Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2006  |  Volume : 24  |  Issue : 1  |  Page : 23--26

Effects of periodontal treatment phase I on birth term and birth weight


S Sadatmansouri1, N Sedighpoor2, M Aghaloo3,  
1 Department of Periodontics, Islamic Azad University, Dental Branch, Iran
2 Department of Gyneclolgy, Islamic Azad University, Dental Branch, Iran
3 Dentist, Islamic Azad University, Dental Branch, Tehran, Iran

Correspondence Address:
S Sadatmansouri
Department of Periodontics, Islamic Azad University, Dental Branch, Tehran
Iran

Abstract

Considering the high prevalence of preterm birth (PTB) and low birth weight (LBW) and their complications as well as the role played by periodontal disease in their incidence and the lack of any report of periodontal therapy on these problems in Iran, the goal of the present research was to determine the effects of periodontal treatment on PLBW incidence among women with moderate or advanced periodontitis who were referred to Javaheri hospital (2004-2005). This clinical trial research was conducted on 30 pregnant women age ranging from 18-35 years old, with moderate or advanced periodontitis. Fifteen subjects randomly underwent the first phase of periodontal treatment including scaling, root planning and the use of 0.2% chlorhexidine mouth rinse for one week. None of these steps were taken for the controls. After necessary follow ups, the effect of periodontal treatment on birth term and birth weight were analyzed statistically. This research was conducted on 30 subjects, 15 controls and 15 cases in study group. In the control group, the observed rate of PLBW was 26.7% whereas among periodontally treated group, phase I, PLBW infant was not observed ( P <0.05). Infants birth weight were (3059.3-389.7) gms in study group and (3371-394.2) gms in the control group and respectively ( P <0.05). Periodontal therapy, phase I, results in a reduction in PLBW incidence rate. Therefore, the application of such a simple method among periodontally diseased pregnant women is recommended.



How to cite this article:
Sadatmansouri S, Sedighpoor N, Aghaloo M. Effects of periodontal treatment phase I on birth term and birth weight.J Indian Soc Pedod Prev Dent 2006;24:23-26


How to cite this URL:
Sadatmansouri S, Sedighpoor N, Aghaloo M. Effects of periodontal treatment phase I on birth term and birth weight. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2022 Jun 27 ];24:23-26
Available from: https://www.jisppd.com/text.asp?2006/24/1/23/22831


Full Text

Preterm birth (PTB) which refers to the delivery of a new born child before the 37th week of pregnancy and low birth weight (LBW) which refers to the birth of a newborn child with a weight equal or less than 2500 gms are grouped under the term of preterm low birth weight (PLB W).[1] PLBW is one of the highly significant causes for mortality and morbidity among infant.[2] Approximately 11% of all pregnancies lead to PLBW[3] and despite considerable progresses in medical care, this rate is increasing in western countries.[4] PLBW infants are greatly exposed to the risk of a number of acute and chronic disorders such as respiratory distress syndrome, cerebral palsy, heart diseases, epilepsy and severe learning disabilities.[5]

According to statistics nearly 10% of pregnant women in U.S.A are affected with pre-term delivery causing more than 60% of all neonatal mortality as well as 50% of infants medic care expenses in this country.[6]

The role of infection as an underlying cause for PLBW has been investigated earlier and have found relationship between periodontal disease and PTB.[7] It has been found that mothers with PLBW babies have more periodontal problems than the mothers with normal babies.

The rate of PLBW among women treated periodontally has been reported less than those who have not received such a treatment.[1],[7],[9]

Considering the importance of this problem and the lack of any related evidence in this country, the aim of this study was to determine the effects of periodontal treatment phase I on pregnant women with moderate or advanced periodontitis.

 Materials and Methods



In this randomized clinical trial research, pregnant women in the 18 to 35 year age group with moderate or advanced periodontal disease who were in the 13th to 20th week of pregnancy participated.

Subjects having a history of congenital heart disease requiring prophylactic antibiotics, diabetes, current use of corticosteroids, chronic renal disease, and with the presence of fetal congenial abnormality (evaluated ultrasonically until the 20th week) were excluded.

Periodontal parameters including pocket depth, clinical attachment loss, bleeding on probing were investigated. Pocket depths, from gingival margin to the pocket base, were measured and recorded in milimeter for all teeth except the third molars, at six points using a Williams probe. Clinical attachment loss was also measured in milimeter at surrounding points of each tooth from CEJ to the base of pocket by a Williams probe. Bleeding on probing was evaluated as positive if bleeding was observed within seconds after pocket depth measurement, otherwise bleeding on probing was considered as negative. Subjects, having 4 or more than 4 teeth, with at least one site with pocket depth of (equal or more than 4 mm) and clinical attachment loss of (equal or more than 3 mm) were diagnosed with periodontal disease. Following the selection of 30 women, based on the above mentioned criteria, they were randomly divided into two groups. Fifteen women, who were less than 28th week of pregnant, underwent the first phase of periodontal treatment including ultrasonic scaling and hand instrument root planning under local anesthesia with Lidocaine or Mepivastesin, if needed. Maintenance phase of treatment consisted of oral hygiene instructions, use of 0.2% chlorhexidine mouth rinse once a night for one week period and periodontal evaluation once every two weeks prior to delivery.

Control group subjects did not receive any treatment and they were recommended all types of periodontal treatment after delivery. The studied women were also investigated for risk factors including cigarette smoking, genitourinary tract infections, history of PLB delivery, weight before pregnancy and antibiotic therapy due to pregnancy infection. Smoking of more than 5 cigarettes was considered as a criteria for smokers. Women with vaginal or urinary tract infection were suggested to consult with a gynecologist. Mothers weight of less than 50 kg before pregnancy was considered as low weight subjects. Those having obstetric disorders, e.g, gestational diabetes, placenta previa, preeclampsia eclampsia and polyhidramnios were excluded.

Periodontal examinations were repeated after the 28th week of pregnancy for control group and 2nd week after treatment (maximally during the 30th week) for the study group.

Infants weight and delivery time in weeks were recorded.

Data were subjected to chi square, Fisher's exact test and T. C test for statistical analysis.

 Results



In this research, 30 pregnant women with moderate or advanced periodontitis were selected. The mean age of control group was 28.4 + 4.1 whereas that of case group was 29.1 + 4.3 ( P P >0.05).

In the control group repeated periodontal examinations were conducted after 28th week of pregnancy while in the study group at 2 weeks post treatment (maximally in 30th week).

Periodontal characteristics in monitored examinations demonstrate that periodontal problems were resolved in the treat group and significant differences in periodontal characteristics existed between groups ( P + 389. 7gr and 3371 + 394.2 gr in control and case groups, respectively showing 312 gr or 10.2% increase among case subjects. Such a difference was statistically significant according to t-test analysis ( P P + O.8 weeks versus 3 7.9 + 1.3 weeks) [Table 4] than the control group, however, the difference was not statistically significant ( P P et al . showed that pregnant women affected with bacterial vaginal infection showed a decrease in PLBW incidence rate ( P 37 years) maternal age, African race, low socioeconomic status, inadequate prenatal care, alchohol and tobacco use, hypertension, genitourinary tract infection; diabetes, multiple pregnancies, vaginosis and a history of previous PTB.[1],[6],[7],[8] Galloway initially suggested that maternal periodontal disease caused potentially harmful effects on the developing fetus. These findings were not considered important until the time of Offenbacher who stated that periodontal infections could act as reservoirs for gram negative anaerobes and bacterial lipopolsyaccharide (LPS) and endotoxin could increase inflammatory mediators including PGE 2 IL -C 1 and TNF-;A and pose a potential threat to the fetal placental unit, even in the absence of genitourinary infection, resulting in preterm labor and premature rupture of membrane.[8] Comparisons between post partum women with PLBW and their counterparts with normal birth outcome revealed higher levels Bacteroides Forsythus and Campylobacter rectus for the first group.[9]

Adequate utilization of prenatal care has been associated with improved birth weights and lower risk of preterm delivery.[1] In a lot of investigations, less than 6 prenatal visits have been known as influencial risk factors on PLBW incidence.[1],[8],[10]

In the present study, all pregnant women were referred to Javaheri hospital for prenatal care on once a month before 28th week of gestation and twice a month thereafter, so the effect of the risk factor was eliminated. There was no statistically significant difference in pre pregnancy weight (less than 50 kg) and history of previous PLBW between groups. The patients were selected from the same hospital and were similar in socioeconomic status.

Periodontal therapy phase I is able to reduce the incidence rate of PLBW. As result, periodontal treatments and oral hygiene instructions are essential to prevent future complications among pregnant women particularly those with periodontitis. Pre pregnancy care and prenatal follow up are thought to be the most reasonable choice.

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