Sanz Mariano, Kornman Kenneth
Facultad de Odontologia, Universidad Complutense de Madrid, Ciudad Universitaria, Madrid, Spain.
J Periodontol. 2013 Apr;84(4 Suppl):S164-9. doi: 10.1902/jop.2013.1340016.
Pregnancy sometimes has adverse outcomes including low birthweight (<2500 g), pre-term birth (<37 weeks), growth restriction, pre-eclampsia, miscarriage and/or stillbirth. Maternal periodontitis directly and/or indirectly have potential to influence the health of the foetal-maternal unit.
To assess the epidemiological evidence for the impact of periodontal disease on adverse pregnancy outcomes and to identify potential underpinning mechanisms.
Low birthweight, pre-term birth and pre-eclampsia have been associated with maternal periodontitis exposure. However, the strength of the observed associations is modest and seems to vary according to the population studied, the means of periodontal assessment and the periodontal disease classification employed.
Two major pathways have been identified, One direct, in which oral microorganisms and/or their components reach the foetal-placental unit and one indirect, in which Inflammatory mediators circulate and impact the foetal-placental unit.
Although periodontal therapy has been shown to be safe and leads to improved periodontal conditions in pregnant women, case-related periodontal therapy, with or without systemic antibiotics does not reduce overall rates of pre-term birth and low birthweight.
Given the current evidence, various treatment strategies could be evaluated that consider specific target populations, as well as timing and intensity of treatment.
妊娠有时会出现不良结局，包括低出生体重（<2500克）、早产（<37周）、生长受限、先兆子痫、流产和/或死产。母体牙周炎直接和/或间接有可能影响胎儿-母体单位的健康。
评估牙周疾病对不良妊娠结局影响的流行病学证据，并确定潜在的基础机制。
低出生体重、早产和先兆子痫与母体暴露于牙周炎有关。然而，观察到的关联强度适中，且似乎因所研究的人群、牙周评估方法和所采用的牙周疾病分类而异。
已确定两条主要途径，一条是直接途径，即口腔微生物和/或其成分到达胎儿-胎盘单位；另一条是间接途径，即炎症介质循环并影响胎儿-胎盘单位。
尽管牙周治疗已被证明是安全的，且能改善孕妇的牙周状况，但无论是否使用全身抗生素，与病例相关的牙周治疗并不能降低早产和低出生体重的总体发生率。
鉴于目前的证据，可以评估各种治疗策略，这些策略要考虑特定的目标人群以及治疗的时机和强度。
