Periodontal Therapy May Reduce Incidence of Preterm Births

Study shows that women with gingivitis who received periodontal therapy before 28 weeks of gestation had a significantly lower incidence of preterm low-birthweight babies than women who did not receive periodontal therapy.

CHICAGO – November 21, 2005 – Pregnant women will want to include a periodontal evaluation as part of their prenatal care. That’s because researchers found that periodontal treatment significantly reduced the risk of having a preterm birth or a low birthweight infant, according to a study published in the Journal of Periodontology.

“We found a significant association between gingivitis and preterm birth after adjusting for the major risk factors for preterm delivery, suggesting that gingivitis, the earliest form of periodontal disease, is an independent risk factor for preterm birth and low birthweight,” said Dr. Néstor J. López, Professor of the University of Chile. “Periodontal therapy reduced preterm birth and low birthweight infant rates by 68 percent in women with pregnancy-associated gingivitis.”

This is in concordance with two other intervention studies in which periodontal treatment reduced the incidence of preterm births and low birth weight infants between 71 percent and 84 percent in pregnant women with moderate to severe chronic periodontitis.

“Ideally, women should begin their pregnancy without periodontal infections, and they should be educated and motivated to maintain a high level of oral hygiene prior to and throughout pregnancy,” said López. “If periodontal infection is diagnosed at any time during pregnancy, the treatment should be administered as soon as possible in order to reduce the risk of preterm birth and low birthweight.”

“Pregnancy-associated gingivitis is a preventable and easy to treat disease,” explains Kenneth A. Krebs, DMD and AAP president. “Although it is still not known what are the precise mechanisms involved in the association between periodontal infections and preterm birth, to date, no harmful damaging effect caused by periodontal intervention in pregnant women has been reported.”

High health care costs are generated by preterm birth, and any strategy that reduces the preterm birth rate is likely to produce both health and economic benefits for mothers and infants. “The real cost saving is best represented by the lives of children saved from premature death and biological and social impairment,” said Lopez.

Researchers from Chile conducted this trial in a population of 870 pregnant women at low risk for preterm birth and low birthweight. Upon entering the study, all women received a full-mouth periodontal examination and the following variables were measured:

Gingival inflammation
Probing depth
Clinical attachment level
Oral hygiene status was assessed
Percentages of surfaces demonstrating plaque
Bleeding on probing (In this study bleeding on probing was selected as the variable describing gingivitis, the earliest stage of periodontal inflammation.)

Researchers divided the women into two groups—a control group and a treatment group. Women in the treatment group received periodontal therapy before 28 weeks of gestation, and maintenance therapy was provided every two to three weeks until delivery. The periodontal therapy consisted of plaque control instructions, supragingival and subgingival scaling and crown polishing. At the beginning of treatment, each woman was provided with toothbrushes and chlorhexidine and instructed to rinse once a day with .12% chlorhexidine until delivery. Women in the control group were monitored two to three times during pregnancy and repeated periodontal examinations were performed after 30 weeks of gestation to assess changes in periodontal status.

Postmenopause and Periodontal Disease: What Women Need to Know

CHICAGO – July 21, 2005 – Postmenopausal women may significantly reduce tooth loss by controlling their periodontal disease, according to a study in the Journal of Periodontology.

Researchers from the University at Buffalo, School of Dental Medicine did a follow-up evaluation on 106 postmenopausal women and found that during an average of 11.7 years follow-up, 57.5 percent of the participants lost at least one tooth.

“We found that alveolar bone loss (the bone that holds the tooth in the mouth) is the strongest independent predictor of tooth loss in the postmenopausal population,” explained Mine Tezal, DDS and study author. “Each millimeter of alveolar bone loss increased the risk of tooth loss 3 times, and the risk of tooth loss increased 2.5 times for each millimeter of clinical attachment loss, or soft tissue attachment between the tooth and alveolar bone.” (This is also known as loss of gums and bone.)

The health of teeth depends upon the integrity of the alveolar bone holding them in the mouth. Periodontal disease is the major cause of alveolar bone loss and tooth loss in patients over 35.

“The long follow-up period is an advantage of this study since researchers were able to evaluate the same people more than 10 years later,” said Vincent J Iacono, DMD and AAP president. “Since alveolar bone loss has been shown to be a significant factor for tooth loss in postmenopausal women, studies will be needed to determine possible aggravating effects of post menopause on the severity of periodontal disease. Until we know more, postmenopausal women will want to control periodontal disease to significantly reduce their risk of alveolar bone loss and tooth loss.”

Estrogen deficiency after menopause and consequent loss of bone mineral density have been shown to be associated with increased rate of tooth loss. These relationships may be explained by increased severity of periodontal disease in estrogen deficiency.

The participants of this study had participated in a past study in 1989 and 1991. The average follow-up time was 11.7 years. The age ranged from 45 to 73 and all subjects had reached menopause with the average age at 48.8 years.

Levels of Bacteria in Plaque Beneath the Gum Line May Increase Risk for Heart Attacks

Researchers Warn: Don’t Let Your Mouth Pollute Your Clean Heart

CHICAGO – May 19, 2005 – Researchers have found evidence that the amount of bacteria in subgingival plaques, the deep plaques in periodontal pockets and around the teeth, may contribute to an individual’s risk of a heart attack, according to two studies appearing in the Journal of Periodontology. These studies further researchers' understanding that periodontal bacteria may increase the risk for heart disease.

In one study researchers looked at 150 individuals with periodontal diseases and found that the total number of periodontal bacteria in subgingival plaques was higher in individuals that have suffered from an acute myocardial infarction (heart attack). The second study found that the same DNA from different kinds of periodontal bacteria in plaque was also in the patients’ heart arteries. Researchers believe that these findings may help substantiate what they have long known; if there is a sterile pathway, such as a bloodstream, near a periodontally infected area that the bacteria from this infected area cause inflammation in the gums that opens up pores in the surrounding blood vessels, which enables the bacteria to enter the bloodstream and travel to other parts of the body and cause great harm.

“It is like setting up a garbage dump on the edge of a river. You wouldn’t be surprised if the lake downstream ended up polluted with the garbage from the dump,” said Vincent J Iacono, DMD and president of the American Academy of Periodontology. “A patient’s bloodstream acts very much like the river in this analogy, in that it carries the bacteria from the periodontal plaques, possibly ‘polluting’ the arteries of the heart with periodontal bacteria, causing inflammation of the arteries which may lead to a heart attack. This potential effect of periodontal bacteria further supports the need for periodic deep cleanings to enhance overall health and wellbeing.”

These studies represent two in a large body of research that investigates the possible link between periodontal diseases and other systemic conditions such as heart disease. “Intervention data is not available to prove a causal relationship between the two. Right now we are currently advising patients that maintaining good periodontal health can only help not hurt,” said Iacono.

Oral Bacteria May Predict Pregnancy Outcomes

CHICAGO – March 23, 2005 – Researchers from New York University found that certain bacteria from the mouth may be related to preterm delivery and low birthweight according to a study in the Journal of Periodontology (JOP).

It’s been reported in the past that periodontal disease may be a factor in the occurrence of preterm low birthweight babies. Now it is believed that bacteria commonly found in dental plaque biofilms may also be related.

Researchers evaluated bacterial levels in the saliva of 297 women in their third trimester of pregnancy. They found that a higher salivary level of the bacteria called Actinomyces naeslundii Genospecies2 (A. naeslundii gsp2) is associated with low birth weight and preterm delivery, while higher levels of the bacteria Lactobacillus casei (L. casei) during pregnancy positively affected the birthweight.

“Our observation that A.naeslundii gsp2 reduced birthweight and preterm delivery fits well with the theory that oral bacteria and the molecules the body produces against them can enter the uterine environment through the blood stream and may influence the delivery process,” explained Dr. Ananda P. Dasanayake, Department of Epidemiology and Health Promotion, New York University College of Dentistry. “Whereas the bacteria L.casei secretes acids that maintain the vaginal pH level below 4.5. This pH level has a protective effect and prevents the overgrowth of more bacteria, including those associated with bacterial vaginosis (a condition associated with preterm labor and deliver).”

“What’s interesting is that the research shows that for each ten-fold increase in A. naeslundii gsp 2 levels, there was a 60 gram (0.13 pound) decline in birthweight and a 0.17 week decrease in gestational age. On the other hand, for one unit increase of L. casei levels there was a 42 gram increase (0.9 pounds) in birth weight and a 0.13 week increase in gestational age,” said Vicent J Iacono, DMD and president of the American Academy of Periodontology. “Future studies should evaluate both oral bacteria and bacteria that are not related to periodontal diseases to better understand this potential important link between periodontal status and prematurity.”

This issue of the JOP included another study, Periodontal Diseases and the Risk of Preterm Birth and Low Birth Weight: A Meta-Analysis. Findings from this study indicate that periodontal diseases in the pregnant mother significantly increase the risk of subsequent preterm birth or low birth weight. Researchers feel it remains important to promote good oral hygiene during routine prenatal visits, but caution that more studies need to be conducted to further our understanding about the effects of periodontal treatment on preterm birth.

Deep Periodontal Pockets Increase Risk for Electrocardiographic Abnormalities

CHICAGO – June 22, 2004 – People with deep periodontal pockets had an increased risk for electrocardiographic abnormalities (ECG) according to a recent study printed in this month's issue of the Journal of Periodontology.

“We found that people with deep periodontal pockets with a mean value greater than two millimeters had an increased risk for ECG abnormalities compared with people who had pockets with a mean value less than two millimeters. And, people with severe attachment loss with a mean value greater than 2.5 millimeters had a significant risk for ECG abnormalities.” said Dr. Yoshihiro Shimazaki, Department of Preventive Dentistry, Kyushu University Faculty of Dental Science, Japan. “Considering these results, the relationship between periodontitis and ECG abnormalities observed in this study suggests a relationship between periodontitis and cardiovascular disease.”

Periodontitis is a chronic inflammatory bacterial infection. Past studies report that periodontitis results in higher systemic levels of C-reactive protein (CRP), interleukin-6 and neutrophils suggesting that elevated levels of these inflammatory substances cause inflammatory changes to atherosclerotic lesions, which increases the risk of cardiac events.

“This study adds to the growing body of evidence that links periodontitis to cardiovascular disease,” said Dr. Michael P. Rethman DDS, MS, and president of the American Academy of Periodontology. “In order to examine the degree of cardiovascular risk from periodontitis compared with other risk factors, cohort studies are required. For example, because problematical ECG results are a widely appreciated risk factor for cardiovascular disease, it could be clinically valuable to know the effects of periodontal treatment on ECG exams.”

As ECG examinations cause no discomfort and take only a few minutes, it is widely used to screen for heart disease in health examinations. ECG abnormalities are significantly related to subsequent death from coronary heart disease and one of the most sensitive predictors of fatal coronary heart disease.

Comprehensive periodontal therapy is provided by dental specialists - known as periodontists - who are graduates of three-year residencies that they undertake after graduating from dental school. General dentists and dental hygienists can also provide more limited periodontal care.