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: 17.45). 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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    • "Despite the lack of dental attendance by the women in this study, pregnancy remains a timely opportunity to raise the importance of maternal oral health. Whilst evidence for the benefits of periodontal treatment in improving birth outcomes remains inconclusive [10, 37], establishing a dental home for these women during pregnancy is likely to improve the oral health outcomes for both mother and future child/ren. This would promote the prevention of ECC. "
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    ABSTRACT: Background Vulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for ‘priority’ care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women’s knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women. Methods One agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data. Results Four community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men’s perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the ‘priority of access’ policy that entitles pregnant women to receive dental care cost-free. Conclusion This study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care.
    Full-text · Article · Dec 2016 · BMC Pregnancy and Childbirth
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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). "

    Full-text · Article · Feb 2014
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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.
    Preview · Article · Apr 2013 · Journal of Periodontology
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