Complications of Pregnancy

      Basis of Current Understanding: Prospective Studies

      Strength of Statistical Evidence: Weak to Moderate

      Studies Link Periodontal Treatment to Reduction of Disease: Possibly

      Reported Risk: Pre-term Births - 77-720%;  Low Birth Weight - 180-260%

      Several studies have linked Periodontal Disease to pregnancy complications, most notably the delivery of pre-term, and/or low-birth weight babies. The extent of the relationship is complicated by the number of definitions used for Periodontal Disease.  When gum disease is defined broadly, the results are small and not statistically significant.  More stringent definitions have resulted in statistically significant risk ratios.

      At present, our understanding of the mechanisms underlying the relationship between Periodontal Disease and pregnancy complications is not well understood.  It is speculated that several mechanisms could cause the increased problems. 

      In women with gingivitis or Periodontal Disease, the numbers and types of bacteria have been found to be much higher than in women with normal gums.  Researchers have speculated that fewer bacteria in the mouth may result in fewer bacteria in the amniotic fluid and chorionic membranes.  Study results appear to supporting this concept.  The beneficial effect of gum care on pre-term delivery has been shown for women with early and moderate gum disease, but the benefit disappears in women with advance Periodontal Disease.  This may be due to the effect of increase bacterial circulation directly after scaling and root planing in the advance Periodontal Disease group.

      Proteins called cytokines are released throughout the body when gum disease is present.  Cytokines have been shown to cause problems with many of our body’s functions.   For instance, Tumor Necrosis Factor-α (TNF-α) can damage the lining of blood vessels.  This may affect the fetal blood supply and the highly vascular vaginal or uterine tissues.

      Gum disease is an inflammatory disease that has been shown to cause oxidative stress and create oxygen free radicals.   These reactive chemicals attack cells and disrupt cell functions. In general, any disease that causes stress to the body can rob pregnant women of nutrients necessary for normal fetal development.

    Several studies have attempted to show improvement in pregnancy complications when participants received periodontal treatment during their pregnancies. While a few studies failed to find a statistically significant link, other studies have supported the relationship.  Results from the Obstetrics and Periodontal Therapy (OPT) Study released in 2008, suggest that periodontal care reduced pre-term births in cases of gingivitis or mild gum disease, but not in cases of more advanced gum problems.  In 2009, Polyzos, et al, showed significant reductions in low birth weight (52%) and pre-term births (45%) after scaling and root planing. 

      It should be noted that several large insurance carriers (including Aetna and CIGNA) feel that current evidence is strong enough to offer their female clients additional dental care when they are pregnant.