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Oral Health and Adverse Pregnancy Outcomes

Written By

Sukumaran Anil, Raed M. Alrowis, Elna P. Chalisserry, Vemina P. Chalissery, Hani S. AlMoharib and Asala F. Al-Sulaimani

Published: 11 March 2015

DOI: 10.5772/59517

From the Edited Volume

Emerging Trends in Oral Health Sciences and Dentistry

Edited by Mandeep Singh Virdi

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1. Introduction

Maternal health has long been recognized as an important determinant in reducing the risk for pregnancy-related complications such as preterm birth and preeclampsia. Preterm (PTB) delivery and low birth weight (LBW) are considered to be the most relevant biological determinants of newborn infant survival in both developed and developing countries. The oral changes that can occur in pregnancy have been a focus of interest for many years. Physiological changes that occur in pregnant women can adversely affect oral health. Elevations in estrogen and progesterone enhance the inflammatory response and consequently alter the gingival tissue (Mascarenhas et al., 2003). During pregnancy, the incidences of gingivitis and periodontitis are increased, and many pregnant women suffer from bleeding and spongy gums.

Periodontal disease, a persistent bacterial infection, leads to a chronic and systemic challenge with bacterial substances and host-derived inflammatory mediators that are capable of initiating and promoting systemic diseases (Williams et al., 2000; Gibbs, 2001). The mechanisms underlying this destructive process involve both direct tissue damage resulting from bacterial products and indirect damage through bacterial induction of the host inflammatory and immune responses. Even though controversy exists regarding the role of oral health as an independent contributor to abnormal pregnancy outcomes, the recognition and understanding of the importance of oral health has led to significant research into the role of maternal oral health in pregnancy outcomes (Sanz et al., 2013). Adequate oral hygiene habits are mandatory to control the development of periopathogenic oral biofilms, which have been reported to be associated with poor obstetric outcomes (Lieff et al., 2004; Han, 2011).

The chapter will cover the following aspects on oral health and adverse pregnancy outcomes including a systematic analysis of the studies linking preterm delivery, low birth weight, preeclampsia and periodontal disease.

  • Association between periodontitis and pregnancy.

  • Pre term birth, low birth weight and periodontal disease.

  • Preeclampsia and periodontal disease.

  • Biological mechanism linking periodontal disease to adverse pregnancy outcome.

  • Evidence based literature analysis.

  • Observational and systematic studies.

  • Intervention studies on the impact of periodontal therapy

  • Other expected oral outcomes due to pregnancy

  • Early childhood caries.

  • Gingival enlargement.

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2. Association between periodontitis and pregnancy

Several studies have revealed the role and influence of periodontitis on adverse pregnancy outcomes. During pregnancy, the changes in hormone levels promote an inflammatory response that increases the risk of developing gingivitis and periodontitis. Even with good plaque control, 50%-70% of all women will develop gingivitis during their pregnancy, commonly referred to as pregnancy gingivitis, due to the variations in hormone levels. Pregnancy gingivitis generally manifests during the second and eighth months of pregnancy and is considered a consequence of the observed increased levels of the hormones progesterone and estrogen, which can effect small blood vessels of the gingiva, making it more permeable (Jensen et al., 1981; Barak et al., 2003).

Research suggests that the presence of maternal periodontitis has been associated with adverse pregnancy outcomes such as preterm birth (Offenbacher et al., 1996; Jeffcoat et al., 2001; Offenbacher et al., 2001), preeclampsia (Boggess et al., 2003), gestational diabetes (Xiong et al., 2006), delivery of a small-for-gestational-age infant, and fetal loss (Moore et al., 2004; Boggess et al., 2006). These increased risks suggest that periodontitis may be an independent risk factor for adverse pregnancy outcomes.

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3. Preterm, Low Birth Weight (LBW) and periodontal disease

Preterm (PTB) delivery is defined as delivery before 37 weeks of gestation. The international definition of low birth weight (LBW), adopted by the 29th World Health assembly in 1976, is a birth weight of less than 2,500 grams (WHO, 1984). The primary cause of LBW is PTB delivery or premature rupture of membranes. Preterm infants who are born with a low birth weight are termed preterm low birth weight (PLBW). PTB and LBW are considered to be the most relevant biological determinants of newborn infants survival, both in developed and in developing countries. Preterm birth is a major cause of infant mortality and morbidity and poses considerable medical and economic burdens on society (Alves and Ribeiro, 2006). The rate of preterm birth appears to be increasing worldwide, and efforts to prevent or reduce its prevalence have been largely unsuccessful. The importance of PTB and LBW deliveries comes from their capacity to predict the increased risk of mortality among infants born with this condition. Preterm births account for 75% of perinatal mortality and more than half of long-term morbidity (Goldenberg et al., 2008). Moreover, one of the targets of the World Health Organization is to reduce the number of births in which the child weighs less than 2,500 g because this is a known predictor of childhood morbidity and mortality (Cruz et al., 2005).

The primary factors causing LBW infant deliveries are high or low maternal age (>34 yrs or <17 yrs.), smoking, alcohol or drug use during pregnancy, inadequate prenatal care, race, maternal demographic characteristics, hypertension, psychological characteristics, adverse behaviors, multiple pregnancies, nutritional status, diabetes, genitourinary tract infections, uterine contractions and cervical length, and biological and genetic markers (Verkerk et al., 1993; Copper et al., 1996; Nordstrom and Cnattingius, 1996; Romero et al., 2002; Marakoglu et al., 2008).

Microbiological studies suggest that intrauterine infection might account for 25–40% of preterm births. Microorganisms can gain access to the amniotic cavity by (1) ascending from the vagina and the cervix; (2) hematogenous dissemination through the placenta; (3) accidental introduction during invasive procedures; and (4) retrograde spreading through the fallopian tubes (Goldenberg et al., 2000). It has been suggested that spontaneous preterm labor is commonly associated with bacterial vaginosis, a vaginal condition characterized by the prevalence of anaerobes (Gibbs, 2001). This has been shown to elicit an inflammatory burden that results in placental damage and distress and, hence, fetal growth restriction. In addition, the cascade of disordered cytokine response can lead to the stimulation of prostaglandin synthesis and the release of matrix metalloproteinases (MMPs), which account for the uterine contractions and membrane rupture, respectively, and lead to the induction of labor (Romero et al., 1992; Winkler et al., 1998). This suggests that distant sites of infection (oral cavity) or sepsis may target the placental membranes. The maternal susceptibility to oral infections during pregnancy increases the sensitivity of the gingiva to the pathogenic bacteria found in dental biofilms (Barak et al., 2003). Studies have reported the presence of higher levels of Porphyromonas gingivalis, Bacteroides forsythus, Actinobacillus actinomycetemcomitans and Treponema denticola, organisms normally associated with periodontal disease, in mothers of PTB and LBW babies as compared to normal controls (Offenbacher et al., 1996). Approximately 25% of PLBW deliveries occur without any of the risk factors discussed in this section, which emphasizes the limited understanding of the causes and pathophysiology of the problem (McGaw, 2002).

In 1996, researchers first reported a relationship between maternal periodontal disease and the delivery of a preterm infant. The 1996 study by Offenbacher and colleagues suggested that maternal periodontal disease could lead to a seven-fold increased risk of delivering a PLBW infant. Since then, researchers have investigated these possible associations for over a decade. It is important to understand the underlying biologic mechanisms for the relationship between periodontal disease and adverse pregnancy outcomes such as preterm birth to provide a rationale for therapeutic interventions and exploration of other methods that may be used as adjuncts to the standard treatment. These authors concluded that approximately 18% of PLBW cases might be attributable to periodontal disease (Offenbacher et al., 1996).

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4. Preeclampsia and periodontal disease

Preeclampsia is a complication recognized by gestational hypertension and proteinuria. It is one of the most significant health problems during pregnancy and affects 8% to 10% of all pregnancies (Roberts et al., 2003). Intravascular inflammation and endothelial cell dysfunction with altered placental vascular development is believed to be central to the pathogenesis of preeclampsia. To prevent fetal morbidity due to preeclampsia, preterm delivery is induced (Boggess et al., 2006). Maternal clinical periodontal disease at delivery has been associated with an increased risk for the development of preeclampsia (Canakci et al., 2007).

Boggess et al. (2003) were the first investigators to report an association between maternal clinical periodontal infection and the development of preeclampsia. In this longitudinal study, they found a two-fold increased risk for preeclampsia among women with periodontal disease during pregnancy compared with controls. A few other studies also reported an association between preeclampsia and periodontal disease (Table). Canakci et al. (2007) reported that women with preeclampsia were three times more likely to have periodontal infections than healthy women and that periodontal disease also affects the severity of preeclampsia. Barak and colleagues (2007) also found that women with preeclampsia experienced more severe periodontitis than healthy controls. They found a significant elevation in the gingival crevicular fluid levels of PGE-2, interleukin (IL)-1 P, and tumor necrosis factor alpha (TNF-a). In their study, Contreras et al. (2006) found more severe periodontal infections in pregnant women with preeclampsia with the presence of P. gingivalis, T. forsythensis, and E. corrodens than in controls.

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5. Biological mechanism linking periodontal disease to adverse pregnancy outcomes

Two potential mechanisms have been put forward to explain the underlying link between oral health and adverse pregnancy outcomes (Han, 2011). First, periodontal disease causes systemic abnormal immunological changes, leading to pregnancy complications. The elevated systemic inflammation leads to elevated C-reactive protein (CRP) levels, which increase the risk for preeclampsia. Translocation of oral bacteria into the placenta has been demonstrated in animal models of both chronic and acute infections (Lin et al., 2003b; Han et al., 2004).

Figure 1.

Possible biological mechanism linking periodontal disease and pregnancy complications.

The biological mechanisms proposed to explain the link between maternal periodontitis and PLBW involve the translocation of either inflammatory mediators such as IL-1 β, TNFα and PGE2 or periodontal bacteria and their products from the periodontal tissues to the fetal-placental unit via the systemic circulation, thereby triggering preterm labor (Hillier et al., 1988). Increased levels of interleukin-1 beta (IL-1β), IL-6, tumor necrosis factor alpha (TNF-α, beta-glucuronidase (β–glucuronidase), prostaglandin E2 (PGE2), aspartate aminotransferase (AST), and metalloproteinase-8 (MMPT-8) and decreased levels of osteoprotegerin (OPG) have been detected not only in the gingival tissues, gingival crevicular fluid (GCF), and saliva but also in the serum/plasma of patients affected by periodontal disease (Lin et al., 2003a; Offenbacher et al., 2006; Furugen et al., 2008; Trindade et al., 2008; Wright et al., 2008; Duarte et al., 2010; Buduneli and Kinane, 2011).

Cytokines such as IL-1, IL-6, and TNF-α are all potent inducers of both prostaglandin synthesis and labor, and the levels of these cytokines have been found to be elevated in the amniotic fluid of patients with amniotic fluid infections in preterm labor (Romero et al., 2006). The intra-amniotic levels of PGE2 and TNF-α rise steadily throughout pregnancy until a critical threshold is reached to induce labor, cervical dilation, and delivery (Offenbacher et al., 1996). Lipo poly sacchrides (LPS), one of the microbial components, can activate macrophages and other cells to synthesize and secrete a wide array of molecules, including the cytokines IL-16, TNF-α, and IL-6, PGE2 and matrix metalloproteinases (Darveau et al., 1997).

The second hypothesis suggests that oral bacteria directly colonize the placenta, causing a localized inflammatory response that results in prematurity and other adverse outcomes. The ratio of anaerobic gram-negative bacterial species to aerobic species increases in dental plaques during the second trimester of pregnancy (Kornman and Loesche, 1980), which may lead to increased cytokine production. If these bacteria escape into the general circulation and cross the placental barrier, they could augment the physiologic levels of PGE2 and TNF-α in the amniotic fluid and induce premature labor. Animal studies have shown that chronic maternal exposure to the periodontal pathogen P. gingivalis results in systemic dissemination, transplacental passage, and fetal exposure (Lin et al., 2003b; Boggess et al., 2005). Studies in murine models have shown that P. gingivalis infection compromises normal fetal development by systemic dissemination and direct targeting of the fetal-placental unit.

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6. Observational studies

The increasing number of case control studies investigating a link between periodontal disease and various adverse pregnancy outcomes in humans has produced conflicting findings (Table 1, 2, 3). Several studies suggest a significant association between maternal periodontal disease and pregnancy complications, including premature delivery, low birth weight and preeclampsia. Periodontal disease and progression during pregnancy appear to confer risk for preterm delivery, and the strength of the association increases at earlier gestational deliveries. However, not all studies supported this contention. Differences in the ethnicity and levels of periodontal disease in patients have been proposed as possible reasons for the conflicting findings reported in these studies. Periodontal disease is twice as prevalent among African-Americans, and this might possibly explain the observed increased risk in preterm delivery and fetal growth restriction among African-Americans (Madianos et al., 2001).Adverse pregnancy outcome and periodontal disease share a number of common risk factors, including age, ethnicity, socioeconomic status and smoking. The majority of studies investigating this association have used a dichotomous definition based on the number of teeth or sites with predefined levels of probing depth and attachment loss. Other studies have employed a range of continuous variables to reflect periodontal status, including probing depth, attachment loss and bleeding on probing. Several studies focused on the clinical measures of periodontal disease, which may not adequately reflect the infectious/ inflammatory burden present in pregnant women. The effect of periodontal disease on adverse pregnancy outcome suggests that periodontal infection as a risk factor but the evidence is insufficient to establish a cause and effect relationship.

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7. Interventional studies

Several studies have examined the effects of periodontal treatment on preterm birth and low birth weight outcomes with conflicting findings (Table.4). Studies showed that periodontal therapy provided to women with periodontitis or gingivitis during pregnancy reduced the incidence of preterm low birth weight compared to those whose treatment was delayed until after birth (Lopez et al., 2002; Jeffcoat et al., 2003; Lopez et al., 2005).

Another study reported that significantly reduced rates of preterm births and low birth weight infants were observed for pregnant women who received plaque control instructions and scaling and root planing (Tarannum and Faizuddin, 2007). A three-year retrospective examination of a large insurance company database suggested that receiving preventive dental treatment is associated with a lower incidence of adverse birth outcomes compared with instances in which no dental services are delivered (Albert et al., 2011). However, a large multi-center study that included over 800 patients reported that periodontal treatment had no effect on pregnancy outcomes, recording the occurrence of preterm birth as 12% in the treatment group and 12.8% in the control group (Michalowicz et al., 2006).

Notably, the incidence of adverse birth outcomes from the various studies was lower among women who received some dental care and more so among those who received post-delivery periodontal care or those who received prophylactic treatment compared with those who received no dental care. The beneficial effect of dental care during the gestation period among these health-conscious and care-seeking women might also represent a coincidence. Good oral hygiene practices, however, can minimize gingival disease during pregnancy (Gibbs, 2001). Therefore, it has been recommended that all women should have a dental examination and appropriate dental hygiene care at least once during their pregnancy (Lieff et al., 2004). The American Academy of Periodontology recommends that women considering pregnancy or who are pregnant undergo a periodontal examination and receive the appropriate preventive and/or therapeutic services, if indicated.

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8. Conclusions from the meta-analysis

The association between maternal periodontitis with adverse pregnancy outcomes such as low birthweight, pre-term birth and pre-eclampsia has been investigated for the past 20 years. Several systematic reviews and meta-analysis has been conducted on various aspect of the association (Table 5). However, the strength of the observed associations based on clinical parameters is modest and seems to vary according to the population studied, the method used to assess periodontal diseases (Ide and Papapanou, 2013)

Khader and Ta’ani (2005) conducted a meta-analysis of periodontal disease in relation to the risk of preterm birth/low birth weight (PTB/LBW) based on two case-control studies and three prospective cohort studies. The sample sizes in the studies ranged from 80 to 1,313 women, with an age range between 12 and 40 years old. The odds ratio in these studies ranged from 3.5 to 7.5. Pregnant women with periodontal disease had an overall adjusted odds ratio of preterm birth that was 4.28 times higher than the odds ratio for healthy subjects (95% CI: 2.62 to 6.99; P < 0.005). They concluded that periodontal disease in pregnant mothers significantly increases the risk of subsequent preterm births or low birth weights.

Based on the meta-analysis, Xiong et al. (2006) concluded that periodontal disease might be associated with an increased risk of adverse pregnancy outcomes. They analyzed 44 studies (26 case-control studies, 13 cohort studies, and five controlled trials). The authors observed that the findings from observational studies yielded inconsistent conclusions on the relationship between periodontal disease and various pregnancy outcomes. Of the 39 observational studies, 25 studies (16 case-control and nine cohort) suggested that periodontal disease was associated with an increased risk of adverse pregnancy outcomes. Several studies demonstrated a direct relationship between the intensity of the periodontal disease and the risk of adverse pregnancy outcomes.

Vergnes and Sixou (2007) too echoed the same association when they reviewed 17 observational studies (11 case/controls, four cohorts, and two cross-sectionals) resulting in preterm low birth weight with an OR = 2.83 (95% CI: 1.95-4.10, P < 0.0001) and low birth weight with OR = 4.03 (95% CI: 2.05-7.93, P < 0.0001)

Though most of the studies have focused on the pregnancy outcome and periodontitis, very few studies have addressed the effect of periodontal treatment on adverse pregnancy outcome. One such review (Michalowicz et al., 2013) analyzed the same and resulted in a lone study on 303 Brazilian women 18 to 35 years of age with a gestational age ≤20 weeks. Randomization was stratified on smoking. All women, regardless of their periodontal status, received comprehensive non-surgical treatment (test group: oral hygiene instruction, scaling and root planing, and at least monthly follow-up visits) or supragingival scaling and oral hygiene instruction (control group).Despite statistically significant and substantial improvements in clinical periodontal measures with treatment (e.g. bleeding on probing (BOP) was reduced from 50% to 11%), there were no significant differences between test and control groups in preterm birth rates at <37 weeks (11.7 versus 9.1%, respectively, p = 0.57) or at <35 weeks (5.5% versus 5.8%, p = 0.99), or in fractions of infants weighing <2500 g (5.6% versus 4.1%,p = 0.59).

In a meta-analysis of the seven randomized trials, Polyzos and colleagues (2009) summarized that overall treatment of periodontal problems substantially reduced the rate of preterm delivery. They evaluated seven randomized controlled trials (n=2,663). There was a statistically significant reduction in incidence of preterm birth (OR 0.55, 95% CI 0.35 to 0.86, p<0.05) and low birth weight (OR 0.48, 95% CI 0.23 to 1.00, p<0.05) in women who received periodontal treatment compared to those who did not. The review findings suggested that treatment of periodontal disease during pregnancy reduced the rate of preterm birth and may reduce the incidence of low birth weight in infants.

Figure 2.

Early childhood caries

Polyzos et al (2010) examined whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate in randomized controlled trials. Of the 11 trials (with 6558 women), five trials were considered to be of high methodological quality (low risk of bias), whereas the rest were low quality (high or unclear risk of bias). It is noteworthy to see that the results among low and high quality trials were consistently diverse; low quality trials supported a beneficial effect of treatment, and high quality trials provided clear evidence that no such effect exists (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15).

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9. Maternal oral health and early childhood caries

Early childhood caries (ECC) is an infectious disease that can present as soon as an infant’s teeth erupt. ECC can progress rapidly and may have a lasting detrimental impact on the health and well-being of the child. Mothers with poor oral health and high levels of cariogenic oral bacteria are at greater risk for infecting their children with bacteria and increasing the risk of their children developing caries at an early age (Ramos-Gomez et al., 2002). Streptococcus mutans (MS) colonization of an infant may occur from the time of birth (Berkowitz, 2006), and significant colonization occurs after dental eruption, as the teeth provide non-shedding and other surfaces for adherence. (Wan et al., 2001; Tanner et al., 2002).

Cariogenic bacteria can be transmitted from mother to child by behaviors that directly pass saliva such as sharing a spoon when tasting baby food, cleaning a dropped pacifier by mouth or wiping the baby’s mouth with saliva (Berkowitz, 2003). Reducing the transmission of cariogenic bacteria can be accomplished by reducing the maternal reservoir, avoiding vectors, and increasing the child’s resistance to colonization (Li et al., 2003). Studies have demonstrated the effectiveness of a primary prevention program initiated during pregnancy to significantly improve the oral health of mothers and their children (Gunay et al., 1998; Soderling et al., 2001). Hence, comprehensive dental care for pregnant women is imperative to safeguard their oral and general health, as well as to reduce their children’s caries risk (Brambilla et al., 1998; Boggess and Edelstein, 2006).

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10. Gingival overgrowth related to pregnancy

Hormonal changes during pregnancy have been associated with varying types of gingival enlargement. These changes can potentiate the effects of local irritants on gingival connective tissue. Localized gingival overgrowth (pregnancy gingival tumor) is found in 0.2‑0.5% of pregnant females. It occurs as a benign, rapidly growing lesion, usually in the 1st trimester of pregnancy and extending up to 3rd trimester. A pregnancy gingival tumor is a smooth or lobulated exophytic lesion with a pedunculated or sessile base (Srivastava et al., 2013) (Figure 3.). Several theories and speculations have been suggested to explain its occurrence during pregnancy, and meticulous maintenance of oral hygiene during pregnancy is important in reducing its incidence and the severity of gingival inflammation. Hormonal factors might play a role in aggravating gingivitis and gingival overgrowth (Oettinger-Barak et al., 2006; Andrikopoulou et al., 2013)

Figure 3.

Pregnancy gingival overgrowth

11. Conclusion

Birth weight is considered to be an important determinant of the chances that an infant survives, grows, and matures. Maternal risk factors include age, height, weight, socio-economic status, ethnicity, smoking, alcohol use, nutritional status, and stress (Copper et al., 1996; Davenport et al., 2002). A review of the available literature has shown an association between periodontal disease and early pregnancy loss, preterm birth, low birth weight and preeclampsia (Jeffcoat et al., 2001; Gomes-Filho et al., 2007; Vergnes and Sixou, 2007; Xiong et al., 2007). However, the results regarding the treatment of oral disease during pregnancy are conflicting; some studies suggest a reduction in the rate of preterm births and dental caries (Brambilla et al., 1998; Jeffcoat et al., 2003; Lopez et al., 2005), whereas others show no impact (Michalowicz et al., 2006; Offenbacher et al., 2009; Macones et al., 2010).

The hypothesis that infection elsewhere in the body may influence PLBW has led to an increased awareness of the potential role of chronic bacterial infections. Periodontal disease is associated with a chronic Gram-negative infection of the periodontal tissues that results in a long-term local elevation of pro-inflammatory prostaglandins and cytokines and an increase in systemic levels of some of these inflammatory mediators (Page and Kornman, 1997). The evidence suggests that periodontitis can have a significant effect on systemic health. Periodontal disease is associated with many adverse pregnancy outcomes such as preterm delivery (Xiong et al., 2006), preeclampsia (Canakci et al., 2004), abortion and stillbirth (Moore et al., 2004), low birth weight (LBW) infants (Jarjoura et al., 2005) and preterm LBW infants (Xiong et al., 2006).

The strength of the association between periodontal disease and PTLB ranges from a two-fold to a seven-fold increase in risk. Although there are several data suggesting a relationship between maternal periodontal infection and preterm birth, several studies have failed to demonstrate such an association (Davenport et al., 2002; Holbrook et al., 2004; Moore et al., 2004; Buduneli et al., 2005; Rajapakse et al., 2005). Some of the factors that might have affected these observations are the lack of a consistent clinical definition and the failure to control for potential confounders (Holbrook et al., 2004; Moore et al., 2004; Buduneli et al., 2005). Another potential reason for the disparate findings among studies is the differences in the populations studied.

Several common risk factors are responsible for PLBW, such as age, socioeconomic status, and smoking, along with periodontal diseases. Because the inflammatory mediators that occur in periodontal diseases also play an important part in the initiation of labor, it is possible that a biological mechanism links the two conditions. Furthermore, intervention studies, animal studies, and more detailed mechanistic examinations are needed to directly correlate periodontal diseases to PLBW babies and eliminate the confounding effects of various other risk factors.

Author, year Subjects, cases/ controls Adverse pregnancy outcome Periodontitis evaluation Findings Association
Jacob and Nath (2014),
India
170/170 LBW BOP,PD, CAL Periodontitis represents a strong, independent, and clinically significant risk factor for LBW Significant
Bulut et al. (2014),
Turkey
50/50 PTB PPD, CAL The findings indicated that maternal periodontitis was not a possible risk factor for pre-term delivery Significant
Santa Cruz et al.(2013),
Spain
54/116 PTB Microbiological tests Clinical periodontal condition was not associated with adverse pregnancy outcomes in a Spanish Caucasian population with medium-high educational level Non-significant
Kumar et al.(2013),
India
61/132 LBW Periodontal examination Maternal periodontitis is associated with an increased preterm delivery and low birthweight infants. Significant
Cruz et al (2009)
Brazil
164/388 LBW PI,BOP, PD, CAL The findings suggest an association between periodontal disease and low birth weight among mothers with low education levels Significant
Vettore et al. (2008)
Brazil
150/66 PTB / LBW PI, CI, BOP, PD, CAL PD was significantly higher in non-preterm low birth weight controls than in subjects in the preterm low birthweight. Non- significant
Santo-Pereira (2007)
Brazil
124 PTB Periodontitis was classified based on CAL Periodontal disease more prevalent in women with preterm vs. term labor Significant
Bassani et al.(2007),
Brazil
304/611 LBW PD, CAL Similar rate of periodontal disease among cases and controls Non-significant
Gomes-Filho et al. (2006), Brazil 44/177 PLBW PI, PD, BOP, CAL No statistically significant difference in the periodontal clinical parameters between the groups Non-significant
Wood et al. (2006), Canada 50/101 PTB Oral hygiene index simplified, PD, CAL, BOP There was no difference in the proportion of sites with significant attachment loss. Non-significant
Skuldbol et al. (2006), Denmark 21/33 PTB PI, PD, BOP, Bitewing radiographs No association between periodontal disease and preterm birth was found Non-significant
Radnai et al. (2006), Hungary 77/84 PTB PI, CI, BOP, PD A significant association was found between PB and initial chronic localized periodontitis Significant
Bosnjak et al.(2006) , Croatia 17/64 PTB CAL, PD, Papillary bleeding index Periodontal disease was a significant independent risk factor for PTB. Significant
Alves and Ribeiro (2006), Brazil 19/40 PLBW The periodontal screening and recording There was a higher rate of periodontal disease in cases (84.21%-16/19) as compared with controls (37.5% -15/40). Significant
Moore et al. (2005)
UK
61/93 (154) PTB PI, PD, CAL, BOP No association between periodontal disease and pregnancy outcome Non-significant
Noack et al. (2005), Germany 59/42 PLBW PI, BOP, PD, CAL Periodontitis was not a detectable risk factor for preterm low birth weight. Non-significant
Buduneli et al. (2005)
Turkey
53/128 (181) PTB/LBW BOP, PD, PI No difference in periodontal disease between cases and controls Non-significant
Jarjoura et al. (2005)
USA
83/120 (203) PTB/LBW PI, BOP, PD, CAL Periodontal disease associated with PTB/LBW Significant
Moliterno et al.(2005), Brazil 76/75 PLBW PD, CAL Significant associations with low birth weight babies was periodontitis Significant
Moore et al.(2004), UK 48/82 PTB PI, PD, CAL, BOP No statistically significant difference in the carriage of the IL-1P + 3953 allelic variant between cases and controls Non-significant
Goepfert et al. (2004)
USA
95/44 PTB CAL Multivariable analyses supported the association between severe periodontal disease and spontaneous preterm birth. Significant
Mokeem et al.(2004) Saudi Arabia 30/60 PLBW PD, BOP, CI, CPITN, There is a correlation between periodontal disease and PLBW Significant
Radnai et al.(2004)Hungary 41/44 PTB /LBW PD,BOP ,CI Periodontitis can be regarded as an important risk factor for PTB Significant
Davenport et al. (2002)
UK
236/507(743) PLBW PD, BOP, CPITN No evidence for an association between periodontal disease and PLBW. Non-significant
Louro et al. (2001)Brazil 13/13 LBW Extension and severity index Periodontal disease may be a risk factor for LBW Significant
Dasanayake et al. (2001)
USA
17/63 LBW Porphyromonas gingivalis (P.g), Serum IgG levels Women with higher levels of P.g. IgG had higher odds of giving birth to LBW infants Significant
Sembene et al (2000).
Senegal
26/87 LBW CPITN score: <1 1- 1.99 2- 2.99 "/>3 Periodontal disease is a potential risk factor for LBW Significant
Dasanayake et al(1998) Thailand 50/ 50 LBW DMFT and CPITN Periodontal disease associated with LBW Significant
Offenbacher et al. (1996)
USA
93/31 PTB/LBW CAL Periodontal disease associated with PTB/LBW Significant

Table 1.

Case-control studies on the relationship between adverse pregnancy outcome and periodontal disease

PTB- Preterm Birth; PLBW- Preterm Low Birthweight; LBW- Low Birth Weight; PI-Plaque Index; GI- Gingival Index ; PD- Probing Depth; CAL- Clinical Attachment Level; CI calculus index; BOP- Bleeding On Probing; CAL - Clinical Attachment Level; CPITN- Community Periodontal Index for Treatment Needs ; DMFT - Decayed, Missing, and Filled Teeth


Study/Country Sample size Periodontal disease -Parameters Conclusions Association
Muwazi et al (2014) 400 PPD, BOP,CD GR, CPI Significant association only between gingival recession and low birth weight Significant
Kothiwale et al (2014) 770 PPD , CPI The severity of periodontal disease was associated with an increased rate of pre-term infants. Severe anemia and periodontal infection may have an adverse effect on pregnancy and fetal development. Significant
Ammanagi (2014)
India
290 Not Known Periodontal disease is a risk factor for PLBW Significant
Abati et al (2013)
Italy
750 Comprehensive oral and dental examination Data failed to demonstrate the association between periodontitis and preterm birth and low birth weight. Non - significant
Srinivas et al. (2009)
India
786 CAL No association between Periodontal disease and Pre term birth Non - significant
Agueda et al. (2008)
Spain
1200 PD,CAL,BOP No significant association between periodontitis and low birth weight Non - significant
Mobeen et al. (2008)
Pakistan
1152 PD, CAL,PI, GI Preterm birth and low birthweight were not related to measures of periodontal disease. Non - significant
Pitiphat et al. (2008)
USA
1635 Self-reported periodontitis Radiographs The results suggest that periodontitis is an independent risk factor for poor pregnancy outcome among middle-class women. Significant
Sharma et al. (2007)
Fiji Islands
670 CPITN There is a highly significant association between pre-term birth and moderate to severe periodontal disease Significant
Toygar et al., (2007)
Turkey
3576 CPITN Maternal periodontal disease may be a risk factor for PTB and LBW Significant
Rajapakse et al (2005)
Sri Lanka
227 PI,CAL,BOP Suggestive association between pre term low birth weight and periodontitis Significant
Dortbudak et al. (2005)
Austria
36 PD Periodontitis can induce a primary host response in chorioamnnion leading to PTB Significant
Moore et al (2004)
UK
3738 PI,CAL,BOP,PD No association between either PTB or LBW and periodontal disease. Not Significant
Holbrook et al. (2004)
Iceland
96 PD, gingival culture No link between low grade periodontal disease and PTB Not Significant
Romero et al (2002)
Venezuela
69 PI- Russell's Index Periodontal disease is a risk factor for PTB &LBW Significant
Lopez et al (2002)
Chile
639 PD,CAL Periodontal disease is an independent risk factor for PTB and LBW Significant
Offenbacher et al (2001)
USA
767 PD, CAL Periodontal disease is a risk factor for PTB and LBW Significant
Jeffcoat et al. (2001)
USA
1313 CAL, PD Periodontal disease is an independent risk for PTB Significant

Table 2.

Adverse outcomes of pregnancy, pregnancy : Pre term birth weight/ low birth weight and Pre term weight-Cohort Studies

PTB- Preterm Birth; PLBW- Preterm Low Birthweight; LBW- Low Birth Weight; PI-Plaque Index; GI- Gingival Index ; PD- Probing Depth; CAL- Clinical Attachment Level; CI calculus index; BOP- Bleeding On Probing; PI - Periodontal Index ; CAL - Clinical Attachment Level; PPD-Probing Pocket Depth; CD - Calculus Deposit; CPI- Community Periodontal Index


Author, year, country Subjects, cases/controls Periodontitis evaluation Observations Association
Kumar et al. (2013)
India
61/132 PI,CAL,BOP Maternal periodontitis is associated with an increased risk of pre-eclampsia. Significant
Chaparro et al (2013)
Chile
43/11 PI,CAL,BOP Increased IL-6 levels in GCF in early pregnancy were associated with increased preeclampsia risk. Significant
Taghzouti et al (2012)
Canada
92/245 CAL,PD No association between periodontal disease and preeclampsia Significant
Hirano et al. (2012)
Japan
18/109 PI,CAL,BOP No statistically significant association between
preeclampsia and periodontitis.
Not Significant
Wang et al. (2012)
Japan
13/106 CAL Polymorphism and subgingival DNA level of A. actinomycetemcomitans were significantly associated with preeclampsia. Significant
Ha et al. (2011)
Korea
16/48 CAL Periodontal disease could be associated with preeclampsia Significant
Politano et al (2011) Brazil 58/58 CAL,BOP,PD There was an association between preeclampsia and periodontitis Significant
Shetty et al. (2010)
India
30/100 PD,CAL,GI Periodontitis both at enrolment (OR = 5.78, 95% CI 2.41-13.89) as well as within 48 hours of delivery (OR = 20.15, 95% CI 4.55-89.29), may be associated with an increased risk of preeclampsia. Significant
Nabet et al. (2010)
France
1108/1094 CAL.PD,BOP Maternal periodontitis is associated with an increased risk of induced preterm birth due to pre-eclampsia. Significant
Lohsoonthorn et al. (2009)
Thailand
150/150 PD,CAL No association between periodontal disease and preeclampsia Not Significant
Srinivas et al (2009)
India
786
CAL
No association between periodontitis and pre-eclampsia
Not Significant
Siqueira et al.(2008)
Brazil
164/1042 PD,CAL,BOP Maternal periodontitis is a risk factor associated with preeclampsia. Significant
Canakci et al (Canakci et al., 2007)
Turkey
38/21 PD, CAL, BOP Mild to severe periodontal disease is associated with an increased risk for development of preeclampsia Significant
Kunnen et al (2007)
Netherlands
17/35 PI, CI, BOP, R, PD Severe periodontal disease was associated with increase of early onset preeclampsia Significant
Barak et al (2007)
Israel
16/14 Women with preeclampsia had higher prevalence of periopathogenic in bacterial placental tissue than controls Significant
Contreas et al (2006)
Columbia
130/243 PD, CAL Periodontal disease is associated with an increased risk for development of preeclampsia Significant
Cota et al (2006)
Brazil
109/479 PI, CI, BOP, R, PD Periodontal disease is associated with an increased risk for development of preeclampsia Significant
Khader et al (2006)
Jordan
115/230 PD, CAL,PI,CI No association between periodontal disease and preeclampsia Significant
Oettinger et al. (2005)
Israel
15/15 PD, CAL,PI,CI Periodontal disease is associated with an increased risk for development of preeclampsia Significant
Canakci et al. (2004)
Turkey
41/41 PD, CAL, BOP Periodontal disease is associated with an increased risk for development of preeclampsia Significant
Castaldi et al (2006)
Argentina
1562 CAL, PD No association between periodontal disease and preeclampsia Not significant
Boggess et al (2003)
USA
763 PI,CAL,BOP,PD Association between periodontal disease and preeclampsia Significant

Table 3.

The relationship between periodontal disease and Preeclampsia : Observational studies

CAL- Clinical Attachment Level; PTB- Preterm Birth; PLBW- Preterm Low Birthweight; LBW- Low Birth Weight; PD- Probing Depth; BOP- Bleeding On Probing; CAL - Clinical Attachment Level; PPD-Probing Pocket Depth; CD - Calculus Deposit; CPI- Community Periodontal Index


Author, year Subjects cases/controls Adverse pregnancy outcome Type of Periodontal Therapy/intervention Results
Albert (2011) 464/12321 LBW,PTB Periodontal treatment Significant
Tarannum and Faizuddin (2007) 53/68 PTB, LBW Scaling and root planning (SRP) and Plaque control instructions Significant
Michalowicz et al.(2006) 413/410 PTB, LBW Scaling and oral hygiene instructions Non-significant
Offenbacher et al.(2006) 40/34 PTB SRP and advised to use of a sonic toothbrush Significant
Sadatmansouri et al. (2006) 30/30 PLBW Oral hygiene instructions, 0.2% Chlorhexidine mouth Significant
Lopez et al.(2005) 580/290 PLBW Scaling, Plaque control, 0.12% chlorhexidine Significant
Jeffcoat et al. (2003) 366/723 PTB Scaling and root planning Significant
Lopez et al.(2002) 163/188 PLBW scaling and root planing (SRP) and Oral Hygiene instructions Significant
Mitchell-Lewis et al (2001) 74/ 90 PLBW Oral prophylaxis Significant

Table 4.

Studies showing the relationship of periodontal therapy on preventing adverse pregnancy outcomes

PTB- Preterm Birth; PLBW- Preterm Low Birthweight; LBW- Low Birth Weight


Authors Studies included Outcomes Conclusions
Ide and Papapanou (2013) Cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia.Preterm birth (<37 weeks gestation), LBW (<2500 g), gestational age, small for gestational age, birthweight, pregnancy loss or miscarriage, or pre-eclampsia. Although significant associations emerge from case-control and cross-sectional studies using periodontitis “case definitions,” these were substantially attenuated in studies assessing periodontitis as a continuous variable. Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the definition of periodontitis appears to impact the findings. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia. It is suggested that future studies employ both continuous and categorical assessments of periodontal status. Further use of the composite outcome preterm LBW is not encouraged.
Michalowicz et al. (2013) To identify randomized controlled trials (RCTs) published between January 2011 and July 2012 and discuss all published RCTs testing whether periodontal therapy reduces rates of preterm birth and low birthweight. The single RCT identified showed no significant effect of periodontal treatment on birth outcomes. Non-surgical periodontal therapy, scaling and root planing, does not improve birth outcomes in pregnant women with periodontitis.
Polyzos et al. (2010) 11 Case control studies trials (with 6558 women) Periodontal treatment had no significant effect on the overall rate of preterm birth (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15).Furthermore, treatment did not reduce the rate of low birthweight infants (odds ratio 1.07, 0.85 to 1.36;P=0.55). Treatment of periodontal disease with scaling and root planing during pregnancy does not reduce the risk of preterm birth and should not be routinely recommended as a measure to prevent preterm birth
Polyzos et al (2009) Seven randomized trials were included based on the criteria.There were 2663 patients: 1491 had been randomized to receive periodontal treatment and 1172 to no treatment. Treatment resulted in significantly lower PTB (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.350.86; P = .008) and borderline significantly lower LBW (OR, 0.48; 95% CI, 0.23-1.00;P = .049), whereas no difference was found for spontaneous abortion/stillbirth (OR, 0.73; 95% CI, 0.41-1.31; P = .292). The analysis showed that treatment with scaling and/or root planing during pregnancy significantly reduces the rate of PTB and may reduce the rate of LBW infants.
Vergnes and Sixou (2007) 17 observational studies (11 case/controls, four cohorts, and two cross-sectionals) Preterm low birth weight:OR = 2.83 (95% CI: 1.95-4.10, P < 0.0001)LBW: OR = 4.03 (95% CI: 2.05-7.93, P < 0.0001) These findings indicate a likely association, but it needs to be confirmed by large, well- designed, multicenter trials
Xiong et al. (2006) 44 studies (26 case-control studies, 13 cohort studies, and five controlled trials) Twenty nine suggested an association between periodontal disease and increased risk of adverse pregnancy outcome (ORs ranging from 1.10 to 20.0) and 15 found no evidence of an association (ORs ranging from 0.78 to 2.54) Preterm Low birth weight:RR = 0.53, 95% CI: 0.30-0.95, P < 0.05Preterm birth: RR = 0.79, 95% CI: 0.55-1.11, P "/> 0.05 Low birth weight: RR = 0.86, 95% CI: 0.58%1.29, P "/> 0.05 The published literature is not vigorous to clinically link periodontal disease and/or its treatment to specific adverse pregnancy outcomes
Khader and Ta’ani (2005) 5 studies (two case-control and three prospective cohorts) PTB: OR = 4.28 (95% CI: 2.62-6.99; P < 0.005)PTLBW: OR = 5.28 (95% CI: 2.21-12.62; P < 0.005)Either PTB or LBW: OR = 2.30 (95% CI: 1.21-4.38; P < 0.005) Periodontal diseases in the pregnant mother significantly increase the risk of subsequent preterm birth or low birth weight

Table 5.

Meta-analysis on periodontal disease and adverse pregnancy outcomes

PTB- Preterm Birth; PLBW- Preterm Low Birthweight; LBW- Low Birth Weight; PI-Plaque Index; GI- Gingival Index ; PD- Probing Depth; CAL- Clinical Attachment Level; CI calculus index; BOP- Bleeding On Probing; PI - Periodontal Index ; CAL - Clinical Attachment Level; PPD-Probing Pocket Depth; CD - Calculus Deposit; CPI- Community Periodontal Index ;


References

  1. 1. AbatiSVillaACetinIDessoleSLuglieP. FStrohmengerLOttolenghiLCampusG. G2013Lack of association between maternal periodontal status and adverse pregnancy outcomes: a multicentric epidemiologic study. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 26369372Abati S, Villa A, Cetin I, Dessole S, Luglie PF, Strohmenger L, Ottolenghi L, Campus GG. 2013. Lack of association between maternal periodontal status and adverse pregnancy outcomes: a multicentric epidemiologic study. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 26:369-372.
  2. 2. AguedaARamonJ. MManauCGuerreroAEcheverriaJ. J2008Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study. Journal of clinical periodontology 351622Agueda A, Ramon JM, Manau C, Guerrero A, Echeverria JJ. 2008. Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study. Journal of clinical periodontology 35:16-22.
  3. 3. AlbertD. ABeggM. DAndrewsH. FWilliamsS. ZWardAConicellaM. LRauhVThomsonJ. LPapapanouP. N2011An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States. American journal of public health 101151156Albert DA, Begg MD, Andrews HF, Williams SZ, Ward A, Conicella ML, Rauh V, Thomson JL, Papapanou PN. 2011. An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States. American journal of public health 101:151-156.
  4. 4. AlvesR. TRibeiroR. A2006Relationship between maternal periodontal disease and birth of preterm low weight babies. Brazilian oral research 20318323Alves RT, Ribeiro RA. 2006. Relationship between maternal periodontal disease and birth of preterm low weight babies. Brazilian oral research 20:318-323.
  5. 5. AmmanagiR2014Low birth weight among newborns and maternal poor periodontal status. Indian journal of public health 58:69.Ammanagi R. 2014. Low birth weight among newborns and maternal poor periodontal status. Indian journal of public health 58:69.
  6. 6. AndrikopoulouMChatzistamouIGkilasHVilarasGSklavounouA2013Assessment of angiogenic markers and female sex hormone receptors in pregnancy tumor of the gingiva. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 7113761381Andrikopoulou M, Chatzistamou I, Gkilas H, Vilaras G, Sklavounou A. 2013. Assessment of angiogenic markers and female sex hormone receptors in pregnancy tumor of the gingiva. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 71:1376-1381.
  7. 7. BarakSOettinger-barakOMachteiE. ESprecherHOhelG2007Evidence of periopathogenic microorganisms in placentas of women with preeclampsia. Journal of periodontology 78670676Barak S, Oettinger-Barak O, Machtei EE, Sprecher H, Ohel G. 2007. Evidence of periopathogenic microorganisms in placentas of women with preeclampsia. Journal of periodontology 78:670-676.
  8. 8. BarakSOettinger-barakOOettingerMMachteiE. EPeledMOhelG2003Common oral manifestations during pregnancy: a review. Obstetrical & gynecological survey 58624628Barak S, Oettinger-Barak O, Oettinger M, Machtei EE, Peled M, Ohel G. 2003. Common oral manifestations during pregnancy: a review. Obstetrical & gynecological survey 58:624-628.
  9. 9. BassaniD. GOlintoM. TKreigerN2007Periodontal disease and perinatal outcomes: a case-control study. Journal of clinical periodontology 343139Bassani DG, Olinto MT, Kreiger N. 2007. Periodontal disease and perinatal outcomes: a case-control study. Journal of clinical periodontology 34:31-39.
  10. 10. BerkowitzR. J2003Causes, treatment and prevention of early childhood caries: a microbiologic perspective. Journal 69304307Berkowitz RJ. 2003. Causes, treatment and prevention of early childhood caries: a microbiologic perspective. Journal 69:304-307.
  11. 11. BerkowitzR. J2006Mutans streptococci: acquisition and transmission. Pediatric dentistry 28106109discussion 192-108.Berkowitz RJ. 2006. Mutans streptococci: acquisition and transmission. Pediatric dentistry 28:106-109; discussion 192-108.
  12. 12. BoggessK. ABeckJ. DMurthaA. PMossKOffenbacherS2006Maternal periodontal disease in early pregnancy and risk for a small-for-gestational-age infant. American journal of obstetrics and gynecology 19413161322Boggess KA, Beck JD, Murtha AP, Moss K, Offenbacher S. 2006. Maternal periodontal disease in early pregnancy and risk for a small-for-gestational-age infant. American journal of obstetrics and gynecology 194:1316-1322.
  13. 13. BoggessK. AEdelsteinB. L2006Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Maternal and child health journal 10:S169174Boggess KA, Edelstein BL. 2006. Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Maternal and child health journal 10:S169-174.
  14. 14. BoggessK. ALieffSMurthaA. PMossKBeckJOffenbacherS2003Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstetrics and gynecology 101227231Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S. 2003. Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstetrics and gynecology 101:227-231.
  15. 15. BoggessK. AMadianosP. NPreisserJ. SMoiseK. JJr., Offenbacher S. 2005Chronic maternal and fetal Porphyromonas gingivalis exposure during pregnancy in rabbits. American journal of obstetrics and gynecology 192554557Boggess KA, Madianos PN, Preisser JS, Moise KJ, Jr., Offenbacher S. 2005. Chronic maternal and fetal Porphyromonas gingivalis exposure during pregnancy in rabbits. American journal of obstetrics and gynecology 192:554-557.
  16. 16. BosnjakAReljaTVucicevic-borasVPlasajHPlancakD2006Pre-term delivery and periodontal disease: a case-control study from Croatia. Journal of clinical periodontology 33710716Bosnjak A, Relja T, Vucicevic-Boras V, Plasaj H, Plancak D. 2006. Pre-term delivery and periodontal disease: a case-control study from Croatia. Journal of clinical periodontology 33:710-716.
  17. 17. BrambillaEFelloniAGaglianiMMalerbaAGarcia-godoyFStrohmengerL1998Caries prevention during pregnancy: results of a 30-month study. Journal of the American Dental Association 129871877Brambilla E, Felloni A, Gagliani M, Malerba A, Garcia-Godoy F, Strohmenger L. 1998. Caries prevention during pregnancy: results of a 30-month study. Journal of the American Dental Association 129:871-877.
  18. 18. BuduneliNBaylasHBuduneliETurkogluOKoseTDahlenG2005Periodontal infections and pre-term low birth weight: a case-control study. Journal of clinical periodontology 32174181Buduneli N, Baylas H, Buduneli E, Turkoglu O, Kose T, Dahlen G. 2005. Periodontal infections and pre-term low birth weight: a case-control study. Journal of clinical periodontology 32:174-181.
  19. 19. BuduneliNKinaneD. F2011Host-derived diagnostic markers related to soft tissue destruction and bone degradation in periodontitis. Journal of clinical periodontology 38 Suppl 1185105Buduneli N, Kinane DF. 2011. Host-derived diagnostic markers related to soft tissue destruction and bone degradation in periodontitis. Journal of clinical periodontology 38 Suppl 11:85-105.
  20. 20. BulutGOlukmanOCalkavurS2014Is there a relationship between maternal periodontitis and pre-term birth? A prospective hospital-based case-control study. Acta odontologica Scandinavica:18Bulut G, Olukman O, Calkavur S. 2014. Is there a relationship between maternal periodontitis and pre-term birth? A prospective hospital-based case-control study. Acta odontologica Scandinavica:1-8.
  21. 21. CanakciVCanakciC. FCanakciHCanakciECicekYIngecMOzgozMDemirTDilsizAYagizH2004Periodontal disease as a risk factor for pre-eclampsia: a case control study. The Australian & New Zealand journal of obstetrics & gynaecology 44568573Canakci V, Canakci CF, Canakci H, Canakci E, Cicek Y, Ingec M, Ozgoz M, Demir T, Dilsiz A, Yagiz H. 2004. Periodontal disease as a risk factor for pre-eclampsia: a case control study. The Australian & New Zealand journal of obstetrics & gynaecology 44:568-573.
  22. 22. CanakciVCanakciC. FYildirimAIngecMEltasAErturkA2007Periodontal disease increases the risk of severe pre-eclampsia among pregnant women. Journal of clinical periodontology 34639645Canakci V, Canakci CF, Yildirim A, Ingec M, Eltas A, Erturk A. 2007. Periodontal disease increases the risk of severe pre-eclampsia among pregnant women. Journal of clinical periodontology 34:639-645.
  23. 23. CastaldiJ. LBertinM. SGimenezFLedeR2006Periodontal disease: Is it a risk factor for premature labor, low birth weight or preeclampsia?]. Rev Panam Salud Publica 19253258Castaldi JL, Bertin MS, Gimenez F, Lede R. 2006. [Periodontal disease: Is it a risk factor for premature labor, low birth weight or preeclampsia?]. Rev Panam Salud Publica 19:253-258.
  24. 24. ChaparroASanzAQuinteroAInostrozaCRamirezVCarrionFFigueroaFSerraRIllanesS. E2013Increased inflammatory biomarkers in early pregnancy is associated with the development of pre-eclampsia in patients with periodontitis: a case control study. Journal of periodontal research 48302307Chaparro A, Sanz A, Quintero A, Inostroza C, Ramirez V, Carrion F, Figueroa F, Serra R, Illanes SE. 2013. Increased inflammatory biomarkers in early pregnancy is associated with the development of pre-eclampsia in patients with periodontitis: a case control study. Journal of periodontal research 48:302-307.
  25. 25. ContrerasAHerreraJ. ASotoJ. EArceR. MJaramilloABoteroJ. E2006Periodontitis is associated with preeclampsia in pregnant women. Journal of periodontology 77182188Contreras A, Herrera JA, Soto JE, Arce RM, Jaramillo A, Botero JE. 2006. Periodontitis is associated with preeclampsia in pregnant women. Journal of periodontology 77:182-188.
  26. 26. CopperR. LGoldenbergR. LDasAElderNSwainMNormanGRamseyRCotroneoPCollinsB. AJohnsonFJonesPMeierA. M1996The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. American journal of obstetrics and gynecology 17512861292Copper RL, Goldenberg RL, Das A, Elder N, Swain M, Norman G, Ramsey R, Cotroneo P, Collins BA, Johnson F, Jones P, Meier AM. 1996. The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks' gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. American journal of obstetrics and gynecology 175:1286-1292.
  27. 27. CotaL. OGuimaraesA. NCostaJ. ELorentzT. CCostaF. O2006Association between maternal periodontitis and an increased risk of preeclampsia. Journal of periodontology 7720632069Cota LO, Guimaraes AN, Costa JE, Lorentz TC, Costa FO. 2006. Association between maternal periodontitis and an increased risk of preeclampsia. Journal of periodontology 77:2063-2069.
  28. 28. CruzS. SCosta Mda C, Gomes-Filho IS, Rezende EJ, Barreto ML, Dos Santos CA, Vianna MI, Passos JS, Cerqueira EM. 2009Contribution of periodontal disease in pregnant women as a risk factor for low birth weight. Community dentistry and oral epidemiology 37527533Cruz SS, Costa Mda C, Gomes-Filho IS, Rezende EJ, Barreto ML, Dos Santos CA, Vianna MI, Passos JS, Cerqueira EM. 2009. Contribution of periodontal disease in pregnant women as a risk factor for low birth weight. Community dentistry and oral epidemiology 37:527-533.
  29. 29. CruzS. SCosta Mda C, Gomes Filho IS, Vianna MI, Santos CT. 2005Maternal periodontal disease as a factor associated with low birth weight]. Revista de saude publica 39782787Cruz SS, Costa Mda C, Gomes Filho IS, Vianna MI, Santos CT. 2005. [Maternal periodontal disease as a factor associated with low birth weight]. Revista de saude publica 39:782-787.
  30. 30. DarveauR. PTannerAPageR. C1997The microbial challenge in periodontitis. Periodontology 20001412Darveau RP, Tanner A, Page RC. 1997. The microbial challenge in periodontitis. Periodontology 2000 14:12-32.
  31. 31. DasanayakeA. P1998Poor periodontal health of the pregnant woman as a risk factor for low birth weight. Annals of periodontology / the American Academy of Periodontology 3206212Dasanayake AP. 1998. Poor periodontal health of the pregnant woman as a risk factor for low birth weight. Annals of periodontology / the American Academy of Periodontology 3:206-212.
  32. 32. DasanayakeA. PBoydDMadianosP. NOffenbacherSHillsE2001The association between Porphyromonas gingivalis-specific maternal serum IgG and low birth weight. Journal of periodontology 7214911497Dasanayake AP, Boyd D, Madianos PN, Offenbacher S, Hills E. 2001. The association between Porphyromonas gingivalis-specific maternal serum IgG and low birth weight. Journal of periodontology 72:1491-1497.
  33. 33. DavenportE. SWilliamsC. ESterneJ. AMuradSSivapathasundramVCurtisM. A2002Maternal periodontal disease and preterm low birthweight: case-control study. Journal of dental research 81313318Davenport ES, Williams CE, Sterne JA, Murad S, Sivapathasundram V, Curtis MA. 2002. Maternal periodontal disease and preterm low birthweight: case-control study. Journal of dental research 81:313-318.
  34. 34. DortbudakOEberhardtRUlmMPerssonG. R2005Periodontitis, a marker of risk in pregnancy for preterm birth. Journal of clinical periodontology 324552Dortbudak O, Eberhardt R, Ulm M, Persson GR. 2005. Periodontitis, a marker of risk in pregnancy for preterm birth. Journal of clinical periodontology 32:45-52.
  35. 35. DuarteP. Mda Rocha M, Sampaio E, Mestnik MJ, Feres M, Figueiredo LC, Bastos MF, Faveri M. 2010Serum levels of cytokines in subjects with generalized chronic and aggressive periodontitis before and after non-surgical periodontal therapy: a pilot study. Journal of periodontology 8110561063Duarte PM, da Rocha M, Sampaio E, Mestnik MJ, Feres M, Figueiredo LC, Bastos MF, Faveri M. 2010. Serum levels of cytokines in subjects with generalized chronic and aggressive periodontitis before and after non-surgical periodontal therapy: a pilot study. Journal of periodontology 81:1056-1063.
  36. 36. FurugenRHayashidaHYamaguchiNYoshiharaAOgawaHMiyazakiHSaitoT2008The relationship between periodontal condition and serum levels of resistin and adiponectin in elderly Japanese. Journal of periodontal research 43556562Furugen R, Hayashida H, Yamaguchi N, Yoshihara A, Ogawa H, Miyazaki H, Saito T. 2008. The relationship between periodontal condition and serum levels of resistin and adiponectin in elderly Japanese. Journal of periodontal research 43:556-562.
  37. 37. GibbsR. S2001The relationship between infections and adverse pregnancy outcomes: an overview. Annals of periodontology / the American Academy of Periodontology 6153163Gibbs RS. 2001. The relationship between infections and adverse pregnancy outcomes: an overview. Annals of periodontology / the American Academy of Periodontology 6:153-163.
  38. 38. GoepfertA. RJeffcoatM. KAndrewsW. WFaye-petersenOCliverS. PGoldenbergR. LHauthJ. C2004Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstetrics and gynecology 104777783Goepfert AR, Jeffcoat MK, Andrews WW, Faye-Petersen O, Cliver SP, Goldenberg RL, Hauth JC. 2004. Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstetrics and gynecology 104:777-783.
  39. 39. GoldenbergR. LCulhaneJ. FIamsJ. DRomeroR2008Epidemiology and causes of preterm birth. Lancet 3717584Goldenberg RL, Culhane JF, Iams JD, Romero R. 2008. Epidemiology and causes of preterm birth. Lancet 371:75-84.
  40. 40. GoldenbergR. LHauthJ. CAndrewsW. W2000Intrauterine infection and preterm delivery. The New England journal of medicine 34215001507Goldenberg RL, Hauth JC, Andrews WW. 2000. Intrauterine infection and preterm delivery. The New England journal of medicine 342:1500-1507.
  41. 41. Gomes-filhoI. SCruzS. SRezendeE. JDos Santos CA, Soledade KR, Magalhaes MA, de Azevedo AC, Trindade SC, Vianna MI, Passos Jde S, Cerqueira EM. 2007Exposure measurement in the association between periodontal disease and prematurity/low birth weight. Journal of clinical periodontology 34957963Gomes-Filho IS, Cruz SS, Rezende EJ, Dos Santos CA, Soledade KR, Magalhaes MA, de Azevedo AC, Trindade SC, Vianna MI, Passos Jde S, Cerqueira EM. 2007. Exposure measurement in the association between periodontal disease and prematurity/low birth weight. Journal of clinical periodontology 34:957-963.
  42. 42. Gomes-filhoI. Sda Cruz SS, Rezende EJ, da Silveira BB, Trindade SC, Passos JS, de Freitas CO, Cerqueira EM, de Souza Teles Santos CA. 2006Periodontal status as predictor of prematurity and low birth weight. J Public Health Dent 66295298Gomes-Filho IS, da Cruz SS, Rezende EJ, da Silveira BB, Trindade SC, Passos JS, de Freitas CO, Cerqueira EM, de Souza Teles Santos CA. 2006. Periodontal status as predictor of prematurity and low birth weight. J Public Health Dent 66:295-298.
  43. 43. GunayHDmoch-bockhornKGunayYGeurtsenW1998Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clinical oral investigations 2137142Gunay H, Dmoch-Bockhorn K, Gunay Y, Geurtsen W. 1998. Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clinical oral investigations 2:137-142.
  44. 44. HaJ. EOhK. JYangH. JJunJ. KJinB. HPaikD. IBaeK. H2011Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea. Journal of periodontology 8216851692Ha JE, Oh KJ, Yang HJ, Jun JK, Jin BH, Paik DI, Bae KH. 2011. Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea. Journal of periodontology 82:1685-1692.
  45. 45. HanY. W2011Oral health and adverse pregnancy outcomes- what’s next? Journal of dental research 90289293Han YW. 2011. Oral health and adverse pregnancy outcomes - what's next? Journal of dental research 90:289-293.
  46. 46. HanY. WRedlineR. WLiMYinLHillG. BMccormickT. S2004Fusobacterium nucleatum induces premature and term stillbirths in pregnant mice: implication of oral bacteria in preterm birth. Infection and immunity 7222722279Han YW, Redline RW, Li M, Yin L, Hill GB, McCormick TS. 2004. Fusobacterium nucleatum induces premature and term stillbirths in pregnant mice: implication of oral bacteria in preterm birth. Infection and immunity 72:2272-2279.
  47. 47. HillierS. LMartiusJKrohnMKiviatNHolmesK. KEschenbachD. A1988ACase-controlstudy of chorioamnionic infection and histologic chorioamnionitis in prematurity. The New England journal of medicine 319972978Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. 1988. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. The New England journal of medicine 319:972-978.
  48. 48. HiranoESugitaNKikuchiAShimadaYSasaharaJIwanagaRTanakaKYoshieH2012The association of Aggregatibacter actinomycetemcomitans with preeclampsia in a subset of Japanese pregnant women. Journal of clinical periodontology 39229238Hirano E, Sugita N, Kikuchi A, Shimada Y, Sasahara J, Iwanaga R, Tanaka K, Yoshie H. 2012. The association of Aggregatibacter actinomycetemcomitans with preeclampsia in a subset of Japanese pregnant women. Journal of clinical periodontology 39:229-238.
  49. 49. HolbrookW. POskarsdottirAFridjonssonTEinarssonHHaukssonAGeirssonR. T2004No link between low-grade periodontal disease and preterm birth: a pilot study in a healthy Caucasian population. Acta odontologica Scandinavica 62177179Holbrook WP, Oskarsdottir A, Fridjonsson T, Einarsson H, Hauksson A, Geirsson RT. 2004. No link between low-grade periodontal disease and preterm birth: a pilot study in a healthy Caucasian population. Acta odontologica Scandinavica 62:177-179.
  50. 50. IdeMPapapanouP. N2013Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review. Journal of clinical periodontology 40 Suppl 14:S181194Ide M, Papapanou PN. 2013. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review. Journal of clinical periodontology 40 Suppl 14:S181-194.
  51. 51. JacobP. SNathS2014Periodontitis among poor rural Indian mothers increases the risk of low birth weight babies: a hospital-based case control study. Journal of periodontal & implant science 448593Jacob PS, Nath S. 2014. Periodontitis among poor rural Indian mothers increases the risk of low birth weight babies: a hospital-based case control study. Journal of periodontal & implant science 44:85-93.
  52. 52. JarjouraKDevineP. CPerez-delboyAHerrera-abreuMDAltonMPapapanouPN. 2005Markers of periodontal infection and preterm birth. American journal of obstetrics and gynecology 192513519Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D'Alton M, Papapanou PN. 2005. Markers of periodontal infection and preterm birth. American journal of obstetrics and gynecology 192:513-519.
  53. 53. JeffcoatM. KGeursN. CReddyM. SCliverS. PGoldenbergR. LHauthJ. C2001Periodontal infection and preterm birth: results of a prospective study. Journal of the American Dental Association 132875880Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. 2001. Periodontal infection and preterm birth: results of a prospective study. Journal of the American Dental Association 132:875-880.
  54. 54. JeffcoatM. KHauthJ. CGeursN. CReddyM. SCliverS. PHodgkinsP. MGoldenbergR. L2003Periodontal disease and preterm birth: results of a pilot intervention study. Journal of periodontology 7412141218Jeffcoat MK, Hauth JC, Geurs NC, Reddy MS, Cliver SP, Hodgkins PM, Goldenberg RL. 2003. Periodontal disease and preterm birth: results of a pilot intervention study. Journal of periodontology 74:1214-1218.
  55. 55. JensenJLiljemarkWBloomquistC1981The effect of female sex hormones on subgingival plaque. Journal of periodontology 52599602Jensen J, Liljemark W, Bloomquist C. 1981. The effect of female sex hormones on subgingival plaque. Journal of periodontology 52:599-602.
  56. 56. KhaderY. SJibrealMAl-omiriMAmarinZ2006Lack of association between periodontal parameters and preeclampsia. Journal of periodontology 7716811687Khader YS, Jibreal M, Al-Omiri M, Amarin Z. 2006. Lack of association between periodontal parameters and preeclampsia. Journal of periodontology 77:1681-1687.
  57. 57. KhaderY. STa’ani Q. 2005Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis. Journal of periodontology 76161165Khader YS, Ta'ani Q. 2005. Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis. Journal of periodontology 76:161-165.
  58. 58. KornmanK. SLoescheW. J1980The subgingival microbial flora during pregnancy. Journal of periodontal research 15111122Kornman KS, Loesche WJ. 1980. The subgingival microbial flora during pregnancy. Journal of periodontal research 15:111-122.
  59. 59. KothiwaleS. VDesaiB. RKothiwaleV. AGandhidMKoninS2014Periodontal disease as a potential risk factor for low birth weight and reduced maternal haemomglobin levels. Oral health & preventive dentistry 128390Kothiwale SV, Desai BR, Kothiwale VA, Gandhid M, Konin S. 2014. Periodontal disease as a potential risk factor for low birth weight and reduced maternal haemomglobin levels. Oral health & preventive dentistry 12:83-90.
  60. 60. KumarABasraMBegumNRaniVPrasadSLambaA. KVermaMAgarwalSSharmaS2013Association of maternal periodontal health with adverse pregnancy outcome. The journal of obstetrics and gynaecology research 394045Kumar A, Basra M, Begum N, Rani V, Prasad S, Lamba AK, Verma M, Agarwal S, Sharma S. 2013. Association of maternal periodontal health with adverse pregnancy outcome. The journal of obstetrics and gynaecology research 39:40-45.
  61. 61. KunnenABlaauwJVan DoormaalJ. JVan PampusM. GVan Der SchansC. PAarnoudseJ. GVan WinkelhoffA. JAbbasF2007Women with a recent history of early-onset pre-eclampsia have a worse periodontal condition. Journal of clinical periodontology 34202207Kunnen A, Blaauw J, van Doormaal JJ, van Pampus MG, van der Schans CP, Aarnoudse JG, van Winkelhoff AJ, Abbas F. 2007. Women with a recent history of early-onset pre-eclampsia have a worse periodontal condition. Journal of clinical periodontology 34:202-207.
  62. 62. LiYDasanayakeA. PCaufieldP. WElliottR. RButtsJ. Trd. 2003Characterization of maternal mutans streptococci transmission in an African American population. Dental clinics of North America 4787101Li Y, Dasanayake AP, Caufield PW, Elliott RR, Butts JT, 3rd. 2003. Characterization of maternal mutans streptococci transmission in an African American population. Dental clinics of North America 47:87-101.
  63. 63. LieffSBoggessK. AMurthaA. PJaredHMadianosP. NMossKBeckJOffenbacherS2004The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women. Journal of periodontology 75116126Lieff S, Boggess KA, Murtha AP, Jared H, Madianos PN, Moss K, Beck J, Offenbacher S. 2004. The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women. Journal of periodontology 75:116-126.
  64. 64. LinDSmithM. AChampagneCElterJBeckJOffenbacherS2003aPorphyromonas gingivalis infection during pregnancy increases maternal tumor necrosis factor alpha, suppresses maternal interleukin-10, and enhances fetal growth restriction and resorption in mice. Infection and immunity 7151565162Lin D, Smith MA, Champagne C, Elter J, Beck J, Offenbacher S. 2003a. Porphyromonas gingivalis infection during pregnancy increases maternal tumor necrosis factor alpha, suppresses maternal interleukin-10, and enhances fetal growth restriction and resorption in mice. Infection and immunity 71:5156-5162.
  65. 65. LinDSmithM. AElterJChampagneCDowneyC. LBeckJOffenbacherS2003bPorphyromonas gingivalis infection in pregnant mice is associated with placental dissemination, an increase in the placental Th1/Th2 cytokine ratio, and fetal growth restriction. Infection and immunity 7151635168Lin D, Smith MA, Elter J, Champagne C, Downey CL, Beck J, Offenbacher S. 2003b. Porphyromonas gingivalis infection in pregnant mice is associated with placental dissemination, an increase in the placental Th1/Th2 cytokine ratio, and fetal growth restriction. Infection and immunity 71:5163-5168.
  66. 66. LohsoonthornVKungsadalpipobKChanchareonsookPLimpongsanurakSVanichjakvongOSutdhibhisalSSookpromeCWongkittikraiwanNKamolpornwijitWJantarasaengaramSManotayaSSiwawejVBarlowW. EFitzpatrickA. LWilliamsM. A2009Maternal periodontal disease and risk of preeclampsia: a case-control study. Am J Hypertens 22457463Lohsoonthorn V, Kungsadalpipob K, Chanchareonsook P, Limpongsanurak S, Vanichjakvong O, Sutdhibhisal S, Sookprome C, Wongkittikraiwan N, Kamolpornwijit W, Jantarasaengaram S, Manotaya S, Siwawej V, Barlow WE, Fitzpatrick AL, Williams MA. 2009. Maternal periodontal disease and risk of preeclampsia: a case-control study. Am J Hypertens 22:457-463.
  67. 67. LopezN. JDa Silva I, Ipinza J, Gutierrez J. 2005Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. Journal of periodontology 7621442153Lopez NJ, Da Silva I, Ipinza J, Gutierrez J. 2005. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. Journal of periodontology 76:2144-2153.
  68. 68. LopezN. JSmithP. CGutierrezJ2002Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial. Journal of periodontology 73911924Lopez NJ, Smith PC, Gutierrez J. 2002. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial. Journal of periodontology 73:911-924.
  69. 69. LouroP. MFioriH. HFilhoP. LSteibelJFioriR. M2001Periodontal disease in pregnancy and low birth weight]. J Pediatr (Rio J) 772328Louro PM, Fiori HH, Filho PL, Steibel J, Fiori RM. 2001. [Periodontal disease in pregnancy and low birth weight]. J Pediatr (Rio J) 77:23-28.
  70. 70. MaconesG. AParrySNelsonD. BStraussJ. FLudmirJCohenA. WStamilioD. MApplebyDClothierBSammelM. DJeffcoatM2010Treatment of localized periodontal disease in pregnancy does not reduce the occurrence of preterm birth: results from the Periodontal Infections and Prematurity Study (PIPS). American journal of obstetrics and gynecology 202:147 e141148Macones GA, Parry S, Nelson DB, Strauss JF, Ludmir J, Cohen AW, Stamilio DM, Appleby D, Clothier B, Sammel MD, Jeffcoat M. 2010. Treatment of localized periodontal disease in pregnancy does not reduce the occurrence of preterm birth: results from the Periodontal Infections and Prematurity Study (PIPS). American journal of obstetrics and gynecology 202:147 e141-148.
  71. 71. MadianosP. NLieffSMurthaA. PBoggessK. AAutenR. LJr., Beck JD, Offenbacher S. 2001Maternal periodontitis and prematurity. Part II: Maternal infection and fetal exposure. Annals of periodontology / the American Academy of Periodontology 6175182Madianos PN, Lieff S, Murtha AP, Boggess KA, Auten RL, Jr., Beck JD, Offenbacher S. 2001. Maternal periodontitis and prematurity. Part II: Maternal infection and fetal exposure. Annals of periodontology / the American Academy of Periodontology 6:175-182.
  72. 72. MarakogluIGursoyU. KMarakogluKCakmakHAtaogluT2008Periodontitis as a risk factor for preterm low birth weight. Yonsei medical journal 49200203Marakoglu I, Gursoy UK, Marakoglu K, Cakmak H, Ataoglu T. 2008. Periodontitis as a risk factor for preterm low birth weight. Yonsei medical journal 49:200-203.
  73. 73. MascarenhasPGapskiRAl-shammariKWangH. L2003Influence of sex hormones on the periodontium. Journal of clinical periodontology 30671681Mascarenhas P, Gapski R, Al-Shammari K, Wang HL. 2003. Influence of sex hormones on the periodontium. Journal of clinical periodontology 30:671-681.
  74. 74. McgawT2002Periodontal disease and preterm delivery of low-birth-weight infants. Journal 68165169McGaw T. 2002. Periodontal disease and preterm delivery of low-birth-weight infants. Journal 68:165-169.
  75. 75. MichalowiczB. SGustafssonAThumbigere-mathVBuhlinK2013The effects of periodontal treatment on pregnancy outcomes. Journal of clinical periodontology 40 Suppl 14:S195208Michalowicz BS, Gustafsson A, Thumbigere-Math V, Buhlin K. 2013. The effects of periodontal treatment on pregnancy outcomes. Journal of clinical periodontology 40 Suppl 14:S195-208.
  76. 76. MichalowiczB. SHodgesJ. SDiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, Buchanan W, Bofill J, Papapanou PN, Mitchell DA, Matseoane S, Tschida PA, Study OPT. 2006Treatment of periodontal disease and the risk of preterm birth. The New England journal of medicine 35518851894Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, Buchanan W, Bofill J, Papapanou PN, Mitchell DA, Matseoane S, Tschida PA, Study OPT. 2006. Treatment of periodontal disease and the risk of preterm birth. The New England journal of medicine 355:1885-1894.
  77. 77. Mitchell-lewisDEngebretsonS. PChenJLamsterI. BPapapanouP. N2001Periodontal infections and pre-term birth: early findings from a cohort of young minority women in New York. Eur J Oral Sci 1093439Mitchell-Lewis D, Engebretson SP, Chen J, Lamster IB, Papapanou PN. 2001. Periodontal infections and pre-term birth: early findings from a cohort of young minority women in New York. Eur J Oral Sci 109:34-39.
  78. 78. MobeenNJehanIBandayNMooreJMcclureE. MPashaOWrightL. LGoldenbergR. L2008Periodontal disease and adverse birth outcomes: a study from Pakistan. American journal of obstetrics and gynecology 198:514 e511518Mobeen N, Jehan I, Banday N, Moore J, McClure EM, Pasha O, Wright LL, Goldenberg RL. 2008. Periodontal disease and adverse birth outcomes: a study from Pakistan. American journal of obstetrics and gynecology 198:514 e511-518.
  79. 79. MokeemS. AMollaG. NAl-jewairT. S2004The prevalence and relationship between periodontal disease and pre-term low birth weight infants at King Khalid University Hospital in Riyadh, Saudi Arabia. J Contemp Dent Pract 54056Mokeem SA, Molla GN, Al-Jewair TS. 2004. The prevalence and relationship between periodontal disease and pre-term low birth weight infants at King Khalid University Hospital in Riyadh, Saudi Arabia. J Contemp Dent Pract 5:40-56.
  80. 80. MoliternoL. FMonteiroBFigueredoC. MFischerR. G2005Association between periodontitis and low birth weight: a case-control study. Journal of clinical periodontology 32886890Moliterno LF, Monteiro B, Figueredo CM, Fischer RG. 2005. Association between periodontitis and low birth weight: a case-control study. Journal of clinical periodontology 32:886-890.
  81. 81. MooreSIdeMCowardP. YRandhawaMBorkowskaEBaylisRWilsonR. F2004A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome. British dental journal 197251258discussion 247.Moore S, Ide M, Coward PY, Randhawa M, Borkowska E, Baylis R, Wilson RF. 2004. A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome. British dental journal 197:251-258; discussion 247.
  82. 82. MooreSRandhawaMIdeM2005ACase-controlstudy to investigate an association between adverse pregnancy outcome and periodontal disease. Journal of clinical periodontology 3215Moore S, Randhawa M, Ide M. 2005. A case-control study to investigate an association between adverse pregnancy outcome and periodontal disease. Journal of clinical periodontology 32:1-5.
  83. 83. MuwaziLRwenyonyiC. MNkambaMKutesaAKagawaMMugyenyiGKwizeraGOkulloI2014Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC oral health 14:42.Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, Kagawa M, Mugyenyi G, Kwizera G, Okullo I. 2014. Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC oral health 14:42.
  84. 84. NabetCLelongNColombierM. LSixouMMussetA. MGoffinetFKaminskiMEpipapG2010Maternal periodontitis and the causes of preterm birth: the case-control Epipap study. Journal of clinical periodontology 373745Nabet C, Lelong N, Colombier ML, Sixou M, Musset AM, Goffinet F, Kaminski M, Epipap G. 2010. Maternal periodontitis and the causes of preterm birth: the case-control Epipap study. Journal of clinical periodontology 37:37-45.
  85. 85. NoackBKlingenbergJWeigeltJHoffmannT2005Periodontal status and preterm low birth weight: a case control study. Journal of periodontal research 40339345Noack B, Klingenberg J, Weigelt J, Hoffmann T. 2005. Periodontal status and preterm low birth weight: a case control study. Journal of periodontal research 40:339-345.
  86. 86. NordstromM. LCnattingiusS1996Effects on birthweights of maternal education, socio-economic status, and work-related characteristics. Scandinavian journal of social medicine 245561Nordstrom ML, Cnattingius S. 1996. Effects on birthweights of maternal education, socio-economic status, and work-related characteristics. Scandinavian journal of social medicine 24:55-61.
  87. 87. Oettinger-barakOBarakSOhelGOettingerMKreutzerHPeledMMachteiE. E2005Severe pregnancy complication (preeclampsia) is associated with greater periodontal destruction. Journal of periodontology 76134137Oettinger-Barak O, Barak S, Ohel G, Oettinger M, Kreutzer H, Peled M, Machtei EE. 2005. Severe pregnancy complication (preeclampsia) is associated with greater periodontal destruction. Journal of periodontology 76:134-137.
  88. 88. Oettinger-barakOMachteiE. EOferB. IBarakSPeledM2006Pregnancy tumor occurring twice in the same individual: report of a case and hormone receptors study. Quintessence international (Berlin, Germany : 1985) 37:213-218.Oettinger-Barak O, Machtei EE, Ofer BI, Barak S, Peled M. 2006. Pregnancy tumor occurring twice in the same individual: report of a case and hormone receptors study. Quintessence international (Berlin, Germany : 1985) 37:213-218.
  89. 89. OffenbacherSBeckJ. DJaredH. LMaurielloS. MMendozaL. CCouperD. JStewartD. DMurthaA. PCochranD. LDudleyD. JReddyM. SGeursN. CHauthJ. CMaternal Oral Therapy to Reduce Obstetric Risk I. 2009Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstetrics and gynecology 114551559Offenbacher S, Beck JD, Jared HL, Mauriello SM, Mendoza LC, Couper DJ, Stewart DD, Murtha AP, Cochran DL, Dudley DJ, Reddy MS, Geurs NC, Hauth JC, Maternal Oral Therapy to Reduce Obstetric Risk I. 2009. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstetrics and gynecology 114:551-559.
  90. 90. OffenbacherSKatzVFertikGCollinsJBoydDMaynorGMckaigRBeckJ1996Periodontal infection as a possible risk factor for preterm low birth weight. Journal of periodontology 6711031113Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J. 1996. Periodontal infection as a possible risk factor for preterm low birth weight. Journal of periodontology 67:1103-1113.
  91. 91. OffenbacherSLieffSBoggessK. AMurthaA. PMadianosP. NChampagneC. MMckaigR. GJaredH. LMaurielloS. MAutenR. LJr., Herbert WN, Beck JD. 2001Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction. Annals of periodontology / the American Academy of Periodontology 6164174Offenbacher S, Lieff S, Boggess KA, Murtha AP, Madianos PN, Champagne CM, McKaig RG, Jared HL, Mauriello SM, Auten RL, Jr., Herbert WN, Beck JD. 2001. Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction. Annals of periodontology / the American Academy of Periodontology 6:164-174.
  92. 92. OffenbacherSLinDStraussRMckaigRIrvingJBarrosS. PMossKBarrowD. AHeftiABeckJ. D2006Effects of periodontal therapy during pregnancy on periodontal status, biologic parameters, and pregnancy outcomes: a pilot study. Journal of periodontology 7720112024Offenbacher S, Lin D, Strauss R, McKaig R, Irving J, Barros SP, Moss K, Barrow DA, Hefti A, Beck JD. 2006. Effects of periodontal therapy during pregnancy on periodontal status, biologic parameters, and pregnancy outcomes: a pilot study. Journal of periodontology 77:2011-2024.
  93. 93. PageR. CKornmanK. S1997The pathogenesis of human periodontitis: an introduction. Periodontology 2000149Page RC, Kornman KS. 1997. The pathogenesis of human periodontitis: an introduction. Periodontology 2000 14:9-11.
  94. 94. PitiphatWJoshipuraK. JGillmanM. WWilliamsP. LDouglassC. WRich-edwardsJ. W2008Maternal periodontitis and adverse pregnancy outcomes. Community dentistry and oral epidemiology 36311Pitiphat W, Joshipura KJ, Gillman MW, Williams PL, Douglass CW, Rich-Edwards JW. 2008. Maternal periodontitis and adverse pregnancy outcomes. Community dentistry and oral epidemiology 36:3-11.
  95. 95. PolitanoG. TPassiniRNomuraM. LVellosoLMorariJCoutoE2011Correlation between periodontal disease, inflammatory alterations and pre-eclampsia. Journal of periodontal research 46505511Politano GT, Passini R, Nomura ML, Velloso L, Morari J, Couto E. 2011. Correlation between periodontal disease, inflammatory alterations and pre-eclampsia. Journal of periodontal research 46:505-511.
  96. 96. PolyzosN. PPolyzosI. PMauriDTziorasSTsappiMCortinovisICasazzaG2009Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a metaanalysis of randomized trials. American journal of obstetrics and gynecology 200225232Polyzos NP, Polyzos IP, Mauri D, Tzioras S, Tsappi M, Cortinovis I, Casazza G. 2009. Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a metaanalysis of randomized trials. American journal of obstetrics and gynecology 200:225-232.
  97. 97. PolyzosN. PPolyzosI. PZavosAValachisAMauriDPapanikolaouE. GTziorasSWeberDMessinisI. E2010Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. Bmj 341:c7017.Polyzos NP, Polyzos IP, Zavos A, Valachis A, Mauri D, Papanikolaou EG, Tzioras S, Weber D, Messinis IE. 2010. Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. Bmj 341:c7017.
  98. 98. RadnaiMGorzoINagyEUrbanENovakTPalA2004A possible association between preterm birth and early periodontitis. A pilot study. Journal of clinical periodontology 31736741Radnai M, Gorzo I, Nagy E, Urban E, Novak T, Pal A. 2004. A possible association between preterm birth and early periodontitis. A pilot study. Journal of clinical periodontology 31:736-741.
  99. 99. RadnaiMGorzoIUrbanEEllerJNovakTPalA2006Possible association between mother’s periodontal status and preterm delivery. Journal of clinical periodontology 33791796Radnai M, Gorzo I, Urban E, Eller J, Novak T, Pal A. 2006. Possible association between mother's periodontal status and preterm delivery. Journal of clinical periodontology 33:791-796.
  100. 100. RajapakseP. SNagarathneMChandrasekraK. BDasanayakeA. P2005Periodontal disease and prematurity among non-smoking Sri Lankan women. Journal of dental research 84274277Rajapakse PS, Nagarathne M, Chandrasekra KB, Dasanayake AP. 2005. Periodontal disease and prematurity among non-smoking Sri Lankan women. Journal of dental research 84:274-277.
  101. 101. Ramos-gomezF. JWeintraubJ. AGanskyS. AHooverC. IFeatherstoneJ. D2002Bacterial, behavioral and environmental factors associated with early childhood caries. The Journal of clinical pediatric dentistry 26165173Ramos-Gomez FJ, Weintraub JA, Gansky SA, Hoover CI, Featherstone JD. 2002. Bacterial, behavioral and environmental factors associated with early childhood caries. The Journal of clinical pediatric dentistry 26:165-173.
  102. 102. RobertsJ. MPearsonGCutlerJLindheimerMPregnancy NWGoRoHD. 2003Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 41437445Roberts JM, Pearson G, Cutler J, Lindheimer M, Pregnancy NWGoRoHD. 2003. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 41:437-445.
  103. 103. RomeroB. CChiquitoC. SElejaldeL. EBernardoniC. B2002Relationship between periodontal disease in pregnant women and the nutritional condition of their newborns. Journal of periodontology 7311771183Romero BC, Chiquito CS, Elejalde LE, Bernardoni CB. 2002. Relationship between periodontal disease in pregnant women and the nutritional condition of their newborns. Journal of periodontology 73:1177-1183.
  104. 104. RomeroREspinozaJGoncalvesL. FKusanovicJ. PFrielL. ANienJ. K2006Inflammation in preterm and term labour and delivery. Seminars in fetal & neonatal medicine 11317326Romero R, Espinoza J, Goncalves LF, Kusanovic JP, Friel LA, Nien JK. 2006. Inflammation in preterm and term labour and delivery. Seminars in fetal & neonatal medicine 11:317-326.
  105. 105. RomeroRMazorMSepulvedaWAvilaCCopelandDWilliamsJ1992Tumor necrosis factor in preterm and term labor. American journal of obstetrics and gynecology 16615761587Romero R, Mazor M, Sepulveda W, Avila C, Copeland D, Williams J. 1992. Tumor necrosis factor in preterm and term labor. American journal of obstetrics and gynecology 166:1576-1587.
  106. 106. SadatmansouriSSedighpoorNAghalooM2006Effects of periodontal treatment phase I on birth term and birth weight. Journal of the Indian Society of Pedodontics and Preventive Dentistry 242326Sadatmansouri S, Sedighpoor N, Aghaloo M. 2006. Effects of periodontal treatment phase I on birth term and birth weight. Journal of the Indian Society of Pedodontics and Preventive Dentistry 24:23-26.
  107. 107. Santa Cruz IHerrera D, Martin C, Herrero A, Sanz M. 2013Association between periodontal status and pre-term and/or low-birth weight in Spain: clinical and microbiological parameters. Journal of periodontal research 48443451Santa Cruz I, Herrera D, Martin C, Herrero A, Sanz M. 2013. Association between periodontal status and pre-term and/or low-birth weight in Spain: clinical and microbiological parameters. Journal of periodontal research 48:443-451.
  108. 108. Santos-pereiraS. AGiraldoP. CSaba-chujfiEAmaralR. LMoraisS. SFachiniA. MGoncalvesA. K2007Chronic periodontitis and pre-term labour in Brazilian pregnant women: an association to be analysed. Journal of clinical periodontology 34208213Santos-Pereira SA, Giraldo PC, Saba-Chujfi E, Amaral RL, Morais SS, Fachini AM, Goncalves AK. 2007. Chronic periodontitis and pre-term labour in Brazilian pregnant women: an association to be analysed. Journal of clinical periodontology 34:208-213.
  109. 109. SanzMKornmanKWorking group 3 of joint EFPAAPw. 2013Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of clinical periodontology 40 Suppl 14:S164169Sanz M, Kornman K, Working group 3 of joint EFPAAPw. 2013. Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of clinical periodontology 40 Suppl 14:S164-169.
  110. 110. SembeneMMoreauJ. CMbayeM. MDialloADialloP. DNgomMBenoistH. M2000Periodontal infection in pregnant women and low birth weight babies]. Odontostomatol Trop 231922Sembene M, Moreau JC, Mbaye MM, Diallo A, Diallo PD, Ngom M, Benoist HM. 2000. [Periodontal infection in pregnant women and low birth weight babies]. Odontostomatol Trop 23:19-22.
  111. 111. SharmaRMaimanukuL. RMorseZPackA. R2007Preterm low birth weights associated with periodontal disease in the Fiji Islands. International dental journal 57257260Sharma R, Maimanuku LR, Morse Z, Pack AR. 2007. Preterm low birth weights associated with periodontal disease in the Fiji Islands. International dental journal 57:257-260.
  112. 112. ShettyMShettyP. KRameshAThomasBPrabhuSRaoA2010Periodontal disease in pregnancy is a risk factor for preeclampsia. Acta obstetricia et gynecologica Scandinavica 89718721Shetty M, Shetty PK, Ramesh A, Thomas B, Prabhu S, Rao A. 2010. Periodontal disease in pregnancy is a risk factor for preeclampsia. Acta obstetricia et gynecologica Scandinavica 89:718-721.
  113. 113. SiqueiraF. MCotaL. OCostaJ. EHaddadJ. PLanaA. MCostaF. O2008Maternal periodontitis as a potential risk variable for preeclampsia: a case-control study. Journal of periodontology 79207215Siqueira FM, Cota LO, Costa JE, Haddad JP, Lana AM, Costa FO. 2008. Maternal periodontitis as a potential risk variable for preeclampsia: a case-control study. Journal of periodontology 79:207-215.
  114. 114. SkuldbolTJohansenK. HDahlenGStoltzeKHolmstrupP2006Is pre-term labour associated with periodontitis in a Danish maternity ward? Journal of clinical periodontology 33177183Skuldbol T, Johansen KH, Dahlen G, Stoltze K, Holmstrup P. 2006. Is pre-term labour associated with periodontitis in a Danish maternity ward? Journal of clinical periodontology 33:177-183.
  115. 115. SoderlingEIsokangasPPienihakkinenKTenovuoJAlanenP2001Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries research 35173177Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J, Alanen P. 2001. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries research 35:173-177.
  116. 116. SrinivasS. KSammelM. DStamilioD. MClothierBJeffcoatM. KParrySMaconesG. AElovitzM. AMetlayJ2009Periodontal disease and adverse pregnancy outcomes: is there an association? American journal of obstetrics and gynecology 200:497 e491498Srinivas SK, Sammel MD, Stamilio DM, Clothier B, Jeffcoat MK, Parry S, Macones GA, Elovitz MA, Metlay J. 2009. Periodontal disease and adverse pregnancy outcomes: is there an association? American journal of obstetrics and gynecology 200:497 e491-498.
  117. 117. SrivastavaAGuptaK. KSrivastavaSGargJ2013Massive pregnancy gingival enlargement: A rare case. Journal of Indian Society of Periodontology 17503506Srivastava A, Gupta KK, Srivastava S, Garg J. 2013. Massive pregnancy gingival enlargement: A rare case. Journal of Indian Society of Periodontology 17:503-506.
  118. 118. TaghzoutiNXiongXGornitskyMChandadFVoyerRGagnonGLeducLXuHTulandiTWeiBSenecalJVellyA. MSalahM. HFraserW. D2012Periodontal disease is not associated with preeclampsia in Canadian pregnant women. Journal of periodontology 83871877Taghzouti N, Xiong X, Gornitsky M, Chandad F, Voyer R, Gagnon G, Leduc L, Xu H, Tulandi T, Wei B, Senecal J, Velly AM, Salah MH, Fraser WD. 2012. Periodontal disease is not associated with preeclampsia in Canadian pregnant women. Journal of periodontology 83:871-877.
  119. 119. TannerA. CMilgromP. MKentRJr., Mokeem SA, Page RC, Riedy CA, Weinstein P, Bruss J. 2002The microbiota of young children from tooth and tongue samples. Journal of dental research 815357Tanner AC, Milgrom PM, Kent R, Jr., Mokeem SA, Page RC, Riedy CA, Weinstein P, Bruss J. 2002. The microbiota of young children from tooth and tongue samples. Journal of dental research 81:53-57.
  120. 120. TarannumFFaizuddinM2007Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis. Journal of periodontology 7820952103Tarannum F, Faizuddin M. 2007. Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis. Journal of periodontology 78:2095-2103.
  121. 121. ToygarH. USeydaogluGKurkluSGuzeldemirEArpakN2007Periodontal health and adverse pregnancy outcome in 3,576 Turkish women. Journal of periodontology 7820812094Toygar HU, Seydaoglu G, Kurklu S, Guzeldemir E, Arpak N. 2007. Periodontal health and adverse pregnancy outcome in 3,576 Turkish women. Journal of periodontology 78:2081-2094.
  122. 122. TrindadeS. CGomes-filhoI. SMeyerR. JValeV. CPuglieseLFreireS. M2008Serum antibody levels against Porphyromonas gingivalis extract and its chromatographic fraction in chronic and aggressive periodontitis. Journal of the International Academy of Periodontology 105058Trindade SC, Gomes-Filho IS, Meyer RJ, Vale VC, Pugliese L, Freire SM. 2008. Serum antibody levels against Porphyromonas gingivalis extract and its chromatographic fraction in chronic and aggressive periodontitis. Journal of the International Academy of Periodontology 10:50-58.
  123. 123. VergnesJ. NSixouM2007Preterm low birth weight and maternal periodontal status: a meta-analysis. American journal of obstetrics and gynecology 196:135 e131137Vergnes JN, Sixou M. 2007. Preterm low birth weight and maternal periodontal status: a meta-analysis. American journal of obstetrics and gynecology 196:135 e131-137.
  124. 124. VerkerkP. HVan Noord-zaadstraB. MFloreyC. DDe JongeG. AVerloove-vanhorickS. P1993The effect of moderate maternal alcohol consumption on birth weight and gestational age in a low risk population. Early human development 32121129Verkerk PH, van Noord-Zaadstra BM, Florey CD, de Jonge GA, Verloove-Vanhorick SP. 1993. The effect of moderate maternal alcohol consumption on birth weight and gestational age in a low risk population. Early human development 32:121-129.
  125. 125. VettoreM. VLealMLeaoA. Tda Silva AM, Lamarca GA, Sheiham A. 2008The relationship between periodontitis and preterm low birthweight. Journal of dental research 877378Vettore MV, Leal M, Leao AT, da Silva AM, Lamarca GA, Sheiham A. 2008. The relationship between periodontitis and preterm low birthweight. Journal of dental research 87:73-78.
  126. 126. WanA. KSeowW. KWalshL. JBirdPTudehopeD. LPurdieD. M2001Association of Streptococcus mutans infection and oral developmental nodules in pre-dentate infants. Journal of dental research 8019451948http://en.wikipedia.org/wiki/Vaccine
  127. 127. WangYSugitaNKikuchiAIwanagaRHiranoEShimadaYSasaharaJTanakaKYoshieH2012FcgammaRIIB-nt645+25A/G gene polymorphism and periodontitis in Japanese women with preeclampsia. International journal of immunogenetics 39492500Wang Y, Sugita N, Kikuchi A, Iwanaga R, Hirano E, Shimada Y, Sasahara J, Tanaka K, Yoshie H. 2012. FcgammaRIIB-nt645+25A/G gene polymorphism and periodontitis in Japanese women with preeclampsia. International journal of immunogenetics 39:492-500.
  128. 128. WHO1984The incidence of low birth weight: an update. World Health Organisation Wkly Epidemiol Rec 59205211WHO. 1984. The incidence of low birth weight: an update. World Health Organisation Wkly Epidemiol Rec 59:205-211.
  129. 129. WilliamsC. EDavenportE. SSterneJ. ASivapathasundaramVFearneJ. MCurtisM. A2000Mechanisms of risk in preterm low-birthweight infants. Periodontology 200023142Williams CE, Davenport ES, Sterne JA, Sivapathasundaram V, Fearne JM, Curtis MA. 2000. Mechanisms of risk in preterm low-birthweight infants. Periodontology 2000 23:142-150.
  130. 130. WinklerMFischerD. CHlubekMvan de Leur E, Haubeck HD, Rath W. 1998Interleukin-1beta and interleukin-8 concentrations in the lower uterine segment during parturition at term. Obstetrics and gynecology 91945949Winkler M, Fischer DC, Hlubek M, van de Leur E, Haubeck HD, Rath W. 1998. Interleukin-1beta and interleukin-8 concentrations in the lower uterine segment during parturition at term. Obstetrics and gynecology 91:945-949.
  131. 131. WoodSFrydmanACoxSBrantRNeedobaSEleyBSauveR2006Periodontal disease and spontaneous preterm birth: a case control study. BMC pregnancy and childbirth 6:24.Wood S, Frydman A, Cox S, Brant R, Needoba S, Eley B, Sauve R. 2006. Periodontal disease and spontaneous preterm birth: a case control study. BMC pregnancy and childbirth 6:24.
  132. 132. WrightH. JMatthewsJ. BChappleI. LLing-mountfordNCooperP. R2008Periodontitis associates with a type 1 IFN signature in peripheral blood neutrophils. Journal of immunology 18157755784Wright HJ, Matthews JB, Chapple IL, Ling-Mountford N, Cooper PR. 2008. Periodontitis associates with a type 1 IFN signature in peripheral blood neutrophils. Journal of immunology 181:5775-5784.
  133. 133. XiongXBuekensPFraserW. DBeckJOffenbacherS2006Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG : an international journal of obstetrics and gynaecology 113135143Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. 2006. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG : an international journal of obstetrics and gynaecology 113:135-143.
  134. 134. XiongXBuekensPVastardisSYuS. M2007Periodontal disease and pregnancy outcomes: state-of-the-science. Obstetrical & gynecological survey 62605615Xiong X, Buekens P, Vastardis S, Yu SM. 2007. Periodontal disease and pregnancy outcomes: state-of-the-science. Obstetrical & gynecological survey 62:605-615.

Written By

Sukumaran Anil, Raed M. Alrowis, Elna P. Chalisserry, Vemina P. Chalissery, Hani S. AlMoharib and Asala F. Al-Sulaimani

Published: 11 March 2015