Preterm Births and Periodontitis Does Periodontal Therapy Work?

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Preterm Births and PeriodontitisDoes Periodontal
Therapy Work?

• Marjorie Jeffcoat DMD
• DeanUniversity of Pennsylvania School of Dental
  Medicine

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Periodontitis and Pregnancy
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Why is preterm delivery important

• Major cause of neonatal death
• Causes nearly half of long-term neurologic
  morbidity

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Pre term delivery and low birth weight
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What defines a preterm low birth weight baby

• A baby born during or before the 36th week of
  gestation (one week before full term) and
  weighing less than 2,500 grams (5 pounds,
  8ounces)

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How does low birth weight affect a baby

• Low birth weight babies may face serious health
  problems such as
• Respiratory distress syndrome (RDS)
• Anemia
• Jaundice
• Mental retardation
• Cerebral palsy
• Impaired lung function, sight and hearing
• Intracranial hemorrhage
• Malnutrition
• Congestive heart failure

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What causes low birth weight

• Some of the known causes include
• Prior preterm births
• Cigarette smoking
• Alcohol
• Multi fetal pregnancies
• Mothers medical problems
• An abnormal placenta, uterus or cervix

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Prospective Studies Periodontitis and PTB

• Jeffcoat et al gt3000 patients examined
• 22 weeks
• Periodontal exams
• O.B. exams
• Determine preterm or not preterm after
  delivery

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Other studies

• Literature since 1996
• Must be case control or longitudinal
• Must have appropriate outcomes
• Periodontal exams prepartum
• Range of periodontal disease and PTB
• Appropriate statistics

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Other studies - results

• 11 studies
• 10 studies show an association
• These studies involve 5686 subjects
• 101 subjects in the negative study

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Do case-control and prospective studies provide
convincing evidence that treatment of
periodontitis will reduce the risk of preterm
birth
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Intervention Studies

• Can demonstrate that treating periodontitis
  reduces the risk of preterm birth

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Intervention studies lt37 weeks
N NO RX PTB lt37 weeks RX PTB lt37 weeks
lopez 05 (g) 870 6.7 2.1
lopez 02 (p) 400 10.1 1.8
jeffcoat 03 1,089 13.7 4.0
lancaster PA (personal) 328 10.2 2.2
michalowicz 06 823.0 12.0 12.8
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Intervention studies lt35 weeks
N NO RX PTB lt35 weeks RX PTB lt35 weeks
sadatamanouri 06 30 26.7 0
jeffcoat 03unpublished 1,089 6.4 0.8
michalowicz 06 823.0 6.4 5.4
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GA by treatment group
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GA by treatment groupplt0.05
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Length of stay vs Gestational Age
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Fewer neonatal days with treatment
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Why the differences?

• Very different prevalence of more severe
  periodontal disease
• Very different proportions of African American
  women in different studies
• These issues are important because effect is
  greatest at smaller GA which happen with a lower
  prevalence
• Sample size

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Length of stay vs Gestational Age
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Costs of prematurity

• Hospital Costs
• 15 times the cost of a full term baby
• Full Costs include
• Hospital Costs
• Physicians
• Drugs
• Loss of productivity

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Cost vs Prematurity
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Calculating the effect of Periodontal RX on Cost

• Take into account
• GA
• Scaling and root planing
• Costs for six months for loss of productivity
• Hospitalization for baby and mother
• Physican and other charges
• Drugs

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The results

• In these studies nearly 15 million dollars were
  saved

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Watch for more results and think about the results