Promoting Oral Health To Reduce Adverse Pregnancy Outcomes

Oral health is an integral component of an individual’s general health and well-being. Research demonstrates that oral diseases and conditions are not only markers for underlying health problems but also important determinants influencing the development and management of adverse chronic health conditions (1). Studies have shown an association between periodontal disease and a number of systemic diseases including preeclampsia, atherosclerosis, diabetes, and coronary heart disease. Although most oral health issues are not unique to the female population, these conditions have important implications both for women’s and their children’s general health and well-being. Fluctuations in levels of estrogen and progesterone associated with puberty, pregnancy, and hormonal birth control use can exacerbate symptoms of gingivitis and promote the development and progression of periodontal diseases (2). Research continues to be conducted to determine the potential influences of women’s oral health status on adverse pregnancy and early childhood outcomes. The study by Boggess et al documents an association between poor maternal oral health and an increased risk for the development of preelampsia. Although the sample size was too small to confirm a direct association, this investigation adds to the growing body of literature on the adverse effects of periodontal disease on general health. Several studies have also shown an association between periodontal disease and preterm low birthweight, which is considered a leading problem in obstetric medicine and remains the leading cause of morbidity and mortality among neonates in the United States (3). Compared with normal-birthweight infants, low-birthweight infants are more likely to die during the neonatal period, and survivors face neurodevelopmental problems, respiratory problems, congenital anomalies, and complications due to neonatal intensive care, causing a tremendous impact on the health care system and the survivor’s own family (4). Preterm low birthweight (<2500g) can be a result of both a short gestational period and retarded intrauterine growth. In the United States approximately 10 percent of women deliver before term, and preterm delivery at less than 32 weeks’ gestation constitute 1 to 2 percent of all births (5). Periodontal infections, which can be a reservoir for inflammatory mediators, may pose a potential threat to the placenta and fetus, thereby increasing the likelihood of preterm delivery (6). Periodontal disease is a gram negative, anaerobic bacterial infection that affects the gingiva and bone supporting the teeth. This condition is characterized by plaque accumulation, which induces chronic inflammation of the periodontal tissues and gradual loss of periodontal attachment, often resulting in loosening and eventual loss of teeth. Since the inflammatory mediators that occur in periodontal disease also play an important part in the initiation of labor, there are plausible biological mechanisms that could link the two conditions (7). Jeffcoat et al found that mothers with severe periodontitis have high levels of prostaglandin in their blood, and are more likely to deliver preterm babies (5). Dolores Cottrell-Carson is on the Senior Dental Attending Staff of Via Health, Rochester General Hospital, Rochester, New York, USA.