Resende Marta, Pinto Elisabete, Pinto Miguel, Montenegro Nuno
Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:419-30. Epub 2011 Dec 31.
Preterm delivery is associated with high mortality and morbility perinatal, being the costs dispended by the family and the National Health System with preterm newborns extremely high. However, it has been difficult to reduce its incidence due to the various factors involved. There is scientific evidence which support the relationship between periodontal disease and preterm delivery. There is also evidence of tobacco as a risk factor for periodontal disease, even though the relationship with preterm delivery is not yet clear. The aims of our study were to evaluate, in women in a post-partum period, dental and periodontal status as well as the exposure to tobacco and to establish the relationship between these two factors with preterm delivery. We performed a case control study with 237 parturient women from the Department of Obstetrics and Gynecology of Hospital S. João, E.P.E., during the first 48 hours after birth. A total of 86 gave birth at a gestational age under 37 weeks (case group ) and 151 gave birth to term newborns with birthweight equal or superior 2500 g (control group). The prevalence of some indicators of periodontal disease in the studied population was extremely high, namely gingival inflammation and gingival recession, and more of 30% had values of probing depth equal or higher than 4 mm significantly. Based on these periodontal indicators, only the presence of recession in more than two teeth seems to increase the risk of preterm delivery in fivefold (OR = 5,28; IC95%: 1,63-17,04). There is a statistically significant association between probing depth equal or higher than 4mm and smoking during pregnancy. This association might be relevant because 20% of preterm newborns mothers smoked during pregnancy and the proportion that stopped smoking during pregnancy in this group of mothers was almost half of the number of the control group. Therefore it is necessary to embody the information about this thematic in the health education, not only in pregnant women but in the general population, alerting for the smoking influence in periodontal disease, in pregnant women and in newborns. Interventions to help pregnant women to stop smoking should be included, not only in prenatal care guidelines used in hospitals, but also by dental medicine providers.
早产与围产期的高死亡率和发病率相关，家庭和国家卫生系统为早产新生儿支出的费用极高。然而，由于涉及多种因素，一直难以降低其发生率。有科学证据支持牙周病与早产之间的关系。也有证据表明烟草是牙周病的一个风险因素，尽管其与早产的关系尚不清楚。我们研究的目的是评估产后妇女的牙齿和牙周状况以及烟草暴露情况，并确定这两个因素与早产之间的关系。我们对圣若昂医院妇产科的237名产妇在分娩后的头48小时内进行了一项病例对照研究。共有86名产妇在孕龄37周以下分娩（病例组），151名产妇分娩足月新生儿，出生体重等于或超过2500克（对照组）。研究人群中一些牙周病指标的患病率极高，即牙龈炎症和牙龈退缩，超过30%的人探诊深度值等于或高于4毫米，具有显著差异。基于这些牙周指标，只有两颗以上牙齿出现退缩似乎会使早产风险增加五倍（比值比=5.28；95%置信区间：1.63 - 17.04）。孕期吸烟与探诊深度等于或高于4毫米之间存在统计学上的显著关联。这种关联可能很重要，因为20%的早产新生儿母亲在孕期吸烟，而该组母亲中孕期戒烟的比例几乎是对照组的一半。因此，有必要在健康教育中纳入关于这一主题的信息，不仅针对孕妇，也针对普通人群，提醒人们注意吸烟对牙周病、孕妇和新生儿的影响。不仅在医院使用的产前护理指南中，而且在牙科医疗服务提供者中，都应纳入帮助孕妇戒烟的干预措施。
