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27
August 2003
The study looked at 366 pregnant women who had periodontitis
in Alabama. Those who were treated with scaling and root planing
before they reached the 35-week stage of their pregnancy reduced
their chance of having a premature baby by 84%.
"What this tells us is that scaling and root planing
may significantly reduce a mother's chance of having a pre-term
birth," said
Dr Marjorie Jeffcoat, currently dean of the School of Dental
Medicine at University
of Pennsylvania,
but who conducted the research while at the University
of Alabama.
Periodontal disease, or periodontitis, is a serious gum infection
that destroys attachment fibres and the supporting bone that
holds teeth in the mouth. As the teeth move from the gums,
allowing plaque to build up and cause infection.
Root scaling and planing is a thorough, deep-cleaning process
concentrating on the spaces between the teeth and gums and
the scraping away of plaque, also known as 'debridement'.
About 10 to 15% of the Australian population has periodontitis,
said Dr Rod Marshall, a periodontist and senior lecturer at
the University of Queensland in Brisbane. "It
is probably the most common infection in man," he said.
The reason why it is not a major public health issue is the
slow chronic nature of the disease for most people, he said.
In very advanced stages, sufferers start losing teeth.
The reason why it is not recognised as a major public health
issue is the slow chronic nature of the disease for most people,
he said. In very advanced stages, sufferers start losing teeth.
Periodontal infections cause a faster-than-normal increase
in the levels of prostaglandin and tumour necrosis factor molecules
that induce labour, causing premature delivery. A baby is classified
as a pre-term baby if born before 37 completed weeks of pregnancy.
Pre-term babies are at higher risk of mental retardation, cerebral
palsy, lung and gastrointestinal problems, and vision and hearing
loss.
The women were recruited from a large study of 3,000 pregnant
women who were between 21 and 25 weeks of gestation, who had
at least three sites of clinical periodontal attachment loss
greater than, or equal to, 3 mm. On average, the women were
aged 22 at delivery.
The research is published in the current issue of the Journal
of Periodontology.
There are some issues that need to be considered with the study,
warned Marshall. The study was conducted in Alabama, which
has a high African-American population, and there is a strong
possibility the incidence of pre-term births are higher there. "It
is difficult to extrapolate the link with periodontal disease," said
Marshall.
This is not the first research to look at the use of dental
treatment to reduce the risk of pre-term deliveries, he said.
A large study completed last year established that treating
periodontal disease in pregnant women greatly improved the
outcome for the baby.
The connection between periodontal disease and early delivery
is not surprising, Marshall said. The total amount of ulceration
when all the teeth are added up would be the equivalent of
the whole inner surface of a forearm being ulcerated.
"You
would expect some systemic effect from that," he said.
The levels of pre-term deliveries overall is lower in Australia
with about 6% of babies born prematurely, he added.
Surprisingly, those women who supplemented their scaling and
root planing with an antibiotic treatment of metronidazole
had a higher incidence of early delivery than those who were
given a placebo. Jeffcoat suggested that more research needs
to be conducted to determine the reason for the decrease in
efficacy.
But Marshall thinks there is a simple explanation. The ineffectiveness
of the antibiotic is probably because the inflammation is the
patient's body responding to the plaque. "Treatment reduces
inflammation," said Marshall. "There are no bugs
to kill."
Women considering falling pregnant should visit their dentist
for a check up and clean, said Marshall.
© 2003
Australian Broadcasting Corporation
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