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Public Health Implications of Chronic Periodontal Infections in Adults


Periodontal Disease as a Risk Factor for Preterm Birth: Epidemiology and a Pilot Intervention Study

Marjorie K. Jeffcoat, DMD, Dean, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania

Preterm birth, resulting in babies born too little and too soon, is a major cause of morbidity. Evidence indicates that infections can be major risk factors in preterm birth. Case-control studies point to an association between periodontal infection and increased rates of preterm birth.

Evidence points to a possible role for periodontal pathogens in preterm birth. In a case-control study of 124 pregnant or post-partum mothers, those who delivered preterm or low birth-weight babies had significantly worse periodontal disease than mothers of normal birth-weight babies. Multivariate logistic regression models controlling for other risk factors and covariates, showed that periodontal disease is a significant risk factor, with odds ratios of 7.9 for all preterm low birth-weight cases and 7.5 for primiparous preterm low-birth-weight cases (1). Other case-control studies show the risk of preterm birth was 3 to 8 times greater for mothers with periodontal disease (3). In a longitudinal study, more than 1,300 women with periodontal disease indicated an overall adjusted odds ratios of 2.83 (95% C.I. 1.79–4.47) for patients with mild-to-moderate disease, and 4.18 (95% C.I. 1.41–12.42) for patients with severe periodontal disease (2,3).

A recently completed pilot study examined whether periodontal treatment reduces the risk of preterm birth (PTB) in pregnant women with periodontitis (4). A total of 366 women with periodontitis between 21–25 weeks' gestation were recruited and randomized to one of three treatment groups and stratified on the following two factors: (a) previous preterm birth at less than 35 weeks, (b) body mass index less than 19.8 or bacterial vaginosis as assessed by gram stain. The treatment groups consisted of (a) dental prophylaxis plus placebo capsule; (b) scaling and root planing plus placebo capsule; and (c) scaling and root planing plus metronidazole capsule (250 mg three times daily for 1 week). Another group of 723 pregnant women meeting the same criteria for periodontitis and enrolled in a prospective study served as an untreated reference group.

The percentage of preterm birth at less than 35 weeks was 4.9% in the prophylaxis group, 3.3% in the scaling and root planing plus metronidazole group, and 0.8% in the root planing and placebo group. The percentage of preterm birth at less than 35 weeks was 6.3% in the reference group.

These findings indicate that root planing dental treatment of pregnant women with periodontitis may reduce preterm birth in this population. Adjunctive metronidazole therapy did not improve pregnancy outcomes. Larger trials are needed to achieve statistical significance, especially at less than 35 weeks gestational age.

References:

  1. Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103–1113.
  2. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth. Results of a prospective study. J Am Dent Assoc 2001;132:875–888.
  3. Jeffcoat MK, Geurs RC, Reddy MS, Goldenberg RL, Hauth JC. Current evidence regarding periodontal disease as a risk factor in preterm birth. Annals of Periodontol 2001;6:183–188.
  4. Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and preterm birth: Results of a pilot intervention study. J Periodontol (in press).

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