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. Several studies also demonstrate positive associations between periodontal disease, pre-eclampsia, and gestational diabetes. There are several potential explanations for these associations. Periodontal disease may increase adverse pregnancy outcomes through infection of the chorioamnion, or by a systemic inflammatory response, or a combination of these factors.
Bacteremia: Direct Mechanism
- Periodontal infection in the mouth may have direct effects on the uterus through bacteremia causing direct infection of the chorioamnion. Some studies have shown higher rates of periodontal pathogens such as P. gingivalis and F. nucleatum within the placental tissues.
- Immunohistochemical and immunofluorescent stains of placental tissues have been used in some studies to support that colonization, as opposed to mere transient bacterial presence, can occur within the placental tissue.
Systemic Inflammatory Response: Indirect Mechanism
- Literature clearly supports a link between infections during pregnancy and preterm labor and birth. It is possible that periodontitis (a polymicrobial infection) increases the risk of preterm labor and birth through a systemic inflammatory response. Studies support an association between increased inflammatory markers and periodontitis and preterm labor and birth. Inflammatory markers such as prostaglandins, interleukins, matrix metalloproteinases, and CRP may increase the risk of preterm labor and birth through preterm rupture of membranes, uterine contractions, and cervical dilation.
- In addition, an 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.
- RCTs to date demonstrate inconsistent results on impact of periodontal therapy for periodontal disease and pregnancy outcomes, but emerging data suggests periodontal therapy may improve outcomes, such as reducing rates of preterm birth and low birth weight. Studies continue to support the safety of receiving dental care, such as periodontal therapy, during pregnancy. More studies are needed to elucidate the optimal therapeutic regimen, and ongoing maintenance strategies.
Kumar J and Samelson R. Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines.
References
Fischer, LA, Demerath, E, et al. Placental Colonization with Periodontal Pathogens: The Potential Missing Link. American College of Obstetrics and Gynecology, November 2019.
Abariga, SA, Whitcomb, BW. Periodontitis and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis Of Observational Studies. BMC Pregnancy and Childbirth. (2016) 16:344.
Vivares-Bulles, AM, Rangel-Rincón, LJ, et al. Gaps in Knowledge About the Association Between Maternal Periodontitis and Adverse Obstetric Outcomes: An Umbrella Review. J Evid Base Dent Pract 2018: [1-27].
Arbildo-Vega, H.I.; Padilla-Cáceres, T.; Caballero-Apaza, L.; Cruzado-Oliva, F.H.; Mamani-Cori, V.; Cervantes-Alagón, S.; Vásquez-Rodrigo, H.; Coronel-Zubiate, F.T.; Aguirre-Ipenza, R.; Meza-Málaga, J.M.; et al. Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review. Medicina 2024,60,943. https:// doi.org/10.3390/medicina60060943
Tsikouras, P, Oikonomou, E, Nikolettos, K, Andreou, S, Kryiakou, D, Damaskos, C, Garmpis, N, Monastiridou, V, Nalmpanti, T, Bothou, A. et al. The Impact of Periodontal Disease on Preterm Birth and Preeclampsia. J. Pers. Med. 2024, 14, 345. https://doi.org/10/3390/jpm14040345