Effect of intra-pregnancy nonsurgical periodontal therapy on inflammatory biomarkers and adverse pregnancy outcomes: a systematic review with meta-analysis

Abstract

BackgroundThe aim of this systematic review with meta-analysis was to analyze the effects of intra-pregnancy nonsurgical periodontal therapy on periodontal inflammatory biomarkers and adverse pregnancy outcomes.MethodsOn June 5, 2017, we searched PubMed, Cochrane, SCOPUS, Web of Science, LILACS, ProQuest, Open Grey, and Google Scholar databases. Randomized clinical trials in which pregnant women with chronic periodontitis underwent nonsurgical periodontal therapy, compared with an untreated group, tested for inflammatory biomarkers, and followed till delivery were included. Primary outcomes were preterm birth, low birth weight, and preeclampsia. Meta-analysis was performed with 5.3.5 version of Review Manager software.ResultsWe found 565 references in the databases, 326 after duplicates removal, 28 met criteria for full text reading, and 4 met eligibility criteria for quantitative and qualitative synthesis. Intra-pregnancy nonsurgical periodontal therapy improved periodontal clinical parameters (periodontal pocket depth, clinical attachment level, and bleeding on probing) and reduced biomarker level from gingival crevicular fluid (GCF), and some from blood serum; however, it did not influence biomarker level from umbilical cord blood. Meta-analysis showed tendency for reduction of the risk of preterm birth before 37 weeks for treated group (risk ratio (RR) = 0.54, 95% CI 0.38–0.77; p = 0.0007; inconsistency indexes (I2) 32%) but did not show any difference for low birth weight occurrence (RR = 0.78, 95%CI 0.50–1.21; p = 0.27; I2 41%). No included study considered preeclampsia as a gestational outcome.ConclusionsThese results demonstrated that the intra-pregnancy nonsurgical periodontal therapy decreased periodontal inflammatory biomarker levels from gingival crevicular fluid and some from serum blood, with no influence on inflammatory biomarker level from cord blood, and it did not consistently reduce adverse gestational adverse outcome occurrence.Systematic review registrationPROSPERO CRD42015027750 Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0587-3) contains supplementary material, which is available to authorized users.

Periodontal diseases and adverse pregnancy outcomes

“…Though some reports found efficacy of periodontal treatment during pregnancy in a high‐risk group mothers, most of the studies concluded that the treatment of periodontal diseases could not reduce the incidence of APO . According to a systematic review with meta‐analysis, nonsurgical periodontal therapy during pregnancy improved periodontal clinical findings; however, it did not reduce PTB or LBW . Another systematic review and meta‐analysis also concluded that treatment of periodontal diseases with scaling and root planing did not reduce the incidence of PTB (OR 1.15, 95% CI 0.95–1.40), LBW (OR 1.07, 95% CI 0.85–1.36) or spontaneous abortions/stillbirths (OR 0.79, 95% CI 0.51–1.22) .…”

“…Since multiple factors, that is, maternal age, body weight, past history, smoking, obstetric history and socioeconomic factors, are associated with the incidence of APO, the analysis should be carefully designed. Another concern is that the definitions of periodontal diseases have varied depending on previous studies . To elucidate the causation of periodontal diseases on APO incidence, randomized clinical trials and widely accepted diagnostic criteria for periodontal diseases that are of high methodological quality are needed.…”

A Importância da Odontologia no Cuidado da Gestante: Revisão de Literatura / The Importance of Dentistry in the Care of Pregnant Women: Literature Review

“…Além disto, há consenso dos artigos apresentados de que há grande importância da atuação do Cirurgião-Dentista na gestante, pois as doenças orais, como a gengivite e periodontite, podem levar bactérias a nível sistêmico ou mesmo pode haver transmissibilidade vertical de doenças, como no caso da cárie e também dos patógenos das doenças periodontais (KLOETZEL et al, 2011;STEINBERG et al, 2013;BOUTIGNY et al, 2016;HARTNETT et al, 2016;SILVA et al, 2017;MARLA et al, 2018;POMINI et al, 2018). Embora haja na literatura a correlação do estado periodontal das pacientes e resultados adversos da gravidez, este ainda é considerado um assunto controverso, necessitando de estudos posteriores (BOUTIGNY et al, 2016;KOMINE-AIZAWA et al, 2018).…”

“…Episódios frequentes de bacteremia ou disseminação de endotoxinas bacterianas do foco periodontal podem induzir a ativação sistêmica da resposta inflamatória e intensa produção de citocinas pró-inflamatórias. Desta forma, o trânsito sistêmico de patógenos periodontais, citocinas pró-inflamatórias e prostaglandinas das bolsas periodontais para a unidade fetoplacentária corrobora com uma hipótese plausível para a associação entre doença periodontal e complicações da gravidez, como partos prematuros e baixo peso ao nascer (SILVA et al, 2017).…”

“…Neste quesito, verificou-se que, imediatamente após o parto, os níveis de IL-1β, IL-6, TNF-α e PGE2 do GCF e os níveis séricos de TNF-α e PGE2 aumentaram significativamente em mulheres com periodontite em comparação com mulheres periodontalmente saudáveis, corroborando com as afirmações apresentadas. Esses achados podem indicar que a inflamação periodontal afeta os níveis circulatórios de estimuladores do parto (AMIN e ELSALHY, 2014;SILVA et al, 2017).…”