Expectant moms needed for study of oral disease, preterm birth

San Antonio (April 14, 2004) – The most important thing you’ll ever do for your baby might be something you do for your mouth – a checkup for gum disease during pregnancy.

Researchers from the departments of periodontics and obstetrics and gynecology at The University of Texas Health Science Center at San Antonio seek to enroll 600 women from San Antonio and surrounding counties for the MOTOR trial – the Maternal Oral Therapy to Reduce Obstetric Risk trial. The Health Science Center is one of three U.S. centers conducting the five-year study, which will offer participants a non-surgical dental procedure called scaling and root planing to treat periodontal (or gum) disease.

One group of women with periodontal disease will have the procedure by 24 weeks gestation. The others will have it after delivery. Researchers will compare the rate of preterm birth (less than 37 weeks) in each group and the mean birth weight adjusted for gestational age. Preliminary studies show that cleaning the mother’s teeth can result in a significant decrease in preterm births.

“The relative risk of having preterm birth is four to seven times greater if you have even moderate periodontal disease,” said Donald J. Dudley, M.D., professor of obstetrics and gynecology and study co-principal investigator. “When you understand that preterm birth affects 12 percent of all deliveries in this country, and numerous efforts have been tried unsuccessfully to reduce that rate, you can see the importance of this study. We could change the way we provide prenatal care in this country. A periodontal evaluation with treatment for even modest amounts of periodontal disease would become the standard of care.”

David L. Cochran, D.D.S., Ph.D., professor and chairman of periodontics at the Health Science Center and overall San Antonio principal investigator, said the study points to the “relationship between the oral cavity and the overall health of the body.” He noted that while the major symptom of periodontal disease is bleeding during brushing and flossing, it typically is a silent disease that presents no warning signs.

“In periodontal disease, soft material known as plaque builds up on teeth and hardens into calculus,” Dr. Cochran explained. “The bacteria that live in the plaque release noxious substances that signal the inflammatory response of the gums. These periodontal pathogens cause tissue to recede, exposing the roots of teeth. If left untreated long enough, tooth loss may occur.”

Scaling and root planing removes plaque and calculus from root surfaces and makes them smooth, ridding them of the unwanted toxins and reducing inflammation. “Women who come into the study must have evidence of periodontal disease,” Dr. Cochran said. “We believe about 30 percent of the women in the study will have only modest periodontitis.”

Researchers hypothesize that even modest periodontal disease can have a significant systemic impact. One theory is that the oral inflammatory response secretes substances into the bloodstream that are disseminated to the uterus, leading to preterm contractions and birth. “Other people think women who have periodontal disease are more prone to inflammation elsewhere and exhibit a heightened response to bacteria in the vagina, also leading to preterm birth,” Dr. Dudley said.

Women who are between 16 and 20 weeks gestation are encouraged to call Marie Barron, study coordinator, at (210) 567-3578. Women who enter the trial will be required to deliver their babies at University Hospital, the Health Science Center’s primary teaching hospital, and attend prenatal study and oral treatment appointments at the University Health Center Downtown. Participants will receive treatment, dental supplies and instructions at no cost.

The University of Alabama and the University of North Carolina, Chapel Hill/Duke University are the other MOTOR sites. A pilot study, reported in 2003 by the University of Alabama at Birmingham, laid the groundwork for the MOTOR study. That study of 366 women indicated that performing scaling and root planing in pregnant women with periodontal disease could reduce preterm birth in the women. The authors called for further study in a larger trial.

The MOTOR trial is funded by the National Institute of Dental and Craniofacial Research.

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