Should We Treat Periodontal Disease During Gestation to Improve Pregnancy Outcomes?

Abstract

Until recently many physicians in the United States including obstetrician gynecologists have been relatively unconcerned with oral health. During most physical examinations, the oral cavity is given only a rudimentary examination. With the recognition of the oral-systemic health care link, physicians have been keenly interested in the findings from their dental colleagues in periodontal medicine which have convincingly linked periodontal disease with such diverse systemic health complications as aging, Alzheimer disease, cardiovascular disease, diabetes, and also pregnancy complications including low birth weight, preterm delivery, preeclampsia, and early pregnancy loss. Intervention trials designed to improve oral health during pregnancy have proven to be safe; however, the outcomes have been inconsistent. Further studies will be required to determine the nature of the association and the optimal timing and efficacy of intervention.

Bi‐directional relationship between pregnancy and periodontal disease

“…Although some of the bacteria in these biofilms are more pathogenic than others, periodontal diseases are diverse polymicrobial infections caused by a complex consortium of bacteria. They are not simply caused by anaerobic gram-negative rods and spirochetes as implied by some authors (20,21,60,180).…”

Are Periodontal Bacterial Profiles and Placental Inflammatory Infiltrate in Pregnancy Related to Birth Outcomes?

“…[4][5][6][7][8][9] Some authors proposed that periodontitis may not be causally related to negative birth outcomes and that both may result from the same hyperinflammatory and/ or environmental influences in the mothers. 10,11 Gram-negative periodontal pathogens and their products (e.g., lipopolysaccharides [LPS]) have been shown to enter the systemic circulation and produce low-grade bacteremia, 12 which may translocate to the placenta or uterus and impair birth outcomes. [13][14][15][16][17] Leó n et al 18 found Porphyromonas gingivalis in the amniotic fluid of postpartum females with PB and intact membranes.…”

“…However, contradictory results were reported by six meta‐analyses on the association between maternal periodontal disease and the risk of PB and/or LBW 4‐9 . Some authors proposed that periodontitis may not be causally related to negative birth outcomes and that both may result from the same hyperinflammatory and/or environmental influences in the mothers 10,11 . Gram‐negative periodontal pathogens and their products (e.g., lipopolysaccharides [LPS]) have been shown to enter the systemic circulation and produce low‐grade bacteremia, 12 which may translocate to the placenta or uterus and impair birth outcomes 13‐17 .…”

Parodontite maternelle et causes d’accouchement prématuré

“…Deux à quatre jours après l'accouchement, les femmes ont eu un examen parodontal dans leur chambre en suites de couches, en aveugle de la cause de prématurité. L'examen a été réalisé avec une sonde parodontale manuelle (PCPUNC-15 Hu-Friedy ® ), sur 6 sites par dent, sur les 14 dents les plus fréquemment touchées par la parodontite (11,12,16,17,24 [8,38,41]. Parodontite et prééclampsie pourraient partager des facteurs de risque communs et refléter une certaine susceptibilité aux pathologies inflammatoires.…”