Relationship between maternal periodontal disease and low-birth-weight pre-term infants

OBJECTIVES: The purpose of this study was to determine the influence of periodontal status on low-birth-weight pre-term delivery. MATERIAL AND METHODS: Ninety-six pregnant women were examined in their first, second and third trimester to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and percentage of sites with depth of >3 mm). Binary logistic regression analyses were performed using SUDAAN 7.5 program. The type 1 (alpha) error established at 0.05 and an (alpha) error of 0.05-0.1 were considered nearly significant. RESULTS: The 96 women delivered 89 newborns: 16 were pre-term and seven of these were of low birth weight. There were seven miscarriages, all in the second trimester. No statistically significant association was found between gestational age and periodontal parameters. No significant relationship was found between low-weight delivery and plaque index measurements, although the association with gingival index was close to significant. A relationship was observed between low-weight birth and probing depth measurements, especially the percentage of sites of >3 mm depth, which was statistically significant (p=0.0038) even when gestational age was controlled for. CONCLUSIONS: According to these results, periodontal disease is a significant risk factor for low birth weight but not for pre-term delivery.     

Change in periodontitis during pregnancy and the risk of pre-term birth and low birthweight

Aim: Determine whether periodontitis progression during pregnancy is associated with adverse birth outcomes.
Methods: We used clinical data and birth outcomes from the Obstetrics and Periodontal Therapy Study, in which randomly selected women received periodontal treatment before 21 weeks of gestation ( N =413) or after delivery (410). Birth outcomes were available for 812 women and follow-up periodontal data for 722, including 75 whose pregnancies ended <37 weeks. Periodontitis progression was defined as 3 mm loss of clinical attachment. Birth outcomes were compared between non-progressing and progressing groups using the log rank and t tests, separately in all women and in untreated controls.
Results: The distribution of gestational age at the end of pregnancy ( p >0.1) and mean birthweight (3295 versus 3184 g, p =0.11) did not differ significantly between women with and without disease progression. Gestational age and birthweight were not associated with change from baseline in percentage of tooth sites with bleeding on probing or between those who did versus did not progress according to a published definition of disease progression ( p >0.05).
Conclusions: In these women with periodontitis and within this study's limitations, disease progression was not associated with an increased risk for delivering a pre-term or a low birthweight infant.     

A case-control study to investigate an association between adverse pregnancy outcome and periodontal disease

OBJECTIVES: The aim of this case-control study was to ascertain if women who experienced a preterm (or premature) birth had any differences in periodontal disease severity compared with women who delivered at term. MATERIAL AND METHODS: Subjects were recruited postpartum. Case subjects delivered a baby before 37 weeks of gestation whereas control subjects gave birth at or around term. A questionnaire was administered by a Research Midwife, designed to collect demographic information, pregnancy outcome variables and information on other factors which may influence health in pregnancy. A periodontal examination was then performed at the bedside. RESULTS: Demographic variables were similar between case and control subjects. There was a higher proportion of case subjects who reported smoking. There were no differences in oral hygiene, bleeding on probing or loss of attachment; however, control subjects had a higher proportion of periodontal pockets probing 5 mm or greater. CONCLUSIONS: There was no association between the severity of periodontal disease and pregnancy outcome in this population.     

The relationship between osteoporosis and periodontitis in women aged 45-70 years

Oral Diseases (2012) 18 , 353–359 Objective: To explore the possible relationship between the osteoporotic condition and the severity of periodontitis in women aged 45–70 years. Materials and Methods: Ninety women with generalized chronic periodontitis, aged 45–70 years, were studied. Areal bone mineral density (BMDa) was assessed using standardized dual energy X‐ray absorptiometry (normal: T‐score ≥ ?1, osteopenic: ?2.5 ≤ T‐score T‐score < ?2.5). Gingival index (GI), bleeding on probing, clinical attachment loss (CAL), probing pocket depth and gingival recession (GR) were recorded. Periodontitis severity was represented by CAL. Menopausal condition and smoking were documented. Results: Mean GI, bleeding on probing, CAL and GR were significantly greater for osteoporotic women than women with normal BMDa (P = 0.002, P = 0.01, P = 0.04, respectively). Osteopenic women and women with normal BMDa significantly differed in mean GI (P = 0.02). The associations found between osteoporotic women and women with normal BMDa and the associations found between osteopenic women and women with normal BMDa existed even after adjusting for smoking and menopausal status. Conclusion: Subjects with osteoporosis (OPR) presented with greater CAL than the subjects with normal BMDa, which suggests a greater severity of periodontitis. Subjects with OPR had greater GR than the subjects with normal BMDa. Subjects with osteopenia and subjects with normal BMDa did not differ in CAL, which might suggest that the early diagnosis of reduced BMDa, prior to the establishment of a significant negative impact on the periodontal tissues, might be important. Smoking and menopausal status did not alter these associations.     

Choosing the left fork: Steven Offenbacher and understanding maternal periodontal disease and adverse pregnancy outcomes

Steven Offenbacher was one of the first researchers to identify periodontal disease as a risk factor for various adverse pregnancy outcomes. Cohort and case-controlled studies of pregnant women have demonstrated periodontal disease as a risk factor for preterm birth, preeclampsia, and fetal growth restriction. Periodontal therapy during the second trimester improves maternal oral health but fails to reduce the risk of preterm birth. A possible association between periodontal disease and gestational diabetes has also been reported. In one model, periodontal bacteria gain access to the systemic circulation, and thereby the placenta, resulting in local inflammation, placental dysfunction, and, consequently, adverse pregnancy outcomes. It is crucial to increase awareness of the links between maternal periodontal and adverse pregnancy outcomes and to promote oral health prophylaxis during pregnancy.     

牙周炎与不良妊娠结局相关关系的研究进展

牙周炎是由牙周致病菌感染引起的慢性炎症性疾病,在妊娠妇女中更容易发生。不良妊娠结局是新生儿围产期死亡的重要原因,受机体全身炎症的影响。该文主要对牙周炎与不良妊娠结局的相关性进行阐述,进一步从阴道感染、菌血症、免疫炎症和肠道菌群方面对其机制进行探讨,并简述了牙周炎与不良妊娠结局共有的宿主易感性遗传背景,以期为临床上预防妊娠期牙周病和不良妊娠结局提供一定的理论指导。     

孕妇牙周健康状况与早产的相关性研究

目的 通过调查孕妇牙周状况和分娩结局,探讨牙周感染与早产的关系。 方法 选择2012年在无锡市妇幼保健院进行孕检孕妇674名,进行临床牙周检查,记录简化口腔卫生指数(OHI-S)、龈沟出血指数（SBI）、探诊深度(PD)和临床附着丧失(CAL),追踪妊娠结局,运用卡方检验,t检验和Spearman检验的统计学方法对数据进行分析。 结果 ①早产组孕妇牙周炎患病率（36.1%）高于足月妊娠组（21.4%）;②早产组孕妇牙周指标OHI-S、SBI、PD、CAL均高于足月妊娠组（P﹤0.05）;③孕妇牙周指标OHI-S、PD、CAL与分娩孕周呈负相关关系（P﹤0.05）。 结论 孕妇牙周感染与早产之间存在着相关性,可能是早产的危险因素之一,应做好孕期口腔健康教育。     

Chronic periodontitis and pre-term labour in Brazilian pregnant women: an association to be analysed

Aim: To investigate the association between chronic periodontitis (CP) and pre‐maturity in a group of Brazilian pregnant women from the State of São Paulo. Materials and Methods: One hundred and twenty‐four women were investigated consecutively in a cross‐sectional study, between December 2003 and May 2005. Sixty‐eight women had pre‐term labour (PTL) and 56 had term labour. A periodontal examination was carried out to identify the presence of CP. Statistical analysis used the Fisher's exact test or χ² for the discrete variables and the Mann–Whitney test for the non‐parametric variables. Odds ratio (OR) was calculated with a 95% confidence interval (CI), to evaluate the relation between CP and pre‐maturity. Results: Periodontal indicators, such as clinical attachment loss (p<0.0001) and bleeding on probing (p=0.012), were observed more in the PTL group. The presence of CP increased the risk for PTL (OR: 4.7, 95% CI: 1.9–11.9), pre‐term birth (PTB; OR: 4.9, 95% CI: 1.9–12.8) and low birth weight (<2500 g; OR: 4.2, 95% CI: 1.3–13.3). The pregnant women with PTL presented low levels of schooling (p=0.029) and the lowest number of pre‐natal appointments (p=0.0001) when compared with those with term labour. Conclusion: CP is strongly associated with PTL, PTB and low birth weight in a group of Brazilian pregnant women. These data point to the necessity of regularly investigating CP during pregnancy.     

Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes

Aim: The aim of this secondary analysis is to explore whether the application of different definition criteria of periodontitis, used in other similar studies, has an influence on the significance of the association between periodontitis and prematurity or low birth weight. Material and Methods: Fourteen periodontitis definitions and more than 50 periodontal disease continuous measurements, found in 23 published studies, were applied to a cohort study that included 1296 pregnant women. The associations with adverse pregnancy outcomes were analysed using logistic regression analysis. Results: Six of the 14 tested definitions of periodontitis resulted in statistically significant adjusted odds ratios (ORs) for some of the adverse pregnancy outcomes, while no significance was found for the other eight case definitions. Out of more than 50 periodontal continuous measurements tested, only 17 demonstrated statistically significant ORs. Conclusions: Our results support the hypothesis that the significance of the association between periodontal disease and pregnancy outcomes may be determined by the periodontal disease definition or measurement used.     

牙周病与早产低体重儿的关系及其机制的研究进展

早产是指新生儿出生时胎龄未满37周,低体重儿是指新生儿出生时体重未满2 500 g,早产常伴发低体重儿。早产被认为是新生儿死亡的主要原因。牙周病是一种口腔常见的慢性感染性疾病,与全身多种系统性疾病具有相关性。流行病学资料表明牙周病与早产低体重儿具有一定相关性,牙周病是早产低体重儿等不良妊娠结局的危险因素之一,可能的机制包括牙周致病菌菌体的直接作用,引起机体炎症反应和过激免疫反应等,然而具体的机制尚未明确。本文就牙周病与早产低体重儿的相关性,开展牙周治疗对早产低体重儿发生率的影响,以及牙周病引发早产低体重儿的相关机制作一综述。     

Maternal periodontitis and adverse pregnancy outcomes

Abstract – Objectives: Maternal periodontal diseases have been associated with increased risk of preterm birth and restricted fetal growth among relatively low socioeconomic groups. Whether the association can be generalized to middle‐class populations remains uncertain. We evaluated periodontitis in relation to preterm birth (<37 weeks’ gestation) and small‐for‐gestational‐age (SGA, birth weight below the 10th percentile of birth weight for gestational age) among a group of medically insured women. Methods: We conducted a prospective study among participants of Project Viva, a US cohort study of pregnant women and their offspring from 1999 to 2002. Pregnancy outcomes were obtained from medical records. Self‐reported periodontitis was assessed during the second trimester of pregnancy, and validated against radiographs. Logistic regression analyses were employed to evaluate the association of periodontitis with pregnancy outcomes adjusted for age, race/ethnicity, smoking status, income, frequency of dental check‐ups, prepregnancy body mass index, pregnancy weight gain, gravidity, prior history of preterm birth and history of genitourinary infection. Results: Of the 1635 women, 72.7% were Caucasian, 65.0% had annual household income >$70 000, 3.8% reported having periodontitis, 6.4% delivered preterm, 5.4% delivered SGA babies, and 11.0% had poor pregnancy outcome (either preterm birth or SGA). The odds ratio (OR) associated with periodontitis was 1.74 (95% CI 0.65–4.66) for preterm delivery and 2.11 (95% CI 0.76–5.86) for SGA individually. When preterm delivery and/or SGA were combined, the OR was 2.26 (95% CI 1.05–4.85) relating periodontitis with poor pregnancy outcome. Conclusion: Within the limitations of the study, the results suggest that periodontitis is an independent risk factor for poor pregnancy outcome among middle‐class women.     

A possible association between preterm birth and early periodontitis. A pilot study

According to many studies, generalised periodontitis can be a risk factor for preterm birth (PB). A case-control study was carried out to examine if early localised periodontitis could be a risk factor for adverse pregnancy outcome. MATERIAL AND METHODS: Postpartum women without any systemic disease were included into the study. Similar numbers of patients belonged to the case (41) and to the control (44) groups. A PB case was defined if a patient had a threatening premature labour during pregnancy, preterm premature rupture of membranes, or spontaneous preterm labour, and/or the weight of the newborn was < or = 2499 g. Control women had delivery after the 37th gestational week and the newborn's weight was > or = 2500 g. Known risk factors like smoking, alcohol, drug consumption, socio-economic status and the periodontal status were recorded. RESULTS: A significant association was found between PB and early localised periodontitis of the patient with the following criterion having bleeding at > or = 50% of the examined sites (6 at each tooth) and having at least at one site > or = 4 mm probing depth (p = 0.001). The odds ratio was 5.46 at the 95% confidence interval. The average weight of the newborns in the periodontitis group was less than in the control group, the difference is significant (p = 0.047). CONCLUSION: The results indicate that early localised periodontitis of the patient during pregnancy can be regarded as an important risk factor for PB.     

The relationship between life-events and periodontitis A case-control study

Abstract This case-control study (n=100 dental patients, matched for age and sex) investigated the rôle of life-events in periodontitis. Data collected included life events, tobacco use, oral health behaviours and socio-demographics. The results of conditional simple logistic regression analysis showed that periodontitis was associated with the negative impact of life-events (p<0.01), the number of negative life-events (p<0.05), high levels of dental plaque (p<0.01), tobacco smoking (p<0.01) and being unemployed (p<0.05). These associations remained statistically significant after adjusting for oral health behaviour and socio-demo-graphic variables, but not tobacco smoking (p>0.05). Marital status became statistically significant after adjusting for the other variables (p<0.05). A model is suggested to explain the pathways through which life events may affect periodontal health. It was concluded that psychosocial factors and oral health risk behaviours cluster together as important determinants of periodontitis.     

Is there an association between periodontal disease,prematurity and low birth weight? A population‐based study

BACKGROUND: The relationship between periodontal diseases in pregnancy and children born prematurely or with low birth weight has been increasingly investigated, showing inconclusive results. OBJECTIVES: To test the link between periodontal disease in pregnant women and low birth weight or prematurity. METHODS: A population-based, cross-sectional study was carried out in Southern Brazil. The sample consisted of 449 parturients who were interviewed and examined up to 48 h post-partum. Three outcomes were investigated: low birth weight, prematurity and prematurity and/or birth weight. Periodontal disease, the exposure, was defined as (i) at least one site with a periodontal pocket; (ii) the presence of pockets at four or more sites. Socio-demographic information relating to health and maternal habits was collected through a questionnaire and by hospital medical records. Simple and multiple regression analysis was performed. FINDINGS: There was no statistically significant association between periodontal disease and low birth weight. Periodontal pocket was not associated with low birth weight and/or pre-term birth after being adjusted. A periodontal pocket in at least one site was associated with prematurity (odds ratio=2.6; 95% confidence interval 1.0-6.9) even after adjusting for maternal schooling, parity, number of previous children of low birth weight, number of pre-natal consultations and body mass index. After the introduction of variables relating to maternal health during pregnancy, this association disappeared. CONCLUSIONS: No association was found between periodontal disease in the mother and the low birth weight. An association between prematurity and periodontal pockets was found but it was confounded by maternal health variables.     

Clinical and microbiological characteristics of smokers with early onset periodontitis

Cigarette smoking is a potential risk factor which has recently been associated with periodontal disease progression. The objective of this study was to compare the microbial profile of smokers and non-smokers in a group of patients with early onset periodontitis. The study population consisted of 60 healthy individuals, 40 males and 20 females aged 22 to 35 yr, exhibiting early onset periodontitis. Thirty patients were smokers (30.9 cigarettes/d) and 30 non-smokers. Smokers had a higher proportion of deep pockets (PD >5 mm), especially in the maxilla anterior and premolar regions (p < 0.001) and presented a significantly greater mean probing depth and attachment loss (p <0.05) in diseased sites and a significantly greater alveolar bone loss (p <0.01) compared to non-smokers. Two pooled bacterial samples were obtained from each patient. Samples were collected from the deepest periodontal pockets of each quadrant. The samples were cultured anaerobically and in 10% CO2 plus air for bacterial isolation using selective and non-selective media. Isolates were characterized to species level by conventional biochemical tests and various identification kits. Smokers harboured a greater number of bacteria in total. Analysis of bacterial counts using the ANOVA (Mann-Whitney U-test) showed that Staphylococcus aureus, Peptostreptococcus micros, Campylobacter concisus, Escherichia coli, Bacteroides forsythus, C. gracilis, C. rectus, Porphyromonas gingivalis, Selenomonas sputigena, Candida albicans and Aspergillus fumigatus were found in significantly higher numbers and more frequently in smokers while Streptococcus intermedius, A. naeslundii, A. israelii and Eubacterium lentum were detected more frequently and in significantly higher proportions in non-smokers. The isolation of bacteria belonging to the exogenous flora such as E. coli, C. albicans, A. fumigatus and S. aureus in smokers' microbiota underscores the importance of the host that is adversely affected by cigarette smoking.     

母体牙周病与新生儿低体质量关系的初步探讨

目的 :探讨母体牙周病与新生儿体质量 (体重 )不足是否有相关性。方法 :调查 2 0 7名产后 4d母亲。新生儿体质量不足 :体质量 <2 50 0 g或者伴有孕期 <37周、胎膜早破等妊娠不良情况 (n =1 0 6)。对照组 :新生儿体质量≥ 2 50 0 g ,正常分娩 (n =1 0 1 )。每位受试者均接受牙周检查并记录临床有关数据。 结果 :LWN组牙周病明显重于对照组 ,经统计学处理P <0 .0 0 1。 2 0 7名母亲牙周袋深度和牙龈指数与新生儿体质量呈负相关 (rGI=- 0 .37,P <0 .0 1 ;rPD=- 0 .1 9,P <0 .0 1 )。结论 :母体牙周病作为新生儿低体质量的危险因素之一尚需进一步研究 ,本调查结果显示母体的牙周病与新生儿低体质量呈低度相关