MEDICINE
Year : 2010  |  Volume : 1  |  Issue : 1  |  Page : 40-42 Table of Contents     

Periodontitis: A risk for delivery of premature labor and low-birth-weight infants


1 Department of Periodontology, Rural Dental College, Loni; Pravara Institute of Medical Sciences, Loni, Ahmed Nagar, Maharashtra, India
2 Department of Microbiology, Rural Dental College, Loni; Pravara Institute of Medical Sciences, Loni, Ahmed Nagar, Maharashtra, India
3 Department of Prosthodontics, Rural Dental College, Loni; Pravara Institute of Medical Sciences, Loni, Ahmed Nagar, Maharashtra, India

Date of Web Publication23-Oct-2010

Correspondence Address:
Rajiv Saini
Department of Periodontology, Rural Dental College- Loni, Ahmednagar, Maharashtra
India
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DOI: 10.4103/0976-9668.71672

PMID: 22096335

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   Abstract 

Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth and is caused by specific microorganisms or group of specific microorganisms. The association of periodontal infection with organ systems like cardiovascular system, endocrine system, reproductive system, and respiratory system makes periodontal infection a complex multiphase disease. Inflamed periodontal tissues produce significant amounts of proinflammatory cytokines, mainly interleukin 1-beta (IL-1β), IL-6, prostaglandin E2, and tumor necrosis factor-alpha (TNF-α), which may have systemic effects on the host. Low birth weight, defined as birth weight less than 2,500 g, continues to be a significant public health issue in both developed and developing countries. Research suggests that the bacteria that cause inflammation in the gums can actually get into the bloodstream and target the fetus, potentially leading to premature labor and low-birth-weight (PLBW) babies. One reasonable mechanism begins with deleterious effects of endotoxins released from Gram-negative bacteria responsible for periodontal disease. Hence periodontal disease appears to be an independent risk factor for PLBW and there is a need to expand preventive measures for pregnant women in harmonization with the gynecological and dental professions.

Keywords: Cytokines, dental, periodontitis, premature labor and low-birth-weight


How to cite this article:
Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sc Biol Med 2010;1:40-2

How to cite this URL:
Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sc Biol Med [serial online] 2010 [cited 2014 Sep 22];1:40-2. Available from: http://www.jnsbm.org/text.asp?2010/1/1/40/71672


   Introduction Top


Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth and is caused by specific microorganisms or group of specific microorganisms [Table 1] resulting in a progressive destruction of the periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession, or both. [1],[2] Periodontal diseases are recognized as infectious processes that require bacterial presence and a host response and are further affected and modified by other local, environmental, and genetic factors. The association of periodontal infection with organ systems like cardiovascular system, endocrine system, reproductive system, and respiratory system makes periodontal infection a complex multiphase disease. Bacteria are the primary etiological agents in periodontal disease, and it is estimated that more than 500 different bacterial species are capable of colonizing the adult mouth. [3] Inflamed periodontal tissues produce significant amounts of proinflammatory cytokines, mainly interleukin 1-beta (IL-1β), IL-6, prostaglandin E2, and tumor necrosis factor-alpha (TNF-α), which may have systemic effects on the host. Periodontitis initiates systemic inflammation and can be monitored by inflammatory markers like C-reactive protein or fibrinogen levels.
Table 1: Microorganisms commonly associated with periodontitis

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   Pharmacology of Proinflammatory Cytokines Associated with Periodontitis Top


The continuous production of cytokines in inflamed periodontal tissues is responsible for the progress of periodontitis and periodontal tissue destruction. Particularly, inflammatory cytokines, such as IL-lα, IL-1β, IL-6, and IL-8, are present in the diseased periodontal tissues, and their unrestricted production seems to play a role in chronic leukocyte recruitment and tissue destruction. Acute periodontal disease primarily involves a local innate immune response to the microflora of the oral biofilm. Gingival epithelial cells recognize bacterial cell components via toll-like receptors and respond by producing IL-1 and TNF-α. Bacteria and bacterial products also penetrate into the underlying tissues. There they interact with fibroblasts and dendrite cells. These cells also produce proinflammatory cytokines. Additional immune signals are generated by alternative complement activation. These bacterial products and proinflammatory cytokines affect vascular endothelial cells as well. Endothelial cells express cellular adhesion molecules (ICAM and VCAM) that recruit circulating immune cells. Vascular permeability is also increased - allowing the influx of phagocyte cells and serum into the gingival tissue. Neutrophils and macrophages are attracted to the site of infection by chemotaxis following gradients of complement proteins, cytokines, and bacterial products. Activated macrophages produce IL-12 and interferon-gamma (IFN-g). Overall, these processes result in gingival inflammation, and are responsible for the clinical manifestations of gingivitis further leading to periodontitis. It is possible that monitoring cytokine production or its profile may allow us to diagnose an individual's periodontal disease status and/or susceptibility to the disease.


   Premature and Low-Birth-Weight Infants Top


Low birth weight, defined as birth weight less than 2,500 g, continues to be a significant public health issue in both developed and developing countries. [4] Preterm delivery, or PTD, is the major cause of neonatal mortality and of nearly one-half of all serious long-term neurological morbidity. [5] Premature and low-birth-weight (PLBW) infants are still 40 times more likely to die during the neonatal period. PLBW infants who survive the neonatal period face a higher risk of several neurodevelopment disturbances, health problems (such as asthma, upper and lower respiratory infections, and ear infections), and congenital anomalies. [4] Some risk factors that have been associated with a PLBW include a high (>34 years) and low (<17 years) maternal age, a low socioeconomic status, inadequate prenatal care, drug abuse, alcohol and tobacco use, hypertension, diabetes, and multiple pregnancies. Despite increasing efforts to diminish the effects of these risk factors through preventive interventions during prenatal care, there has been an only a small decrease in the number of PLBW infants. There is a reason to believe that other unrecognized risk factors may contribute to the continuing prevalence of PLBW infants. One possible contributing factor to this phenomenon is the effect of an infection on PLBW. It is possible that subclinical genitourinary and periodontal infections can adversely affect the pregnancy outcomes. Women with preterm labor do not invariably present with positive amniotic fluid culture, suggesting that subclinical infections, resulting in the translocation of bacteria, bacterial metabolites, and lipopolysaccharide (LPS), may account for some of the inflammatory processes associated with PLBW.


   Periodontal Infection in Premature and Low-Birth-Weight Top


The concept that periodontal disease might influence systemic health is not new. Miller originally published his focal infection theory in 1891 [6] suggesting that microorganisms or their waste products obtain entrance to parts of the body adjacent to or remote from the mouth. Infection is now considered one of the major causes of PLBW deliveries, responsible for somewhere between 30% and 50% of all cases, and periodontitis and periodontal diseases are true infections of the oral cavity. [1] The oral cavity works as a continuous source of infectious agents, and its condition often reflects progression of systemic pathologies. Periodontal infection happens to serve as a bacterial reservoir that may exacerbate systemic diseases. Research suggests that the bacteria that cause inflammation in the gums can actually get into the bloodstream and target the fetus, potentially leading to PLBW babies. One possible mechanism begins with endotoxins resulting from Gram-negative bacterial infections (such as periodontal disease). These endotoxins stimulate the production of cytokines and prostaglandins (IL-1b, IL-6, and TNF-α) and in appropriate quantities stimulate labor,[5] and proinflammatory mediators may cross the placenta barrier and cause fetal toxicity resulting in preterm delivery and low-birth-weight babies. [7] High concentrations of these cytokines, in pregnant women, are responsible for rupture of the uterine membranes causing premature birth and retardation. As periodontal medicine is still in its infancy here in Asia, there is a compelling need to determine the possible association between adverse pregnancy outcomes and periodontal infections. It has been well documented that periodontal disease is a treatable and preventable condition. In the event of a positive association of periodontal infection with PLBW, this would have potential applications in preventive oral health programs as an integral component of prenatal care for pregnant mothers. Indeed, as healthcare professionals working as a team, an understanding of the role of periodontal and systemic relationship and its implications will further enhance the quality of medical and dental care being provided to our patients in the community. [7] Several animal and clinical studies clearly indicate an association between periodontal infection and adverse pregnancy outcomes. Although no definitive causal relationship has been established, and other explanations for the correlation might be offered, a model can nevertheless be envisaged wherein chronic periodontal infection could mediate this systemic effect through one or more of the following mechanisms: [4]

  • Translocation of periodontal pathogens to the fetoplacental unit
  • Action of a periodontal reservoir of LPS on the fetoplacental unit
  • Action of a periodontal reservoir of inflammatory mediators (IL-1, IL-6, TNF-α, PGE2) on the fetoplacental unit.

   Recommended Oral Hygiene Practices and Visits to Dentist During Pregnancy Top


Oral health guidelines for pregnant women were accomplished to assist them in maintaining healthy teeth and gums during their pregnancy and into the early stages of motherhood. The American Academy of Pediatric Dentistry (AAP) announced new oral health guidelines for pregnant women in 2009, modified and illustrated in [Table 2].
Table 2: Oral health guidelines

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   Summary Top


Thus it can be concluded that periodontal disease appears to be an independent risk factor for PLBW and there is a need to expand preventive measures for pregnant women in harmonization with the gynecological and dental professions, and to provide professional oral hygiene measurements during pregnancy.

 
   References Top

1.Saini R, Marawar PP, Shete S, Saini S. Periodontitis a true infection. J Glob Infect Dis 2009;1:149-51.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.D'Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS. Periodontitis and atherogenesis: Causal association or simple coincidence. J Clin Periodontol 2004;31:402-11.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Moore WE, Moore LV. The bacteria of periodontal disease. Periodontol 2000 1994;5:66-77.  Back to cited text no. 3      
4.McGaw T. Periodontal diseases and pre-term delivery of low birth weight infants. J Can Dent Assoc 2002;68:165-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-80.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Miller WD. The human mouth as a focus of infection. Dent Cosmos 1891;33:689-713.  Back to cited text no. 6      
7.Yeo BK, Lim LP, Paquette DW, Williams RC. Periodontal disease - the emergence of a risk for systemic conditions: Pre-term low birth weight. Ann Acad Med Singapore 2005;34:111-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  



 
 
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  [Table 1], [Table 2]



 

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