An article in Lifelines by Mickey Emmons Wener and Salme E. Lavigne discusses the growing evidence that periodontal disease may contribute to premature births. Gram-negative microbes associated with periodontal infection contain lipopolysaccharides in their cell walls that act as a green light for connective tissue macrophages to release cytokines. Two of these cytokines, tumor necrosis factor alpha (TNF-[alpha]) and interleukin 1 beta (IL-1-[beta]), stimulate prostaglandin (PGE2) production. This unsaturated fatty acid encourages the initiation of labor. High levels of PGE2, created by periodontal disease, are believed to increase the likelihood of premature labor and birth. The authors state: "A number of case-control and prospective cohort studies have established an odds ratios of up to seven, meaning that mothers with periodontitis were as much as seven times more likely to give birth prematurely as those without. All of these studies controlled for other risk factors, resulting in strong support for the hypothesis that maternal periodontal disease is an independent risk factor for preterm birth." Preterm, low-birth-weight infants have a greater risk of multiple health problems, including neurologic disabilities, respiratory problems, congenital anomalies, and complications from neonatal intensive care.
Two of the three randomized controlled studies on this subject have had "statistically significant results suggesting a direct link between periodontal disease and preterm birth." In a 2002 Journal of Dental Research study, 351 pregnant women with periodontal disease were randomly divided into two groups. One group received non-surgical periodontal therapy throughout pregnancy that included scaling to remove plaque, calculus, and bacteria and root planing to smooth root surfaces so that plaque is less likely to form. The control group received the same treatment after delivery. The group receiving treatment before delivery "had significantly fewer premature births than the control group." A 2003 pilot intervention study (Journal of Periodontology, 74(8)), by M.K. Jeffcoat and colleagues "showed that pregnant women with periodontal disease who received deep scaling and root planing had an 84% reduction in preterm birth (defined as <35 weeks gestation) when compared with those who only received shallow treatment." While these studies have limitations, Wener and Lavigne believe that the data justifies the expense of larger intervention studies that may provide a direct casual link between periodontal disease and preterm delivery.
By acknowledging this possible link, health care providers can encourage pregnant women to practice preventive care and to obtain professional dental assessment and education during the first trimester. Elective dental treatment should be avoided during that time because of the fetus' susceptibility to harm, and major dental work should be postponed until after delivery, if possible. Women with periodontal disease can be treated with scaling and root planing in the second trimester, according to Jeffcoat and colleagues. During pregnancy, hormones make women's gums more tender and more likely to bleed. Brushing with a soft-bristled toothbrush for two minutes, twice a day, and daily flossing help prevent the build-up of plaque and the risk of periodontal disease.
Wener, Mickey Emmons, BS, Med, CTESL & Lavigne, Salme E., RDH, BA, HS. Can Periodontal Disease Lead to Premature Delivery?
Lifelines (The Association of Women's Health, Obstetric and Neonatal Nurses) October/November 2004
COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group
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