The Relationship Between Periodontal Disease and Preterm Birth

Preterm birth is the number one cause of neonatal mortality in the U.S., with substantial cost burdens. If treatment of periodontal disease in pregnant women improved pregnancy outcomes, this would be a significant public health benefit.

Numerous studies have documented an association between maternal periodontal disease and preterm birth and low birth weight. There are several potential explanations for this association. Periodontal disease may have direct effects on the uterus through bacteremia causing direct infection of the chorioamnion. However, it is more likely that an indirect mechanism mediated by a systemic inflammatory response occurs.

Bacteremia: Direct Mechanism

  • Periodontal infection in the mouth may have direct effects on the uterus through bacteremia causing direct infection of the chorioamnion.

Systemic Inflammatory Response: Indirect Mechanism

  • It is postulated that preterm birth results from a systemic inflammatory response to periodontal infection that increases prostaglandins and interleukins and affects labor initiation.
  • Inflammatory response may lead to placental blood flow restrictions, placental necrosis, and consequent low birth weight.
  • A similar mechanism has been proposed to explain the association seen between periodontitis and increased rates of heart disease and diabetes.

Kumar J and Samelson R. Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines.

Albany, NY. New York State Department of Health. 2006. P. 23.
Albany, NY. New York State Department of Health. 2006. P. 23.

References

Boggess KA, Edelstein BL. Oral health in women during preconception and pregnancy: Implications for birth outcomes and infant oral health. Matern Child Health J 2006;10:S169-174.

Dörtbudak O, Eberhardt R, Ulm M, Persson GR. Periodontitis, a marker of risk in pregnancy for preterm birth. J Clin Periodontol 2005;32:45-52.

Goepfert AR, Jeffcoat MK, Andrews WW, Faye-Petersen O, Cliver SP, Goldenberg RL, et al. Periodontal Disease and Upper Genital Tract Inflammation in Early Spontaneous Preterm Birth. Obstetrics & Gynecology 2004;104:777-783.

Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: A systematic review. BJOG 2006;113:135-143.