Skip to main content

Advertisement

SpringerLink
Log in

Association between high risk for preterm birth and changes in gingiva parameters during pregnancy—a prospective cohort study

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The objective of this study was to investigate clinical and microbiological gingival changes during pregnancy in women without periodontal disease. Additionally, these parameters were to be compared in women with high risk for preterm birth and women with a normal course of pregnancy.

Method and materials

Group I consisted of 40 subjects at high risk for preterm birth, while group II involved 49 subjects with a normal course of pregnancy. The control group (III) was made up of 50 non-pregnant women. Clinical parameters (plaque index, gingival index, probing pocket depths, gingival swelling, bleeding on probing) and microbiological changes were monitored during pregnancy and 2–4 weeks after parturition.

Results

In the high-risk preterm group (I), 19 women could be included in data analysis. This group was compared to 41 women in the normal pregnancy group (II) and 50 non-pregnant women (III). Gingival inflammation was significantly higher in women with high risk for preterm birth (I) compared to non-risk pregnant women (II, p < 0.05). In addition, in this group (I), the subgingival amounts of Fusobacterium nucleatum (> 105) were found to be significantly higher after childbirth compared to non-pregnant women (p < 0.05).

Conclusions

Even without having periodontal disease, women with high risk for preterm birth showed worse clinical values compared to non-risk pregnant and non-pregnant women and an increased detection of Fusobacterium nucleatum after delivery.

Clinical relevance

High risk for preterm birth might be associated with the occurrence of increased gingival inflammation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S (2010 Dec) 3.6 million neonatal deaths—what is progressing and what is not? Semin Perinatol 34(6):371–386

    Article  PubMed  Google Scholar 

  2. Sanz M, Kornman K (2013) Working group 3 of the joint EFP/AAP workshop. Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 84(4 Suppl):S164–S169

    PubMed  Google Scholar 

  3. Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S (2006 Feb) Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG Int J Obstet Gynaecol 113(2):135–143

    Article  Google Scholar 

  4. Madianos PN, Bobetsis YA, Offenbacher S (2013) Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Periodontol 84(4 Suppl):S170–S180

    PubMed  Google Scholar 

  5. Laine MA (2002) Effect of pregnancy on periodontal and dental health. Acta Odontol Scand 60(5):257–264

    Article  PubMed  Google Scholar 

  6. Amar S, Chung KM (1994) Influence of hormonal variation on the periodontium in women. Periodontol 2000 6:79–87

    Article  PubMed  Google Scholar 

  7. Carrillo-de-Albornoz A, Figuero E, Herrera D, Bascones-Martínez A (2010) Gingival changes during pregnancy: II. Influence of hormonal variations on the subgingival biofilm. J Clin Periodontol 37(3):230–240

    Article  PubMed  Google Scholar 

  8. Lin D, Moss K, Beck JD, Hefti A, Offenbacher S (2007) Persistently high levels of periodontal pathogens associated with preterm pregnancy outcome. J Periodontol 78(5):833–841

    Article  PubMed  Google Scholar 

  9. Contreras A, Herrera JA, Soto JE, Arce RM, Jaramillo A, Botero JE (2006) Periodontitis is associated with preeclampsia in pregnant women. J Periodontol 77(2):182–188

    Article  PubMed  Google Scholar 

  10. Skuldbøl T, Johansen KH, Dahlén G, Stoltze K, Holmstrup P (2006) Is pre-term labour associated with periodontitis in a Danish maternity ward? J Clin Periodontol 33(3):177–183

    Article  PubMed  Google Scholar 

  11. Dörtbudak O, Eberhardt R, Ulm M, Persson GR (2005) Periodontitis, a marker of risk in pregnancy for preterm birth. J Clin Periodontol 32(1):45–52

    Article  PubMed  Google Scholar 

  12. Noack B, Klingenberg J, Weigelt J, Hoffmann T (2005) Periodontal status and preterm low birth weight: a case control study. J Periodontal Res 40(4):339–345

    Article  PubMed  Google Scholar 

  13. Martínez-Martínez RE, Moreno-Castillo DF, Loyola-Rodríguez JP, Sánchez-Medrano AG, Miguel-Hernández JHS, Olvera-Delgado JH et al (2016) Association between periodontitis, periodontopathogens and preterm birth: is it real? Arch Gynecol Obstet 294(1):47–54

    Article  PubMed  Google Scholar 

  14. Radnai M, Pál A, Novák T, Urbán E, Eller J, Gorzó I (2009) Benefits of periodontal therapy when preterm birth threatens. J Dent Res 88(3):280–284

    Article  PubMed  Google Scholar 

  15. Chambrone L, Guglielmetti MR, Pannuti CM, Chambrone LA (2011) Evidence grade associating periodontitis to preterm birth and/or low birth weight: I. A systematic review of prospective cohort studies. J Clin Periodontol 38(9):795–808

    Article  PubMed  Google Scholar 

  16. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg Lond Engl 12(12):1495–1499

    Article  Google Scholar 

  17. Grossi SG, Dunford RG, Ho A, Koch G, Machtei EE, Genco RJ (1996) Sources of error for periodontal probing measurements. J Periodontal Res 31(5):330–336

    Article  PubMed  Google Scholar 

  18. Tonetti MS, Claffey N (2005) European Workshop in Periodontology group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th European Workshop in Periodontology. J Clin Periodontol 32(Suppl 6):210–213

    Article  PubMed  Google Scholar 

  19. Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551

    Article  PubMed  Google Scholar 

  20. Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135

    Article  PubMed  Google Scholar 

  21. Cosyn J, De Bruyn H, Sabzevar MM (2007) Subgingival application of chlorhexidine in the treatment of periodontitis. Rev Belge Médecine Dent 62(4):176–182

    Google Scholar 

  22. Weatherspoon DJ, Borrell LN, Johnson CW, Mujahid MS, Neighbors HW, Adar SD (2016) Racial and ethnic differences in self-reported periodontal disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Oral Health Prev Dent 14(3):249–257

    PubMed  PubMed Central  Google Scholar 

  23. Kim JK, Baker LA, Seirawan H, Crimmins EM (2012) Prevalence of oral health problems in U.S. adults, NHANES 1999-2004: exploring differences by age, education, and race/ethnicity. Spec Care Dent Off Publ Am Assoc Hosp Dent Acad Dent Handicap Am Soc Geriatr Dent 32(6):234–241

    Google Scholar 

  24. Fox CH (1992) New considerations in the prevalence of periodontal disease. Curr Opin Dent 2:5–11

    PubMed  Google Scholar 

  25. Borrell LN, Lynch J, Neighbors H, Burt BA, Gillespie BW (2002) Is there homogeneity in periodontal health between African Americans and Mexican Americans? Ethn Dis 12(1):97–110

    PubMed  Google Scholar 

  26. Needleman I, Hyun-Ryu J, Brealey D, Sachdev M, Moskal-Fitzpatrick D, Bercades G et al (2012) The impact of hospitalization on dental plaque accumulation: an observational study. J Clin Periodontol 39(11):1011–1016

    Article  PubMed  Google Scholar 

  27. Lindhe J, Brånemark PI, Lundskog J (1967) Changes in vascular proliferation after local application of sex hormones. J Periodontal Res 2(4):266–272

    Article  PubMed  Google Scholar 

  28. Mariotti A (1994) Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med Off Publ Am Assoc Oral Biol 5(1):27–53

    Article  Google Scholar 

  29. Lindhe J, Brånemark PI (1967) Changes in vascular permeability after local application of sex hormones. J Periodontal Res 2(4):259–265

    Article  PubMed  Google Scholar 

  30. Dahan M, Timmerman MF, Van Winkelhoff AJ, Van der Velden U (2004) The effect of periodontal treatment on the salivary bacterial load and early plaque formation. J Clin Periodontol 31(11):972–977

    Article  PubMed  Google Scholar 

  31. Seth S, Lewis AJ, Galbally M (2016) Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth 16(1):124

    Article  PubMed  PubMed Central  Google Scholar 

  32. Socransky SS, Haffajee AD (1992) The bacterial etiology of destructive periodontal disease: current concepts. J Periodontol 63(4 Suppl):322–331

    Article  Google Scholar 

  33. Watts DH, Krohn MA, Hillier SL, Eschenbach DA (1992) The association of occult amniotic fluid infection with gestational age and neonatal outcome among women in preterm labor. Obstet Gynecol 79(3):351–357

    Article  PubMed  Google Scholar 

  34. Chaim W, Mazor M (1992) Intraamniotic infection with fusobacteria. Arch Gynecol Obstet 251(1):1–7

    Article  PubMed  Google Scholar 

  35. Blanc V, O’Valle F, Pozo E, Puertas A, León R, Mesa F (2015) Oral bacteria in placental tissues: increased molecular detection in pregnant periodontitis patients. Oral Dis 21(7):905–912

    Article  PubMed  Google Scholar 

  36. Aagaard K, Ma J, Antony KM, Ganu R, Petrosino J, Versalovic J (2014) The placenta harbors a unique microbiome. Sci Transl Med 6(237):237ra65

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jeffcoat MK, Jeffcoat RL, Tanna N, Parry SH (2014) Association of a common genetic factor, PTGER3, with outcome of periodontal therapy and preterm birth. J Periodontol 85(3):446–454

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors like to thank Markus Kaiser, Barbara Dannenhauer, Dr. Julia Blank, Dr. Susanne Proksch, and Prof. Nadine Schlüter for supporting the practical realization and publication of this study.

Funding

The study was mainly based on institutional funding, financially supported by the German Society for Dental and Oral Medicine (DGZMK) and supported with products from Glaxo Smith Kline, Braun Oral B©, and Hain Life Science©.

Author information

Authors and Affiliations

  1. Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Freiburg Medical Center, Freiburg, Germany

    Anne Brigitte Kruse, Johan P. Woelber, Ali Al-Ahmad & Petra Ratka-Krueger

  2. Private Dental Practice, Dres. Kuerschner & Kuerschner, Friedrichshafen, Germany

    Anja C. Kuerschner

  3. Department for Obstetrics and Gynaecology, Division of Perinatology, University Freiburg Medical Center, Freiburg, Germany

    Mirjam Kunze

  4. Institute of Medical Microbiology and Hospital Hygiene, University Freiburg Medical Center, Freiburg, Germany

    Annette Wittmer

  5. Department of Medical Biometry and Medical Informatics, University Freiburg Medical Center, Freiburg, Germany

    Kirstin Vach

Authors
  1. Anne Brigitte Kruse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anja C. Kuerschner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mirjam Kunze
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johan P. Woelber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Al-Ahmad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Annette Wittmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kirstin Vach
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Petra Ratka-Krueger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ACK and PRK developed the research question; ABK, ACK, MK, JPW, AA, KV, and PRK developed the study protocol; ACK, ABK, and JPW conducted the clinical examinations; AA and AW conducted the microbiological analysis; KV conducted the statistical analysis; ABK drafted the primary version of the paper; and ACK, PRK, MK, JPW, AA, and AW finalized the paper and approved the final version.

Corresponding author

Correspondence to Anne Brigitte Kruse.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Availability of data and materials

The dataset supporting the conclusions of this article is included within the article and its additional files.

Electronic supplementary material

ESM 1

(DOC 40 kb)

ESM 2

(DOC 83 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kruse, A.B., Kuerschner, A.C., Kunze, M. et al. Association between high risk for preterm birth and changes in gingiva parameters during pregnancy—a prospective cohort study. Clin Oral Invest 22, 1263–1271 (2018). https://doi.org/10.1007/s00784-017-2209-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-017-2209-9

Keywords

Search

Navigation