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Periodontal disease and preterm delivery of low birth weight infants: a small survey.

Introduction

Pregnant women with periodontal disease may be at increased risk for having preterm low birth weight children (PLBW). Numerous studies carried out with hamsters and with humans showed evidence of an association between periodontitis and PLBW. While few studies did not show such an association. PLBW is one of highly significant causes for mortality and morbidity among infant.[1]. A case control study found that periodontal infection may be a potential independent risk factor for preterm low birth weight[2], and two prospective studies showed an association between preterm birth and periodontal infection.[3,4]. Women with pre-term labour do not invariably present with positive amniotic fluid culture, suggesting that sub clinical infections, resulting in translocation of bacteria, bacterial metabolites, and lip polysaccharides (LPS),may account for some of the inflammatory processes associated with PLBW[3]. Periodontal infections have much in common with genitourinary infections. In both these situations, the infection may be caused by Gram negative micro-organisms which release LPS. The patients defense system reacts to these antigens in a way that the blood levels of inflammatory cytokines such as PGE2,TNF-alpha etc increase significantly. High concentrations of these cytokines, in pregnant women, are responsible for rupture of the uterine membranes causing premature birth and retardation [1,3]. The rate of PLBW among women treated periodontal has been reported less than those who have not received such treatment[4,5]. The aim of the present study was to examine the relationship between periodontal disease and preterm low birth weight infants.

Materials and methods

In this small study, 26 pregnant women (who delivered an infant weighting under 2500 g and born before 37 week's gestation) and 16 pregnant women (who delivered an infant weighting more than 2500 g and born after 38 week's gestation) acts as control was selected for Gynecological Department. Demographic data such as age, marital status, educational level, and detailed data about the pregnancy were recorded from the patient's medical records. The risk factors included into the analyses were smoking (Yes or no),alcohol drinking problems (Yes or no), educational level, diabetes mellitus (yes or no),genitourinary infection during pregnancy, including bacterial vaginosis (yes or no), hemorrhage during pregnancy (yes or no), arterial hypertension (Yes or no). Detailed data on delivery were copied from the patients record in the deptt., while the additional information was gathered in an interview with every subjects after the periodontal examination. Data concerning the periodontal status of the mothers, such as probing pocket depth (PD) and clinical attachment loss (CAL) were measured using periodontal probe (HuFriedy, Chicago, IL, USA). Subjects having four or more than four teeth, with at least two site with pocket depth of (equal or more than 4 mm) and clinical attachment loss of (equal or more than 4 mm) were diagnosed with periodontal disease. The data was analyzed by SPSS 11.0 version.

Results and Discussion

Results

There was no statistically significant difference in frequency of smokers, diabetics, alcohol, Percentage and number of sites with probing depth > 5mm and clinical attachment loss > 4mm, gestational weeks and birth weight in case and control group.

Discussion

This study has found no evidence that periodontal disease is associated with an increased risk of premature low birth weight births. It may due to small sample study. PLBW may be associated with some other factors. A previous history of PLBW is one of the most important risk factors for subsequent preterm birth (PTB).[6] However; this factor may be associated with PLBW in our study. Inadequate pre-natal care is often cited as a risk factor for poor pregnancy outcomes in low socioeconomic status and poorly educated women. Vrinary infections is well known risk factors for PLBW.[7]

Cigarette smoking has been related to PLBW.[8]. But these factors were not associated with any of pregnancy outcomes in our study. Periodontal disease has been recently identified as potential risk factor for PLBW[2,9]. but this factor was not associated with any of pregnancy outcomes in our study of associations between periodontal disease and PLBW are more moderate than had been thought, than large, well controlled epidemiological studies will be needed to study this issues, and randomized trials of treatment of periodontal disease may be necessary to establish casual relationships.

References

[1.] McCramick, M.C., P.H. Wise, 1993. Infant mortality. Curr Opin Pediatr; 5: 552-7.

[2.] Offenbacher, S., V. Katz, G. Fertik, J. Collins, D. Boyd, G. Maynor, 1996. Periodontal infection as a possible risk factor for preterm low birth weight. J. Periodontal., 67: 1103-13.

[3.] Jeffcoat, M.K., N.C. Geurs, M.S. Reddy, S.P. Giver, R.L. Goldenberg, J.C. Hauth, 2001. Periodontal infection and preterm birth. Results of a prospective study. J. Am. Dent. Assoc., 132: 875-900.

[4.] Mitchell Lewis, D., S.P. Engerbretson, J. Chen, I.B. Lamster, P.N. Papapanon, 2001. Periodontal infections and pre term birth: early findings from a cohort of young minority women in New York. Eur. J. Oral Sci., 109: 34-39.

[5.] Jeffcoat, M.K., J.C. Hauth, N.C. Geurs, 2003. Periodontal disease and preterm birth: results on pilot intervention study. J. Periodontal., 3(74): 1214-18.

[6.] Berkowitz, G.S., E. Papiernik, 1993. Epidemiology of preterm birth. Epidemiol. Rev., 15: 414-40.

[7.] Paige, D.M, M. Augustyni, W.K. Adih, F. Witter, J. Chang, 1998. Bacterial vaginosis and preterm birth. A comprehensive review of the literature. J. Nurse Mid. Wifery, 43: 83-89.

[8.] Kierse, M.J., 1989. An evaluation of formal risk scoring for preterm birth. Am J Perinat, 6: 226-233.

[9.] Lopez, N.J, P.C. Smith, J. Gutierrez, 2002 Higher risk of preterm birth and low birth weight in women with periodontal disease. J. Dent. Res., 81(1): 58-63.

Corresponding Author

Dr. Balwant Rai, Editor In chief Internet Journal Of Dental Science, USA. Editor In Chief Indian Journal Of Dental Science Founder Of BR regression equation. Email-drbalwantraissct@rediffmail.com

Dr. Balwant Rai, Editor In chief Internet Journal Of Dental Science, USA. Editor In Chief Indian Journal Of Dental Science Founder Of BR regression equation. Email-drbalwantraissct@rediffmail.com
Table 1: Frequency of smokers, diabetics, and patients with alcohol
drinking problems, and median (minimum and maximum) number and
percentage of sites with probing pocket depth in the control and case.

 Case Control
Variables Group Group

Diabetics 4.8% 4.6%
Smokers 1% 1%
Alcohol 1% 1%
Percentage of sites with probing depth > 5mm 7.9 7.8
 and clinical attachment loss > 4mm
Number of sites with probing depth > 5mm and 9 8
 clinical attachment loss > 4mm

Table 2: Mean and standard deviation of birth weight (g) and number
of gestational weeks in control and case groups

Variables Case Group Control Group

Gestational weeks 37.6+ 5.7 37.8+ 7.8
Birth weight 3152+ 532 3154+ 546
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Title Annotation:Original Article
Author:Rai, Balwant
Publication:Advances in Medical and Dental Sciences
Article Type:Report
Geographic Code:1USA
Date:Sep 1, 2008
Words:1126
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