
- Amare Teshome
- Department of Dentistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Asmare Yitayeh
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Ethiopia
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Lohana MH, Suragimath G, Patange RP, Varma S, Zope SA. A Prospective Cohort Study to Assess and Correlate the Maternal Periodontal Status with Their Pregnancy Outcome. J Obstet Gynaecol India 2016; 67:27-32. [PMID: 28242964 DOI: 10.1007/s13224-016-0920-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association between periodontal disease and preterm low birth weight of babies. MATERIALS AND METHODS A total of 300 pregnant women, between 20 and 24 weeks of gestation i.e., second trimester, were considered for the study. The periodontal status was recorded using the following parameters: probing pocket depth, clinical attachment level, oral hygiene index and plaque index. After initial examination in the second trimester, the pregnant women were followed till delivery of the baby. Postpartum data i.e., weight of baby, gestational age of pregnancy and type of delivery, were recorded. RESULTS Out of 300 pregnant women, 248 women had full-term delivery (12 low birth weight and 236 normal birth weight) while 52 had preterm delivery (6 normal birth weight and 46 low birth weight). There was significant association between body mass index and level of periodontal disease severity of pregnant women with birth weight of babies, gestational age of pregnant women and mode of delivery, respectively. As the level of periodontal disease severity increased, the proportion of delivering preterm and low birth weight babies also increased. CONCLUSION The conclusions obtained revealed that Periodontal disease is a potential risk factor for preterm low birth weight babies of pregnant women.
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Affiliation(s)
- M H Lohana
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - G Suragimath
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - R P Patange
- Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - S Varma
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - S A Zope
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
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Prevalence and Relationship Between Maternal Periodontal Disease and Preterm Low Birth Weight Baby. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Michalowicz BS, Gustafsson A, Thumbigere-Math V, Buhlin K. The effects of periodontal treatment on pregnancy outcomes. J Periodontol 2016; 84:S195-208. [PMID: 23631579 DOI: 10.1902/jop.2013.1340014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Bryan S Michalowicz
- Department of Developmental and Surgical Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
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Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review. J Periodontol 2016; 84:S181-94. [PMID: 23631578 DOI: 10.1902/jop.2013.134009] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association. DATA SOURCES Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases. STUDY ELIGIBILITY CRITERIA Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (<37 weeks gestation), LBW (<2500 g), gestational age, small for gestational age, birthweight, pregnancy loss or miscarriage, or pre-eclampsia. PARTICIPANTS Pregnant women with or without periodontal disease, and with or without adverse pregnancy outcomes, assessed either during pregnancy or postpartum. No intervention studies were included. Study appraisal and synthesis methods - Publications were assessed based on predefined screening criteria including type of periodontal assessment, consistency in the timing of the periodontal assessment with respect to gestational age, examiner masking and consideration of additional exposures and confounders. RESULTS Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Although significant associations emerge from case-control and cross-sectional studies using periodontitis "case definitions," these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia. LIMITATIONS There is a high degree of variability in study populations, recruitment and assessment, as well as differences in how data are recorded and handled. As a result, studies included in meta-analyses show a high degree of heterogeneity. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Maternal periodontitis is modestly but independently associated with adverse pregnancy outcomes, but the findings are impacted by periodontitis case definitions. It is suggested that future studies employ both continuous and categorical assessments of periodontal status. Further use of the composite outcome preterm LBW is not encouraged.
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Affiliation(s)
- Mark Ide
- Periodontology, King's College London Dental Institute, London, UK.
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Michalowicz BS, Gustafsson A, Thumbigere-Math V, Buhlin K. The effects of periodontal treatment on pregnancy outcomes. J Clin Periodontol 2016; 40 Suppl 14:S195-208. [PMID: 23627329 DOI: 10.1111/jcpe.12081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/08/2013] [Accepted: 11/14/2012] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Bryan S Michalowicz
- Department of Developmental and Surgical Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA.
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Maternal periodontitis decreases plasma membrane GLUT4 content in skeletal muscle of adult offspring. Life Sci 2016; 148:194-200. [DOI: 10.1016/j.lfs.2016.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
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Middleton P, Esposito M, Iheozor-Ejiofor Z. Treating periodontal disease for preventing adverse birth outcomes in pregnant women. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd005297.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Miyoshi H, Konishi H, Teraoka Y, Urabe S, Furusho H, Miyauchi M, Takata T, Kudo Y. Enhanced Expression of Contractile-Associated Proteins and Ion Channels in Preterm Delivery Model Mice With Chronic Odontogenic Porphyromonas Gingivalis Infection. Reprod Sci 2015; 23:838-46. [PMID: 26692542 DOI: 10.1177/1933719115620497] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation and infection have been reported to induce preterm delivery. We have studied the relationship between inflammation and various ion channels, including the L-type Ca(2+) channel and P2X7 receptor, during acute inflammation of the pregnant rat uterus induced by lipopolysaccharides. Recently, we found that mice with odontogenic Porphyromonas gingivalis (P.g, an important odontogenic pathogen) infection delivered at day 18.3 of gestation (vs. day 20.5 in normal mice). The purpose of this study was to investigate the expression of myometrial contractile-associated proteins inducing contractions and confirm that these mice are useful as a model for preterm delivery induced by chronic inflammation. We examined the expression of the oxytocin receptor, connexin 43, prostaglandin F receptors, L-type Ca(2+) channel, and P2X7 receptor in the myometrium at day 18 of gestation by real-time PCR and western blot analyses. We also measured TNF-α and IL-1β levels in the blood serum, placenta, fetal membrane and myometrium on the same day. mRNA expression of the oxytocin receptor, connexin 43, prostaglandin F receptors, L-type Ca(2+) channel, and P2X7 receptor was elevated by 5.4, 3.2, 2.4, 2.5, and 1.7 fold, respectively, in the P.g-infected mice. Protein levels of the oxytocin receptor and connexin 43 also increased. Serum levels of TNF-α and IL-1β were elevated, showing that systemic inflammation continued during pregnancy. IL-1β levels in the placenta and fetal membrane also increased, suggesting inflammatory reactions were induced. Thus, mice with odontogenic infection may be useful as a model of chronic inflammation-induced preterm delivery.
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Affiliation(s)
- Hiroshi Miyoshi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruhisa Konishi
- Department of Obstetrics and Gynecology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Teraoka
- Department of Obstetrics and Gynecology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Urabe
- Department of Obstetrics and Gynecology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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Gümüş P, Öztürk VÖ, Bozkurt E, Emingil G. Evaluation of the gingival inflammation in pregnancy and postpartum via 25-hydroxy-vitamin D3, prostaglandin E2 and TNF-α levels in saliva. Arch Oral Biol 2015; 63:1-6. [PMID: 26658365 DOI: 10.1016/j.archoralbio.2015.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/30/2015] [Accepted: 11/22/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physiological changes and immunological modifications occur during pregnancy. The clinical and biological features of periodontal infections are affected by pregnancy. The aim of the present study was to evaluate saliva levels of 25-hydroxy-vitamin D3 (25(OH)D3), prostaglandin E2 (PGE2) and TNF-alpha (TNF-α) in pregnancy, postpartum and non-pregnant controls. METHODS Whole saliva samples together with full-mouth clinical periodontal recordings were obtained from 59 pregnant, 47 post partum and 70 systemically healthy non-pregnant women. Groups were also evaluated according to the periodontal health status. 25(OH)D3, PGE2 and TNF-α levels in the saliva samples were determined by enzyme-linked immunoassays. Data were statistically tested by nonparametrical tests. RESULTS Saliva TNF-α and PGE2 levels were significantly lower and 25(OH)D3 levels were significantly higher in the pregnant group than postpartum group (p<0.0001). Saliva TNF-α and 25(OH)D3 levels were significantly higher and PGE2 levels were significantly lower in the control group than postpartum group (p<0.0001). In the pregnant healthy, gingivitis and periodontitis groups saliva TNF-α levels were significantly lower than postpartum and control counterparts (p<0.0001, p=0.032, p=0.003 and p=0.013; p=0.027; p=0.007, respectively). In control healthy, gingivitis and periodontitis groups saliva 25(OH)D3 levels were significantly higher than the postpartum counterparts (p<0.0001, p<0.0001, p=0.002, respectively). In the control healthy and gingivitis groups saliva 25(OH)D3 levels were significantly higher than pregnant healthy and gingivitis (p<0.0001). CONCLUSIONS In conclusion, within the limits of the present study it seems that pregnancy have an effect on parameters in saliva in relation to the periodontal status of the women. Further studies are required for better understanding of the impact of periodontal diseases on pregnancy or otherwise.
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Affiliation(s)
- Pınar Gümüş
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.
| | - V Özgen Öztürk
- Department of Periodontology, School of Dentistry, Adnan Menderes University, Aydin, Turkey
| | - Emir Bozkurt
- Section of Molecular Biology, Department of Biology, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Gülnur Emingil
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
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Martínez-Martínez RE, Moreno-Castillo DF, Loyola-Rodríguez JP, Sánchez-Medrano AG, Miguel-Hernández JHS, Olvera-Delgado JH, Domínguez-Pérez RA. Association between periodontitis, periodontopathogens and preterm birth: is it real? Arch Gynecol Obstet 2015; 294:47-54. [PMID: 26576767 DOI: 10.1007/s00404-015-3945-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify the association between periodontitis and periodontal pathogens with preterm birth despite the strict control of some important confounders, such as infectious processes and criteria for diagnosis of periodontitis during pregnancy. MATERIALS AND METHODS In this cross-sectional study were included 70 healthy puerperal women between 20 and 35 years without a history of genitourinary infections during pregnancy. Based on the gestational age they were divided into two groups: 45 with term birth (>37 weeks) and 25 with preterm birth (<37 weeks). Previous informed consent, a gynecologic and dental history that included gynecologic and obstetric background, periodontal status applying different authors' criteria of periodontitis diagnosis, presence of periodontopathogens, dental caries and oral hygiene were recorded. RESULTS There was no association between periodontitis, periodontopathogens and preterm birth. There were no statistical differences applying different authors' criteria diagnosis of periodontitis. Gingivitis status was similar, but probing depth was greater in preterm birth subjects, perhaps they are young women, and this finding could be an early sign of periodontitis. In like manner, the main periodontal bacterial species are not associated with preterm birth, general hygiene and care habits are poorer than term birth subjects. CONCLUSION We could suggest that preterm birth is a multifactorial condition and the role of periodontitis and the periodontopathogens itself is not sufficient to trigger the preterm birth. There are factors such as infectious processes and diagnostic criteria for periodontitis that could be responsible for controversial results.
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Affiliation(s)
- Rita Elizabeth Martínez-Martínez
- Advanced General Dentistry Program, San Luis Potosi University, Dr. Manuel Nava no. 2, Zona Universitaria, San Luis Potosí, SLP, Mexico.
| | - Diana Francisca Moreno-Castillo
- Advanced General Dentistry Program, San Luis Potosi University, Dr. Manuel Nava no. 2, Zona Universitaria, San Luis Potosí, SLP, Mexico
| | - Juan Pablo Loyola-Rodríguez
- Advanced General Dentistry Program, San Luis Potosi University, Dr. Manuel Nava no. 2, Zona Universitaria, San Luis Potosí, SLP, Mexico
| | - Ana Gabriela Sánchez-Medrano
- Advanced General Dentistry Program, San Luis Potosi University, Dr. Manuel Nava no. 2, Zona Universitaria, San Luis Potosí, SLP, Mexico
| | - Jesús Héctor San Miguel-Hernández
- Division of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, Faculty of Medicine, San Luis Potosi University, Av. Venustiano Carranza #2395, Zona Universitaria, San Luis Potosí, SLP, Mexico
| | - José Honorio Olvera-Delgado
- Advanced General Dentistry Program, San Luis Potosi University, Dr. Manuel Nava no. 2, Zona Universitaria, San Luis Potosí, SLP, Mexico
| | - Rubén Abraham Domínguez-Pérez
- Advanced General Dentistry Program, San Luis Potosi University, Dr. Manuel Nava no. 2, Zona Universitaria, San Luis Potosí, SLP, Mexico
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Kayar NA, Alptekin NÖ, Erdal ME. Interleukin-1 receptor antagonist gene polymorphism, adverse pregnancy outcome and periodontitis in Turkish women. Arch Oral Biol 2015; 60:1777-83. [PMID: 26445016 DOI: 10.1016/j.archoralbio.2015.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine associations between interleukin (IL)-1A (+4845), IL-1B (+3954), and IL-1 receptor antagonist (RN) variable number tandem repeat polymorphisms and adverse pregnancy outcomes and periodontitis in a Turkish women. DESIGN A total of 156 patients, including 64 women with normal birth outcome (NB) and 92 women with preterm/low birth weight outcome (PLBW) were included in this case-control study. Within 24h after labor, maternal demographic characteristics and clinical periodontal parameters were recorded. The distribution and genotype frequencies of IL-1 were analyzed with polymerase chain reaction-restriction fragment length polymorphism assay. Statistical analyses were carried out for clinical periodontal parameters, genotype frequencies, and to identify explanatory variables for PLBW. RESULTS PLBW was associated with maternal age (p<0.05), irregular prenatal care (p<0.001), previous PLBW (p<0.05), and antibiotic use during pregnancy (p<0.05). Measurements of probing depth and clinical attachment level (CAL) were significantly higher in the PLBW group than in the NB group (p<0.001). PLBW was associated with IL-1RN allele 2 (p<0.001). Moreover, stepwise logistic regression analysis showed that CAL (OR 1.39, 95% CI: 1.04-1.85) and IL-1RN polymorphism (OR 7.92, 95% CI: 2.76-22.79), previous PLBW (OR 5.01, 95% CI: 1.08-23.17), age (OR 1.22, 95% CI: 1.04-1.44) were predictors found to increase the risk of PLBW (p<0.05). There was a negative association between PLBW and regular prenatal care, total number of births, use an antibiotic during pregnancy period (p<0.05). CONCLUSION Our study showed that, IL-1RN allele 2, periodontal disease characterized with clinical attachment loss, previous PLBW and age could be an important risk factors for PLBW.
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Affiliation(s)
- Nezahat Arzu Kayar
- The Ministry Health of Turkey, Oral and Dental Health Center, Antalya, Turkey
| | - Nilgün Özlem Alptekin
- Baskent University, Faculty of Dentistry, Department of Periodontology, Ankara, Turkey.
| | - Mehmet Emin Erdal
- Mersin University, Faculty of Medicine, Department of Medical Biology and Genetics, Mersin, Turkey
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Gümüş P, Emingil G, Öztürk VÖ, Belibasakis GN, Bostanci N. Oxidative stress markers in saliva and periodontal disease status: modulation during pregnancy and postpartum. BMC Infect Dis 2015; 15:261. [PMID: 26152310 PMCID: PMC4495776 DOI: 10.1186/s12879-015-1003-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/29/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Periodontal diseases may affect local and systemic inflammation, and reactive oxygen species (ROS) levels. This systemic health burden could compromise the outcome of pregnancy in expectant mothers. The aim of the present study was to evaluate oxidative stress markers, including glutathione peroxidase (GPx), thiobarbituric acid-reactive substances (TBARS) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), and total bacterial loads in the saliva of pregnant and postpartum women, and to investigate their association with periodontal disease severity. METHODS A total of 187 women were originally recruited for this case-control study, assigned to the following groups a) pregnant group, b) postpartum group: the pregnant group re-evaluated 6 months after giving birth, c) control group: systemically healthy and non-pregnant women. The levels of the studied oxidative stress markers in saliva were measured by commercially available kits. RESULTS The levels of salivary 8-OHdG were significantly elevated in the pregnant, compared with the control group. Although salivary 8-OHdG levels slightly decreased after giving birth (postpartum group), the difference did not reach significance. In contrast, the activity of antioxidant enzyme GPx in saliva was significantly lower in the pregnant than the control group. Although no differences in lipid peroxidation (represented by TBARS) were observed between the pregnant and control groups, after giving birth TBARS levels were significantly lowered. Only in the postpartum and control groups did clinical measurements of periodontal disease severity correlate with oxidative stress markers. Interestingly, there were no such correlations with TBARS in the pregnant and postpartum groups. CONCLUSIONS The present study shows changes in the oxidant/antioxidant balance in saliva during pregnancy and after birth, which may be affected by periodontal health status in the latter case. Whether this is associated with adverse pregnancy outcomes, or not, remains to be elucidated. Early identification of ROS markers in saliva may be of clinical value in the periodontal management of pregnant women.
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Affiliation(s)
- Pınar Gümüş
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.
| | - Gülnur Emingil
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.
| | - Veli-Özgen Öztürk
- Department of Periodontology, School of Dentistry, Adnan Menderes University, Aydın, Turkey.
| | - Georgios N Belibasakis
- Section of Oral Microbiology and Immunology, Institute of Oral Biology, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032, Zürich, Switzerland.
| | - Nagihan Bostanci
- Section of Oral Microbiology and Immunology, Institute of Oral Biology, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032, Zürich, Switzerland.
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Walia M, Saini N. Relationship between periodontal diseases and preterm birth: Recent epidemiological and biological data. Int J Appl Basic Med Res 2015; 5:2-6. [PMID: 25664259 PMCID: PMC4318095 DOI: 10.4103/2229-516x.149217] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
Preterm infants are born prior to completion of 37 weeks of gestation. These patients are seen on the rise despite the efforts put in to control them. Global incidence of preterm birth is around 9.6% of all birth representing 12.9 million births with regional disparities: From 12% to 13% in USA, from 5% to 9% in Europe, and 18% in Africa. First reported by Offenbacher et al. in 1996 relationship exist between maternal periodontal disease and delivery of a preterm infant. This article reviews the recent epidemiological and biological data. The articles were searched on Google, PubMed recent articles were selected. Mainly, three hypotheses by which periodontal bacteria can affect the outcome of pregnancy. Biological hypothesis: (a) Bacterial spreading, (b) Inflammatory products dissemination, (c) Role of fetomaternal immune response against oral pathogens. The promotion of the early detection and treatments of periodontal disease in young women before and during pregnancy will be beneficial especially for women at risk.
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Affiliation(s)
- Moneet Walia
- Department of Gynecology and Obstetrics, Christian Medical College, Ludhiana, Punjab, India
| | - Navdeep Saini
- Department of General Surgery, Christian Medical College, Ludhiana, Punjab, India
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Bulut G, Olukman O, Calkavur S. Is there a relationship between maternal periodontitis and pre-term birth? A prospective hospital-based case-control study. Acta Odontol Scand 2014; 72:866-73. [PMID: 24850505 DOI: 10.3109/00016357.2014.919663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study is to verify the existence of an association between maternal periodontal disease and pre-term delivery in an unselected population of post-partum Turkish women. MATERIALS AND METHODS This case-control study was conducted on 100 women who gave birth in either a special or a government maternity hospital. The case group consisted of 50 mothers who had delivered an infant before 37 weeks' gestation and weighed under 2500 g. The control group included 50 mothers who had given birth to an infant with a birth weight of more than 2500 g and a gestational age of ≥37 weeks. Data of mothers and infants were collected using medical registers and questionnaires. Clinical periodontal examinations were carried out in six sites on every tooth in the mother's mouth. A participant who presented at least four teeth with one or more sites with a PPD ≥4 mm and CAL ≥3 mm at the same site was considered to have periodontal disease. Statistical methods included parametric and non-parametric tests and multiple logistic regression analysis. RESULTS There were no statistically significant differences between the cases and controls with regard to periodontal disease and pre-term delivery (OR = 1.48; 95% CI = 0.54-4.06). CONCLUSION The findings indicated that maternal periodontitis was not a possible risk factor for pre-term delivery. Further studies with additional clinical trials are needed to explore the possible relationship between periodontal disease and pre-term birth.
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Cassini MA, Pilloni A, Condò SG, Vitali LA, Pasquantonio G, Cerroni L. Periodontal bacteria in the genital tract: are they related to adverse pregnancy outcome? Int J Immunopathol Pharmacol 2014; 26:931-9. [PMID: 24355228 DOI: 10.1177/039463201302600411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One of the most important factors implicated in preterm birth (PTB) is acute genitourinary tract infection. The bacteria causing chronic periodontal inflammation include Gram-negative rods and anaerobes similar to those found in women with bacterial vaginosis. The aim of this prospective study is to investigate the relationship between oral and vaginal microflora and preterm low birth weight. Real-time polymerase chain reaction was used to detect both the presence and level of six periodontitis-related species: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Fusobacterium nucleatum ssp(Fn), and Prevotella intermedia (Pi) for both oral samples of subgingival plaque and cervical samples, obtained from 80 patients, during gynaecological examinations. The more representative oral pathogen (less than 60 percent) species in oral samples of preterm and term group were Tf, Td, and Fn. 24.4 percent of pregnant women presented periodontal pathogens in vaginal swab; the most representative species with a percentage over 0.1 percent of total bacteria in genital tract of preterm group were Tf, Td, and Piwith a positive correlation (less than 0.5). The presence of the bacterium T. denticolain the vagina, regardless of the amount, adversely affects preterm delivery.
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Affiliation(s)
- M A Cassini
- Department of Odontostomatologic and Maxillofacial Science, Sapienza University of Rome, Italy
| | - A Pilloni
- Department of Odontostomatologic and Maxillofacial Science, Sapienza University of Rome, Italy
| | - S G Condò
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L A Vitali
- School of Pharmacy, Microbiology Unit, University of Camerino, Camerino, Italy
| | - G Pasquantonio
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L Cerroni
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Qualitative assessment of attitudes and knowledge on preterm birth in Malawi and within country framework of care. BMC Pregnancy Childbirth 2014; 14:123. [PMID: 24690288 PMCID: PMC3975452 DOI: 10.1186/1471-2393-14-123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background The overarching goal of this study was to qualitatively assess baseline knowledge and perceptions regarding preterm birth (PTB) and oral health in an at-risk, low resource setting surrounding Lilongwe, Malawi. The aims were to determine what is understood regarding normal length of gestation and how gestational age is estimated, to identify common language for preterm birth, and to assess what is understood as options for PTB management. As prior qualitative research had largely focused on patient or client-based focused groups, we primarily focused on groups comprised of community health workers (CHWs) and providers. Methods A qualitative study using focus-group discussions, incidence narrative, and informant interviews amongst voluntary participants. Six focus groups were comprised of CHWs, patient couples, midwives, and clinical officers (n = 33) at two rural health centers referring to Kamuzu Central Hospital. Semi-structured questions facilitated discussion of PTB and oral health (inclusive of periodontal disease), including definitions, perception, causation, management, and accepted interventions. Results Every participant knew of women who had experienced “a baby born too soon”, or preterm birth. All participants recognized both an etiology conceptualization and disease framework for preterm birth, distinguished PTB from miscarriage and macerated stillbirth, and articulated a willingness to engage in studies aimed at prevention or management. Identified gaps included: (1) discordance in the definition of PTB (i.e., 28–34 weeks or less than the 8th month, but with a corresponding fetal weight ranging 500 to 2300 grams); (2) utility and regional availability of antenatal steroids for prevention of preterm infant morbidity and mortality; (3) need for antenatal referral for at-risk women, or with symptoms of preterm birth. There was no evident preference for route of progesterone for the prevention of recurrent PTB. Conclusions Qualitative research was useful in (1) identifying gaps in knowledge in urban and rural Malawi, and (2) informing the development of educational materials and implementation of programs or trials ultimately aimed at reducing PTB. As a result of this qualitative work, implementation planning was focused on the gaps in knowledge, dissemination of knowledge (to both patients and providers), and practical solutions to barriers in known efficacious therapies.
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Kumar A, Begum N, Prasad S, Lamba AK, Verma M, Agarwal S, Sharma S. Role of cytokines in development of pre-eclampsia associated with periodontal disease - Cohort Study. J Clin Periodontol 2014; 41:357-65. [PMID: 24393049 DOI: 10.1111/jcpe.12226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 12/12/2022]
Abstract
AIM The present study was designed to find any association of cytokines in women with periodontal disease and development of pre-eclampsia in North Indian population. MATERIALS AND METHODS A total of 504 consecutively registered primigravida with a single live pregnancy were recruited at 14-18 weeks of gestation from antenatal clinic of Maulana Azad Medical College & associated Lok Nayak Hospital and Maulana Azad Institute of Dental Sciences, New Delhi. One periodontist performed oral health examination of all patients at inclusion into study. Blood samples were collected to measure the level of cytokines IL-4, IL-10, TNF-α and IFN-γ. RESULTS The profile of blood levels of cytokines from women with periodontal disease was observed. The log serum levels of TNF-α & IL-4 at 16-18 weeks of gestation were significantly higher in women with periodontal disease (4.13 ± 2.06; 0.47 ± 1.56 pg/ml respectively) than in women with healthy gums (2.16 ± 1.51; 0.02 ± 1.84 pg/ml respectively, p < 0.001). Periodontal disease is associated with log serum TNF-α levels at cut-off ≥14.43 pg/ml at sensitivity 71.2% and specificity 62% (OR = 4.04; 95%CI = 2.77-5.87). Woman with periodontal disease who later developed pre-eclampsia had lower levels of TNF-α (3.72 ± 1.33 pg/ml) than those with periodontal disease who did not develop pre-eclampsia (4.20 ± 2.15 pg/ml, p ≥ 0.05). CONCLUSION Reduced TNF-α level secretion in the early second trimester in women with periodontal disease appears to be associated with the development of pre-eclampsia.
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Affiliation(s)
- Ashok Kumar
- Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India
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Abstract
During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.
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Wang YL, Liou JD, Pan WL. Association between maternal periodontal disease and preterm delivery and low birth weight. Taiwan J Obstet Gynecol 2013; 52:71-6. [PMID: 23548222 DOI: 10.1016/j.tjog.2013.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE It has been suggested that periodontal disease is an important risk factor for preterm low birth weight (PLBW). The purpose of this study was to determine the association of maternal periodontitis with low birth weight (LBW) and preterm birth (PB). MATERIALS AND METHODS Pregnant women (n = 211) aged 22-40 years were enrolled while receiving prenatal care. Dental plaque, probing depth, bleeding on probing, and clinical attachment level were used as criteria to classify three groups: a healthy group (HG; n = 82), a gingivitis group (GG; n = 67), and a periodontitis group (PG; n = 62). At delivery, birth weight was recorded. RESULTS Mean infant weight at delivery was 3084.9 g. The total incidence of preterm birth and LBW infants was 10.4% and 8.1%, respectively. The incidence of LBW infants was 4.2% for term and 40.9% for preterm gestations. Maternal height was not correlated with infant birth weight (p = 0.245). Significant differences in mean infant birth weight were observed among the HG, GG, and PG groups (p = 0.030). No significant relationship was found between periodontal disease and PB, but the association between periodontal disease and LBW was significant. CONCLUSION After appropriately controlling for confounding variables, our results do not support the hypothesis of an association that was observed in previous studies of maternal periodontal disease and infant PB, but the association between periodontal disease and LBW is significant.
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Affiliation(s)
- Yen-Li Wang
- Department of Periodontics, Dental Section, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
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