Treatment of periodontal disease and the risk of preterm birth.
BACKGROUND
Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth.


METHODS
We randomly assigned women between 13 and 17 weeks of gestation to undergo scaling and root planing either before 21 weeks (413 patients in the treatment group) or after delivery (410 patients in the control group). Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene. The gestational age at the end of pregnancy was the prespecified primary outcome. Secondary outcomes were birth weight and the proportion of infants who were small for gestational age.


RESULTS
In the follow-up analysis, preterm birth (before 37 weeks of gestation) occurred in 49 of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery (P=0.70; hazard ratio for treatment group vs. control group, 0.93; 95% confidence interval [CI], 0.63 to 1.37). There were no significant differences between the treatment and control groups in birth weight (3239 g vs. 3258 g, P=0.64) or in the rate of delivery of infants that were small for gestational age (12.7% vs. 12.3%; odds ratio, 1.04; 95% CI, 0.68 to 1.58). There were 5 spontaneous abortions or stillbirths in the treatment group, as compared with 14 in the control group (P=0.08).


CONCLUSIONS
Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. (ClinicalTrials.gov number, NCT00066131 [ClinicalTrials.gov].).
Michalowicz
Bryan S
BS
Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, USA. micha002@umn.edu
Hodges
James S
JS
DiAngelis
Anthony J
AJ
Lupo
Virginia R
VR
Novak
M John
MJ
Ferguson
James E
JE
Buchanan
William
W
Bofill
James
J
Papapanou
Panos N
PN
Mitchell
Dennis A
DA
Matseoane
Stephen
S
Tschida
Pat A
PA
D000328:Adult; D001724:Birth Weight; D012534:Dental Scaling; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010510:Periodontal Diseases / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*; D016745:Root Planing; D017211:Treatment Failure