Pre-term, Low Weight Babies
Pre-term delivery (births occurring prior to 37 weeks gestation) and low birth weight are among the adverse pregnancy outcomes that represent a significant public health concern. According to the March of Dimes, 1 in every 13 babies born in the United States is born with low birth weight. Since birth weight is one of the most important factors in the growth, development and survival of an infant, this rate is substantial. Low birth weight is defined as less than 5 pounds, 8 ounces at birth. Modern day science and medicine has increased the survival rate of these babies significantly. However, adverse pregnancy outcomes are the leading cause of neonatal death, long-term neurodevelopmental disturbances and other serious complications.
Could the health of a mother’s mouth affect the outcome of her pregnancy?
The cause of pre-term, low birth weight babies (PTLBW) is not truly known. Scientific evidence identifies many associated risk factors, which include a multiples pregnancy, uterus or cervix abnormalities, mother’s chronic health issues, smoking while pregnant, drugs and alcohol, insufficient prenatal care, low socioeconomic factors, maternal age (under 18 or over 35), and maternal or fetal infection (including the systemic inflammation resulting from infection).
Gum disease (periodontitis) is a chronic infection of the gums surrounding the teeth, which in recent years is being linked with contributing to systemic infection. The association between gum disease and pre-term, low weight babies has been observed for many years. Although the exact association is still being reviewed by researchers around the world, there seems to be an agreement that good oral health is increasingly important to women of child bearing age.
Some scientific research suggests that the bacteria around teeth that are affected by periodontal (gum) disease produce toxins which enter the blood stream, cross the placenta, and interfere with growth and development of the developing fetus. While this is happening, other substances are being produced which may enhance the trigger mechanism for early delivery of the fetus. Yet other studies indicate that it is the body’s immune system, which responds to the circulating chronic oral bacteria and its endotoxin by-products with systemic inflammation that contributes to pre-term, low weight babies. Based on these theories, periodontal disease (particularly in the advanced stage) may be an independent risk factor to PTLBW outcomes.
Will treating Periodontal Disease During Pregnancy Decrease the Incidence of Adverse Pregnancy Outcome?
At this time, there are some research conclusions that demonstrate a significant reduction in the rate of PTLBW, as well as those that show no improvement in the risk outcome. There is, however, a biological plausibility that untreated periodontal disease may increase the risk of PTLBW babies. Several larger studies are currently in progress to further examine this possibility.
Oral Health Recommendations
Maintaining good oral hygiene, both at home and with a professional, in conjunction with annual periodontal probing visits with a dental professional, is the best proactive approach.
For women who are experiencing loose or shifting teeth, have a family history of periodontal disease, who have chronic bad breath or bleeding gums, a comprehensive Periodontal Risk Evaluation is recommended. This exam should be performed by a periodontist or dentist trained in the diagnosis and treatment of periodontal disease. This examination should include the review of current, full mouth x-rays (if pregnant, check with your obstetrician prior to x-rays) to determine the degree of possible periodontal bone loss.
Many factors can contribute to PTB. Gum disease is one factor easily eliminated as a cause of PTB. Therefore, it should be monitored closely, and treated immediately if detected prior to becoming pregnant and during pregnancy. During pregnancy, treatment of periodontal disease, usually in the 2nd trimester, can be provided safely to improve the oral health of the mother.