Effects of periodontal therapy during pregnancy on periodontal status, biologic parameters, and pregnancy outcomes: a pilot study.
BACKGROUND
Few studies have examined the potential effects of periodontal treatment during pregnancy on pregnancy outcomes, periodontal status, and inflammatory biomarkers.


METHODS
A randomized, delayed-treatment, controlled pilot trial was conducted to evaluate the effects of second-trimester scaling and root planing and the use of a sonic toothbrush on the rate of preterm delivery (<37 weeks gestation). Secondary outcome measures included changes in periodontal status, levels of eight oral pathogens, levels of gingival crevicular fluid (GCF) interleukin-1beta (IL-1beta), prostaglandin E(2) (PGE(2)), 8-isoprostane (8-iso), and IL-6, and serum levels of IL-6, soluble intercellular adhesion molecule 1 (sICAM1), 8-isoprostane, soluble glycoprotein 130 (sGP130), IL-6 soluble receptor (IL-6sr), and C-reactive protein (CRP). Logistic regression models were used to test for effects of treatment on preterm delivery. Secondary outcomes were analyzed by analysis of covariance adjusting for subject baseline values.


RESULTS
Periodontal intervention resulted in a significantly decreased incidence odds ratio (OR) for preterm delivery (OR = 0.26; 95% confidence interval = 0.08 to 0.85), adjusting for baseline periodontal status which was unbalanced after randomization. Pregnancy without periodontal treatment was associated with significant increases in probing depths, plaque scores, GCF IL-1beta, and GCF IL-6 levels. Intervention resulted in significant improvements in clinical status (attachment level, probing depth, plaque, gingivitis, and bleeding on probing scores) and significant decreases in levels of Prevotella nigrescens and Prevotella intermedia, serum IL-6sr, and GCF IL-1beta.


CONCLUSIONS
Results from this pilot study (67 subjects) provide further evidence supporting the potential benefits of periodontal treatment on pregnancy outcomes. Treatment was safe, improved periodontal health, and prevented periodontal disease progression. Preliminary data show a 3.8-fold reduction in the rate of preterm delivery, a decrease in periodontal pathogen load, and a decrease in both GCF IL-1beta and serum markers of IL-6 response. However, further studies will be needed to substantiate these early findings.
Offenbacher
Steven
S
Department of Periodontology, Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7455, USA. steve_offenbacher@dentistry.unc.edu
Lin
Dongming
D
Strauss
Robert
R
McKaig
Rosemary
R
Irving
Joanna
J
Barros
Silvana P
SP
Moss
Kevin
K
Barrow
David A
DA
Hefti
A
A
Beck
James D
JD
D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000302:isolation & purification; D012534:Dental Scaling / Q000009:adverse effects; D005260:Female; D005883:Gingival Crevicular Fluid / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D053583:Interleukin-1beta / Q000097:blood / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D016015:Logistic Models; D016017:Odds Ratio; D010510:Periodontal Diseases / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000628:therapy; D010512:Periodontal Index; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000276:immunology* / Q000628:therapy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000097:blood / Q000209:etiology* / Q000276:immunology; D016745:Root Planing / Q000009:adverse effects*; D016037:Single-Blind Method; D014099:Toothbrushing / Q000009:adverse effects / Q000295:instrumentation
D004269:DNA, Bacterial; D053583:Interleukin-1beta; D015850:Interleukin-6