Effects of periodontal treatment phase I on birth term and birth weight

Considering the high prevalence of preterm birth (PTB) and low birth weight (LBW) and their complications as well as the role played by periodontal disease in their incidence and the lack of any report of periodontal therapy on these problems in Iran, the goal of the present research was to determine the effects of periodontal treatment on PLBW incidence among women with moderate or advanced periodontitis who were referred to Javaheri hospital (2004-2005). This clinical trial research was conducted on 30 pregnant women age ranging from 18-35 years old, with moderate or advanced periodontitis. Fifteen subjects randomly underwent the first phase of periodontal treatment including scaling, root planning and the use of 0.2% chlorhexidine mouth rinse for one week. None of these steps were taken for the controls. After necessary follow ups, the effect of periodontal treatment on birth term and birth weight were analyzed statistically. This research was conducted on 30 subjects, 15 controls and 15 cases in study group. In the control group, the observed rate of PLBW was 26.7% whereas among periodontally treated group, phase I, PLBW infant was not observed (P < 0.05). Infants birth weight were (3059.3-389.7) gms in study group and (3371-394.2) gms in the control group and respectively (P < 0.05). Periodontal therapy, phase I, results in a reduction in PLBW incidence rate. Therefore, the application of such a simple method among periodontally diseased pregnant women is recommended.     

牙周疾病与早产儿及低体重儿相关性的研究进展

妇女在妊娠期间身体和情绪的变化会影响其口腔健康。孕期常见的口腔表现是牙龈炎和牙周炎。牙周疾病与分娩出早产儿(PTB)及低体重儿(LBW)的相关性是近年颇具争议的研究热点。本文就这一方面的研究现状作一综述。     

Preterm low birth weight and periodontal disease among African Americans

African Americans consistently experience higher rates of preterm and low birth weight (LBW) deliveries than do whites. LBW and preterm infants are more likely to die before their first birthday and survivors may suffer from a number of health problems. Therefore, identification of modifiable risk factors for preterm deliveries and LBW has considerable public health significance. Pregnant women's poor periodontal healtlh is emerging as one such factor. Maternal clinical periodontal status and bacteriologic and immunologic profiles related to periodontal disease have been associateted with risk of fetal growth and preterm LBW, and periodontal treatment during pregnancy has reduced the incidence of preterm deliveries. This article reviews the literature on the above association and presents data from a previously published prospective study of predominantly African Americans to show that preterm LBW deliveries are associated with higher midtrimester maternal serum antibody levels against Porphyromonas gingivalis.     

孕产妇牙周疾病与早产低体重儿相关性分析

目的:研究孕产妇牙周疾病与早产低体重儿的相关性. 方法:采用横断面调查的方法,根据随机原则并按照纳入标准抽取2006-05～2007-02间在湖北省妇幼保健院进行生产的已作婚姻登记的,并且孕前1 年内及孕期未曾患有下生殖泌尿系统性疾病的妇女432 名.调查方法包括问卷和临床检查:调查问卷为被调查人员相关情况的结构式问题调查;牙周检查项目包括软垢指数、龈沟出血指数、牙周袋探诊深度及临床附着丧失水平等,同时记录新生儿体重和分娩时孕周.运用卡方检验及Logistic回归分析的统计学方法对数据进行分析.结果:分娩出早产低体重儿的孕产妇53 名,占12.3%;正常分娩的孕产妇379 名,占87.7%.早产低体重组孕产妇牙龈炎的患病率为86.6%,牙周炎的患病率为64.2%,正常分娩组的分别为73.6%和32.7%.患有牙龈炎孕产妇分娩出早产低体重儿的OR值为1.30, 95%CI为0.53～3.22;患有牙周炎的孕产妇分娩出早产低体重儿的OR值为2.69, 95%CI为1.37～5.27.结论:孕产妇牙周疾病是引起早产低体重儿的主要危险因素之一.     

Higher risk of preterm birth and low birth weight in women with periodontal disease

Pregnant women with periodontal disease (PD) may be at increased risk for having preterm low-birth-weight (PLBW) children. We investigated whether the maintenance of the mothers' periodontal health after 28 weeks' gestation reduces the risk of PLBW. Of the 639 women studied, 406 had gingivitis and received treatment before 28 weeks' gestation, and 233 had PD and were treated after delivery. Data about previous and current pregnancies and known risk factors were obtained from patients' medical records. Primary outcomes were delivery before 37 weeks' gestation or an infant with birth weight below 2500 g. The incidence of PLBW was 2.5% in periodontally healthy women, and 8.6% in women with PD (p = 0.0004, relative risk = 3.5, 95% CI, 1.7 to 7.3). Risk factors significantly associated with PLBW were previous PLBW, PD, fewer than 6 pre-natal visits, and low maternal weight gain. PD was associated with both preterm birth and low birth weight, independent of other risk factors.     

牙周炎与早产低出生体重儿

牙周炎可作为早产低出生体重儿(PLBWI)的一个可能的病原因素。虽然25%～50%的PLBWI并不知道其确切原因,但是越来越多的证据表明慢性感染在PLBWI的发生中起了重要的作用,炎症反应介导了早产和牙周疾病之间的关系。因此,控制牙周疾病是否能减少PLBWI的发生亦是学者们所要研究的重要内容。下面就牙周炎与PLBWI之间的关系及其可能的机制的最新研究进展作一综述。     

Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis

BACKGROUND: This meta-analysis of periodontal disease in relation to the risk of preterm birth/low birth weight (PTB/ LBW) is based on two case-control studies and three prospective cohort studies that met pre-stated inclusion criteria. METHODS: Information on the designs of the studies, characteristics of the study population, exposure and outcome measures, control for confounders, and risk estimates were abstracted independently by two investigators using a standard protocol. RESULTS: Pregnant women with periodontal disease had an overall adjusted risk of preterm birth that was 4.28 (95% confidence interval [CI], 2.62 to 6.99; P <0.005) times that risk for healthy subjects. The overall adjusted odds ratio of preterm low birth weight was 5.28 (95% CI, 2.21 to 12.62; P <0.005), while the overall adjusted odds ratio of a delivery of either PTB or LBW was 2.30 (95% CI, 1.21 to 4.38; P <0.005). CONCLUSIONS: Our findings indicate that periodontal diseases in the pregnant mother significantly increase the risk of subsequent preterm birth or low birth weight. While it remains important to promote good oral hygiene during routine prenatal visits, there is no convincing evidence, on the basis of existing case control and prospective studies, that treatment of periodontal disease will reduce the risk of preterm birth. Consequently, large randomized, placebo-controlled, masked clinical trials are required.     

Association between periodontitis and low birth weight: a case-control study

OBJECTIVE: To verify a possible association between periodontitis and low-birth-weight babies. MATERIAL AND METHODS: One hundred and fifty-one mothers were examined. The case group included 76 mothers (mean age 25.6 years), whose babies at birth weighed <2500 g and had a gestational age (GA) <37 weeks, while 75 mothers (mean age 24.4 years), whose babies were born with a weight of >2500 g and with a GA>37 weeks, were the control group. Data from the mothers and the babies were collected from the Hospital registration records and during an interview with the mother. The periodontal examination included measurements of probing pocket depth (PPD) and clinical attachment loss (CAL) in six sites from all existing teeth, except for third molars. Mothers with periodontitis had at least four sites with PPD> or =4 and CAL> or =3 mm, while healthy mothers had PPD< or =3 mm and CAL< or =1 mm. RESULTS: The median number of sites with PPD> or =4 and CAL> or =3 mm was eight in the case group, and four in the control group. The significant associations with low birth weight (LBW) babies were periodontitis (odds ratio (OR)=3.48, 95% confidence interval (CI): 1.17; 10.36), arterial hypertension (OR=9.65, 95% CI: 2.22; 41.91), haemorrhage during pregnancy (OR=10.88, 95% CI: 1.95; 60.53), number of pre-natal examinations (OR=0.10, 95% CI: 0.02; 0.43) and genitourinary infection (OR=3.21, 95% CI: 1.25; 8.20). CONCLUSION: Periodontitis was considered a risk indicator for LBW in this sample, similar to other risk factors already recognized by obstetricians.     

Periodontal infection in pregnant women and low birth weight babies]

Among several factors in preterm low birth weight, we can find pre-conceptional causes and others depending on pregnant women's behaviour. In 1996 a scientific team composed by periodontists, gynaecologists and epidemiologists found that 18% of preterm low birth weight in 250,000 babies are due to periodontal infection. In our survey we used 113 pregnant women in gynaecological clinic in university hospital. By using Community Periodontal Index Treatment Needs (CPITN) in pregnant woman and by weighting babies as soon as accouchement done. In spite of percentage of preterm low birth weight, we registered 33.9% babies of normal birth weight with mother's CPITN under 1.     

Periodontal infections and pre-term low birth weight: a case-control study

OBJECTIVE: Pre-term delivery of low-birth-weight infants [pre-term low birth weight (PLBW)] remains a significant public health issue and a major cause of neonatal death and long-term health problems. There is a growing consensus that infections remote from fetal-placental unit may influence PLBW infants. Recent studies have suggested that maternal periodontal disease may be an independent risk factor for PLBW. The purpose of the present study was to evaluate the possible link between periodontal infections and PLBW by means of clinical and microbiological data in post-partum women with low socioeconomic level. METHODS: Clinical periodontal recordings comprising dental plaque, bleeding on probing, probing pocket depth and gingival recession were performed (six sites/tooth) in a total number of 181 women (53 cases and 128 controls) within 3 days post-partum. Subgingival plaque samples from mesio-or disto-buccal aspect of randomly selected one first molar and one incisor tooth have been obtained by paperpoints and were analysed by checkerboard DNA-DNA hybridization with respect to 12 bacterial species. In all analyses, the individual subject was the computational unit. Thus, mean values for all clinical parameters were calculated and bacterial scores from each individual sample were averaged. Statistical methods included Student's t-test, Fisher's exact test/chi(2) test, and multiple logistic regression analysis. RESULTS: The cases have gained significantly less weight during the pregnancy than did the controls (p<0.05). There were no statistically significant differences between the cases and controls with regard to the dental and periodontal parameters and the values of clinical periodontal recordings were found to be very similar (p>0.05). Mean and median scores (bacterial loads) of Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Actinobacillus actinomycetemcomitans, and Streptococcus intermedius in the subgingival plaque sampling sites were significantly higher in the controls than in the cases (p<0.05). The occurrence rates of P. intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, Campylobacter rectus, Eikenella corrodens, Selenomonas noxia and S. intermedius were higher in the cases compared with the controls, but the differences were not statistically significant (p>0.05). According to the model created by the multiple logistic regression analysis, P. micros and C. rectus were found to significantly increase the risk of PLBW (p<0.01 and p<0.05 respectively), while P. nigrescens and A. actinomycetemcomitans decreased this risk (p<0.01). CONCLUSION: The present findings indicated that when subgingival bacteria were evaluated together, P. micros and C. rectus may have a role in increasing the risk for PLBW, although no single bacteria exhibited any relation with the risk of PLBW. Further studies are required to better clarify the possible relationship between periodontal diseases and PLBW.     

母体牙周炎与早产低体重儿关系的研究进展

早产低体重儿(preterm low birth weight,PLBW)是指妊娠时间不足37周,体重不足2500 g的新生儿。据统计,早产约占所有分娩人数的5%-15%,,是当前围产儿死亡的主要原因,约有2/3—3/4围产儿死亡及患病与早产有关,比足月产儿高11-16倍。由于过早分娩,中断了胎儿在宫内的正常生长发育,约有1/4的PLBW留有神经或智力方面的后遗症。因此,防治PLBW是降低围产儿死亡率,提高新生儿质量的主要举措之一。     

北京地区母亲牙周状况与早产低出生体重新生儿的关系

目的 初步评价北京地区人群中母亲牙周状况与早产低出生体重新生儿的关系.方法 对2004年1月至2005年12月在北京市4家医院分娩的83例早产低体重新生儿(preterm low birth weight,PLBW)的母亲(PLBW组)以及44名正常新生儿(normal birth weight,NBW)的母亲(NBW组)进行牙周临床指标的检查.所有受检者均全身健康.检查指标包括:菌斑指数(plaque index,PLI)、探诊深度(probing depth,PD)、临床附着丧失(attachment loss,AL)和出血指数(bleeding index,BI).结果 中度慢性牙周炎及侵袭性牙周炎母亲发生PLBW的风险是牙龈炎或轻度慢性牙周炎母亲的4.26倍.PLBW组与NBW组PD≥4 mm位点率(分别为8.1%和6.9%)、AL≥2 mm 位点率(分别为12.8%和6.1%)和BOP(+)位点率(分别为70.4%和66.9%),PLBW组均显著高于NBW组(P值分别小于0.01、0.001、0.01).结论 本组人群中母亲的牙周状况与PLBW之间可能存在关联,较差的牙周状况可能是发生PLBW的危险因素之一.