Oral Health and Preterm Delivery Education

Resident: Swan
Article Title: Oral Health and Preterm Delivery Education: A New Role for the Pediatric Dentist
Author: Katz et al.
Journal: Pediatric Dentistry
Volume (Number): 28:6 2006
Major Topic: Preterm Delivery and Poor oral health status
Type of Article: Literature Review
Main Purpose: Review the current literature that correlates poor oral health status and risk of preterm delivery; identify pediatric dentist’s role in educating expecting mothers
Findings: Periodontal disease and its associated bacteria are thought to be involved with various systemic conditions. Recent literature has suggested that these bacteria or their byproducts may cross the placenta and affect the developing fetus by stimulating an inflammatory response in the mother, which may ultimately result in PTD (before 37 weeks). Several human studies have highlighted this potential correlation:
1. significant inverse relationship between mother’s P.Gingivalis-specific IgG levels and birth weight
2. women with severe periodontal disease 7-8 times more likely to have PLBW infants
3. PTD significantly associated with attachment loss; periodontal disease independently associated with PTD and LBW
4. one systematic review: of 25 relevant studies, 18 suggested association between perio disease and adverse pregnancy outcome.
5. trends in literature support association between perio disease and adverse outcomes, primarily in economically disadvantaged populations.

One possible mechanism: PGE2, TNF alpha levels rise within amniotic fluid until threshold is reached, which induces labor/delivery. These molecules are produced in perio disease, possibly inducing labor if they cross the placenta. (PGE2 in crevicular fluid can be measured to give current perio disease activity).
Interventional Studies:
1. SRP may reduce Spontaneous Preterm Birth (study with 300 pregnant women)
2. Perio therapy significantly decreased levels of PGE2.
Animal Models:
1.rabbit model showed that P gingivalis cells implanted into subcutaneous chambers resulted in systemic dissemination, transplacental passage and fetal exposure. All rabbits exposed showed placental exposure to the bacteria.
2. Injected LPS from 3 perio bacteria compared to E. Coli LPS in sheep. Perio LPS had high rates of fetal lethality compared to E Coli LPS.
Key Points/Summary: PTD is a major public health concern. >20 % among poor/minorities and hasn’t changed for 30 years. Studies in humans argue for a correlation between perio disease and preterm delivery/LBW infants. Could be argued that those at increased risk for perio disease are more prone to experience pregnancy complications—intervention and animal model studies support the link though—especially with P. Gingivalis. It’s our job to emphasize the importance of oral health care during pregnancy to the mothers we see in the clinic.
Assessment of Article: Good review that helped clarify and somewhat murky subject.