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.
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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ABSTRACT: The association between periodontitis and some of the problems with pregnancy such as premature delivery, low weight at birth, and preeclampsia (PE) has been suggested. Nevertheless, epidemiological data have shown contradictory data, mainly due to differences in clinical parameters of periodontitis assessment. Furthermore, differences in microbial composition and immune response between aggressive and chronic periodontitis are not addressed by these epidemiological studies. We aimed to review the current data on the association between some of these problems with pregnancy and periodontitis, and the mechanisms underlying this association. Shifts in the microbial composition of the subgingival biofilm may occur during pregnancy, leading to a potentially more hazardous microbial community. Pregnancy is characterized by physiological immune tolerance. However, the infection leads to a shift in maternal immune response to a pathogenic pro-inflammatory response, with production of inflammatory cytokines and toxic products. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the fetus-placenta unit. In severe periodontitis patients, the infection agents and their products are able to activate inflammatory signaling pathways locally and in extra-oral sites, including the placenta-fetal unit, which may not only induce preterm labor but also lead to PE and restrict intrauterine growth. Despite these evidences, the effectiveness of periodontal treatment in preventing gestational complications was still not established since it may be influenced by several factors such as severity of disease, composition of microbial community, treatment strategy, and period of treatment throughout pregnancy. This lack of scientific evidence does not exclude the need to control infection and inflammation in periodontitis patients during pregnancy, and treatment protocols should be validated.Frontiers in Public Health 01/2014; 2:290. DOI:10.3389/fpubh.2014.00290
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ABSTRACT: Gingival changes during pregnancy have been well-documented. The prevalence of gingivitis in pregnant women has reportedly ranged from 30% to 100%. Increase in both the rate of estrogen metabolism and synthesis of prostaglandins by the gingiva contributed to the gingival changes observed during pregnancy. In effect increased prevalence of dental caries, gingivitis, periodontitis and tooth mobility may be encountered in pregnancy. The purpose of the study was to determine the association of some variables and the periodontal status in a sample of pregnant women attending the Ante Natal Clinic (ANC) of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos. Women at various stages of pregnancy, attending the ANC of LASUTH, constituted the target population. The questionnaire was administered on each patient followed by dental examinations. Periodontal status was assessed using the community periodontal index (CPI) of treatment needs. Oral hygiene status was evaluated according to Green and Vermilion simplified oral hygiene index (OHI-S). The association between the CPI scores; OHI-S scores and variables such as trimester and dental visits were statistically significant. This study indicated that the gestational age of pregnancy and dental visits have a definite impact on the periodontal status. Oral health education should be included as an integral part of antenatal care to increase the women awareness. This would improve the mothers' dental care-seeking behavior.11/2014; 4(6):852-7. DOI:10.4103/2141-9248.144876
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ABSTRACT: Preterm birth is a major cause of neonatal morbidity and mortality in both developed and developing countries. Preterm birth is a highly complex syndrome that includes distinct clinical subtypes in which many different causes may be involved. The results of epidemiological, molecular, microbiological and animal-model studies support a positive association between maternal periodontal disease and preterm birth. However, the results of intervention studies carried out to determine the effect of periodontal treatment on reducing the risk of preterm birth are controversial. This systematic review critically analyzes the methodological issues of meta-analyses of the studies to determine the effect of periodontal treatment to reduce preterm birth. The quality of the individual randomized clinical trials selected is of highest relevance for a systematic review. This article describes the methodological features that should be identified a priori and assessed individually to determine the quality of a randomized controlled trial performed to evaluate the effect of periodontal treatment on pregnancy outcomes. The AMSTAR and the PRISMA checklist tools were used to assess the quality of the six meta-analyses selected, and the bias domain of the Cochrane Collaboration's Tool was applied to evaluate each of the trials included in the meta-analyses. In addition, the methodological characteristics of each clinical trial were assessed. The majority of the trials included in the meta-analyses have significant methodological flaws that threaten their internal validity. The lack of effect of periodontal treatment on preterm birth rate concluded by four meta-analyses, and the positive effect of treatment for reducing preterm birth risk concluded by the remaining two meta-analyses are not based on consistent scientific evidence. Well-conducted randomized controlled trials using rigorous methodology, including appropriate definition of the exposure, adequate control of confounders for preterm birth and application of effective periodontal interventions to eliminate periodontal infection, are needed to confirm the positive association between periodontal disease and preterm birth.Periodontology 2000 02/2015; 67(1). DOI:10.1111/prd.12073 · 4.01 Impact Factor