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: 2.71). 03/2012; 83(12). DOI: 10.1902/jop.2012.110636
Source: PubMed


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 ; 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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    • "In spite of this, advantages of periodontal care during pregnancy on birth outcomes have been previously documented in clinical trials and intervention studies (Cruz et al, 2010; Jeffcoat et al, 2011; Radnai et al, 2009; Tarnnum and Faizuddin, 2007). Kim et al. (2012) proved reduced risk only for high risk pregnant women in a meta-analysis of randomized controlled trials on scaling and root planing treatment. "

    Full-text · Article · Feb 2014
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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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    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.
    Preview · Article · Apr 2013 · Journal of Periodontology
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    ABSTRACT: Tooth extractions are one of the most common procedures in oral surgery. The objective of this study was to identify the reasons for tooth extraction in adult patients seeking care at teaching dental clinics. A cross-sectional study was carried out in 331 subjects between 18 and 85 (45.37 +/- 13.85) years of age seeking dental care in dental clinics of the Universidad Autónoma del Estado de Hidalgo, from January 2009 to December, 2009. Data pertaining to age, sex, tooth number and the reason for extraction according to Kay & Blinkhorn were analyzed with non-parametric tests. 779 extractions were undertaken. The main reason for extraction was dental caries (43.1%), periodontal disease (PD) (27.9%), and prosthetic reasons (21.5%). There was no significant difference across sex for reasons of extraction (p > 0.05). Significant differences (p < 0.001) were found for age (extraction due to periodontal disease increased with age); in patients attending in a single visit vs. patients attending a series of dental appointments (caries reasons were more common in patients having a single appointment vs. PD in those attending a series of appointments); for type of teeth (upper, posterior, and molars were extracted primarily because of caries, while lower, anterior and incisors were more often extracted because of PD). Dental caries was the most common reason for tooth extraction, followed by periodontal disease. Differences in the reasons for extraction were observed across patient characteristics and type of tooth.
    Full-text · Article · Mar 2013 · Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion
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