Periodontal Therapy During Pregnancy and Preterm Births: A Meta-Analysis

Objectives: To determine during a high risk pregnancy the effectiveness of scaling and root planning on the reduction of the incidence of preterm births.
Methods: Study selection inclusionary criteria described pregnant women, randomized clinical trials, periodontal diseases, treatment of root planning and scaling, and preterm births (<28 weeks of gestation, and random sampling. The effect size was measured in risk ratios. Search strategy included dates from January 1, 1988 to October 31, 2013. The electronic databases were Medline, EMBASE, and Cochrane library. Ten clinical trials in English were identified with 6,782 patients who received nonsurgical treatments of scaling and root planning. Keywords were preterm births, periodontal disease, pregnancy, clinical trials, and scaling and root planning. Data extraction determined quality of the study with a Jadad scale and a funnel plot to assess publication bias. Statistical analysis was performed with Comprehensive Meta-analysis, Version II computer software. Heterogeneity was detected with the fixed effect model for Z-value, -2.158 (p<0.031), Cochran Q-test, 26.95 (p<0.001), I-squared test, 66.604 and the Tau Squared, 0.88. The random effect model determined the Z-value,
-1.518 (p<0.129).
Results: The selection process revealed publication bias in the identified studies. The quality of the several publications was threatened by their internal validity. Subject allocations to experimental and control groups for periodontal treatment was not explicitly disclosed. There was no statistical significant association between periodontal therapy and preterm births. A summary statistic for preterm births ascertained the random effect models for a pooled point estimate at 0.827 (0.647-1.057) and fixed effect model at 0.872 (0.770-0.988). Future research should be performed on the impact of periodontal therapy, oral hygiene instruction and chlorhexidine on preterm births at the beginning of each pregnancy. Preterm births should be measured as risk ratios.
Conclusions:
Periodontal therapy was not effective in reducing preterm births during pregnancies.

Future research should explore the effectiveness of reducing preterm births with oral health promotion, chlorhexidine, and scaling and root planning at the beginning of the pregnancy on preterm births.