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Medicine Oral Health Research Periodontics Restorative Dentistry

Is There an Association between Maternal Periodontitis and Adverse Pregnancy Outcomes?

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By 

  • Mohammad A. Javaid;  McGill University, Montréal, Québec  (currently at the University of British Columbia)
  • Robert Durand;  Université de Montréal, Montréal, Québec
  • Yannie Chea;  Private office, Montreal, Quebec
  • Andrea Hsu;  Private office, Montreal, Quebec
  • Simon D. Tran; McGill University, Montréal, Québec

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Context

Pregnancy is a normal physiological process that may sometimes result in adverse events like preterm birth, low birth weight (LBW) and/or pre-eclampsia. A multitude of risk factors may increase the incidence of these adverse pregnancy outcomes (APOs), including maternal periodontitis.

Purpose of Review

In this review, we present the most recent epidemiological evidence with regard to the association between maternal periodontitis and APOs, as well as updated treatment guidelines for pregnant patients. Although several hypotheses explaining the association between periodontitis and adverse pregnancy outcomes are consistent with the medical literature, no clear consensus has been reach among clinicians and researchers. In the following section, we summarize the most up-to-date epidemiological evidence associating periodontitis with APOs. This evidence was recently published in the Journal of Periodontology and the Journal of Clinical Periodontology as the result of a joint workshop between the American Academy of Periodontology and the European Federation of Periodontology (1).

Key Messages

Fusobacterium nucleatum (F. nucleatum), a known periodontal pathogen, has been detected in the amniotic fluid and fetal tissues of cases involving stillbirth and preterm birth.

Evidence suggests existence of fetal antibodies directed against Porphyromonas gingivalis (P. gingivalis) and presence of P. gingivalis in placental tissues of mothers who delivered a preterm infant.

Research shows that elevated serum IgG levels against P. gingivalis are associated with LBW.

Pooled data from various prospective, cross-sectional studies to assess the association between periodontitis and APOs shows conflicting results. When probing depth is used as a criterion for definition of maternal periodontitis, no association with LBW is established. However, when attachment level is used to identify cases, a significant correlation is found.

Likewise, pooled data from case-control studies investigating a relationship between maternal periodontitis and pre-eclampsia or preterm birth demonstrates a positive association with significantly deeper probing depth and higher gingival bleeding index in cases as compared to controls. However, no association has been established between preterm birth and attachment loss. While maternal periodontitis was shown to be an independent risk factor for APOs, the results are impacted by the definition used to identify cases.

Randomized clinical trials investigating the effect of periodontal therapy on APOs have demonstrated that improved periodontal status after therapy does not result in a decrease in overall rates of preterm birth rate or LBW. However, in specific populations, it might be beneficial since some trials have shown an overall positive effect.

Guidelines for Oral Health Professionals

Obstetric guidelines recommend that elective procedures should be avoided during the first trimester of pregnancy due to the increased risk to negatively affect the foetus and should be rendered during the second trimester.

Pregnant Patients Exhibiting a Healthy Periodontium

  • Educate about physiological changes taking place during pregnancy, e.g. increased vascularisation, possibility of higher incidence of gingival bleeding or enlargement.
  • Encourage maintaining good oral health with specific hygiene instructions.
  • Re-evaluate later in pregnancy.

Pregnant Patients with Gingivitis

  • Same oral health promotion interventions as discussed above.
  • Professional interventions aiming at reducing the bacterial load and signs of inflammation (bleeding on probing).
  • Monitor the patient periodically.

Pregnant Patients with Periodontitis

  • Same oral health promotion interventions as discussed above.
  • Provide non-surgical periodontal therapy to reduce the subgingival biofilm and periodontal inflammation.
  • Provide oral hygiene instructions.
  • Elective surgical procedures should be avoided.
  • In presence of gingival enlargement, surgical excision should be delayed until the inflammation is under control.
  • Closely monitor the patient.
  • Re-evaluate after pregnancy. 

References

  1. Sanz M, Kornman K. Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol 2013;40 Suppl 14:S164-169.

 

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1 Comment

  1. VR January 30, 2014

    Are there any measurements of bacteria in patients with normal births? That is absolutely necessary to compare. It’s not mentioned here; only that bacteria and antibodies were seen in select patients.

    Reply

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