Link between gingivitis and pre-term birth
By Stacy L. Graham-Hunt

There is an association between gingivitis and preterm birth, but whether the gum disease causes pre-term birth is debatable, according to Dr. Errol Norwitz, who works in the Obstetrics, Gynecology, and Reproductive department at Yale University’s School of Medicine.

Andrés Sanchez and his colleagues at the Division of Periodontics, Marquette University School of Dentistry, came to the conclusion that there is a moderate correlation between periodontal disease and pre-term and low birth weight babies, after conducting a study, which was featured in the April edition of the Journal of the International Academy of Periodontology.

However, another researcher on this topic, Yiping Han of Case Western University, said it’s too early to make any conclusions about the link between periodontal disease and premature births.

"It’s a study that needs more work, Han said.

Dr. Cindy Flanagan from the Academy of General Dentistry said this topic started showing up in her literature about five years ago. She said a change in someone’s mouth could indicate a change in health. For instance, gingivitis could be an indication of heart disease, blood infection, diabetes, and strokes.

"I can even tell when my cycle is about to start based on the way my mouth feels," Flanagan said.

Norwitz said due to genetic factors, the same women who are predisposed to having gingivitis are also predisposed to having a pre-term birth and genital tract infections, such as bacterial vaginosis and trichomoniais. He said there are genetic factors and proteins that women’s bodies develop which make them at higher risk for having both gingivitis and preterm birth.

Dr. Vincent Hoyt Pepe, the director of the Obstetrics and Gynecological Division of Mid State Medical Center in Meriden, said plaque harbors bacteria, which can be released into the body.

Norwitz said it was first thought that gingivitis was releasing a chemical that was causing premature births in mothers, as Pepe said, but he said bigger and better studies have shown that the two symptoms are independent of each other.

One of the bigger studies included 823 women with periodontal disease. The Obstetrics and Periodontal Therapy Trial was conducted in November 2006 and concluded that pregnant women who receive nonsurgical treatment for their gum diseases, such as scaling and rooting, do not significantly lower their risk of delivering a premature or low birth weight baby. The National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, conducted this study.

Pepe said there are different types of bacteria that can be found in any person’s mouth and there is not a specific bacteria that causes pre-term or low-weight birth.

Han said, "This is a very controversial issue."

Pepe said as studies begin to agree more, people will have a better idea of which direction to take.

Dr. Miles Hall DDS, the Chief Clinical Director of Cigna Dental, said there is undoubtedly going to be conflicting data.

Despite all of the conflicting opinions about the link between gum disease and preterm or low weight births, Cigna Dental launched a prenatal dental program in January 2006, the Dental Oral Health Maternity Program. This program covers 100 percent of the costs of periodontal scaling and rooting, a non-surgical dental procedure to treat gum disease. Hall said Cigna would rather be aggressive on the preventive side than waiting for a worse condition to occur.

"We’re very confident in the program," he said.

Although many dentists disagree about the prenatal effects of gingivitis, they have come to similar conclusions about "pregnancy gingivitis."

Han said pregnancy gingivitis is a condition where women get gingivitis during pregnancy, but it usually heals after pregnancy.

Flanagan said a woman’s progesterone levels increase during pregnancy and it can cause gingivitis. Prostaglandins respond to the bacteria found in plaque that cause gingivitis and try to fight the infection. "The immune system goes wacko" when a woman is pregnant, Han said.

Norwitz said he recommends that pregnant women see the dentist for routine checkups, but he does not recommend getting a root canal or any cosmetic surgery during pregnancy. He said he likes the fact that women are being encouraged to continue going to the doctor during pregnancy.

"Pregnancy is a normal health physiological state," Norwitz said.

Pepe said just because a woman is pregnant, this does not mean she should stop seeing the dentist. He said it is important to receive proper dental care before conceiving.

"Dental care is important, pregnant or not," he said.

Hall said cleaning teeth is a good thing, and it can’t be a bad thing to support oral hygiene.

"I don’t think anyone would disagree with that," Hall said.