Pregnancy and Periodontitis

Over the past 20 years, studies have looked into whether periodontitis can cause negative outcomes in pregnancy, such as pre-term birth and low birth weight. The studies, however, have been mixed and the results are controversial. Based on the most current research, can we correctly state that a mother’s gum disease can negatively impact the health of her baby? If so, what public health message should periodontists give to expecting mothers and what health reforms are needed to prevent the premature delivery of newborn babies?

Pre-term birth, or having a baby born before 37 weeks, is nothing to be taken lightly. According to the Centers for Disease Control, pre-term birth happens in 1 out of every 10 births in the United States. In 2015, about 17% of these pre-term babies died at birth, and those who survived may suffer from cerebral palsy, developmental delay, and/or breathing, feeding, vision, and hearing problems. It also takes an emotional and financial toll on the whole family. If babies can ideally be born on time, it gives them the best outcome for a healthy delivery and outcome for life. Therefore, if gum disease does negatively impact the birth of a baby, treating and preventing periodontitis would be critical for females who are trying to have a baby or are currently expecting.

The reason why gum disease may trigger pre-term birth may be due to inflammation in the body. The idea is that the bacteria that causes gum disease can trigger an immune response in the mother, and might also prevent growth factors from occurring naturally in the placenta. These responses from the immune system to the bacteria may inadvertently trigger early labor for the mother (1).

Unfortunately, studies have been all over the place as to whether periodontitis really does or does not cause pre-term birth. There are studies that show it has an impact, and other studies that show it does not. The reasons for these different results may be due to differences in study methods, lack of uniformity, and differing definitions of periodontitis and adverse outcomes in pregnancy (2). The majority consensus, however, is that there is an association between periodontal health and adverse outcomes in pregnancy, although the strength of the association is modest (3). Better designed studies and more uniform definitions of adverse pregnancy outcomes are needed to make a better conclusion regarding periodontitis and pre-term births.

It would be prudent, whether or not periodontitis really affects birthing negatively, that mothers be in their best shape health-wise, including oral health. Interestingly, according to the latest 2017 Cochrane review (4), it is not clear that interventional therapy (in other words, trying to treat the gum disease while the mother is still pregnant) really reduces the number of babies born before 37 weeks. Nevertheless, maintaining good oral health is an important part of preventive care that is shown to be effective and safe throughout pregnancy.

When should a pregnant woman be seen by a dentist? Is it okay to be treated by a dentist while one is expecting? Many dentists believe that the second trimester is the safest time to be working on a pregnant mother, or that they should wait until after the mother gives birth before treating her. There may be concerns from the dentist about liability if anything adverse happens to the baby following dental treatment. However, many studies show that anesthetics and x-rays are safe to use on pregnant women (5,6), as long as proper protocol and safety measures are put into place, as should be used on all patients. Certain medications, such as tetracycline, should be avoided during pregnancy. And of course, the risks and benefits of dental procedures must always be explained to expecting mothers before starting any treatment. However, overall, scientific evidence does not support the belief that the fetus is at risk with routine dental procedures. Oral health is important to maintain for the health of the mother and possibly for her baby as well.

In conclusion, there is some evidence that gum disease may adversely cause babies to be born early, although it is not a very strong association. Regardless of whether it is strong or not, it makes sense that a physically healthy mother will give her baby the best chance of a healthy delivery. My recommendation is that all expecting mothers continue to see their dentists before and during pregnancy to ensure that everything orally is in good shape, and urge them to take good care of themselves for the sake of their own health and potentially for their babies’ as well.

SOURCES

(1) J Matern Fetal Neonatal Med. 2018 Mar;31(5):597-602. doi: 10.1080/14767058.2017.1293023. Epub 2017 Feb 28. Association of periodontitis with preterm birth and low birth weight: a comprehensive review. Puertas A1, Magan-Fernandez A2, Blanc V3, Revelles L1, O'Valle F4, Pozo E2, León R3, Mesa F2.

(2) Front Immunol. 2017 Feb 13;8:139. doi: 10.3389/fimmu.2017.00139. eCollection 2017.

Role of Maternal Periodontitis in Preterm Birth.

(3) Quintessence Int. 2016 Mar;47(3):193-204. doi: 10.3290/j.qi.a34980. Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association. Corbella S, Taschieri S, Del Fabbro M, Francetti L, Weinstein R, Ferrazzi E.

(4) Cochrane Database Syst Rev. 2017 Jun 12;6:CD005297. doi: 10.1002/14651858.CD005297.pub3. Treating periodontal disease for preventing adverse birth outcomes in pregnant women. Iheozor-Ejiofor Z1, Middleton P, Esposito M, Glenny AM.

(5) Hagai, A., Diav-Citron, O., Shechtman, S., and Ornoy, A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: a prospective comparative cohort study. ([published correction appears in JADA. 2015;146(12):874])JADA. 2015; 146: 572–580

(6) Oral Health Care During Pregnancy Expert Workgroup. Oral Health Care During Pregnancy: A National Consensus Statement. (Available at:) (Accessed April 27, 2016)National Maternal and Child Health Resource Center, Washington, DC; 2012