Public Health Implications of Chronic Periodontal Infections in Adults

Potential Impact of Maternal Periodontitis on Reproductive Outcomes
Steve Offenbacher, DDS, PhD, Professor, Periodontology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, and James Beck, MS, PhD, Distinguished Professor, Dental Ecology and Research

Recent United States studies indicate that periodontal disease during pregnancy may be a newly identified obstetric risk factor for preterm delivery and fetal growth restriction (1-3). Mothers with periodontal disease early in pregnancy or with worsening periodontal status during pregnancy appear to have 2–8 times the risk for preterm delivery as other mothers. Maternal periodontitis confers risk that is particularly high at the earlier gestational ages, rather than late in pregnancy. As a result, the impact on neonatal morbidity and mortality is dramatic. Babies of mothers with periodontal infections that disseminate to the fetus are twice as likely as other babies to be admitted to the neonatal intensive care unit and three times more likely to require extended hospital stay beyond 7 days. Other studies conducted on Bangladeshi patients in London, however, failed to find an association between maternal clinical signs of periodontitis and prematurity. These findings suggest that there may be significant ethno-racial or geographical differences in attributable risk (4).

Early findings from antepartum periodontal treatment intervention trials point to a potentially dramatic 5-fold reduction in the rate of prematurity (5). This trial, conducted by Lopez and colleagues, divided almost 400 women into a treatment and a delayed treatment group. They reported that periodontal treatment during pregnancy not only is safe but may improve pregnancy outcomes. Other new findings suggest that approximately 25% of pregnant women demonstrate increased periodontal pocketing during pregnancy and that this condition raises the risk for prematurity. The research suggests that preventing periodontal disease initiation and progression, even in relatively healthy individuals, may improve pregnancy outcomes (3). The transfer of maternal oral organisms or microbial components to the fetus has been documented, suggesting that there may be translocation of specific oral organisms, such as Campylobacter rectus (6), contributing to prematurity and growth restriction. Thus, there is emerging evidence that this linkage with prematurity may represent a specific infection of the fetus by oral organisms of maternal origin. The identification of specific infectious etiological organisms in this pathology will have diagnostic and therapeutic implications. To prove that periodontal therapy has potential protective benefits against obstetric complications, however, researchers must conduct multi-centered, randomized clinical trials.

Periodontal care will become an integral as part of obstetric care if maternal periodontal disease interventions and/or elimination of specific periodontal pathogens are shown to improve pregnancy outcomes. Further studies are needed to define the key pathogens and pathology mechanisms to optimize potential for diagnostic and therapeutic strategies will enable characterization of appropriate at-risk populations for demonstration projects to determine the effectiveness of reducing the burden of oral infection on obstetric and neonatal morbidity and mortality. In addition, education and outreach programs are needed to help coordinate and integrate obstetric and dental services.

This work was supported by NIDCR grants R01-HD26652, R01-DE08289, R01-DE012435, R01-DE1551, P60-DE13079.

References:

1. Offenbacher S, Vern LK, Fertik GS, Collins JG, Boyd DL, Maynor GB, McKaig R, Beck JD. Periodontal infection as a potential risk factor for preterm low birth weight. J Periodontol 1996;67:1103–1113.

2. Offenbacher S, Lieff S, Jared H., Madianos PN, McKaig R, Murtha A, Boggess K, Beck JD. Maternal periodontitis and prematurity: Part 1 - Obstetric outcomes of prematurity and growth restriction. Ann Periodontal 2001;6:164–174.

3. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenerg RL, Hauth JC. Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc 2001;132:875–880.

4. Davenport ES, Williams CE, Sterne JA,et al. The East London study of maternal chronic periodontal disease and preterm low birth weight infants: Study design and prevalence data. Ann Periodontol 1998;3:213–221.

5. Lopez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized controlled trial. J Periodontol 2002;73:911–924.

6. Offenbacher S, Madianos PN, Lieff S, Jared H, McKaig R, Murtha A, Boggess K, Beck JD. Maternal periodontitis and prematurity: Part 2 - Maternal infection and fetal exposure. Ann Periodontol 2001;6:175–182.

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Page last reviewed: February 2, 2005
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion