The association between periodontal disease and preterm birth

Objectives: While dental health and systemic health were once viewed as two distinct fields of research, recent empirical studies have begun evaluating the potential health-related associations connecting the two health realms. Scientists have discovered biological pathways that may link poor oral health to certain diseases, including diabetes, cardiovascular disease, and adverse pregnancy outcomes. The principal aim of this thesis is to comprehensively examine the relationship existing between periodontal disease and preterm birth. This goal will be completed in two main steps. The first objective is to evaluate this putative relationship by conducting an observational study in a cohort of pregnant Canadian women. The second objective is to systematically assess and summarize the current literature examining whether or not there exists an association between periodontal disease and preterm birth. Research design & methods: Two separate studies were conducted in order to fulfill the goal of this thesis. The first was a retrospective cohort study. We used a database consisting of 337 pregnant Canadian women recruited for a previously conducted case-control study that examined the association between periodontal disease and preeclampsia. These women were recruited at several hospitals in Quebec, Canada, and included 92 women with preeclampsia and 245 controls. We excluded the preeclamptic cases from our study as they were often induced preterm births, and evaluated the effect of periodontal disease on preterm birth in our new cohort of 245 pregnant women using multivariate logistic regression, adjusting models for maternal age, ethnicity, and income. The second consisted of a systematic review and meta-analysis, which included 37 observational studies assessing the effect of periodontal disease on the incidence of preterm birth. Studies were included if they consisted of an observational design (cohort or casecontrol), and if the exposure (periodontal disease) was clinically evaluated and diagnosed. Results: In the cohort of Canadian women, the estimated risk of preterm birth and very preterm birth were, respectively, 1.51 (95% CI 0.61-3.71) and 0.90 (0.09-8.82) times higher in women with periodontal disease compared with periodontally healthy women, although results were not statistically significant. Separately, in the meta-analysis, we identified 842 total studies through our database search, from which we excluded 805 studies that did not meet our inclusion criteria. Out of 37 studies included in the meta-analysis, 26 were case-control studies and 11 were cohort studies. Twenty-four studies suggested that periodontal disease is a risk factor for preterm birth. The pooled OR was 2.20 (95% CI 1.80-2.69). We further stratified the studies by the type of observational study, the country it was conducted in, and the definition used to define the exposure (i.e. periodontal disease). All of the pooled ORs were greater than 1, demonstrating a significant association. Conclusion: The combined results of both of these studies suggest that although some individual studies may not be sufficiently powered to display a positive association, the overall literature does suggest such a relationship. The retrospective cohort study did not demonstrate a statistically significant association between periodontal health and preterm birth; however, the small sample size may have failed to provide us with the necessary power to detect an association that may have existed. On the other hand, the meta-analysis provided strong evidence that a relationship between the two variables does exist. Health professionals should use this information to counsel pregnant women about the importance of maintaining good oral health throughout pregnancy and the possible detrimental effects of not doing so. Further research involving treatment of periodontal disease should be undertaken to evaluate if the risk of preterm birth can be reduced in these high risk women.

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