Study: Perio treatment doesn't reduce preterm birth risk

Jan 29, 2009

Contrary to prevailing wisdom, treating periodontal disease during pregnancy does not reduce the risk of preterm birth.

That is the conclusion of a new study conducted at Duke University Medical Center, the University of Alabama at Birmingham, and the University of Texas at San Antonio.

The study was one of the largest randomized trials ever to look at the link between the two conditions, according to the researchers. The findings were presented January 29 at the Society for Maternal-Fetal Medicine annual meeting in San Diego.

Previous research had suggested that gum disease was associated with very preterm deliveries (less than 32 weeks gestation). That led insurance policies and healthcare providers to recommend scaling and root planing in pregnant women. It was thought that such care had the potential to reduce preterm delivery risk.

However, these new findings indicate that routine gum treatments do not reduce the risk of early delivery. Some 1,800 pregnant women with periodontal disease were randomly assigned to two groups: one received periodontal treatment before 23 weeks gestation; the other did not. Overall, no significant differences were reported regarding obstetric or neonatal outcomes when the two groups were compared.

"I'm always asked whether we should mandate dental treatment for all pregnant women," Amy Murtha, M.D., director of obstetrics research at Duke University Medical Center in Durham, NC, said in a press release. "The biggest implication of this study is that this level of standard periodontal care will not affect the birth outcome."

That's not to say pregnant women should not get dental exams and treatment as needed, Dr. Murtha added. "Our study emphasizes that treating periodontal disease during pregnancy is safe, but that standard periodontal care is not enough."

The American Association of Periodontology issued this statement regarding the study: "These study results demonstrate the need for additional research to clarify the potential impact that periodontal disease has on the risk of preterm births; and if needed, what periodontal treatment modalities are most effective in helping to prevent premature deliveries."

In fact, despite the study findings, much remains unknown about the relationship between the two conditions, Dr. Murtha said. "Periodontal disease and poor pregnancy outcomes travel together, but we don't know why," she said.

Additional research is needed to determine whether more intensive periodontal care during pregnancy might make a difference.

"Although we did not reduce the risk of preterm births, the level of periodontal care provided in this study was not as effective as compared to earlier studies," said Steven Offenbacher, D.D.S., Ph.D., of the University of North Carolina Center for Oral and Systemic Diseases and lead investigator of the study. "It may be that a more aggressive approach to periodontal disease management could have a different outcome, he added.