Preterm birth is a leading cause of infant mortality. Periodontal disease has been associated with multiple adverse pregnancy outcomes. In a study published in 2019 in the Journal of Clinical Periodontology the authors aimed to “compare the periodontal status of women with preterm prelabor rupture of membranes (PPROM) and women with uncomplicated singleton pregnancies.”1
Hajishengallis (2015) determined that spontaneous preterm birth can occur as the result of periodontal bacterial infection. The potential pathway by which the bacteria infect the placental tissues is through transitory bacteremia. Aagaard et al. (2014) found similarities between the oral microbiome and the placental microbiomes supporting the idea that oral bacteria can be transferred to the placenta.
In this study, PPROM was diagnosed by examination to verify pooling of amniotic fluid in the posterior fornix of the vagina. It was further confirmed by the presence of insulin-like growth factor binding proteins when clinical examination was inconclusive.
Participants were selected upon admission to the hospital for preterm birth. Individuals with signs of fetal growth restriction, the presence of either congenital or chromosomal fetal abnormalities, signs of fetal hypoxia, or significant vaginal bleeding were excluded. Upon admission women were offered periodontal examination. Probing depths and clinical attachment loss were documented on each fully erupted tooth; third molars and retained root tips were omitted. Gingival index and plaque index were evaluated using Silness & Loe method.
The key finding in the study was that “the periodontal status of women with PPROM differed from that of healthy women with uncomplicated singleton pregnancies.” Previous studies have been inconclusive regarding the association between periodontal disease and adverse pregnancy outcomes, such as PPROM. This could be attributed to multiple factors such as socioeconomic status, lifestyle and behavioral factors, cultural and racial-ethnic backgrounds, and oral hygiene practices.
The authors also pose the question, “is periodontal disease a cause or consequence of PPROM?” The authors go on to speculate “changes at the uterine tissue level, specifically membrane inflammation, may contribute to changes in oral physiology.”
The authors conclude by stating, “Our study showed that a cohort of pregnant women with PPROM residing in central Europe had worse periodontal status than women with uncomplicated pregnancies.”
Do you believe periodontal disease is the cause of adverse pregnancy outcomes or the consequence of factors that contribute to both conditions? Do you discuss increased risks of adverse pregnancy outcomes with your patients of childbearing age with periodontal disease? Would you be interested in seeing further studies to better define the pathway and association between periodontal disease and PPROM?
Radochova V, Stepan M, Kacerovska Musilova I, et al. Association between periodontal disease and preterm prelabour rupture of membranes. J Clin Periodontol. 2019;46(2):189-196. doi:10.1111/jcpe.13067
