Treatment of Periodontal Disease and the Risk of Preterm Birth

Treatment of Periodontal Disease and the Risk of Preterm Birth
Michalowicz BS et al.
N Engl J Med. 2006 Nov 2;355(18):1885-94.
( abstract link here!)

Perio Talk: ~ My personal view

The results of the study by Michalowicz have certainly raised few intresting questions and doubts regarding the association of periodontal disease and preterm birth.

After I read the full article following facts got my attention

1) In inclusion exclusion criteria it was not defined whether the patients selected in the study were chronic generalized periodontitis patients or localized periodontitis patients. Certainly the affect of each of them on the systemic inflammatory cascade would be different, and so would be the affect on preterm birth.

2) The results showed that the number of spontaneous abortion and still birth in the control group to be higher than in the treatment group (the difference was not significant). Although not preterm birth per se but certainly the adverse outcomes do show a trend for increase in untreated group.

As has been mentioned in the editorial by Goldenburg, the above study did not show a significant reduction in the rate of preterm birth before 37 weeks of gestation. Also it mentions that observational studies have suggested that periodontal disease is much more strongly associated with late miscarriage, stillbirth, and early spontaneous preterm birth than with preterm birth in general.

The times to come are certainly interesting with results of the 3 studies by Newham JP et al, Offenbacher S et al, and Macones GA et al, which enroll more patients than the above mentioned study, will throw more light on role of periodontal disease in preterm birth. Till then according to findings of Michalowicz periodontal treatment dose not reduce preterm birth.

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