Apical Periodontitis, a Predictor Variable for Preeclampsia: A Case-Control Study

Khalighinejad et al, JOE 43:10 pp1611-1614, October 2017

Preeclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (>140/90) and proteinuria amongst other symptoms.  This condition begins, by definition, after 20 weeks of pregnancy and is one of the most common causes of maternal fatalities, preterm birth, and reduced birth weight.  Furthermore, women who have had PE are at increased risk of heart disease and stroke later in life.

Risk factors for PE include obesity, preexisting hypertension, diabetes, first pregnancy, in vitro fertilization, multiple fetus pregnancies, and both younger and older mothers.  PE appears to be related to changes in placental vascular development.  The blood vessels supplying the placenta appear to be narrower than normal and react differently to hormonal signaling which limits the amount of blood flow to the fetus.  The causes of PE have not been fully elucidated though there seems to some association with damage to the blood vessels, certain genes, and immune system factors. Maternal periodontal disease has been shown to increase systemic inflammatory stressors at the maternal-fetal interface and may also have some involvement.

Apical periodontitis (AP) is the inflammation and destruction of peri-radicular tissues after an endodontic infection.  People with AP show systemic elevation of proinflammatory cytokines such as interleukins 1, 6, and tumor necrosis factor.  With evidence that the systemic immunological results of periodontal disease may affect maternal outcomes, the authors aimed to investigate whether there may be a relationship between apical periodontitis and PE.

This pair matched, case controlled study was performed from January 2014 – January 2016 in the maternity department of Case Western University Hospital.  Only subjects who had attended the maternal program prior to pregnancy were considered.  As part of the maternal program, all participants underwent a comprehensive medical and dental examination.  All women with known risk factors for PE were excluded from the study.  50 women who developed PE during their pregnancy became the experimental group.  50 women who had uneventful pregnancies were matched to the experimental group with respect to age, smoking status, body mass index, educational level, and both periodontal and endodontic status before pregnancy and became the control group.  The endodontic evaluation recorded the number of teeth with apical periodontitis and the number of teeth with prior endodontic treatment.

The authors found at least one endodontically treated tooth in 44% of the experimental group and 76% of the control group.  AP was found in at least one tooth in 54% of the mothers who developed PE and only 32% of the mothers with uneventful pregnancies.  Statistical analysis found this result to be highly significant at the 95% confidence level.

Khalighinejad et al concluded that all women considering becoming pregnant should undergo a comprehensive dental examination including a full radiographic examination and pulp testing to identify and appropriately treat any necrotic teeth or teeth with apical periodontitis.


Dr. Howard Bittner, DMD, CAGS

Dr. Howard Bittner, DMD, CAGS

Dr. Bittner was born and raised in the Surrey / Langley area. Following his pre-dental training at Simon Fraser University, he received his Doctor of Dental Medicine from the University of British Columbia in 1982 and his Certificate in Advanced Graduate Studies in Endodontics from Boston University’s Goldman School of Dental Medicine in 1995.
Dr. Bittner was in private practice in general dentistry for 11 years in Langley before his Endodontic specialty training. He has been practicing Endodontics since 1995.
In his free time, Dr. Bittner loves to participate in a variety of sports including golf. He also enjoys being a grandfather to 4, which if you ask him is just the best!


On January 29, 2018, posted in: News for Doctors by

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