Marjorie K. Jeffcoat

Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth.

OBJECTIVE: To estimate the relationship between maternal periodontal disease and both early spontaneous preterm birth and selected markers of upper genital tract inflammation. METHODS: In this case-control study, periodontal assessment was performed in 59 women who experienced an early spontaneous preterm birth at less than 32 weeks of gestation, in a control population of 36 women who experienced an early indicated preterm birth at less than 32 weeks of gestation, and in 44 women with an uncomplicated birth at term (≥ 37 weeks). Periodontal disease was defined by the degree of attachment loss. Cultures of the placenta and umbilical cord blood, cord interleukin-6 levels, and histopathologic examination of the placenta were performed for all women. RESULTS: Severe periodontal disease was more common in the spontaneous preterm birth group (49%) than in the indicated preterm (25%, P = .02) and term control groups (30%, P = .045). Multivariable analyses, controlling for possible confounders, supported the association between severe periodontal disease and spontaneous preterm birth (odds ratio 3.4, 95% confidence interval 1.5–7.7). Neither histologic chorioamnionitis, a positive placental culture, nor an elevated cord plasma interleukin-6 level was significantly associated with periodontal disease (80% power to detect a 50% difference in rate of histological chorioamnionitis, α = 0.05). CONCLUSION: Women with early spontaneous preterm birth were more likely to have severe periodontal disease than women with indicated preterm birth or term birth. Periodontal disease was not associated with selected markers of upper genital tract inflammation. LEVEL OF EVIDENCE: II-2

Radiographic Methods for the Detection of Progressive Alveolar Bone Loss

Intraoral transmission radiographs have been the primary diagnostic method for the assessment of bone support as well as for the detection and measurement of osseous changes due to periodontitis. The purpose of the present paper is three-fold. The first is to review radiographic techniques for the assessment of periodontal disease progression, presenting the strengths and weaknesses of each method while placing special emphasis on digital subtraction radiography. The second purpose is to present data from a recent study that compared the ability of digital subtraction radiography and automated attachment level probing to detect the same active sites. Thirty periodontitis patients and eight control patients were studied over a 6-month period. The results indicate that when these two sensitive methods for the assessment of progressive periodontitis were used there was concordance between the presence or absence of probing attachment loss and bone loss in 82.1% of the sites. The final goal of this paper is to present future directions for the quantitative analysis of digital radiographic images. J Periodontol 1992; 63:367- 372.

Treatment of localized periodontal disease in pregnancy does not reduce the occurrence of preterm birth: results from the Periodontal Infections and Prematurity Study (PIPS)

OBJECTIVE The purpose of this study was to test whether treating periodontal disease (PD) in pregnancy will reduce the incidence of spontaneous preterm delivery (SPTD) at < or = 35 weeks of gestation. STUDY DESIGN A multicenter, randomized clinical trial was performed. Subjects with PD were randomized to scaling and root planing (active) or tooth polishing (control). The primary outcome was the occurrence of SPTD at <35 weeks of gestation. RESULTS We screened 3563 subjects for PD; the prevalence of PD was 50%. Seven hundred fifty-seven subjects were assigned randomly; 378 subjects were assigned to the active group, and 379 subjects were assigned to the placebo group. Active treatment did not reduce the risk of SPTD at <35 weeks of gestation (relative risk, 1.19; 95% confidence interval [CI], 0.62-2.28) or composite neonatal morbidity (relative risk, 1.30; 95% CI, 0.83-2.04). There was a suggestion of an increase in the risk of indicated SPTD at <35 weeks of gestation in those subjects who received active treatment (relative risk, 3.01; 95% CI, 0.95-4.24). CONCLUSION Treating periodontal disease does not reduce the incidence of SPTD.

The Association Between Osteoporosis and Oral Bone Loss

BACKGROUND Osteoporosis and osteopenia are characterized by reductions in bone mass and may lead to skeletal fragility and fracture. The purpose of this paper is to review studies to determine the relationship between oral bone loss and osteoporosis. In addition, the major modes of therapy for osteoporosis are discussed. METHODS In this convenience review, papers studying the possible correlation between oral bone loss and osteoporosis in humans, written in the English language since 1983, were reviewed. RESULTS The methods used to assess oral and systemic bone varied greatly from study to study. Therefore, the results were not amenable to meta-analysis. Thirteen of the 15 studies did show a positive correlation between systemic bone mass and oral bone mass (or bone loss). CONCLUSION Studies to date indicate a possible correlation between systemic and oral bone loss.

Periodontal infection and preterm birth: successful periodontal therapy reduces the risk of preterm birth

Please cite this paper as: Jeffcoat M, Parry S, Sammel M, Clothier B, Catlin A, Macones G. Periodontal infection and preterm birth: successful periodontal therapy reduces the risk of preterm birth. BJOG 2011;118:250–256.

Evidence of a gene-environment interaction that predisposes to spontaneous preterm birth: a role for asymptomatic bacterial vaginosis and DNA variants in genes that control the inflammatory response

OBJECTIVE We determined whether an environmental exposure to bacterial vaginosis (BV) modified genetic susceptibilities for spontaneous preterm delivery within genes that regulate the inflammatory response. STUDY DESIGN Maternal DNA samples and vaginal smears for Gram staining were collected from 743 women (68 preterm births). We used a 1536-single nucleotide polymorphism (SNP) custom chip to study associations between genotype distributions and preterm birth. RESULTS For 8 SNPs in 3 genes (protein kinase C alpha, fms-like tyrosine kinase 1, and interleukin 6), the odds ratios for preterm birth ranged from 1.9-4.0 among women with susceptible genotypes who were BV positive. The odds ratios for preterm birth were 2.0-5.0 times greater among women who were BV positive than among women who were BV negative. The significance of these differences was demonstrated by logistic regression analyses for genotype/BV interaction. CONCLUSION These results demonstrate that the risk of preterm delivery that is associated with tag SNPs in genes that regulate the inflammatory response is modified by an environmental exposure such as bacterial vaginosis.

Impact of Periodontal Therapy on General Health Evidence from Insurance Data for Five Systemic Conditions

BACKGROUND Treatment of periodontal (gum) disease may lessen the adverse consequences of some chronic systemic conditions. PURPOSE To estimate the effects of periodontal therapy on medical costs and hospitalizations among individuals with diagnosed type 2 diabetes (T2D); coronary artery disease (CAD); cerebral vascular disease (CVD); rheumatoid arthritis (RA); and pregnancy in a retrospective observational cohort study. METHODS Insurance claims data from 338,891 individuals with both medical and dental insurance coverage were analyzed in 2011-2013. Inclusion criteria were (1) a diagnosis of at least one of the five specified systemic conditions and (2) evidence of periodontal disease. Subjects were categorized according to whether they had completed treatment for periodontal disease in the baseline year, 2005. Outcomes were (1) total allowed medical costs and (2) number of hospitalizations, per subscriber per year, in 2005-2009. Except in the case of pregnancy, outcomes were aggregated without regard to reported cause. Individuals who were treated and untreated for periodontal disease were compared independently for the two outcomes and five systemic conditions using ANCOVA; age, gender, and T2D status were covariates. RESULTS Statistically significant reductions in both outcomes (p<0.05) were found for T2D, CVD, CAD, and pregnancy, for which costs were lower by 40.2%, 40.9%, 10.7%, and 73.7%, respectively; results for hospital admissions were comparable. No treatment effect was observed in the RA cohorts. CONCLUSIONS These cost-based results provide new, independent, and potentially valuable evidence that simple, noninvasive periodontal therapy may improve health outcomes in pregnancy and other systemic conditions.

Semiautomated image registration for digital subtraction radiography

OBJECTIVE The purpose of this study was to evaluate the semiautomatic alignment and correction of affine geometric discrepancies for digital subtraction radiography. STUDY DESIGN Algorithms were tested in vitro to determine their ability to semiautomatically select reference points on a second image based on points selected on a first (reference) image. A preserved human mandible was imaged with and without bone-equivalent material chips at varying degrees of angulation. Each chip had a mass of less than 10 mg and was no more than 0.3 mm thick. High levels of specificity and sensitivity for chip detection were achieved with 6 degrees of angular discrepancy or less. The algorithms were then applied to radiographs from six human subjects through use of the bone-chip validation model. RESULTS Sensitivity was 89% and 100% for the three-point and four-point affine warp algorithms, respectively. Specificity for both algorithms was 100%. CONCLUSIONS The data indicate that semiautomated alignment algorithms may enhance the efficacy of digital subtraction radiography while maintaining diagnostic efficacy in clinical trials.

Advances in Measurements of Periodontal Bone and Attachment Loss

Periodontal probing and measurements using intraoral radiographs are widely utilized clinical techniques to measure attachment and bone levels, respectively. Determination of progressive disease, healing, or regeneration in clinical studies may require maximal sensitivity and attention to measurement error in order to assure that changes detected by new methodology are accurate. Both types of methods are susceptible to errors due to resolution, repeatability, and accuracy of the technique. While both probing and radiographic methods are useful in clinical trials they vary widely with respect to these errors. For example, manual probing is repeatable to within 1 mm better than 90% of the time, and state-of-the-art radiographic methods, such as digital subtraction radiography, can detect as little as 1 mg of bony change.

Effects of nonsteroidal antiinflammatory drugs on bone loss in chronic inflammatory disease.

Several controlled clinical trials have indicated that nonsteroidal antiinflammatory drugs may slow alveolar bone loss in periodontitis. Demonstration of this efficacy is dependent on the development of accurate, sensitive, and specific quantitative methods for the assessment of bony change, such as digital subtraction radiography. Further studies of such methodologies are required to more fully investigate the effect of nonsteroidal antiinflammatory drugs in rheumatoid arthritis.