Resource Highlights: Focus on Pregnancy and Periodontal Health

Offenbacher S, Beck JD, Jared HL, Mauriello SM, Mendoza LC, Couper DJ, Stewart DD, Murtha AP, Cochran DL, Dudley DJ, Reddy MS, Geurs NC, Hauth JC, for the Maternal Oral Therapy to Reduce Obstetric Risk (MOTOR) Investigators. 2009. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstetrics and Gynecology 114(3):551-559.

This randomized trial tested whether maternal periodontal disease treatment reduced the incidence of preterm birth. Periodontal therapy consisting of a single treatment of scaling and root planing and oral hygiene instruction did not resolve gingival inflammation or prevent disease progression in the majority of the enrolled pregnant women. The periodontal therapy resulted in a small but statistically significant improvement in periodontal clinical signs relative to the delayed-treatment group (control). However periodontal therapy did not restore most pregnant women to periodontal health, nor did it reduce the incidence of preterm delivery at less than 37, 35, or 32 weeks of gestational age; low birthweight or fetal growth restriction; or neonatal morbidity.

Srinivas SK, Sammel MD, Stamilio DM, Clothier B, Jeffcoat MK, Parry S, Macones GA, Elovitz MA, Metlay J. 2009. Periodontal disease and adverse pregnancy outcomes: Is there an association?. Obstetrics and Gynecology 200(5):497.e1-497.e8. Abstract available.

This study compared the risk of a composite of adverse pregnancy outcomes in women with and without identified (early in pregnancy) periodontal disease in a multicenter urban population. The study also compared the risk of specific adverse outcomes, preeclampsia and preterm birth, in women with and without periodontal disease. This study demonstrated that no association between periodontal disease and adverse pregnancy outcomes exists.

Horton AL, Boggess KA, Moss KL, Jared HL, Beck J, Offenbacher S. 2008. Periodontal disease early in pregnancy is associated with maternal systemic inflammation among African American women. Journal of Periodontology 79(7):1127-32. Abstract available.

This study determined whether maternal periodontal disease in early pregnancy is associated with elevated serum C-reactive protein (CRP) levels and whether maternal race influences the relationship between maternal periodontal disease and systemic inflammatory responses. The authors found that African American race and moderate/severe periodontal disease were significantly associated with elevated CRP levels. When stratified by race, moderate/severe periodontal disease remained associated with an elevated CRP level among African American women but not among white women after adjusting for age, smoking, parity, marital status, insurance status, and weight.

Ruma M, Boggess K, Moss K, Jared H, Murtha A, Beck J, Offenbacher S. 2008. Maternal periodontal disease, systemic inflammation, and risk for preeclampsia. American Journal of Obstetrics and Gynecology 198(4):389.e1-5. Abstract available.

This study determined the relationship between maternal periodontal disease, maternal systemic inflammation, and the development of preeclampsia. The authors found that maternal periodontal disease with systemic inflammation (as measured by C-reactive protein) is associated with an increased risk for preeclampsia.

Boggess KA for the Society for Maternal-Fetal Medicine Publications Committee. April 2008. Maternal oral health in pregnancy. Obstetrics and Gynecology 111(4):976-986. Abstract available.

This article examines the effects of oral disease and, specifically, the effect of maternal oral disease on pregnancy health. Emerging issues and future directions in oral health care for pregnant women are also discussed. The author concludes that (1) there is significant racial disparity in oral health, (2) research on the causal nature of the association between maternal oral health and pregnancy is ongoing, (3) data support preventive care in pregnancy, and (4) obstetricians-gynecologists should educate clients about the importance of oral health and preventive measures for maintaining oral health.

Buerlein J, Peabody H, Santoro K. 2010. Improving access to perinatal oral health care: Strategies and considerations for health plans. Washington, DC: National Institute for Health Care Management Foundation and Children's Dental Health Project.

This issue brief explores how oral health practices and utilization of dental care among pregnant women may affect a woman’s overall health, her birth outcome, and the oral health of her children. Oral health guidelines and statements are reviewed, and barriers that limit utilization of perinatal dental care are explained. The brief concludes with opportunities for health plans to play a role in removing these barriers to ensure that all pregnant women have access to needed dental care during pregnancy.

California Dental Association Foundation. 2010. Oral health during pregnancy and early childhood: Evidence-based guidelines for health professionals. Sacramento, CA: California Dental Association Foundation. Guidelines; policy brief.

These guidelines are intended to assist health professionals in private, public, and community-based practices in delivering oral health services to pregnant women and their children, and are based on a review of the science-based literature.

Delta Dental of Minnesota. 2006. Oral and medical health connections. Minneapolis, MN: Delta Dental of Minnesota.

This series of briefing reports presents information for employees, dentists, health plans, and physicians on emerging research that suggests a potential link between oral health and overall health. The report provides an overview of the background, systematic process, and evidence-to-date followed by a review of peer reviewed articles related to the oral-medical connection. The inaugural March 2006 issue addresses periodontal disease and adverse pregnancy, diabetes, and cardiovascular disease outcomes.

Holt K,. Barzel R., Clark M. 2009. Two healthy smiles: Tips to keep you and your baby healthy. Washington, DC: National Maternal and Child Oral Health Resource Center. Also available in Spanish.

This brochure is designed to educate women about the importance of oral hygiene and oral care during pregnancy. Topics include brushing, flossing, eating healthy foods, and getting dental checkups and treatment.

Idaho Department of Health and Welfare. 2006. Protecting the health of your unborn baby: Tooth and gum care during pregnancy. Boise, ID: Idaho Department of Health and Welfare. Also available in Spanish.

This brochure provides information for pregnant women on the importance of oral health and oral health care during pregnancy. Topics include oral hygiene, oral health care, and the prevention of gingivitis and periodontal disease. Available in English and Spanish.

Illinois Department of Public Health, Division of Oral Health. 2005. Improving women's and children's oral health = Mejorando la salud oral de Mujeres y Niños. Springfield, IL: Division of Oral Health, Illinois Department of Public Health.

This illustrated flipchart was designed to facilitate discussion between Special Supplemental Nutrition Program for Women, Infants and Children (WIC) staff and the individuals they serve about oral health during pregnancy and early childhood. The tool has also been implemented in Head Start programs in Illinois. Topics include dental caries (including early childhood caries), gingivitis and periodontal disease, toothbrushing and flossing, fluoride use, dental sealants, and dental visits. A summary of key messages is also provided. The information is written in English and Spanish.

Kumar, J. and Samelson, R. (Eds.). 2006. Oral health care during pregnancy and early childhood: Practice guidelines. Albany, NY: New York State Department of Health.

These practice guidelines are intended for use by prenatal, oral health, and child health professionals in bringing about changes in the health care delivery system and improving the overall standard of care for pregnant women and young children. Contents include general information about oral health and pregnancy and about oral health and early childhood, along with background information and specific recommendations for prenatal, oral health, and child health professionals. The guidelines have been summarized in the 8-page Oral health care during pregnancy: A summary of practice guidelines, published by the National Maternal and Child Oral Health Resource Center in 2008.

American Academy of Pediatric Dentistry (AAPD)

• Clinical Guideline on Perinatal Oral Health Care

American Academy of Periodontology

• Recommendations for a Healthy Pregnancy and On-Time Delivery

American Dental Association

• Evidence-Based Dentistry: Pregnancy and Oral Health
• Oral Health Topics: Pregnancy

March of Dimes

• Changes During Pregnancy: Gum and Teeth Changes

National Women's Health Information Center

• Oral Health