Elliot Abt DDS, MSc, MS; Hana Hasson DDS, MS
In pregnant women with periodontal disease, scaling/ root planing may lower the incidence of pre-term birth.
Of the seven included studies, two large RCT’s did not lend support to this conclusion and results of ongoing well-designed RCT’s are awaited for a more definitive conclusion.
In pregnant women with periodontal disease, does scaling and/or root planning compared to no treatment or prophylaxis have the potential to improve peri-natal outcomes such as pre-term birth (PTB), low birth weight (LBW) incidence and spontaneous abortion/stillbirth?
The authors searched two databases and the Cochrane Central Trials Registry for studies published in any language up to January 2008. They reviewed references of all eligible trials and also conducted a hand search. Two independent investigators performed a cross search in Medline using the names of the lead authors of the identified trials. The search yielded 429 titles of which seven RCT’s were included. They combined the data using a meta-analysis.
The authors reported that: 1) scaling and/or planning in pregnant women with periodontal disease significantly reduced the incidence of PTB (odds ratio [OR], 0.55; confidence interval [CI], 0.35 to 0.86) and resulted in a borderline reduction in incidence of LBW (OR, 0.48; 95 CI, 0.23 to 1.00); 2) no difference was found for spontaneous abortion/stillbirth. To determine the effect of baseline periodontal disease severity on PTB and LBW, the authors performed sub-group analyses. The analyses suggest that in women with mild periodontitis, there was a more significant reduction in incidence of PTB (OR, 0.49; 95 percent CI, 0.28 to 0.87). However in women with more severe disease i.e. probing depth > 4mm in more than 20% of the examined sites, there was no statistically significant reduction in incidence of PTB (OR = 0.92; 95% CI = 0.62 – 1.38). A second sub-group analysis to determine the effect of previous history of PTB/LBW suggests that women without a previous history of preterm birth or low birth weight were at lower risk for preterm birth (OR, 0.48; 95 percent confidence interval, 0.29 to 0.77) following treatment for periodontitis during pregnancy.
Scaling and/or root planing in pregnant women with periodontal disease may significantly reduce the incidence of PTB, and to a lesser extent reduce the incidence of LBW. If ongoing large and well-designed randomized trials support these results, practitioners may need to reassess current practice or at least be cautious prior to rejecting treatment of periodontal disease with scaling and/or root planning during pregnancy.
Source of Funding:
Importance and Context:
Preterm birth can cause significant neonatal morbidity and mortality, and periodontal disease has been associated with adverse pregnancy outcomes.(1) If treating periodontal disease during pregnancy can improve perinatal outcomes, practitioners should be aware of this evidence.
Strengths and Weaknesses of the Systematic Review:
The authors conducted a comprehensive search of several databases although they did not attempt to search the grey literature. They employed independent data extraction. A lack of well-defined inclusion and exclusion criteria limited their review. In addition, the authors did not provide descriptions of the subjects of the included studies, did not provide a list of study withdrawals, and did not define the term of the pregnancy.
Strengths and Weaknesses of the Evidence:
Several of the included trials had a moderate to high risk of bias due to inadequate randomization or blinding. There were significant differences in study designs and characteristics of patients included in the studies. In addition the potential for publication bias also exists. The two largest trials that were judged to have low risk of bias did not show a statistically significant difference in the incidence of PTB. Another trial included patients with gingivitis. Only 1 trial had statistically significant results, was of moderate size (220 patients), but weighted heavily as there were unusually high of PTB rates in both the experimental and control groups of the study. A subgroup analysis showed that the benefit of periodontal treatment was eliminated in patients with more severe disease, further weakening the evidence from this review.
Implications for Dental Practice:
There is limited evidence to indicate that scaling and/or root planning to treat periodontal disease in pregnant women might be beneficial. However, this conclusion is based on a small number of trials with inconsistent results. Further, a recent, multi-center randomized trial involving over 1800 patients found that periodontal therapy in pregnant women had no effect on preterm birth.(2)
1. Jeffcoat, MK, Geurs, NC, Reddy, MS, Cliver, SP, Goldenberg, RL, and Hauth, JC. Periodontal infection and pre-term birth. Results of a prospective study. JADA 132(7)857-880, 2001.
2. Offenbacher, S, Beck, JD, Jared HL, et al. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstet Gynecol 2009; 114:551-559.