Periodontal disease is common as is pregnancy and preterm labour is a complication in 10-15% of all pregnancies. It is therefore not unsurprising that an association between periodontal disease and pre-term labour has been noted in a number of studies. The aim of this latest review was quantify the relationship between periodontal disease, preterm birth and low birth weight in order to explore the reasons for the ongoing controversies surrounding this issue.
The authors took a standard approach to this systematic review using the PRISMA guidelines searching the Medline, Embase, BIOSIS, LILACS, Scopus, the Cochrane Central Register of Controlled Trials, the ISI Web of Science and IBECS databases for randomised controlled trials that allocated pregnant women to receive treatment with scaling and root planing, versus no treatment or prophylaxis. The outcomes of interest were preterm birth (< 37 weeks), low birth weight (< 2,500g). Trials were assessed for risk of bias.
- Thirteen trials involving 3,576 women in intervention groups with 3,412 women receiving usual care were included.
- Meta-analysis found a non-significant reduction of
- preterm births (RR = 0.90; 95%CI: 0.68-1.19) and
- low birth weights (RR = 0.92; 95%CI: 0.71-1.20).
- a funnel plot revealed clear evidence of publication bias.
The authors concluded
Primary periodontal care during pregnancy cannot be considered an efficient way of reducing the incidence of preterm birth.
This is a component and well-presented meta-analysis of the relationship between periodontal treatment and obstetric outcomes. However, it is worth asking how many more reviews we need on this topic when the number of primary studies is low. A quick and dirty search of Medline at least 17 previous reviews ( see links) of this area since 2002 so a more comprehensive search strategy could well find additional ones. The search strategy in this current review only identified 8 other primary studies (which were excluded) in addition to the 13 that formed this analysis.
Rosa MI, Pires PD, Medeiros LR, Edelweiss MI, Martínez-Mesa J. Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis. Cad Saude Publica. 2012 Oct;28(10):1823-33. PubMed PMID: 23090163.
Shanthi V, Vanka A, Bhambal A, Saxena V, Saxena S, Kumar SS. Association of pregnant women periodontal status to preterm and low-birth weight babies: A systematic and evidence-based review. Dent Res J (Isfahan). 2012 Jul;9(4):368-80. PubMed PMID: 23162575; PubMed Central PMCID: PMC3491321.
Kim AJ, Lo AJ, Pullin DA, Thornton-Johnson DS, Karimbux NY. Scaling and root planing treatment for periodontitis to reduce preterm birth and low birth weight: a systematic review and meta-analysis of randomized controlled trials. J Periodontol. 2012 Dec;83(12):1508-19. doi: 10.1902/jop.2012.110636. Epub 2012 Mar 1. PubMed PMID: 22376207.
Corbella S, Taschieri S, Francetti L, De Siena F, Del Fabbro M. Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies. Odontology. 2012 Jul;100(2):232-40. doi: 10.1007/s10266-011-0036-z. Epub 2011 Jul 8. PubMed PMID: 21739194.
Chambrone L, Pannuti CM, Guglielmetti MR, Chambrone LA. Evidence grade associating periodontitis with preterm birth and/or low birth weight: II: a systematic review of randomized trials evaluating the effects of periodontal treatment. J Clin Periodontol. 2011 Oct;38(10):902-14. doi: 10.1111/j.1600-051X.2011.01761.x. Epub 2011 Jul 7. Review. PubMed PMID: 21736600.
Chambrone L, Guglielmetti MR, Pannuti CM, Chambrone LA. Evidence grade associating periodontitis to preterm birth and/or low birth weight: I. A systematic review of prospective cohort studies. J Clin Periodontol. 2011 Sep;38(9):795-808. doi: 10.1111/j.1600-051X.2011.01755.x. Epub 2011 Jun 26. Review. PubMed PMID: 21707694.
George A, Shamim S, Johnson M, Ajwani S, Bhole S, Blinkhorn A, Ellis S, Andrews K. Periodontal treatment during pregnancy and birth outcomes: a meta-analysis of randomised trials. Int J Evid Based Healthc. 2011 Jun;9(2):122-47. doi: 10.1111/j.1744-1609.2011.00210.x. Review. PubMed PMID: 21190966.
Polyzos NP, Polyzos IP, Zavos A, Valachis A, Mauri D, Papanikolaou EG, Tzioras S, Weber D, Messinis IE. Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. BMJ. 2010 Dec 29;341:c7017. doi: 10.1136/bmj.c7017. Review. PubMed PMID: 21190966; PubMed Central PMCID: PMC3011371.
Fogacci MF, Vettore MV, Leão AT. The effect of periodontal therapy on preterm low birth weight: a meta-analysis. Obstet Gynecol. 2011 Jan;117(1):153-65. doi: 10.1097/AOG.0b013e3181fdebc0. PubMed PMID: 21173658.
Uppal A, Uppal S, Pinto A, Dutta M, Shrivatsa S, Dandolu V, Mupparapu M. The effectiveness of periodontal disease treatment during pregnancy in reducing the risk of experiencing preterm birth and low birth weight: a meta-analysis. J Am Dent Assoc. 2010 Dec;141(12):1423-34. PubMed PMID: 21119126.
Agueda A, Echeverría A, Manau C. Association between periodontitis in pregnancy and preterm or low birth weight: Review of the literature. Med Oral Patol Oral Cir Bucal. 2008 Sep 1;13(9):E609-15. Review. PubMed PMID: 18758408.
Xiong X, Buekens P, Vastardis S, Yu SM. Periodontal disease and pregnancy outcomes: state-of-the-science. Obstet Gynecol Surv. 2007 Sep;62(9):605-15. PubMed PMID: 17705886.
Vergnes JN, Sixou M. Preterm low birth weight and maternal periodontal status: a meta-analysis. Am J Obstet Gynecol. 2007 Feb;196(2):135.e1-7. PubMed PMID: 17306654.
Vettore MV, Lamarca Gde A, Leão AT, Thomaz FB, Sheiham A, Leal Mdo C. Periodontal infection and adverse pregnancy outcomes: a systematic review of epidemiological studies. Cad Saude Publica. 2006 Oct;22(10):2041-53. Review. PubMed PMID: 16951876.
Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006 Feb;113(2):135-43. Review. PubMed PMID: 16411989.
Khader YS, Ta’ani Q. Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis. J Periodontol. 2005 Feb;76(2):161-5. Review. PubMed PMID: 15974837.
Scannapieco FA, Bush RB, Paju S. Periodontal disease as a risk factor for adverse pregnancy outcomes. A systematic review. Ann Periodontol. 2003 Dec;8(1):70-8. Review. PubMed PMID: 14971249.
Madianos PN, Bobetsis GA, Kinane DF. Is periodontitis associated with an increased risk of coronary heart disease and preterm and/or low birth weight births? J Clin Periodontol. 2002;29 Suppl 3:22-36; discussion 37-8. Review. PubMed PMID: 12787204.
On this topic we have less than 20 prospective studies (not all RCT and not all well designed) and 17 systematic reviews…
I can not remember who defined stupidity as: “Doing the same thing over and over, expecting a different outcome”, however this looks like a good example.
reviewing this issue, we found that the 20 systematic review extracted different data from the cited papers…. :/
Please help me understand why anyone would consider epidemiologic evidence when several randomized intervention trial findings are available?
All the intervention trials have found that adverse pregnancy outcomes are not reduced from periodontal tx. Doesn’t this answer the clinical question “Does periodontal treatment reduce adverse pregnancy outcomes?”
Good question! – The question of the the effect of periodontal treatment on periodontal outcomes was discussed at the workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. The reviewed the available randomised controlled trials and concluded
Michalowicz BS, Gustafsson A, Thumbigere-Math V, Buhlin K. The effects of periodontal treatment on pregnancy outcomes. J Clin Periodontol. 2013 Apr;40Suppl 14:S195-208
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