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Gomersall JC, Slack-Smith L, Kilpatrick N, Muthu MS, Riggs E. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2024; 5:CD012155. [PMID: 38753314 PMCID: PMC11098061 DOI: 10.1002/14651858.cd012155.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Dental caries, a common chronic disease of childhood, is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). This review updates one published in 2019. OBJECTIVES To assess the effects of interventions undertaken with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years). SEARCH METHODS We searched Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register (clinicaltrials.gov) and WHO International Clinical Trials Registry Platform (apps.who.int/trialsearch). The latest searches were run on 3 January, 2023. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing interventions with pregnant women, or new mothers and other primary caregivers of infants in the first year of life, against standard care, placebo or another intervention, reporting on a primary outcome: caries presence in primary teeth, dmfs (decayed, missing, filled primary surfaces index), or dmft (decayed, missing, filled teeth index), in children up to six years of age. Intervention types include clinical, oral health promotion/education (hygiene education, breastfeeding and other dietary advice) and policy or service. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence (GRADE). MAIN RESULTS We included 23 RCTs (5 cluster-randomised), involving 25,953 caregivers (mainly mothers) and their children. Fifteen trials assessed oral health education/promotion interventions against standard care. Six trials assessed a clinical intervention for mother dentition, against placebo, or a different type of clinical intervention. Two trials assessed oral health/education promotion plus clinical intervention (for mother's dentition) against standard care. At most, five trials (maximum of 1326 children and 130 mothers) contributed data to any comparison. Enamel-only caries were included in the diagnosis of caries in some studies. For many trials, the risk of bias was unclear due to lack of methodological details reported. In thirteen trials, participants were socioeconomically disadvantaged. No trial indicated receiving funding that was likely to have influenced their results. Oral health education/promotion interventions Child diet and feeding practice advice versus standard care: We observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a slightly lower mean dmfs (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, the evidence is very uncertain regarding the difference between groups in mean dmft (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). Breastfeeding promotion and support versus standard care: We observed little or no difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence) and in mean dmft (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). dmfs was not reported. Child diet advice compared with standard care: We are very uncertain about the effect on the risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). dmfs and dmft were not reported. Oral hygiene, child diet and feeding practice advice versus standard care: The evidence is very uncertain about the effect on the risk of caries presence in primary teeth (RR 0.73, 95% CI 0.50 to 1.07; 5 trials; 1326 participants; very low-certainty evidence) and there maybe little to no difference in mean dmfs (MD -0.87, 95% CI -2.18 to 0.43; 2 trials; 657 participants; low-certainty evidence) and mean dmft (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; low-certainty evidence). High-dose versus low-dose vitamin D supplementation during pregnancy: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.99, 95% CI 0.70 to 1.41; 1 trial; 496 participants; very low-certainty evidence). dmfs and dmft were not reported. Clinical interventions (for mother dentition) Chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo: We are very uncertain regarding the difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment for mother dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trial reported dmfs or dmft. Xylitol compared with CHX antimicrobial treatment: We are very uncertain about the effect on caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence), but we observed there may be a lower mean dmft with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence). No trial reported dmfs. Oral health education/promotion plus clinical interventions (for mother dentition) Diet and feeding practice advice for infants and young children plus basic dental care for mothers compared with standard care: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.44, 95% CI 0.05 to 3.95; 2 trials, 324 participants; very low-certainty evidence) or on mean dmft (1 study, not estimable). No trial reported dmfs. No trials evaluated policy or health service interventions. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very-low certainty and is insufficient for determining which, if any, other intervention types and features may be effective for preventing ECC, and in which settings. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine the effects and relative effects of different interventions and inform practice. We have identified 13 ongoing studies. Future studies should consider if and how effects are modified by intervention features and participant characteristics (including socioeconomic status).
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Affiliation(s)
- Judith C Gomersall
- Life Course and Intergenerational Health Research Group, Robinson Research Institute and School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nicky Kilpatrick
- Vascular Biology, Murdoch Children's Research Institute, Melbourne, Australia
- Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Carlton, Australia
| | - M S Muthu
- Centre for Early Childhood Caries Research, Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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Muacevic A, Adler JR, Alghamdi WK, Alghamdi FT. The Potential Association Between Periodontal Diseases and Adverse Pregnancy Outcomes in Pregnant Women: A Systematic Review of Randomized Clinical Trials. Cureus 2023; 15:e33216. [PMID: 36733569 PMCID: PMC9888319 DOI: 10.7759/cureus.33216] [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] [Accepted: 09/23/2022] [Indexed: 01/02/2023] Open
Abstract
Preceding studies have demonstrated that periodontitis might increase the liability of adverse pregnancy outcomes such as preterm birth, preeclampsia, low birth weight, and perinatal fatality in pregnant women. Nonetheless, there is no convincing testimony that periodontitis is related directly to adverse pregnancy outcomes in pregnant women. This systematic review intended to assess and review all the available randomized clinical trials that concentrated on the association between periodontal diseases and adverse pregnancy outcomes, and the impact of periodontal disease therapy on adverse pregnancy outcomes. The databases like Scopus, PubMed, Google Scholar, and Web of Science were consumed to explore relevant and suitable studies after adopting the inclusion and exclusion criteria. The search included articles with no time restrictions and certain keywords were utilized in the databases. The investigation was done through four independent reviewers employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-three studies fulfilled the exclusion and inclusion criteria and were used and included in this systematic review. The above-mentioned studies assessed the association between periodontal diseases and adverse pregnancy outcomes and the effect of periodontal disease treatment in reducing the influence of adverse pregnancy outcomes. This systematic review revealed that there is a relationship between periodontitis and adverse pregnancy outcomes, and periodontal treatment has a reducing impact on adverse pregnancy outcomes in pregnant women with periodontitis. Prospect studies are warranted to investigate the relationship between periodontitis and different adverse pregnancy outcomes and to decide the best type and the most effective therapy to treat periodontitis in pregnant women.
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Rajendiran M, Trivedi HM, Chen D, Gajendrareddy P, Chen L. Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases. Molecules 2021; 26:molecules26072001. [PMID: 33916013 PMCID: PMC8037529 DOI: 10.3390/molecules26072001] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023] Open
Abstract
Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.
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Affiliation(s)
- Meenakshi Rajendiran
- The Center for Wound Healing and Tissue Regeneration, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Harsh M Trivedi
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (H.M.T.); (D.C.)
| | - Dandan Chen
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (H.M.T.); (D.C.)
| | - Praveen Gajendrareddy
- The Center for Wound Healing and Tissue Regeneration, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (P.G.); (L.C.); Tel.: +1-312-413-8405 (P.G.); +1-312-413-5387 (L.C.)
| | - Lin Chen
- The Center for Wound Healing and Tissue Regeneration, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (P.G.); (L.C.); Tel.: +1-312-413-8405 (P.G.); +1-312-413-5387 (L.C.)
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Handschuh Briones RA, Silva Arcos EN, Urrutia M, Godoy-Martínez P. Actividad antifúngica de los enjuagues bucales frente a Candida albicans y Rhodotorula mucilaginosa: un estudio in vitro. Rev Iberoam Micol 2020; 37:47-52. [DOI: 10.1016/j.riam.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 10/03/2019] [Accepted: 10/30/2019] [Indexed: 10/23/2022] Open
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Riggs E, Kilpatrick N, Slack‐Smith L, Chadwick B, Yelland J, Muthu MS, Gomersall JC. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2019; 2019:CD012155. [PMID: 31745970 PMCID: PMC6864402 DOI: 10.1002/14651858.cd012155.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). OBJECTIVES To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age). SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach. MAIN RESULTS We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.
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Affiliation(s)
- Elisha Riggs
- Murdoch Children's Research InstituteIntergenerational HealthFlemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of General PracticeBerkeley StreetMelbourneVictoriaAustralia3000
| | - Nicky Kilpatrick
- Murdoch Children's Research InstituteVascular BiologyFlemington RoadParkvilleMelbourneVictoriaAustralia3052
- Royal Children's HospitalPlastic and Maxillofacial Surgery50 Flemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of PaediatricsBerkeley StreetCarltonVictoriaAustralia3010
| | - Linda Slack‐Smith
- The University of Western AustraliaSchool of Population and Global Health35 Sterling Highway, CrawleyPerthWestern AustraliaAustralia6009
| | - Barbara Chadwick
- Cardiff UniversitySchool of DentistryHeath ParkCardiffUKCF14 4XY
| | - Jane Yelland
- Murdoch Children's Research InstituteIntergenerational HealthFlemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of General PracticeBerkeley StreetMelbourneVictoriaAustralia3000
| | - M S Muthu
- Pedo Planet ‐ Children Dental CentersPediatric Dentistry161/62 A Mount Poonamallee RoadPorurChennaiIndia600116
- Sri Ramachandra Institute of Higher Education and ResearchCentre for Early Childhood Caries Research, Department of Pediatric and Preventive DentistryChennaiIndia
| | - Judith C Gomersall
- Women and Kids, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
- School of Public Health, University of AdelaideAdelaideAustralia
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Prevention of spontaneous preterm birth. Arch Gynecol Obstet 2019; 299:1261-1273. [DOI: 10.1007/s00404-019-05095-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
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Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, Rasubala L, Malmstrom H, Ren Y, Eliav E. Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis. Caries Res 2019; 53:411-421. [PMID: 30630167 PMCID: PMC6554051 DOI: 10.1159/000495187] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA,
| | - Naemah Alkhers
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ronald J Billings
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Daniel A Castillo
- Miner Library, University of Rochester Medical Center, Rochester, New York, USA
| | - Linda Rasubala
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Hans Malmstrom
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
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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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Tartaglia GM, Kumar S, Fornari CD, Corti E, Connelly ST. Mouthwashes in the 21 st century: a narrative review about active molecules and effectiveness on the periodontal outcomes. Expert Opin Drug Deliv 2016; 14:973-982. [PMID: 27835926 DOI: 10.1080/17425247.2017.1260118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Poor oral hygiene is a major risk factor for oral diseases. Regular home-based care is essential to maintain good oral hygiene. In particular, mouthrinses can support conventional tooth brushing in reducing accumulation of oral plaque. Areas covered: The most common molecules contained in mouthrinses (chlorhexidine, essential oils, cetyl pyridinium chloride, triclosan, octeneidine, delmopinol, polyvinylpyrrolidone, hyaluronic acid, natural compounds) are discussed, together with relevant clinical and in vitro studies, focusing on their effects on periodontal health. Currently, chlorhexidine is the most efficacious compound, with both antiplaque and antibacterial activities. Similar results are reported for essential oils and cetyl pyridinium chloride, although with a somewhat reduced efficacy. Considering the adverse effects of chlorhexidine and its time-related characteristics, this molecule may best be indicated for acute/short-term use, while essential oils and cetyl pyridinium chloride may be appropriate for long-term, maintenance treatment. Expert opinion: The literature has not clearly demonstrated which compound is the best for mouthrinses that combine good efficacy and acceptable side effects. Research should focus on substances with progressive antibacterial activity, prompting a gradual change in the composition of oral biofilm and mouthrinses that combine two or more molecules acting synergistically in the mouth.
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Affiliation(s)
- Gianluca M Tartaglia
- a Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC) , Università degli Studi di Milano , Milano , Italy.,b SST Dental Clinic , Segrate , Italy
| | - Santhosh Kumar
- c Population and Social Health Research Programme, Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University , Gold Coast , Australia
| | | | - Eleonora Corti
- d Department of Regulatory Affairs , Biokosmes srl , Bosisio Parini , Italy
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Jiang H, Xiong X, Su Y, Peng J, Zhu X, Wang J, Chen M, Qian X. Use of antiseptic mouthrinse during pregnancy and pregnancy outcomes: a randomised controlled clinical trial in rural China. BJOG 2016; 123 Suppl 3:39-47. [PMID: 27627596 DOI: 10.1111/1471-0528.14010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- H Jiang
- School of Public Health; Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education; Fudan University; Shanghai China
| | - X Xiong
- School of Public Health and Tropical Medicine; Tulane University; New Orleans LA USA
| | - Y Su
- Eye & ENT Hospital of Fudan University; Shanghai China
| | - J Peng
- Maternal and Child Health Care Hospital; Leping Jiangxi Province China
| | - X Zhu
- Maternal and Child Health Care Hospital; Leping Jiangxi Province China
| | - J Wang
- Maternal and Child Health Care Hospital; Leping Jiangxi Province China
| | - M Chen
- School of Public Health; Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education; Fudan University; Shanghai China
| | - X Qian
- School of Public Health; Fudan University; Shanghai China
- Global Health Institute; Fudan University; Shanghai China
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