Transcript Slide 1 - Amazon S3

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SMFM Consult Series
Peridontal disease and preterm
birth
Society of Maternal Fetal Medicine with the assistance of
Kim Bogess, MD
Published in Contemporary OB/GYN / Dec 2012
Definition & Incidence
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Dental caries, gingivitis, and periodontal infection are conditions commonly encountered in
children, young adults, and women of reproductive age.
Adult periodontal infection affects up to 40% of women of reproductive age. Dental caries is
considered an infectious and transmissible disease of multifactorial origin.
Gingivitis (inflammation of the gum tissue) is a nondestructive periodontal disease. In the
absence of treatment, gingivitis may progress to periodontitis (inflammation of tissues that
surround and support the teeth), which is a destructive form of periodontal disease.
Periodontitis involves progressive loss of the alveolar bone around the teeth and if left
untreated can lead to the loosening and subsequent loss of teeth. This process involves both
direct tissue damage from plaque bacterial products and indirect damage through
bacterial stimulation of local and systemic inflammatory and immune responses.
Subgingival colonization with Porphyromonas gingivalis and Prevotella intermedia leads to
adult manifestations of oral infection because these organisms are able to induce
inflammatory responses that lead to gingival edema, bleeding, and ultimately the tissue
destruction characteristic of periodontal disease.
Gingivitis causes the gums to redden, swell, and bleed more easily. With time, bacterial
plaque on the tooth surface spreads and grows below the gum line.
Treatment in pregnancy is safe.Most studies of treatment of periodontal disease during
pregnancy use scaling and planning techniques. Scaling is debridement and nonsurgical
cleaning below the gumline. Root planning involves the use of specialized curettes to
mechanically remove plaque and calculus (hardened dental plaque) from below the
gumline.
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Does treatment of periodontal disease during pregnancy
decrease the rate of preterm birth?
 The Periodontal Infections and Prematurity Study
was a multicenter, randomized, controlled trial
(RCT) of pregnant women to determine whether
treatment of periodontal disease (scaling and
root planing vs placebo [tooth polishing])
decreased spontaneous PTB.
 Of women screened for the study, 50% had
periodontal disease. Treatment did not reduce
spontaneous PTB before 35 weeks' gestation
(8.6% treatment vs 5.5% placebo) or composite
neonatal morbidity.
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Does treatment of periodontal disease during pregnancy
decrease the rate of preterm birth?
 Jeffcoat and colleagues evaluated pregnant women with
periodontal disease and compared the rate of PTB before
35 weeks among those with successful and unsuccessful
treatment.
 Lower rate of PTB in those with successful treatment and
hypothesized that this may be the key to improvement,
not just the use of periodontal therapy.
 Polyzos and associates: meta-analysis and systematic
review of 11 trials, 5 of which were of high methodologic
quality.
 The pooled results of these 5 high-quality RCTs did not
indicate significant reduction in the risk of PTB after
treatment for periodontal disease (odds ratio, 1.15; 95%
CI, 0.95-1.40; P=.15).
 The current available data do not support this specific
strategy and therapy as an intervention to decrease PTB.
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Current recommendations for evaluation and treatment of
periodontal disease in pregnancy
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Oral health interventions during pregnancy should be performed as
general health maintenance, rather than to improve specific pregnancy
outcomes.
Despite the apparent inability of treatment of periodontal disease to
reduce PTB rates, it is important to consider that treatment of maternal
periodontal disease during pregnancy has also not been associated with
increased risk of any adverse maternal or fetal outcomes. Thus there is no
reason to delay indicated treatment.
Most treatment trials demonstrate that maternal oral health improves with
antepartum periodontal therapy, a finding that is important for overall
maternal health and well-being.
Several states have also issued practice guidelines for perinatal oral health.
Key action items for obstetricians are listed in the table next slide.
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Current recommendations for evaluation and treatment of
periodontal disease in pregnancy
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Disclaimer
 The practice of medicine continues to
evolve, and individual circumstances will
vary. This opinion reflects information
available at the time of its submission for
publication and is neither designed nor
intended to establish an exclusive
standard of perinatal care. This
presentation is not expected to reflect the
opinions of all members of the Society for
Maternal-Fetal Medicine.
 These slides are for personal, noncommercial and educational use only
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Disclosures
 This opinion was developed by the Publications Committee
of the Society for Maternal Fetal Medicine with the
assistance of Stanley M. Berry, MD, Joanne Stone, MD, Mary
Norton, MD, Donna Johnson, MD, and Vincenzo Berghella,
MD, and was approved by the executive committee of the
society on March 11, 2012. Dr Berghella and each member
of the publications committee (Vincenzo Berghella, MD
[chair], Sean Blackwell, MD [vice-chair], Brenna Anderson,
MD, Suneet P. Chauhan, MD, Jodi Dashe, MD, Cynthia
Gyamfi-Bannerman, MD, Donna Johnson, MD, Sarah Little,
MD, Kate Menard, MD, Mary Norton, MD, George Saade,
MD, Neil Silverman, MD, Hyagriv Simhan, MD, Joanne Stone,
MD, Alan Tita, MD, Michael Varner, MD) have submitted a
conflict of interest disclosure delineating personal,
professional, and/or business interests that might be
perceived as a real or potential conflict of interest in relation
to this publication.
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