an increase in estrogen and progesterone levels
a higher vascular permeability, providing essential bacterial growth factors (vitamin K)
Estrogen and progesterone receptors in gingival tissues
increases in probing depth (PD) and bleeding on probing (BOP)
(prevalence: 35% to 100%)
Valimaa H. et al. J Endocrinol 2004;180:55-62.
Miyazaki H. et al. J Clin Periodontol 1991;18:751-754.
Loe H, Silness J. Acta Odontol Scand 1963; 21:533-551.
Raber-Durlacher JE. et al. J Clin Periodontol 1994;21:549-558.
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The prevalence of periodontitis in women of child-bearing age and during pregnancy
is not well known.Assuming that the prevalence of periodontitis increases with age,
the tendency toward an older age for pregnant women may result in a higher
proportion of pregnant women having periodontitis.
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Does periodontal treatment during pregnancy reduce
the rate of preterm births, low birth weight?
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Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol
Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a
prospective study. J Am Dent Assoc 2001;132:875-880.
Lo ́pez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal
disease: A randomized con- trolled trial. J Periodontol 2002;73:911-924.
Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and preterm birth: Results of a pilot interven- tion study. J Periodontol
Radnai M, Gorzo I, Nagy E, Urban E, Novak T, Pal A. A possible association between preterm birth and early periodontitis. A pilot
study. J Clin Periodontol 2004; 31:736-741.
Do ̈rtbudak O, Eberhardt R, Ulm M, Persson GR. Peri- odontitis, a marker of risk in pregnancy for preterm birth. J Clin Periodontol
Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D’Alton M, Papapanou PN. Markers of periodontal infection and preterm
birth. Am J Obstet Gynecol 2005;192:513-519.
H, Plancak D. Pre-term delivery and periodontal disease: A case-control study from
Croatia. J Clin Periodontol 2006;33:710-716.
Offenbacher S, Boggess KA, Murtha AP, et al. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol
A. Possible association between mother’s periodontal status and preterm
delivery. J Clin Periodontol 2006; 33:791-796.
Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am
Dent Assoc 2006;137:7S-13S.
Santos-Pereira SA, Giraldo PC, Saba-Chujﬁ E, et al. Chronic periodontitis and pre-term labour in Brazilian pregnant women: An
association to be analysed. J Clin Periodontol 2007;34:208-213.
Offenbacher S, Jared HL, O’Reilly PG, et al. Potential pathogenic mechanisms of periodontitis associated pregnancy complications.
Ann Periodontol 1998;3: 233-250.
Bearﬁeld C, Davenport ES, Sivapathasundaram V, Allaker RP. Possible association between amniotic ﬂuid micro-organism infection
and microﬂora in the mouth. BJOG 2002;109:527-533.
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Any PLBW and PLBW cases showed signiﬁcantly
greater probing depth and attachment loss,
increased anaerobic bacterial counts.
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J Periodontol 2009;80:884-891.
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OIBI was signiﬁcantly associated with preterm birth after adjusting for confounding
factors (odds ratio [OR], 1.85; 95% conﬁdence interval [CI]: 1.10 to 3.10; P = 0.02).
:The combined effects of multiple oral infections were signiﬁcantly associated with
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10 Cochrane Library
173 Web of Science
7 eligible randomized
411 reports excluded
news, letters, editorials,
American Journal of Obstetrics & Gynecology MAR, 2009
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treatment with scaling and root planing reduces the rate of PTB
and may reduce the rate of LBW infants.
the decline of oral cavity
pathogen concentration ->
the consequent reduction of
transportation of organisms
in the amniotic ﬂuid and
a reduction in circulating
produced in the oral crevice ->
reduced exposure of genital
tract tissues to these
the local inﬂammatory
response in the crevice->
a systemic inﬂammatory
immune response increasing
the sensitivity of immune cells
in the amnion to an
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The rate of preterm delivery for the treatment group was
13.1% and 11.5% for the control group (P=.316)
: no stastically difference
LEVEL OF EVIDENCE—I
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no differences between the control and treatment groups in preterm birth (9.3%
compared with 9.7%, odds ratio [OR] 1.05, 95% conﬁdence interval [CI 0.7-1.58],
P=.81), birth weight (3,450 compared with 3,410 g, P=.12), preeclampsia (4.1%
compared with 3.4%, OR 0.82, 95% CI 0.44-1.56, P=.55), or other obstetric endpoints.
Periodontal treatment was not hazardous to the women or their pregnancies.
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the acquisition of infection with Streptococcus mutans
to pathogenic levels
frequent and prolonged exposure to caries-promoting carbohydrates
rapid demineralization of enamel, if unchecked, leads to cavitations.
Cauﬁeld PW. et al. J Dent Res 1993; 72(1):37-45.
Dental caries(tooth decay)
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A woman’s dental caries risk may increase
1. the consumption of small, frequent, carbohydrate-rich meals
2. increased acid in the mouth from vomiting
3. a lack of attention to proper hygiene during pregnancy.
Silk H. et al. Am Fam Physician 2008;77(8):1139-1144.
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International Journal of Paediatric Dentistry 2002; 12: 2–7
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the amount of radiation
18 intraoral dental radiographs(with a lead apron)
- 0.0000001Gy (fetal embryonic dose)
Dental diseases in Gleichner. Principles and practice of medical therapy in pregnancy.
Stanford, Conneticut: Appleton & Lange, 1998:1093-1095
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dental amalgam, gold, composite ﬁllings
: class II medical devices(FDA)
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Journal of American Dental Association 2008;139(6):685-695.
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A survey of 249 obstetricians practicing in Ohio during 2004–2005
• 29% performed a visual mouth inspection during prenatal care.
• 20% used oral health screening questions.
• 6% referred clients to a dentist.
Stafford KE. et al. Journal of Maternal-Fetal and Neonatal Medicine 2008;21(1):63–71
However, most (64%) agreed that oral screening should be part of prenatal care.
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The Dentists Insurance Company (TDIC)— which is endorsed by eight U.S. state
dental associations and insures 17,000 dentists nationwide—reports
only one incidence in the past 15 years or more.
http://www. cdafoundation.org/library/docs/poh_policy_ 8. brief.pdf. Accessed March 2010
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Educating health care professionals and their patients about
the safety and advantages of dental treatment during
pregnancy can beneﬁt all women,especially low-income women.
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a community-based intervention to provide dental services for low-income pregnant women.
J Public Health Dent. 2008 ; 68(3): 170–173.
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a community-based intervention
to provide dental services
for low-income pregnant women
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fear of treatment,
myths about treatment, myths about pregnancy,
lack of insurance, lack of money,
and no provider available
we must understand women’s beliefs, attitudes, and
behaviors about their oral health during this unique time.
JOURNAL OF WOMENʼS HEALTH Volume 14, Number 10, 2005
CDC Pregnancy Risk Assessment Monitoring System (PRAMS)
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a community health
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Initial contact focused on participation.
The focus of subsequent home/WIC visits was on providing
information on the mother seeing the dentist and preventing
A major goal was to reduce barriers to care.
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Case management focused on reducing no-shows.
on eliminating reservoirs of disease
with the extraction of hopeless teeth and ﬁlling of open cavities.
After delivery, xylitol chewing gum for six months
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Continuing Education - doctors, dental hygienists, students
A major concern was that the medical community was
unaware of the need for treatment during pregnancy
and that dental care was safe.
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Result—Between February 2004 and January 2006, 503 pregnant women were
identiﬁed: 421 women were contactable. Of these, 339 received home visits
(339/421, 80.5%) and 235 received care (235/339, 69.3%).
Overall, 55.8% of eligible women received care (235/421).
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Barriers to careBarriers to care
fear of lawsuits
Education and training
beliefs and customs
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American Academy of Periodontology Statement
Regarding Periodontal Management of the Pregnant Patient
Periodontal health is a component of general health. Prevention and treatment of
periodontal diseases are important to maintain to maintain health.
For pregnant women, proper periodontal examination and treatment, if indicated,
can have a beneﬁcial effect on the health of their babies.
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