Periodontal disease linked to premature low birth weight babies. The preterm delivery of low birth weight infants is a huge problem in public health and is the leading cause of neonatal death and health problems throughout life. Preterm delivery may lead to learning disabilities, neurodevelopment problems and other major developmental issues. Studies have suggested that periodontal disease may be an independent risk factor for the premature delivery of these infants (Wilder, Robinson, Heather, & Lieff, 2007).
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Periodontal disease is a serious disease affecting the gingiva and surrounding structures, which leads to the destruction of the supporting structures of the teeth. Periodontitis is an infection that leads to destruction of the periodontal tissues and supporting bone. Many of the organisms associated with periodontal disease are Porphyromonas gingivalis, Actinobacillus actinomycetemcomitan, Prevotella intermedia (Wilder, Robinson, Heather, & Lieff, 2007). For many years people believed it was the bacteria alone that caused this disease. Later, studies have showed that the immune response mediates the reaction to these bacteria and stimulates the disease progress. This is why gingivitis does not always turn into periodontitis.
Many risk factors for periodontitis including stress, smoking, obesity, poor oral hygiene, genetics, other medical diseases and hormonal changes such as menopause, puberty and pregnancy have been discovered through research (Heather & Boggess, 2008). It is estimated that over 50% of pregnant women suffer from some form of gingival disease, either periodontitis or gingivitis. Dental treatment during pregnancy may potentially improve maternal and infant health (Aucoin, 2008). It has been found that women with periodontal disease are seven times more likely to give birth prematurely and have a low birth weight baby, than women with a healthy dentition (Aucoin, 2008). It is important to understand and consult others that overall health and systemic health starts with good oral health.
During pregnancy is it very important to maintain good oral hygiene for several reasons. With the increase in the hormones, the body releases an inflammatory response that increases the risk for gingival conditions such as, gingivitis or periodontitis. A lot of women develop gingivitis when they are pregnant and this is commonly referred to as pregnancy gingivitis. It is typically seen between the second and third trimesters of pregnancy. It can consist of red, inflamed, and bleeding gums that are sensitive to the touch, and sometimes mobility may be present. After delivery, the hormones are regulated and the gingival tissues usually return to normal (Weinberg et al, 2010).
There is a misconception that going to the dentist during pregnancy will be harmful and it is better to put it off until the baby is born. However, it is very important for women to get a cleaning as soon as possible when they find out they are pregnant, for preventative measures. The bacterium that is found in periodontitis accumulates in the pockets of the gingiva and has the ability to travel to the bloodstream and have other effects on the rest of the body. When the immune system is triggered, the body will try to attack whatever harmful bacterium is in the body. In doing so, the body releases prostaglandins, which are fatty acids that control inflammation and smooth muscle contraction that can induce labor. High levels of prostaglandins may trigger the body into labor and cause the birth of a premature baby (Wilder, Robinson, Heather, & Lieff, 2007).
In the 1990ââ‚¬â„¢s, it was hypothesized that oral infections such as gingivitis and periodontitis could spread the bacteria and the inflammatory response could reach the placenta and induce complications within the pregnancy. Many studies have showed that bacteria that cause oral infections can reach the fetus through the placenta and bloodstream and can interfere with the growth and development of the fetus. A study done by the National Institute of Dental and Craniofacial Research showed that as many as 18 percent of premature, low birth weight babies born in the U.S. each year result from some sort of oral infection (Aucoin, 2008). Preterm labor is sometimes a result of a maternal infection that initiates labor before the normal period of time.
Normal labor at term involves the production of prostaglandins. Prostaglandins ripen the cervix, cause myometrial contraction and change membranes structures. Throughout pregnancy the levels of prostaglandin increase steadily until they reach a threshold to induce labor, dilate the cervix and get ready for delivery. There are several factors that show researchers how prostaglandins participate in the labor of women. Studies have shown that prostaglandins have been shown to be the cause of abortions and labor, drugs that inhibit prostaglandins delay the onset of labor and can delay preterm labor, and high levels of prostaglandins are found in the amniotic fluid and plasma at term deliveries. Arachidonic acid is a precursor for prostaglandins and is increased in the amniotic fluid during labor (Wilder, Robinson, Heather, & Lieff, 2007).
In the last decade and a half a lot of research has been conducted on the relationship between periodontal disease and adverse pregnancy outcomes. (Collins et al) did a study where he infected pregnant hamsters with Porphyromonas gingivalis to see the adverse pregnancy outcomes. These included lower fetal weight, malformations of the fetus, and an increase in the embryo lethal events. Significant findings were found between higher levels of PGE2 and TNF, fetal growth restriction, and embryo lethality. This study showed how periodontal pathogens can result in poor pregnancy outcomes and the levels of PGE2 and TNF produced were associated with the effects of the fetus (Wilder, Robinson, Heather, & Lieff, 2007).
Another study used P gingivalis and Escherichia coli and injected the pregnant hamsters intravenously to see the outcomes of the exposures. The study showed embryo lethal effects on the fetus and when multiple exposures where given it resulted in lower fetal weight, and fetal mortality. These studies showed how significant periodontal pathogens and poor pregnancy outcomes are related (Wilder, Robinson, Heather, & Lieff, 2007).
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OffenBacher et al() did a study called the Oral Conditions and Pregnancy study (OCAP). It was a 5 year study that showed that periodontal disease is an independent risk factor for preterm labor and low birth weight. The study consisted of full mouth periodontal examinations of the woman prior to 26 weeks gestational age and again with 48 hours postpartum in order to see the periodontal changes that occurred during pregnancy. The mothers who had a healthy periodontium had a much lower prevalence of premature infants than the mothers who had periodontal disease. These findings indicated how significant periodontal disease affects gestational age and birth weight. It also indicated that the mothers with the worst periodontal status had the smallest infants and how the disease impairs fetal growth and induces labor when not ready. The authors of this study suggested that periodontal disease is a significant risk factor for poor pregnancy outcomes and is just as important as other known risk factors such as smoking cigarettes, drinking alcohol, using drugs and genitourinary tract infections (Wilder, Robinson, Heather, & Lieff, 2007).
Many physicians who treat and care for pregnant women do not emphasize the importance of oral health and do not give oral examinations at evaluations. When a study was done to see how many physicians knew the correlation between oral infections and the overall health of a pregnant women, many said they were not trained to give oral examinations, did not learn the importance of good oral health in medical school, or simply just didnââ‚¬â„¢t have the time in the appointments to evaluate the oral cavity. Physicians are the people we trust and listen to during important events for example, during child birth. If our own doctors do not stress the importance of a healthy oral cavity, why should patients be worried?
Research has shown that if pregnant women receive periodontal care and treatment, premature births may be reduced by about 45,000 each year. This, in turn, saves about $1 billion dollars in neonatal care. A report published in the Journal of Periodontology stated that women who received scaling and root planing at less than 35 weeks pregnant reduced premature births by 84 percent (“Dental procedure may,” 2003).
These studies have shown us the importance of overall health starts with oral health. This goes for all living beings not only those who can reproduce. Dentists have found that a simple scaling and root planing procedure can eliminate or decrease the risk for a premature delivery. As a dental professional, the importance of good oral hygiene techniques need to be demonstrated and the outcomes and risks of not taking the time to care for your oral hygiene needs to be emphasized (“Dental procedure may,” 2003).
In conclusion, the link between periodontal disease and pregnancy outcomes needs further research. As more research is done, the knowledge between periodontal disease and other health issues are becoming more apparent. The more knowledge obtained, the more opportunity for improved health care will increase. Physicians need to start communicating the importance of good oral hygiene practices and emphasizing the importance of dental visits not only when pregnant but throughout life. This shows something as little as a cleaning procedure in a dental office could eliminate something so big such as an illness or death of an infant as well as a systemic disease of any human being.
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