Conflict of interest and source of funding statement The authors declare that they have no conflict of interests. No external funding, apart from the support of the authors' institution, was provided for this review. The 6th European Workshop on Periodontology was supported by an unrestricted educational grant from Straumann AG.
A critical assessment of adverse pregnancy outcome and periodontal disease
Article first published online: 26 AUG 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Munksgaard
Journal of Clinical Periodontology
Special Issue: The 6th European Workshop on Periodontology Contemporary Periodontics
Volume 35, Issue Supplement s8, pages 380–397, September 2008
How to Cite
Wimmer, G. and Pihlstrom, B. L. (2008), A critical assessment of adverse pregnancy outcome and periodontal disease. Journal of Clinical Periodontology, 35: 380–397. doi: 10.1111/j.1600-051X.2008.01284.x
- Issue published online: 26 AUG 2008
- Article first published online: 26 AUG 2008
- Accepted for publication 20 May 2008
- adverse pregnancy outcomes;
- low birth weight;
- periodontal disease;
- periodontal therapy;
- pre-term birth;
Background: Pre-term birth is a major cause of infant mortality and morbidity that has considerable societal, medical, and economic costs. The rate of pre-term birth appears to be increasing world-wide and efforts to prevent or reduce its prevalence have been largely unsuccessful.
Aim: To review the literature for studies investigating periodontal disease as a possible risk factor for pre-term birth and adverse pregnancy outcomes.
Main Findings and Conclusion: Variability among studies in definitions of periodontal disease and adverse pregnancy outcomes as well as widespread inadequate control for confounding factors and possible effect modification make it difficult to base meaningful conclusions on published data. However, while there are indications of an association between periodontal disease and increased risk of adverse pregnancy outcome in some populations, there is no conclusive evidence that treating periodontal disease improves birth outcome. Based on a critical qualitative review, available evidence from clinical trials indicates that, although non-surgical mechanical periodontal treatment in the second trimester of pregnancy is safe and effective in reducing signs of maternal periodontal disease, it does not reduce the rate of pre-term birth. Clinical trials currently underway will further clarify the potential role of periodontal therapy in preventing adverse birth outcomes. Regardless of the outcomes of these trials, it is recommended that large, prospective cohort studies be conducted to assess risk for adverse pregnancy outcome in populations with periodontal disease. It is critical that periodontal exposure and adverse birth outcomes be clearly defined and the many potential confounding factors and possible effect modifiers for adverse pregnancy outcome be controlled in these studies. If periodontal disease is associated with higher risk of adverse pregnancy outcome in these specific populations, large multicenter randomized-controlled trials will be needed to determine if prevention or treatment of periodontal disease, perhaps combined with other interventions, has an effect on adverse pregnancy outcome in these women.