By Dr. Robert A. Levine
Jewish Exponent
Premature births have many causes: systemic infection, cigarette smoking, alcohol, drugs, hypertension, diabetes and malnutrition. But a new culprit has been added to that list: gum disease.
According to a recent report in The Journal of Periodontology, periodontal problems may be the cause of many premature births that were previously unexplained.
Does that seem hard to believe? For many, the idea that something as seemingly innocuous - or, at least, physically far-removed - as gingivitis can harm a fetus seems far-fetched. We don't generally associate gum disease with pregnancy - even though traditional folk advice warns against having dental work done while pregnant.
Unfortunately, that's not very good advice. In fact, it's bad advice. Pregnancy makes dental care all the more imperative. A fairly common phenomenon known as pregnancy gingivitis occurs with the advent of pregnancy.
In the study published in The Journal of Periodontology, a team of periodontists and obstetrician/gynecologists interviewed women in the high-risk obstetric clinic at the University of North Carolina Hospital in Chapel Hill.
The researchers examined 124 of these women for gum disease after they had delivered their babies. They performed these periodontal exams within three days of childbirth and with no knowledge of which women had given birth to a full-term infant and which had delivered prematurely.
Once all other risk factors had been taken into account, the researchers found that women with gum disease are seven times more likely to deliver low-birth weight infants than women without periodontal problems.
Dr. Steven Offenbacher and his colleagues at Chapel Hill estimated that 18 percent of the 250,000 premature infants delivered annually - babies born during or before week 36 and weighing less than 5 1/2 pounds - may be directly linked to untreated gum disease during pregnancy.
What this means is that, each year, an estimated 46,000 infants - an astonishing number - are born prematurely because of gum disease in the mother. Gingivitis may also be "the infection of unknown origin" that specialists say accounts for a large number of unexplained preterm births.
How can gum disease have a deleterious effect on the fetus? What we know is that systemic infections - specifically genito-urinary tract infections - create a fetal environment that doubles the risk of preterm delivery.
This is because systemic infections, including periodontal infection, cause an increase in two molecules in the body that can bring on early labor - prostaglandin and tumor-necrosing factor alpha. It appears that periodontal disease serves as a chronic reservoir for bacteria and bacteria products that can target the placental membranes via the bloodstream.
Entering the placenta, these bacteria can actually induce labor. For example, intra-amniotic levels of prostaglandin and tumor-necrosing factor alpha rise steadily throughout pregnancy until a critical threshold level is reached to induce labor, cervical dilation and delivery
Childbirth Mediators
Since these molecules are normal physiological mediators of childbirth is not surprising that genito-urinary tract infections, which results in excessive secretion of these mediators, result in preterm delivery and low-birth weight.
Over the last four decades, advances in medical technology have resulted in a significant decrease in infant-mortality rates. At the same time, there has been only a minimal decline in the number of preterm, low-birth-weight babies born in this country. And, according to the National Center for Health Statistics, neonatal hospital costs account for $5 billion expenditure each year.
There are other costs, as well. Preterm deliveries can result in infants with cerebral palsy, epilepsy, lung problems and learning disabilities - all which tax families emotionally, psychologically and financially and have profound long-term consequences for society as a whole. The sad fact is that many of these tragic outcomes could have been avoided.
To avoid such an outcome, women should have a careful periodontal evaluation and have any clinical problems treated before becoming pregnant, if possible. Pregnant women should have periodontal problems treated prior to delivery.
Brush and floss regularly, and don't trivialize bleeding gums. Get a periodontal exam. Remember that the mouth is indeed connected to the rest of the body. And make sure your physician and obstetrician/gynecologist understand the strong likelihood that gum disease can result in premature delivery and babies who are less healthy than they might have been.
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