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Pathogenic Mechanisms Linking Periodontal Diseases With Adverse Pregnancy Outcomes

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Abstract

In the last 2 decades, a large proportion of studies have focused on the relationship between maternal periodontal disease and poor obstetric outcomes. The aim of the present review is to summarize the current knowledge about human studies on the pathogenetic mechanisms linking periodontal diseases with adverse pregnancy outcomes. A search of the medical literature was conducted using NIH (National Institute of Health) Pubmed through April 2011. Articles were identified with the Medical Subject Heading (MeSH) and free text terms “small for gestational age (SGA),” “preeclampsia,” “preterm labor,” and “periodontal disease.” Experimental human studies have shown that periodontal pathogens may disseminate toward placental and fetal tissues accompanied by an increase in inflammatory mediators in the placenta. As such, new inflammatory reactions within the placental tissues of the pregnant woman may occur, the physiological levels of prostaglandin E2 (PGE2) and tumor necrosis factor-α (TNF-α) in the amniotic fluid may increase and eventually lead to premature delivery. Although many data from clinical trials suggest that periodontal disease may increase the adverse pregnancy outcome, the exact pathogenetic mechanism involved remains controversial. The findings explain the potential link between periodontal infections and adverse pregnancy outcomes. First, periodontal bacteria can directly cause infections both of the uteroplacenta and the fetus; second, systemic inflammatory changes induced by periodontal diseases can activate responses at the maternal–fetal interface. Of note, associative studies have produced different results in different population groups and no conclusive evidence has still been produced for the potential role of preventive periodontal care to reduce the risk factors of preterm birth.

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  1. Unit of Obstetrics and Gynecology, Department of Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy

    I. Cetin MD, P. Pileri MD & S. Calabrese MD

  2. Dental Clinic, Department of Medicine, Surgery and Dentistry, University of Milano and WHO Collaborating Centre of Milan for Epidemiology and Community Dentistry, Milano, Italy

    A. Villa DDS, MPH & S. Abati MD

  3. Preventive and Community Dentistry, Department of Oral Sciences, University of Rome “La Sapienza”, Roma, Italy

    L. Ottolenghi MD

  4. Ostetricia e Ginecologia, Ospedale Luigi Sacco, Via G.B. Grassi 74, 20157, Milano, Italy

    I. Cetin MD

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Cetin, I., Pileri, P., Villa, A. et al. Pathogenic Mechanisms Linking Periodontal Diseases With Adverse Pregnancy Outcomes. Reprod. Sci. 19, 633–641 (2012). https://doi.org/10.1177/1933719111432871

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