Periodontal disease and adverse pregnancy outcomes: a systematic review

Abstract

Background Recent studies suggest that periodontal disease, as a source of subclinical and persistent infection, may induce systemic inflammatory responses that increase the risk of adverse pregnancy outcomes. Objectives To examine the existing evidence on the relationship between periodontal disease and adverse pregnancy outcomes. Search strategy Published studies identified via searches of the MEDLINE, EMBASE, CINAHL, and Current Contents full‐text databases. Selection criteria We identified and selected observational studies (i.e. case–control, cross‐sectional, and cohort) and nonrandomised controlled studies or randomised controlled trials that examined periodontal disease as a risk factor for adverse pregnancy outcomes. Data collection and analysis Odds ratios (OR) or risk ratios (RR) were extracted or calculated from the studies’ data. We calculated pooled effect size for two clinical controlled trials but not for the observational studies due to the heterogeneity in definitions for periodontal disease and adverse pregnancy outcomes across studies. Main results Twenty‐five studies (13 case–control, 9 cohort, and 3 controlled trials) were identified. The studies focused on preterm low birthweight, low birthweight, preterm birth, birthweight by gestational age, miscarriage or pregnancy loss, and pre‐eclampsia. Of the chosen studies, 18 suggested an association between periodontal disease and increased risk of adverse pregnancy outcome (ORs ranging from 1.10 to 20.0) and 7 found no evidence of an association (ORs ranging from 0.78 to 2.54). Three clinical trial studies suggest that oral prophylaxis and periodontal treatment can lead to a 57% reduction in preterm low birthweight (pooled RR 0.43; 95% CI 0.24–0.78) and a 50% reduction in preterm births (RR 0.5; 95% CI 0.20–1.30). Author's conclusions Periodontal disease may be associated with an increased risk of adverse pregnancy outcome. However, more methodologically rigorous studies are needed for confirmation.

Preterm births, low birth weight, and intrauterine growth restriction in three birth cohorts in Southern Brazil: 1982, 1993 and 2004

“…Potential determinants among the latter include infections (urinary, gynecological 6 , and even periodontal 21 ), capable of producing systemic inflammatory reactions. Another potential cause of preterm delivery is emotional stress, which manifests itself especially among ethnic/racial minorities 22 .…”

Management of subsequent pregnancy after an unexplained stillbirth

“…Most infectious events associated with stillbirth are acute and hence unlikely to recur, but empirically it is important to exclude chronic infectious conditions such as toxoplasmosis, syphilis and possibly Chlamydia. 20 There is some evidence that chronic periodontal disease increases the risk of adverse pregnancy outcomes, 21 and evidence from animal models suggests that these effects could include stillbirth. 22 If there is any history suggestive of periodontal disease (typically bleeding from the gums with vigorous tooth brushing) then examination and management by a dentist is prudent.…”

Is gum disease killing your patient?

“…The nature of the association is variable, but two recent systematic reviews have suggested that periodontal disease is a risk for coronary heart disease and an adverse pregnancy outcome. 1,2 If periodontal disease is a signifi cant risk factor for a variety of systemic conditions, it does raise the important question of whether failure to address poor oral health increases the risk of patients succumbing to the various conditions outlined in Table 1 and their sequelae. The converse argument can also apply -that is, what impact does improving oral health have on general health?…”