Association between Chronic Apical Periodontitis and Low Birth Weight Preterm Births

The literature contains a number of studies showing association between chronic apical periodontitis (CAP) and systemic health issues such as diabetes and cardiovascular diseases. Research from the field of periodontics has suggested that periodontitis in pregnancy is a risk factor for low birth weight and preterm birth (LBWPB).

Periodontal and endodontic disease while having differences in pathogenicity, do share some common microbial factors including anaerobic gram-negative bacteria and the attendant production of higher levels of inflammatory cytokines such as the interleukin cascade. Bacterial products such endotoxin and lipopolysaccharides, from anaerobic cell wall breakdown, stimulate Il-1, Il-6, TNF, and prostaglandin formation. These types of inflammatory mediators have been shown previously to be associated with LBWPB.

Leal et al, JOE 41:3, 353-357 set out to investigate whether there was any relationship between CAP and LBWPB. 63 women, between 2 and 5 months postpartum were enrolled in this study. The study group consisted of 33 women who had preterm infants between 27 and 37 weeks gestation (mean 29.8 weeks) and under 2500 grams/5.51 lbs (mean 1597 grams/3.52 lbs). The control group, well matched for age, race, marital status, family income, and education levels, was formed of 30 mothers of full term infants born between 37 and 42 weeks (mean 38.3 weeks) and weighing more than 2500 grams (mean 3327 grams/7.33 lbs). At the postpartum evaluation, full mouth radiographs were exposed on all participants. The radiographs were evaluated by two blinded, calibrated, Endodontists to determine the presence and severity of CAP using the periodontal index (PI).

The authors found the presence of CAP in 54.5% of the LBWPB group and only 20% in the control group (P=.004) indicating that chronic endodontic lesions may increase the risk factor for prematurity and low birth weight babies by as much as 5 times (compared with women without CAP). The authors noted that the use of 3-D radiography such as CBCT, with its increased ability to detect CAP, may further increase this already statistically significant finding.

As dental health professionals it is important that we use the literature to support our diagnosis and treatment protocols (evidence based). In Dentistry we find ourselves pulled between two opposing forces, the regulatory and populist demands to expose our patients to as few radiographs as possible and the ability to diagnose asymptomatic osseous pathology without radiographs. Balancing these concerns can be confusing and frustrating at times.

The results of this study would suggest that we should inform women of child bearing years of the potential for LBWPB associated with CAP and, if they so chose, do appropriate testing to determine pulpal vitality, followed with targeted radiography in those teeth which are non-responsive.

Dr. Bittner was in private practice in general dentistry for 11 years in Langley prior to his Endodontic specialty training. He has been practicing the Dental Specialty of Endodontics since 1995.

In his free time, Dr. Bittner loves to participate in a variety of sports including most recent, golfing! He also enjoys being a new grandfather, which if you ask him is just the best!

On December 2, 2015, posted in: News for Doctors by