Association between excessive maternal weight, periodontitis during the third trimester of pregnancy, and infants' health at birth

Burden and impact of periodontal diseases on oral health-related quality of life and systemic diseases and conditions: Latin America and the Caribbean Consensus 2024

Periodontal diseases are highly prevalent globally, and represent a significant public health burden that could affect the quality of life in Latin American and in Caribbean countries and territories. The primary objective is to explore the existing research and epidemiological studies on the burden of periodontal diseases, particularly their impact on oral health-related quality of life (OHRQoL) and associations with systemic health conditions in Latin America and the Caribbean (LAC). An electronic literature search was conducted across multiple databases, including MEDLINE (PubMed), Scopus, LILACS, SciELO, and Web of Science, without publication date or language limitations, up until December 2023. Reviewers independently assessed titles and abstracts based on the eligibility criteria. The search yielded 1195 articles, with 63 meeting the inclusion criteria. The results of epidemiological studies showed that periodontitis is extremely prevalent at 90% in LAC; severe periodontitis can affect nearly 10% of the adult population and that periodontitis is aggravated by smoking, poverty, low education level, and limited access to proper dental care. Periodontitis was consistently associated with worse OHRQoL; and causing pain, and/or triggering psychological discomfort, physical disability, and social disability. Associations were also reported between periodontitis and comorbidities such as diabetes, cardiovascular disease, rheumatoid arthritis, respiratory disease, mental illness, and adverse pregnancy outcomes that are also affecting the quality of life of individuals and their families. This scoping review offers a thorough examination of the burden of periodontal diseases in LAC and highlights the significant public health concern that it represents for the region.

Knowledge and Attitudes on Preventing and Treating Dentin Hypersensitivity and Its Predicting Factors: A Cross-sectional Study with Brazilian Citizens

OBJECTIVES

 Most dental schools have included dentin hypersensitivity (DH) as part of their taught curriculum to educate undergraduates; however, it is possible that the public still does not recognize its symptoms and the factors that predispose to the onset of this condition. Thus, the aim of this study was to assess the knowledge of a Brazilian population regarding the prevention and treatment of DH and to identify what self-reported factors can serve as predictors of the frequency of DH.

MATERIALS AND METHODS

 An online questionnaire investigated the demographic characteristics, oral health self-perception and attitudes, and DH prevention and treatment measures of 226 participants.

STATISTICAL ANALYSIS

 Data were analyzed descriptively and by a multiple linear regression with DH frequency score as the dependent variable (α < 0.05).

RESULTS

 Total 61.1% of females (n = 138) and 38.9% of males (n = 88) (mean age: 35.1 ± 12.2 years) completed the questionnaire. The sample's mean DH frequency score (minimum 0; maximum 20) was 4.2 and classified as low, with 19.1% using desensitizing products and 22.1% reporting having noncarious cervical lesions (NCCLs). When experiencing DH episodes, 21.2% never and 30.1% rarely scheduled dental appointments. Regression analysis retrieved a significant final model (F [5,220] = 12.047; p < 0.001; R 2 = 0.215).

CONCLUSION

 This study identified that 36.7% and 18.6% of the sample were unaware that DH can be both prevented and treated, respectively. Moreover, the presence of NCCLs, frequency of daily toothbrushing, use of desensitizing products, presence of DH modulating factors, and the presence of parafunctional habits symptoms served as predictors of DH frequency.

Is There a Difference in the Proteomic Profile of Stimulated and Unstimulated Saliva Samples from Pregnant Women with/without Obesity and Periodontitis?

This study aimed to compare the proteomic profile of stimulated and unstimulated saliva samples from pregnant women with/without obesity and periodontitis. Pregnant women were allocated into four groups: with obesity and periodontitis (OP); with obesity but without periodontitis (OWP); with normal BMI but with periodontitis (NP); with normal BMI and without periodontitis (NWP). Stimulated saliva (SS) and unstimulated saliva (US) samples were collected, and salivary proteins were extracted and individually processed by proteomic analysis (nLC-ESI-MS/MS). Proteins involved with the immune response process, antioxidant activity, and retina homeostasis were decreased or absent in SS samples from all groups (i.e., Antileukoproteinase, Lysozyme C, Alpha-2-macroglobulin-like protein 1, Heat shock proteins-70 kDa 1-like, 1A, 1B, 6, Heat shock-related 70 kDa protein 2, Putative Heat shock 70 kDa protein 7, Heat shock cognate 71 kDa). Additionally, proteins related to the carbohydrate metabolic process and glycolytic and glucose metabolic process were absent in SS, mainly from OP and OWP (i.e., Frutose-bisphosphate aldose A, Glusoce-6-phosphate isomerase, Pyruvate kinase). Saliva stimulation decreased important proteins involved with immune response and inflammation process in all groups. Unstimulated salivary samples seem to be the best choice for the proteomic approach in pregnant women.

Association between gestational weight gain and preterm birth and post-term birth: a longitudinal study from the National Vital Statistics System database

BACKGROUND

To evaluate the association between gestational weight gain (GWG) and preterm birth and post-term birth.

METHODS

This longitudinal-based research studied singleton pregnant women from the National Vital Statistics System (NVSS) (2019). Total GWG (kg) was converted to gestational age-standardized z scores. The z-scores of GWG were divided into four categories according to the quartile of GWG, and the quantile 2 interval was used as the reference for the analysis. Univariate and multivariate logistic regression analyses were performed to investigate the association between GWG and preterm birth, post-term birth, and total adverse outcome (preterm birth + post-term birth). Subgroup analysis stratified by pre-pregnancy body mass index (BMI) was used to estimate associations between z-scores and outcomes.

RESULTS

Of the 3,100,122 women, preterm birth occurred in 9.45% (292,857) population, with post-term birth accounting for 4.54% (140,851). The results demonstrated that low GWG z-score [odds ratio (OR): 1.04, 95% confidence interval (CI): 1.03 to 1.05, P < 0.001], and higher GWG z-scores (quantile 3: OR: 1.42, 95% CI: 1.41 to 1.44, P < 0.001; quantile 4: OR: 2.79, 95% CI: 2.76 to 2.82, P < 0.001) were positively associated with preterm birth. Low GWG z-score (OR: 1.18, 95% CI: 1.16 to 1.19, P < 0.001) was positively associated with an increased risk of post-term birth. However, higher GWG z-scores (quantile 3: OR: 0.84, 95% CI: 0.83 to 0.85, P < 0.001; quantile 4: 0.59, 95% CI: 0.58 to 0.60, P < 0.001) was associated with a decreased risk of post-term birth. In addition, low GWG z-score and higher GWG z-scores were related to total adverse outcome. A subgroup analysis demonstrated that pre-pregnancy BMI, low GWG z-score was associated with a decreased risk of preterm birth among BMI-obesity women (OR: 0.96, 95% CI: 0.94 to 0.98, P < 0.001).

CONCLUSION

Our result suggests that the management of GWG may be an important strategy to reduce the number of preterm birth and post-term birth.

Knowledge, attitudes and practices of undergraduate students and dentists about dental prenatal care

INTRODUCTION

Prenatal care is a fundamental moment for health promotion to be carried out, since at that moment women are more receptive to new knowledge, with the aim of providing better healthcare for the baby. This study aimed to evaluate the knowledge, attitudes and practices of undergraduate students and professionals, both from the public and from private sectors in Brazil, regarding dental prenatal care.

MATERIALS AND METHODS

This study corresponded to an online questionnaire survey, via Google Forms, consisting of 17 general questions for undergraduates (n = 103) and 16 for professionals (n = 227) for demographic and school mapping, and 18 specific questions about the importance and protocol of dental prenatal care. T-test, Mann-Whitney U-test and multiple linear regression were adopted (p < .05).

RESULTS

The average total score of the questionnaire for students and professionals was 12.40 and 15.65, respectively (p < .0001), indicating moderate knowledge. Professionals showed a higher prevalence of moderate (77%) and high (2%) knowledge of the subject when compared to undergraduate students (51% and 0% respectively). The graduation period in which the students were enrolled was a predictor of the total score of the questionnaire [F (1, 101) = 21.21; p < .0001; R²  = .165]. The female gender and the lower weekly workload were the main predictors of the total score of the questionnaire for professionals [F (3, 223) = 6.74; p < .0001; R²  = .083].

CONCLUSIONS

Although professionals have greater knowledge about dental prenatal care than students, there are still deficiencies in the knowledge and practices of them in respect of dental management during pregnancy. Higher education institutions need to change the teaching-learning plan regarding the holistic dental approach for women during pregnancy.

Label-Free Quantitative Proteomic Analysis Reveals Inflammatory Pattern Associated with Obesity and Periodontitis in Pregnant Women

Obesity and pregnancy may have synergistic effects on periodontal condition, and proteomics could be an ideal approach to highlight the pathophysiological mechanisms associated with these outcomes. This study analyzed the salivary proteomics related to obesity and periodontitis in women during pregnancy (T1) and after delivery (T2). Initially, 126 women were recruited and forty were allocated into groups: with obesity and periodontitis (OP); with obesity, but without periodontitis (OWP); with normal BMI, but with periodontitis (NP); with normal BMI and without periodontitis (NWP). Whole-mouth saliva was collected in T1 and T2, and proteins were extracted and individually processed by label-free proteomics (nLC-ESI-MS/MS). The up-regulations of Heat shock 70 kDa protein 1A, 1B, and 1-like were related to both obesity and periodontitis, separately. Albumin and Thioredoxin were up-regulated in periodontitis cases, while Cystatins (mainly S, SA, SN) and Lactotransferrin were down-regulated. The high abundances of Submaxillary gland androgen-regulated protein 3B, Protein S100-A8, Matrix metalloproteinase-9, Heat shock 70 kDa protein 2 and 6, Putative Heat shock 70 kDa protein 7, Heat shock 71 kDa protein, Haptoglobin and Plastin-1 were significant in the combination of obesity and periodontitis. Obesity and periodontitis remarkably altered the proteome of the saliva during pregnancy with substantial alterations after delivery.

Is overweight associated with periodontitis in pregnant women? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to generate pooled evidence for the association between excessive weight and pregnancy induced periodontitis. EMBASE, SCOPUS, PubMed/MEDLINE, Web of Science, BVS/LILACS, Cochrane Library and SCIELO databases were accessed. Eligibility criteria were: human clinical studies published between year 2000 and 2021. Newcastle-Ottawa scale was used to evaluate risk of bias of the studies. Meta-analysis was performed using MedCalc® Statistical Software. Eleven studies were included, evaluating 2152 pregnant women (743 with overweight/obesity and 1409 with normal body mass index - BMI), with a mean age of 29.62 years. Most studies had low risk of bias. A positive association between overweight/obesity and periodontitis was found, with an average of 61.04% of women with overweight/obesity and periodontitis, showing the overall random-effects relative risk and 95% CI of 2.21 (1.53–3.17) (p < 0.001). Arterial hypertension, gestational diabetes mellitus and excessive gestational weight gain were the most common adverse effects of maternal obesity that may have been linked to periodontitis induced pro-inflammatory state. In conclusion, a positive association was found between overweight/obesity and periodontitis during pregnancy. However, the high heterogeneity between the studies related to sample size, periodontal classification and the cutoff-points for BMI are the main limitation.

Metabolomic Profiles Associated with Obesity and Periodontitis during Pregnancy: Cross-Sectional Study with Proton Nuclear Magnetic Resonance (1H-NMR)-Based Analysis

This study aimed to elucidate the metabolomic signature associated with obesity and periodontitis during pregnancy in plasma and saliva biofluids. Ninety-eight pregnant women were divided into: with obesity and periodontitis (OP = 20), with obesity but without periodontitis (OWP = 27), with normal BMI but with periodontitis (NP = 21), with normal BMI and without periodontitis (NWP = 30). Saliva and plasma were analyzed by 1H-NMR for metabolites identification. Partial Least Squares-Discriminant Analysis (PLS-DA), Sparse PLS-DA (sPLS-DA), and Variable Importance of Projection (VIP) were performed. ANOVA and Pearson’s correlation were applied (p < 0.05). Plasmatic analysis indicated the levels of glucose (p = 0.041) and phenylalanine (p = 0.015) were positively correlated with periodontal parameters and BMI, respectively. In saliva, periodontitis was mainly associated with high levels of acetic acid (p = 0.024), isovaleric acid, butyric acid, leucine, valine, isoleucine, and propionic acid (p < 0.001). High salivary concentrations of glycine (p = 0.015), succinic acid (p = 0.015), and lactate (p = 0.026) were associated with obesity. Saliva demonstrated a more elucidative difference than plasma, indicating the glucose-alanine cycle, alanine metabolism, valine, leucine and isoleucine degradation, glutamate metabolism, and Warburg effect as the main metabolic pathways.

Obesity during pregnancy and its oral repercussions

Obesity during pregnancy and its oral repercussions: what is the current evidence?

Porphyromonas gingivalis Administration Induces Gestational Obesity, Alters Gene Expression in the Liver and Brown Adipose Tissue in Pregnant Mice, and Causes Underweight in Fetuses

Preventing adverse pregnancy outcomes is crucial for maternal and child health. Periodontal disease is a risk factor for many systemic diseases including adverse pregnancy outcomes, such as preterm birth and low birth weight. In addition, the administration of the periodontopathic bacterium Porphyromonas gingivalis exacerbates obesity, glucose tolerance, and hepatic steatosis and alters endocrine function in the brown adipose tissue (BAT). However, the effects of having periodontal disease during pregnancy remain unclear. Thus, this study investigates the effect of P. gingivalis administration on obesity, liver, and BAT during pregnancy. Sonicated P. gingivalis (Pg) or saline (Co) was injected intravenously and administered orally to pregnant C57BL/6J mice three times per week. Maternal body weight and fetal body weight on embryonic day (ED) 18 were evaluated. Microarray analysis and qPCR in the liver and BAT and hepatic and plasma triglyceride quantification were performed on dams at ED 18. The body weight of Pg dams was heavier than that of Co dams; however, the fetal body weight was decreased in the offspring of Pg dams. Microarray analysis revealed 254 and 53 differentially expressed genes in the liver and BAT, respectively. Gene set enrichment analysis exhibited the downregulation of fatty acid metabolism gene set in the liver and estrogen response early/late gene sets in the BAT, whereas inflammatory response and IL6/JAK/STAT3 signaling gene sets were upregulated both in the liver and BAT. The downregulation of expression levels of Lpin1, Lpin2, and Lxra in the liver, which are associated with triglyceride synthesis, and a decreasing trend in hepatic triglyceride of Pg dams were observed. P. gingivalis administration may alter lipid metabolism in the liver. Overall, the intravenous and oral administration of sonicated P. gingivalis-induced obesity and modified gene expression in the liver and BAT in pregnant mice and caused fetuses to be underweight.

Periodontal status and quality of life in pregnant women with both overweight/obesity and hypertension: A cross-sectional study

Background

The aim of this study was to assess the periodontal condition and quality of life of pregnant women affected with both overweight/obesity and arterial hypertension.

Material and Methods

Pregnant women were dived into three groups: with overweight/obesity and hypertension (G1 = 23), with overweight/obesity without hypertension (G2 = 31) and with normal BMI and without hypertension (G3 = 38). They were evaluated regarding: contextual variables (age, socioeconomic level and anthropometric parameters); periodontal status; and quality of life (adapted version of Oral Health Impact Profile – OHIP-14). ANOVA, Kruskal-Wallis, chi-square and binary logistic regression model were adopted (p< 0.05).

Results

There were no intergroup differences for age (p = 0.700), education level (p = 0.119) and gestational weight gain (p = 0.415), nevertheless G2 differed from G3 regarding household monthly income (p = 0.040). G2 had higher prevalence of bleeding on probing than G3 (p = 0.001), but G1 and G2 presented higher prevalence of periodontitis (p< 0.001). Household monthly income (adjusted OR = 0.71; 95% CI = 0.52 - 0.98; p = 0.038) and hypertension (adjusted OR = 3.70; 95% CI = 1.16 - 11.80; p = 0.026) remained in the final logistic regression model [X2(4) = 21.79; p = 0.0002; R2 of Nagelkerke = 0.284]. G1 showed worse impact on quality of life, mainly regarding physical pain (p< 0 .001), psychological discomfort (p< 0 .001), physical disability (p< 0 .001), social disability (p = 0.005) and handicap (p< 0 .001).

Conclusions

In conclusion, maternal excessive weight is associated with periodontitis during pregnancy. Moreover, the presence of hypertension in overweight pregnant women seems to be determinant to negatively influence their quality of life, resulting in physical, psychological and social damages.

Key words:Hypertension, obesity, overweight, periodontitis, quality of life.

Periodontitis and Gestational Diabetes Mellitus: A Potential Inflammatory Vicious Cycle

Periodontitis is a chronic inflammatory immune disease associated with a dysbiotic state, influenced by keystone bacterial species responsible for disrupting the periodontal tissue homeostasis. Furthermore, the severity of periodontitis is determined by the interaction between the immune cell response in front of periodontitis-associated species, which leads to the destruction of supporting periodontal tissues and tooth loss in a susceptible host. The persistent bacterial challenge induces modifications in the permeability and ulceration of the sulcular epithelium, which facilitates the systemic translocation of periodontitis-associated bacteria into distant tissues and organs. This stimulates the secretion of pro-inflammatory molecules and a chronic activation of immune cells, contributing to a systemic pro-inflammatory status that has been linked with a higher risk of several systemic diseases, such as type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM). Although periodontitis and GDM share the common feature of systemic inflammation, the molecular mechanistic link of this association has not been completely clarified. This review aims to examine the potential biological mechanisms involved in the association between periodontitis and GDM, highlighting the contribution of both diseases to systemic inflammation and the role of new molecular participants, such as extracellular vesicles and non-coding RNAs, which could act as novel molecular intercellular linkers between periodontal and placental tissues.

Salivary cytokines levels, maternal periodontitis and infants' weight at birth: A cohort study in pregnant women with obesity

INTRODUCTION

Obesity and pregnancy may have synergistic effects on maternal periodontal tissues. In contrast, maternal obesity and periodontitis are antagonistic factors for the babies' weight at birth. This study evaluated, during pregnancy (T1) and after delivery (T2), periodontal parameters and salivary levels of cytokines in women with obesity, and the association of these outcomes with the baby's weight at birth.

METHODS

After matching by age, socioeconomic status and systemic health, the sample was composed of pregnant women with obesity (GO = 25; BMI ≥30 kg/m²) and normal BMI (GN = 25; BMI between 18.5 and 24.99 kg/m²), who were evaluated regarding: periodontal parameters; salivary levels of TNF-α, IL-1β and leptin (Luminex® assay); and babies' weight at birth. Mann-Whitney, Friedman, ANOVA; chi-square and Cochran's Q tests were applied (p < 0.05).

RESULTS

GO showed higher prevalence of periodontitis in T1 and T2 (p <0.001), with higher salivary levels of TNF-α (p = 0.003) and IL-1β (p = 0.009) in T1. IL-1β significantly decreased after delivery in GO. No intergroup differences for leptin levels were found, but both groups had a significant reduction of leptin levels between periods (p <0.001). GO had children with lower birth weight (p = 0.022), being classified as low (<2,500 g) or insufficient (2,500-2,999 g) weight.

DISCUSSION

It is suggestive that the inflammatory pattern caused by obesity and periodontitis, mainly related to high levels of TNF-α, impair the babies' weight at birth, resulting in more frequency of low/insufficient weight at birth.

Systemic Condition, Periodontal Status, and Quality of Life in Obese Women During Pregnancy and After Delivery

OBJECTIVE

To evaluate the systemic condition, periodontal status, and quality of life of obese women during pregnancy and after delivery.

METHODS

This prospective cohort consisted of 60 women examined in the third trimester of pregnancy (32nd-36th gestational week [T1]) and after delivery (T2) and were divided into elevated body mass index (BMI; GO = 30) and normal BMI (GN = 30) according to the World Health Organization. The variables assessed were: (1) gestational weight gain, arterial hypertension (AH), and diabetes mellitus; (2) oral hygiene behaviour (frequency of dental floss using and toothbrushing); (3) probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and dental biofilm; and (4) quality of life (Oral Health Impact Project [OHIP]-14). Analysis of variance (ANOVA), Friedman, Cochran's Q and χ2 tests, and logistic regression model were adopted (P < .05).

RESULTS

GO showed a higher frequency of AH in T1 (P < .001). Both groups decreased the frequency of dental floss use (P = .013) and toothbrushing (P < .001) and increased the percentage of dental biofilm in T2 (P < .001). GO presented a greater PPD and CAL in T1 and T2 and higher BOP in T1 (P < .001), demonstrating a negative impact in the following dimensions of Oral Health Impact Project-14 during T1 functional limitation (P = .020), physical disability (P = .020), and handicap (P = .021).

CONCLUSION

Obese women presented higher prevalence of AH during pregnancy and higher prevalence of periodontitis in both periods. They showed a poor quality of life in T1 regarding functional limitation, physical disability, and handicap.

Periodontal Conditions and Pathogens Associated with Pre-Eclampsia: A Scoping Review

BACKGROUND

Pre-eclampsia, the second most frequent direct source of maternal mortality, is a multisystem gestational disorder characterized by proteinuria and maternal hypertension after the 20th gestational week. Although the causes of pre-eclampsia are still discussed, research has suggested that the placenta has a central place in the pathogenesis of this disease. Moreover, current surveys indicated that periodontal disorders observed during the pregnancy and more particularly, periodontal pathogens could be link to the risk of pre-eclampsia.

OBJECTIVES

This article aims to review recent studies focusing on periodontal conditions and pathogens associated with pre-eclampsia.

METHODS

The process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

RESULTS

Metabolic conditions, immunological changes, fluctuating progesterone and estrogen levels of the pregnant woman induce a dysbiosis of the oral microbiota and contribute to increase inflammation of periodontal tissues. Periodontal pathogens could diffuse through the bloodstream inducing a placenta inflammatory response as well as inflammatory molecules produced in response to periodontopathogens could migrate through the bloodstream leading to a placenta inflammatory response. Also, periodontopathogens can colonize the vaginal microbiota through the gastrointestinal tract or during oro-genital contacts.

CONCLUSION

A cumulative bi-directional relationship between periodontal conditions, pathogens and the pre-eclampsia exists.

Association Between Arterial Hypertension and Periodontal Status in Morbidly Obese Patients Who Are Candidates for Bariatric Surgery

Objective

This study aimed to compare the systemic and periodontal conditions between morbidly obese patients with and without hypertension who were candidates for bariatric surgery.

Methods

The study cohort had 111 morbidly obese patients stratified into two groups: patients with (G1 = 54) and without (G2 = 57) arterial hypertension. The following characteristics were compared between the two groups: (i) education level; (ii) anthropometric parameters [weight, height, body mass index (BMI), waist and hip circumferences and waist-to-hip ratio (WHR)]; (iii) risk of developing cardiovascular diseases (based on patients’ sex, age and WHR); (iv) behaviours regarding oral hygiene; and (v) periodontal status. The t-test, Mann–Whitney U-test, chi-square test and logistic regression were applied, with a significance level of 5%.

Results

Patients in G1 had a lower level of education (P = 0.002). There were no intergroup differences for weight (P = 0.211), height (P = 0.126), BMI (P = 0.551), waist circumference (P = 0.859) and WHR (P = 0.067); however, patients in G2 had a smaller hip circumference (P = 0.029), and 78% of patients in G1 had a high/very high risk of developing cardiovascular diseases. The prevalence of periodontitis was 72.2% (n = 39) in G1 and 38.6% (n = 22) in G2. On logistic regression analysis, age [adjusted odds ratio (OR) = 1.07; 95% CI = 1.01–1.13; P = 0.008) and the presence of arterial hypertension (OR = 2.77; 95% CI = 1.17–6.56; P = 0.019) were identified as the independent variables associated with periodontitis.

Conclusion

Morbid obesity and arterial hypertension are associated with a higher prevalence of cardiovascular diseases. Moreover, morbidly obese patients with hypertension have a higher prevalence of periodontitis and greater severity of periodontal disease than those without hypertension.