Periodontal disease or Periodontitis is an ailment that affects the tissues of the teeth. If often begins with an infection by various types of bacteria followed by inflammation in a person’s gums. It affects more than 30% of people in certain communities and 5-20% of pregnant women. When pregnant women have this illness, it can cause adverse pregnancy outcomes such as low birth weight, preeclampsia, preterm birth, gestational diabetes and perinatal fatality. The mechanisms responsible for these changes are not fully known, but one common view is that periodontal disease leads to the release of inflammatory factors or compounds that may travel to the amniotic fluid or embryonic tissue and lead to harm of the fetus.
Searching for association between pregnancy and dental disease
Periodontal disease is unclearly linked to adverse pregnancy outcomes, and it is uncertain whether treating it during pregnancy can help prevent it. A few reviews of literature in this area have discussed the relationship between these conditions. There are also a few randomized clinical trials that focus on this topic. Recently, the authors of a recent systematic review in the journal Cureus set out to evaluate and review all existing clinical trials regarding the connection between periodontitis and pregnancy. They review a large amount of research articles and narrowed them down to a few that focused on this connection. This process was done in a systematic way, so it was called a systematic review of literature. The review evaluated the association between periodontitis and adverse pregnancy outcomes.
Primary and Secondary Outcomes
Three out of 23 studies identified for the literature review focused on the primary outcome of determining the relationship between periodontal diseases and adverse pregnancy outcomes, with all three indicating a significant association between them.
The secondary outcomes explored the relationship between periodontal diseases and adverse pregnancy outcomes such as low birth weight, preterm birth, preeclampsia, eclampsia, HELLP syndrome, intrauterine growth restriction and gestational diabetes. 23 studies from 2002 to 2019 were examined to determine the impact of periodontal disease treatment on reducing the risk of adverse pregnancy outcomes, with 11 showing a significant association and positive impact. Nine studies indicated no impact on reducing adverse pregnancy outcomes while two observed limitations due to small sample sizes.
Results of Review
This systematic review evaluated 23 human studies and randomized control clinical trials conducted in 12 countries to assess the relationship between periodontitis and adverse pregnancy outcomes, as well as the effect of treatment. The total sample size included 9724 participants with ages ranging from 16 to 43 years old. The studies reviewed had different inclusion and exclusion criteria for who participated in the studies based on patients’ periodontal, medical and gestational status, with almost all of them reporting preterm birth and low birth weight as potential outcomes. Other potential risks were also found or mentioned, such as abortion, stillbirth, gestational diabetes and hypertension, preeclampsia and HELLP syndrome.
Overall, an association was found between periodontitis and adverse pregnancy outcomes. However, researchers did not find periodontal bacteria in the amniotic fluid of preterm births, despite its presence in dental plaque. Additionally, a certain type of bacteria (Fusobacterium nucleatum) in vaginal swab samples and dental plaque were not associated with the bacteria in amniotic fluid.
This systematic review utilized a variety of search engines, broad and general search terms, and only included randomized controlled trials for human subjects. However, it was not possible to perform a meta-analysis (large study seeking the answer to one research question using various studies) due to the discrepancy in the included articles. The authors indicated that future reviews should incorporate other study designs such as observational studies in order to gain a more comprehensive understanding of the relationship between periodontal diseases and perinatal morbidity/mortality, malformations and chromosomal abnormalities.
This systematic review illustrates the relationship between periodontal diseases and adverse pregnancy outcomes, and the effect of periodontal treatment on these outcomes. However, there is insufficient evidence to prove the relationship or effectiveness of periodontal treatment in reducing these outcomes, though there is a need for more clinical trials. The authors of the article indicate that obstetric physicians should take this association into account and advise pregnant women with periodontitis to visit the dentist for treatment. They also argue that medical and dental clinical assessments are essential before utilizing periodontal therapy in pregnant women with periodontal diseases.
The researchers suggest that obstetric physicians should take this association into account and advise any pregnant woman with periodontitis symptoms to visit the dentist for treatment, which is simple and cost-effective. Preconception screening, oral hygiene instruction and periodic dental visits during pregnancy are recommended to help eliminate periodontitis as a risk factor and reduce the incidence of adverse pregnancy outcomes while cutting costs.
Future studies are needed to investigate the relationship between periodontitis and different adverse pregnancy outcomes, as well as decide on the best type and most effective therapy to treat it in pregnant women.