July 20, 2011 (Stockholm, Sweden) — There is a significant association between having untreated periodontal disease (PD) and experiencing a prolonged time to conception (TTC), new research has confirmed.
"We strongly suggest that women considering starting a family should visit their dentist, along with taking other lifestyle measures such as reducing weight, eating healthily, stopping smoking, reducing alcohol consumption, and taking folic acid," said lead investigator Roger Hart, MD, professor of reproductive medicine in the School of Women's and Infants Health at the University of Western Australia, Perth, who presented the results here at the European Society of Human Reproduction and Embryology's 2011 annual meeting.
Dr. Hart and several coinvestigators carried out the SMILE trial, a controlled trial of PD treatment in midpregnancy, which involved 7 sites in Perth. The women in the study were carrying singleton pregnancies and were between 12 and 20 weeks' gestation. Each woman recruited into the study was screened by 1 of 5 hygienists or periodontists, using the Community Periodontal Index of Treatment Needs. PD was defined as having periodontal pockets with a depth of at least 4 mm at 12 or more probing sites in fully erupted teeth. The subjects also completed a questionnaire on demographic, dental, and medical aspects of their health.
The results were reported in the December 2009 issue of Obstetrics & Gynecology. No significant improvement in pregnancy outcome in treated women was found, even though there were 4 stillbirths among women with untreated PD and no stillbirths among those whose PD was treated. This lack of difference in outcome was confirmed in a subsequent meta-analysis published in December 2010 in BMJ.
Dr. Hart and colleagues then launched an in-depth retrospective analysis of TTC data among 3737 pregnant women in the SMILE study, 3576 of whom had pregnancy planning and outcomes data. The investigators excluded 160 women who had used fertility treatment, yielding a study population of 3416 women.
Information on miscarriage was not available, and there was no information on TTC in more than one third of the patients.
Of the participants, 1014 (26.4%) had untreated PD. PD was present in 23.8% of white subjects and in 41.4% of nonwhite subjects.
The mean TTC among women who did not have PD was 5.0 months (confidence interval [CI], 4.4 - 5.5,); it was 7.1 months (CI, 5.7 - 8.6) among women with documented PD. This difference is statistically significant (P = .019).
Using multivariate analysis, Dr. Hart's team discovered that maternal factors associated with having a TTC of more than 1 year were age older than 35 years, being nonwhite, having a body mass index of at least 25 kg/m2, smoking during pregnancy, and (among nonwhites only) having documented PD (all P ≤ .011).
Leandro Chambrone, DDS, MSc, a specialist in orthodontics and dentofacial orthopedics from the School of Dentistry, University of São Paulo, Brazil, and a member of the Cochrane Collaboration's Oral Health Group, told Medscape Medical News he "strongly" agrees with Dr. Hart's suggestion that women have regular dental visits before and after conceiving.
However, he noted that Dr. Hart's study has the inherent limitations associated with retrospective analyses. In addition, the use of the Community Periodontal Index of Treatment Needs "is not the most adequate for a complete periodontal examination," said Dr. Chambrone, who was not a participant in the study.
The trial was supported by the National Health and Medical Research Council in Australia, Women and Infants Research Foundation of Western Australia, and the Channel 7 Telethon of Western Australia. Funds also were provided by Colgate-Palmolive to supplement the salaries of the dental hygienists. Furthermore, Oral B provided oral healthcare products that were given to the women at the time of treatment. Dr. Hart is a shareholder of Western IVF Pty Ltd, a member of the Fertility Advisory Boards of MerckSerono and MSD, and has received sponsorships to attend meetings from MerckSerono and MSD. Dr. Chambrone has disclosed no relevant financial relationships.
European Society of Human Reproduction and Embryology 27th Annual Meeting: Abstract O-177. Presented July 5, 2011.
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