Perio treatment, preterm delivery unrelated, study shows

Chapel Hill, N.C.—A new study suggests that traditional treatments of periodontal disease in pregnant women are safe, but have no discernable effect on the rates of preterm deliveries.

The study was led by Dr. Steven Offenbacher, director of the University of North Carolina at Chapel Hill School of Dentistry Center for Oral and Systemic Diseases, and was conducted by investigators at Duke University Medical Center, the University of Alabama at Birmingham and the University of Texas at San Antonio, who were overseen by the UNC School of Dentistry.

The results were based on a trial of 1,800 pregnant women with periodontal disease who were randomly assigned to two groups: one received periodontal treatment (scaling and root planing) before 23 weeks gestation; the other did not. Neither group received any follow-up treatment until delivery. Overall, no significant differences in periodontal disease were reported when the two groups were compared for obstetric or neonatal outcomes, according to a Duke press release.

“Although we did not reduce the risk of preterm births, the level of periodontal care provided in this study was not as effective in improving periodontal health as compared to earlier
studies,” Dr. Offenbacher said. “It may be that a more aggressive approach to periodontal disease management could have a different outcome.

“Unfortunately, periodontal disease progresses rapidly in pregnant women,” he continued, “and mothers-to-be still need to have their disease treated to protect their teeth.”

The findings were presented at the annual meeting of the Society for Maternal-Fetal Medicine in San Diego. The study, which was funded by the National Institute of Dental and Craniofacial Research, has been submitted for publication and is considered one of the largest randomized trials ever to look at the link between periodontal disease and preterm delivery. Dr. Offenbacher said results were released prior to publication so that physicians at the SMFM meeting could learn how to advise their patients regarding the need for periodontal care.

“I’m always asked whether we should mandate dental treatment for all pregnant women,” said Amy Murtha, M.D., director of obstetrics research at Duke who presented the study at the SMFM meeting. “The biggest implication of this study is that this level of standard periodontal care will not affect the birth outcome.”

“This was a well-designed study that provides additional insight on the possible relationships of periodontal disease to preterm delivery,” said Dr. Daniel Meyer, ADA senior vice president for science/interprofessional relations. “The ADA certainly encourages all women, especially those of child-bearing age and who are pregnant, to have regular check-ups and to maintain optimal oral health. We will continue to monitor the issue as the science continues to evolve.”

A preterm delivery is considered to be any delivery that takes place with less than 32 weeks gestation. Previous evidence has led researchers to say that periodontal treatment could reduce some preterm births and prompted some insurance carriers and health care providers to recommend scaling and root planing in pregnant women. This new study—which provided one treatment with no follow-up visits—reinforced that pregnant women should continue to undergo dental exams and treatment as needed.

“Overall 1 in 4 pregnant women get worse periodontal disease during pregnancy,” Dr. Offenbacher said. “And in this study of mothers with pre-existing periodontal disease, 40 percent of the untreated mothers got worse. Unfortunately, the treatment was not very effective, as 30 percent of the treated mothers still had disease progression during pregnancy. Therefore, we need to understand better how to treat gum disease in pregnant women before we can fully understand the systemic implications.”

According to Dr. Offenbacher, the evidence that periodontal disease and poor pregnancy outcomes are related still exists, but more research is needed to answer whether more intensive periodontal care during pregnancy can help lower the incidence of preterm births. Most importantly, he said, it may also be that preterm birth and periodontal disease share a common underlying trait, such as an exaggerated inflammatory response that places a patient at risk for both conditions, or that periodontal disease is not a modifiable cause of pregnancy complications.

For more information about periodontal treatment and its relation to pregnancy, visit ADA.org.