title: Treatment of periodontal disease and prevention of preterm birth: systematic review and meta-analysis.
abstract: OBJECTIVE
  There is a controversy regarding the benefits of periodontal treatment during pregnancy. We aimed to evaluate its effect on the risk of preterm birth and to explore the heterogeneity between studies.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials were performed. Studies in which women were randomized for periodontal treatment versus no treatment were included. Pooled risk ratios (RRs) with their 95% confidence intervals (CIs) were calculated using random-effect models. A sensitivity analysis was performed.
  
  
  RESULTS
  Twelve randomized trials were included in the meta-analysis. Pooled estimates showed no significant reduction of preterm birth with periodontal treatment (RR: 0.89; 95% CI: 0.73 to 1.08). However, the substantial heterogeneity among studies (I2 = 52%) could be explained either by the risk of bias, the level of income, or by the use of chlorhexidine mouthwashes as a cointervention. Daily use of chlorhexidine mouthwash was associated with a reduction of preterm birth (RR: 0.69; 95% CI 0.50 to 0.95), with moderate heterogeneity among the five studies included (I2 = 43%).
  
  
  CONCLUSIONS
  There is an important heterogeneity between randomized trials that evaluated the effect of periodontal treatment on the risk of preterm birth. Chlorhexidine mouthwash as a preventive agent should be further evaluated.
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, Québec, Canada.
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.forename: Suzanne
authors.initials: S
authors.lastname: Demers
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Roberge
authors.forename: Amélie
authors.initials: A
authors.lastname: Roy-Morency
authors.forename: Fatiha
authors.initials: F
authors.lastname: Chandad
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
mesh_terms: D015982:Bias; D002710:Chlorhexidine / Q000627:therapeutic use*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D009067:Mouthwashes / Q000627:therapeutic use*; D016017:Odds Ratio; D010510:Periodontal Diseases / Q000628:therapy*; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
chemical_list: D009067:Mouthwashes; D002710:Chlorhexidine