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is routinely performed in many healthcare systems across the world, and therefore is in itself feasible, accepting the limitations outlined in R12.1.
Subgingival instrumentation has traditionally been delivered dur- ing multiple sessions (e.g., quadrant-wise). As an alternative, full- mouth protocols have been suggested. Full-mouth protocols included single-stage and two-stage therapy within 24 hours; however, proto- cols including adjunctive antiseptics (full-mouth disinfection) were not included in this analysis.
Ethical considerations The evaluation of the efficacy of the treatment of periodontitis on systemic health outcomes is ethically challenging for the reasons stated in R12.2. Economic considerations Insufficient evidence exists on the cost-effectiveness of the treatment of periodontitis when evaluating biomarker or other surrogate outcomes of systemic disease and/or complications of systemic conditions.
Available evidence
Number and design of included studies Sixteen RCTs reported on the effect of treatment of periodontitis on pregnancy outcomes. The pregnancy outcomes assessed in the meta- analysis comprised pre-term birth <37, <35, and <32 weeks, low birth weight <2500 g and less than <1500 g, pre-term low birth weight, pre-eclampsia, gestational age at delivery, CRP, stillbirth, birthweight and perinatal loss. Risk of bias Of the 16 studies, 3 were at high risk of bias, 10 studies were graded as moderate and the remaining 3 as low risk of bias based on the ROB 2 tool. Effect sizes and their clinical relevance Based on 14 RCTs, the treatment of periodontitis resulted in a statisti- cally significant reduction of pre-term births (<37 weeks) (risk ratio = 0.77, 95% CI [0.60; 0.98]). No statistically significant impact was observed for other pregnancy outcomes.
Legal considerations Not applicable.
12.1.3 | Does periodontal treatment reduce the risk of adverse pregnancy outcomes? R12.4. Does periodontal treatment during pregnancy reduce adverse pregnancy outcomes?
PICOS question addressed by a SR
R12.4: Evidence-based statement It is unclear whether treatment of periodontitis during pregnancy may reduce pre-term births (<37 weeks) or reduces other adverse pregnancy outcomes . Supporting literature (Orlandi et al., 2021) Quality of evidence Moderate — 3 RCTs were of high risk of bias, 10 studies were graded as moderate and the remaining 3 as low risk of bias. Grade of recommendation GradeO — $ Statement: unclear, additional research needed, specifically focused on high-risk individuals. Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Consistency Nine of 14 RCTs resulted in a reduction of pre-term births (<37 weeks).
Balance of benefit and harm Of the studies included that reported adverse effects, none reported maternal mortality following non-surgical periodontal inter- ventions. Clinicians should be aware that there is evidence of sys- temic consequences (e.g., acute-phase systemic inflammatory response and vascular dysfunction, i.e., FMD) with full-mouth pro- tocols. While the clinical relevance of such changes remains to be determined, such an approach should always include careful consid- eration of the general health status of the pregnant patient.
Background
Intervention
Overall certainty of the evidence Moderate.
Treatment of periodontitis was as described under R12.1. Epidemio- logical studies have shown that periodontal diseases increase the odds of several pregnancy complications, with the strength of the associa- tions varying depending upon the study population (Offenbacher et al., 1996; Jeffcoat et al., 2001; Ide & Papapanou, 2013). Prevention strategies including oral hygiene instructions and supra/subgingival instrumentation of the dentition are encouraged during pregnancy to maintain/restore oral health. However, it is still unclear whether the treatment of periodontal diseases has an effect on preventing adverse pregnancy outcomes such as pre-term birth or low birth weight.
From evidence to recommendation — additional considerations
Acceptability Little is known about patient preferences regarding the treatment of periodontitis during pregnancy, due to the lack of studies addressing relevant PROMs.
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