Sha Yue-qin, Huang Zhen, Chen Zhi-bin, Kang Jun, He Lu, Yu Xiao-qian
Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2009 Feb 18;41(1):117-20.
There were increasing studies on the association of periodontitis with preterm low birth weight (PLBW) in the recent 10 years. PLBW is associated with about half of all perinatal mortality. Known factors which could induce PLBW include smoking, genetics, alcohol, prenatal care, nutrition, urinary tract infections, However, there are still about 25% of PLBW cases occur with etiology unknown. Many evidences supported the association between periodontitis and PLBW. Periodontitis is a risk factor of PLBW, but the mechanism is unclear. Current theory suggests that periodontal inflammation adversely affects pregnancy outcomes by one or two mechanisms. First, women with periodontal disease may experience more frequent and severe bacteremia than periodontally healthy women. As a result, the uterine cavity may become exposed to or colonized by periodontal bacteria or their byproducts (e.g. lipopolysaccharides). Once they reach the maternal-fetal unit, oral bacteria may elicit an inflammatory cascade that leads to preterm labor. A second putative mechanism does not require oral bacteria to colonize the uterine cavity. Rather, cytokines generated within the diseased periodontal tissue may enter the systemic circulation and precipitate a similar cascade, again leading to spontaneous preterm labor and birth. Therefore, oral health instruction and periodontal treatment may decrease the infection of periodontal pathogens and reduce the risk of PLBW. For the present, the best advice for a woman who contemplate pregnancy is effective brushing for two times per day and regular periodontal treatment.
近10年来,关于牙周炎与早产低体重(PLBW)之间关联的研究越来越多。PLBW约占所有围产期死亡率的一半。已知可导致PLBW的因素包括吸烟、遗传、酒精、产前护理、营养、尿路感染。然而,仍有大约25%的PLBW病例病因不明。许多证据支持牙周炎与PLBW之间的关联。牙周炎是PLBW的一个危险因素,但其机制尚不清楚。目前的理论认为,牙周炎症通过一种或两种机制对妊娠结局产生不利影响。首先,患有牙周病的女性可能比牙周健康的女性经历更频繁、更严重的菌血症。因此,子宫腔可能会接触到牙周细菌或其副产物(如脂多糖),或被其定植。一旦它们到达母胎单位,口腔细菌可能引发炎症级联反应,导致早产。另一种假定机制并不要求口腔细菌定植于子宫腔。相反,患病牙周组织内产生的细胞因子可能进入体循环并引发类似的级联反应,同样导致自发性早产和分娩。因此,口腔健康指导和牙周治疗可能会减少牙周病原体的感染,并降低PLBW的风险。目前,对于打算怀孕的女性,最好的建议是每天有效刷牙两次并定期进行牙周治疗。