Obstetric outcomes after treatment of periodontal disease during pregnancy: Systematic review and meta-analysis

Section of Obstetrics and Gynaecology, Panhellenic Association for Continual Medical Research (PACMeR), Athens, Greece.
BMJ British medical journal (Impact Factor: 16.3). 12/2010; 341:c7017. DOI: 10.1136/bmj.c7017
Source: PubMed


To examine whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate.
Systematic review and meta-analysis of randomised controlled trials.
Cochrane Central Trials Registry, ISI Web of Science, Medline, and reference lists of relevant studies to July 2010; hand searches in key journals.
Randomised controlled trials including pregnant women with documented periodontal disease randomised to either treatment with scaling and root planing or no treatment.
Data were extracted by two independent investigators, and a consensus was reached with the involvement a third. Methodological quality of the studies was assessed with the Cochrane's risk of bias tool, and trials were considered either high or low quality. The primary outcome was preterm birth (<37 weeks). Secondary outcomes were low birthweight infants (<2500 g), spontaneous abortions/stillbirths, and overall adverse pregnancy outcome (preterm birth <37 weeks and spontaneous abortions/stillbirths).
11 trials (with 6558 women) were included. Five trials were considered to be of high methodological quality (low risk of bias), whereas the rest were low quality (high or unclear risk of bias). Results among low and high quality trials were consistently diverse; low quality trials supported a beneficial effect of treatment, and high quality trials provided clear evidence that no such effect exists. Among high quality studies, treatment had no significant effect on the overall rate of preterm birth (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15). Furthermore, treatment did not reduce the rate of low birthweight infants (odds ratio 1.07, 0.85 to 1.36; P=0.55), spontaneous abortions/stillbirths (0.79, 0.51 to 1.22; P=0.28), or overall adverse pregnancy outcome (preterm births <37 weeks and spontaneous abortions/stillbirths) (1.09, 0.91 to 1.30; P=0.34).
Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.

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    • "There are also results from studies suggesting that periodontal care patterns or treatment of the disease during pregnancy is not associated with changes in the risk for LBW delivery (Hujoel et al, 2006; Michalowicz et al, 2006; Oliveira et al, 2011). Recent supporting meta-analyses further illustrate that treatment with scaling and root planing in this period is not protective statistically (Fogacci et al, 2011; Polyzos et al, 2010). "

    02/2014; DOI:10.5171/2014.469747
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    • "Numerous meta-analyses and systematic reviews of periodontitis treatment and pregnancy outcomes have been published in the recent past, including at least eight since 2010 (Pimentel Lopes De Oliveira et al. 2010, Polyzos et al. 2010, Uppal et al. 2010, Chambrone et al. 2011, Fogacci et al. 2011, George et al. 2011, Xiong et al. 2011, Kim et al. 2012). Notably, these reviews have included most of same randomized controlled trials (RCTs) published in 2011 or earlier (Lopez et al. 2002, 2005, Jeffcoat et al. 2003, 2011b, Michalowicz et al. 2006, Offenbacher et al. 2006, 2009, Sadatmansouri et al. 2006, Tarannum & Faizuddin 2007, Newnham et al. 2009, Radnai et al. 2009, Macones et al. 2010, Oliveira et al. 2011). "
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    ABSTRACT: Preterm infants are at greater risk than term infants for physical and developmental disorders. Morbidity and mortality increases as gestational age at delivery decreases. Observational studies indicate an association between poor periodontal health and risk for preterm birth or low birthweight, making periodontitis a potentially modifiable risk factor for prematurity. To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight. Search of databases including PubMed, ISI Web of Science and Cochrane Library. The single RCT identified showed no significant effect of periodontal treatment on birth outcomes. All published trials included non-surgical periodontal therapy; only two included systemic antimicrobials as part of test therapy. The trials varied substantially in terms of sample size, obstetric histories of subjects, study preterm birth rates and the periodontal treatment response. The largest trials – also judged to be high-quality and at low risk of bias – have yielded consistent results, and indicate that treatment does not alter rates of adverse pregnancy outcomes. Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.
    Journal of Periodontology 04/2013; 84(4 Suppl):S195-208. DOI:10.1902/jop.2013.1340014 · 2.71 Impact Factor
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    • "Even if new periodontal pockets appear and revert after pregnancy [12], it is important to take into consideration that preventing inflammation during pregnancy should be a therapeutic objective. Although treatment and prevention of PD are known to improve oral health status during pregnancy, no studies have yet shown that these therapies are definitively able to reduce adverse delivery outcomes [35,36]. Therefore, it is of clinical interest to evaluate individual risks of changes in PD during pregnancy so that adequate planning of periodontal therapy may be implemented [35]. "
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    ABSTRACT: To evaluate the prevalence of periodontal disease (PD) among Brazilian low-risk pregnant women and its association with sociodemographic factors, habits and oral hygiene. This cross-sectional study included 334 low-risk pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. Independent variables were: age, race/color, schooling, marital status, parity, gestational age, smoking habit, alcohol and drugs consumption, use of medication, presence of any systemic diseases and BMI (body mass index). Statistical analyses provided prevalence ratios and their respective 95%CI and also a multivariate analysis. The prevalence of PD was 47% and significantly associated with higher gestational age (PR 1.40; 1.01-1.94 for 17-24 weeks and PR 1.52; 1.10-2.08 for 25-32 weeks), maternal age 25-29 years, obesity (PR 1.65; 1.02-2.68) and the presence of gingival bleeding on probing (OR(adj) 2.01, 95%CI 1.41-2.88). Poor oral hygiene was associated with PD by the mean values of plaque and bleeding on probing indexes significantly greater in PD group. The prevalence of PD is high and associated with gingival bleeding on probing, more advanced gestational age and obesity. A program of oral health care should be included in prenatal care for early pregnancy, especially for low-income populations.
    Reproductive Health 01/2012; 9(1, article 3):3. DOI:10.1186/1742-4755-9-3 · 1.88 Impact Factor
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