Alcohol, smoking, certain seafoods — most expectant mothers can recite the pregnancy don’ts by heart. But should dentistry be added to the roster? For a long time, women have been cautioned against dental visits while pregnant, but a new four-year, $10 million interprofessional study that included the University of Minnesota School of Dentistry and Hennepin County Medical Center suggests treating periodontal disease during pregnancy causes no ill effects to mother or child.
The word periodontal means “around the tooth,” and the disease itself is a chronic bacterial infection that affects the gums and bone supporting the teeth. The disease starts when the bacteria in plaque — the film that forms naturally on your teeth — causes your gums to become inflamed. This can lead (in its mildest form) to red gums that are prone to bleeding and, if left untreated, will lead to the tissues and bone supporting the teeth being destroyed. A variety of factors can cause the disease, and while some are easily addressed (poor nutrition, smoking, stress, grinding your teeth) others are more complicated. For example, genetics may play a part; research has shown that up to 30 percent of the population may be genetically susceptible to periodontal disease.
In recent years plenty of data has been reported that periodontal disease in pregnant women was linked to both premature and low-birth-weight babies. Because of this research, the National Institute of Dental and Craniofacial Research (NIDCR) sought to conduct a study to determine whether treating periodontal disease during pregnancy would improve birth outcomes. That meant rounding up 816 pregnant women at four nationwide locations: Jackson, Miss.; Lexington, Ky.; New York; and Minneapolis. Each participant had periodontal disease, and half received scaling and root planing (nonsurgical work to remove plaque) and monthly oral hygiene instruction during the second trimester, while the other half had only oral exams during their appointments.
Bryan Michalowicz, associate professor of periodontology at the U’s dental school, says the collaboration between dental professionals and obstetrics made the experience better for the participants. “We paired up health professionals that typically don’t work together in terms of patient care and research, and part of the success of the study was the fact that we were able to establish dental operations right in obstetric wards,” says Michalowicz. “None of the women had to go to a separate clinic or leave the wards to participate.”
After following all of the women through the birth of their babies, the study published its results in the New England Journal of Medicine last fall: in the end, while nonsurgical periodontal treatment didn’t improve birth outcomes, it also caused no negative effects on the infants. Michalowicz points out that it’s too soon to interpret the results as a sweeping endorsement of periodontal treatment during pregnancy. “No single study can definitively conclude some finding or result and instantly change public policy in terms of recommending women get treated,” he says. “There are two other large multi-center trials under way, so the cautious approach would be to see how those pan out and what results they get.”
In the meantime what should expectant mothers do? Michalowicz advises women to maintain optimal oral health and not to avoid seeking dental care when necessary. “Our study went a long way to show in an evidence-based way that nonsurgical periodontal procedures in the second trimester are indeed safe,” says Michalowicz, who monitored women for fetal anomalies and adverse events during pregnancy. That said, Michalowicz does not recommend extensive dental work in the first trimester beyond a routine cleaning.
Women can also stay tuned for more information on the effects of a mother’s periodontal treatment on her child because the NIDCR has provided Michalowicz and his co-researchers with a supplemental grant to continue monitoring the neurological development of the children born to the mothers in the original study. The grant will allow Michalowicz and a group of child-development experts to assess things like motor development in the children through November 2008.
Monica Wright is Minnesota Parent’s assistant editor.
