ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Periodontal Therapy Does Not Reduce Adverse Pregnancy Outcomes
Clinical Question In pregnant women with periodontal disease, what is the effect of periodontal therapy on reducing risk of adverse pregnancy outcomes?
Clinical Bottom Line For pregnant women with periodontal disease, periodontal therapy does not reduce adverse pregnancy outcomes.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21190966Polyzos/20106558 women in 11 trialsMeta-Analysis
Key resultsThe included studies were determined to be of methodological high or low quality based on Cochrane’s risk of bias tool. Low-quality studies showed that periodontal therapy has a significant effect on adverse pregnancy outcomes (odds radio 0.55, 0.41 to 0.73; P<0.0001), but high-quality studies showed that treatment has no significant effect (odds ratio 1.09, 0.91 to 1.1.30; P=0.34)
Evidence Search Search terms: periodont* and pregnan*
Comments on
The Evidence
Validity: This is a meta-analysis of 11 randomized controlled trials. A thorough and comprehensive search by two independent investigators was done through the Cochrane Central Trials Registry, ISI Web of Science, and Medline, and was confirmed by a third investigator. The authors did additional cross searches and hand searches against two dental journals. Since this paper was published in 2010, searches were done on current publications up to July 2010. The selected studies were assessed for bias and methodological quality using Cochrane’s risk of bias tool. The findings of this unique assessment demonstrated clearly the potential for bias to contribute to the positive findings seen in many studies. For example, CATs 2704 and 2113 both evaluated systematic reviews that did not calculate bias into their associations. The lack of association seen in higher-quality studies reinforces the spurious nature of previous reports.
Applicability This is applicable to periodontists and general dentists who may treat pregnant patients in their practice. Pregnant patients should be encouraged to accept periodontal therapy to maintain oral hygiene but told not to expect reduction in risks of adverse pregnancy outcomes.
Specialty/Discipline (Periodontics)
Keywords Periodontitis, periodontal disease, pregnancy, adverse pregnancy outcomes, preterm birth, low birthweight, spontaneous abortion, stillbirth
ID# 2867
Date of submission: 04/10/2015spacer
E-mail ton@livemail.uthscsa.edu
Author Ai Ton
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail Oates@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Thomas Oates (San Antonio, TX) on 10/06/2015
Similar to Polyzos, Schwendicke 2015 (PMID 26035835) also demonstrated an effect of study design on LBW outcomes, with higher quality studies (lower risk of bias) not identifying a treatment effect, in contrast to lower quality studies.
by John P. Hatch, PhD (San Antonio, Texas) on 10/06/2015
A more recent meta-analysis (Rosa 2012; PMID 23090163) supports the conclusion of this CAT that the risks of adverse pregnancy outcomes are not reduced by SRP. Two recent analyses of the same data (Kim 2012, PMID 22376207; Schwendicke 2015, PMID 26035835) used subgroups analysis and reported a possible benefit only for women at high risk of adverse pregnancy outcomes. Results based on subgroups analysis should be noted cautiously.
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