Article

Scaling and Root Planing Treatment for Periodontitis to Reduce Preterm Birth and Low Birth Weight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
Journal of Periodontology (Impact Factor: 2.57). 03/2012; 83(12). DOI: 10.1902/jop.2012.110636
Source: PubMed

ABSTRACT Objectives: To investigate whether scaling and root planing treatment in pregnant women with periodontitis reduces the preterm birth or low birth weight risks compared to placebo or no treatment before delivery. Methods: We searched the entire Cochrane Library (1990-September, 2011), MEDLINE (1950- September, 2011), CINAHL (1980- September, 2011), University of Michigan School of Dentistry "Dentistry and Oral Sciences" database (1990- September, 2011), conference proceedings, and clinicaltrials.gov ; and contacted authors when clarification was needed. Selection criteria were 1) randomized controlled trials that reported preterm birth risk (<37 weeks) outcomes and 2) compared scaling and root planing treatment to either placebo or no treatment in 3) pregnant patients with periodontitis (probing depth >4mm or clinical attachment loss >2mm for ≥one site). Two reviewers independently extracted data from each included study using a standardized, piloted form and assessed quality using a Risk of Bias tool modeled after Cochrane. An additional reviewer resolved discrepancies. We used a random-effects model to calculate relative risks (RR) and 95% confidence intervals (CI) for pooled data. For sub-group analysis with heterogeneity less than 50%, we used a fixed-effects model. Results: Following abstract review, 12 studies were identified by the search; 11 were included in the main meta-analysis (preterm birth < 37 weeks). Overall quality and design of included studies was fair or good. For the main meta-analysis, results ranged from risk ratio with periodontal treatment 0.14 (95% CI: 0.01, 2.55) to 1.24 (95% CI: 0.93, 1.67) for an overall risk ratio of 0.81 (95% CI: 0.64, 1.02). When analyzed separately by subgroup for excess prematurity risk, the high-risk group (overall prematurity 22.2% - 62.8%) showed combined risk ratios of 0.66 (95% CI: 0.54, 0.80). Remaining studies (overall prematurity 4.0% to 10.4%) showed combined risk ratio of 0.97 (95% CI: 0.75, 1.25). Conclusions: This systematic review and meta-analysis indicates statistically significant effect in reducing risk of preterm birth for scaling and root planing in pregnant women with periodontitis only for groups with high risks of preterm birth. Future research should attempt to confirm these findings and further define groups where risk reduction may be effective.

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    • "Although each review included a slightly different set of RCTs, all RCTs have been included in at least one review. Thus, our goal was not to conduct yet another systematic review; the reader is referred to two recent and comprehensive reviews (Chambrone et al. 2011, Kim et al. 2012). Rather, we searched the literature from January 2011 through July 2012 to identify RCTs published since the latest reviews. "
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