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Preterm births not reduced by periodontal treatment

Clinical Question:
Does the treatment of periodontal disease in pregnancy reduce the rate of preterm birth?

Bottom Line:
Treatment of periodontal disease in pregnancy does not reduce preterm births. These results differ from those of a prior meta-analysis of 7 small randomized controlled trials.* (LOE = 1b)

Reference:
Newnham JP, Newnham IA, Ball CM, et al. Treatment of periodontal disease during pregnancy: A randomized controlled trial. Obstet Gynecol 2009;114(6):1239-1248.  [PMID:19935025]

Study Design:
Randomized controlled trial (single-blinded)

Allocation:
Concealed

Setting:
Population-based

Synopsis:
This Australian randomized controlled trial enrolled 1082 pregnant women with a minimum of 20 teeth and periodontal disease. Periodontal disease was defined as periodontal pockets of at least 4 mm deep at 12 or more probing sites in fully erupted teeth, which typically excluded wisdom teeth. The study participants were enrolled from a total population in which approximately 15% of pregnant women had periodontal disease by this definition. Eligible women had a singleton gestation of less than 20 weeks without known fetal anomalies or characteristics that would put the pregnancy at imminent risk of complications. Women were randomized to receive periodontal treatment starting at 20 weeks' gestation or at 6 weeks postpartum (the control group). Treatment included plaque removal and treatment of predisposing factors including calculus, root planing, and adjustment of overhanging restorations, and hygiene instruction over several visits. Allocation was concealed, pregnancy care providers were masked, and analysis was by intention to treat. Among women assigned to the treatment group, 88% completed treatment. There were no differences between groups in the rates of preterm birth (9.7% vs 9.3%). *Polyzos NP, Polyzos IP, Mauri D, et al. Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a meta-analysis of randomized trials. Am J Obstet Gynecol 2009; 200(3):225-232.

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