Periodontal therapy for pregnant women and cases of low birthweight: an intervention study.

BACKGROUND: Over the past decade, strong evidence for an association between maternal periodontitis and low birthweight has started to appear. However, few intervention studies have been proposed for investigating this hypothesis. The aim of this study was to evaluate whether periodontal therapy among pregnant women would reduce the incidence of low birthweight. METHODS: A nonrandomized intervention study was performed, with two control groups. The sample comprised 339 pregnant women: 141 in the experimental group (treated for periodontitis), 145 in control group 1 (without periodontitis) and 53 in control group 2 (with untreated periodontitis). The experimental group received periodontal treatment throughout pregnancy, whereas control group 1 was only monitored over the same period. After delivery, birthweight information on the newborns was obtained. The analysis procedures consisted of stratified analysis followed by logistic regression. RESULTS: The frequency of low birthweight among the women with treated periodontitis was 9.22%, while it was 13.10% in the group without periodontal disease. However, the difference was not statistically significant (RR 0.72; 95% CI 0.36-1.45). The occurrence of this outcome in the group with untreated periodontitis (24.53%) was greater than in the other two groups. CONCLUSION: This suggests that periodontal therapy is a protective factor for birthweight.

Periodontitis and nosocomial lower respiratory tract infection: preliminary findings.

AIM: To evaluate the possible association between periodontitis and nosocomial lower respiratory tract infection (LRTI). MATERIAL AND METHODS: A case-control study was conducted at a General Hospital in Feira de Santana, Bahia, Brazil. The sample consisted of 103 individuals: 22 cases (presence of nosocomial LRTI) and 81 controls (absence of nosocomial LRTI). The diagnosis of periodontitis was based on probing depth, gingival recession, clinical attachment loss and bleeding on probing. The diagnosis of nosocomial LRTI was made in accordance with established medical criteria. RESULTS: Invasive ventilation was much more frequent in cases (95.5%) than in controls (7.4%). An orotracheal tube was used in 81.8% of cases and in 7.4% of controls; bronchoaspiration was suspected in 81.8% of cases and in 6.2% of controls. There was no statistically significant difference in any of the clinical periodontal parameters between cases and controls. The crude odds ratio (OR) value for individuals with periodontitis having LRTI was not statistically significant [OR(crude)=1.70; 95% confidence interval:(0.60-4.87)]. After including age, smoking and duration of hospitalization in the logistic regression, the adjusted OR for individuals with periodontitis having LRTI was statistically significant [OR(adjusted)=3.67 (1.01-13.53); p=0.049]. CONCLUSIONS: A marginal association between periodontitis and LRTI was found when smoking, age and length of hospitalization were included as covariates. Patients with LRTI had a high frequency of suspected bronchoaspiration and this could explain the possible association of periodontal disease and LRTI found in this and other studies. Additional studies are needed to further clarify the possible relationship between periodontal disease and LRTI.

The association between postmenopausal osteoporosis and periodontal disease.

BACKGROUND: The clinical importance of systemic bone loss as a contributory factor to alveolar bone loss and the subsequent loss of teeth merits further study, given that osteoporosis and periodontal disease lead to significantly increased morbidity and mortality and higher public expenditure of funds. This case-control study evaluated the association between osteoporosis and periodontal disease. METHODS: The sample consisted of 139 postmenopausal women: 48 in the case group (with periodontal disease) and 91 in the control group (without periodontal disease). The diagnosis of periodontal disease was established following a complete clinical examination using measurements of probing depth, gingival recession and hyperplasia, clinical attachment loss, and bleeding index, and confirmed by panoramic radiography. The diagnosis of osteoporosis was made by reviewing densitometry reports obtained previously. Descriptive, stratified, and logistic regression analyses were applied to the data collected. Comparison of proportions was performed using the chi(2) and Fisher tests. Association measurements (odds ratios [ORs]) with and without adjustment for confounding factors and control for effect modifiers were obtained at a significance level of 5%. RESULTS: The OR(unadjusted) for the principal association was 2.58 (95% confidence interval [CI]: 1.01 to 6.82). In subgroup analyses of the stratified model, the OR(unadjusted) for low education was 6.40 (95% CI: 1.77 to 23.18). When adjusted for smoking habit and age, the OR(adjusted) was 7.05 (95% CI: 1.90 to 26.19), which also was statistically significant. CONCLUSION: Postmenopausal women with osteoporosis and low educational levels have a greater chance of having periodontal disease than do those without osteoporosis.

Exposure measurement in the association between periodontal disease and prematurity/low birth weight.

AIM: To compare the use of different definitions for exposure measurement in cases of association between periodontal disease (PD) and prematurity and/or low birth weight (PLBW). MATERIAL AND METHODS: A database from a previous case-control study was used to compare four different definitions for periodontitis: at least one site with probing depth > or =4 mm (1); at least one site with clinical attachment loss (CAL)> or =3 mm (2); at least four teeth with one or more sites presenting probing depth > or =4 mm, with CAL> or =3 mm at the same site (3); and at least four teeth with one or more sites with probing depth > or =4 mm, with CAL> or =3 mm at the same site and presence of bleeding on probing (4). The PD frequency, diagnostic values and adjusted association measurements were calculated. RESULTS: PD frequency ranged from 33.1% to 94.7%. Odds ratio(adjusted) varied slightly according to the exposure measurement used. CONCLUSIONS: The association between PD and PLBW weight was consistent, except for exposure measurement 1, i.e. using at least one site with CAL> or =3 mm for periodontitis diagnosis, while the magnitude of this varied according to the definition established.