Fertility hit by perio disease

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Perio disease makes this more difficult.

At a press conference in Sweden on Tuesday, Professor Roger Hart, Professor of Reproductive Medicine at the University of Western Australia (Perth, Australia) and Medical Director of Fertility Specialists of Western Australia, said that, from the time that a woman starts trying to conceive, poor oral health can have a significant effect on the time to pregnancy.

Professor Roger Hart told the annual meeting of the European Society of Human Reproduction and Embryology that the negative effect of gum disease on conception was of the same order of magnitude as the effect of obesity. A press release from the conference is available here.

The importance of the research is underlined by the statistic that, in Australia, over 2,100 babies die before birth, and almost half of these deaths are from unknown causes.

Prof Hart told the conference, “Until now, there have been no published studies that investigate whether gum disease can affect a woman’s chance of conceiving, so this is the first report to suggest that gum disease might be one of several factors that could be modified to improve the chances of a pregnancy.”

The researchers followed a group 3737 pregnant women, who were taking part in a Western Australian study called the SMILE study, and they analysed information on pregnancy planning and pregnancy outcomes for 3416 of them.

They found that women with gum disease took an average of just over seven months to become pregnant—two months longer than the average of five months that it took women without gum disease to conceive.

In addition, non-Caucasian women with gum disease were more likely to take over a year to become pregnant compared to those without gum disease: their increased risk of later conception was 13.9 per cent compared to 6.2 per cent for women without gum disease. Caucasian women with gum disease also tended to take longer to conceive than those who were disease-free but the difference was not statistically significant (8.6 per cent of Caucasian women with gum disease took over one year to conceive and 6.2 per cent of women with gum disease).

Information on time to conception was available for 1,956 women, and of, these, 146 women took longer than 12 months to conceive – an indicator of impaired fertility. They were more likely to be older, non-Caucasian, to smoke and to have a body mass index over 25 kg/m2. Out of the 3416 women, 1014 (26 per cent) had periodontal disease.

Prof Hart said: “Our data suggest that the presence of periodontal disease is a modifiable risk factor, which can increase a woman’s time to conception, particularly for non-Caucasians. It exerts a negative influence on fertility that is of the same order of magnitude as obesity. This study also confirms other, known negative influences upon time to conception for a woman; these include being over 35 years of age, being overweight or obese, and being a smoker. There was no correlation between the time it took to become pregnant and the socio-economic status of the woman.

“All women about to plan for a family should be encouraged to see their general practitioner to ensure that they are as healthy as possible before trying to conceive and so that they can be given appropriate lifestyle advice with respect to weight loss, diet and assistance with stopping smoking and drinking, plus the commencement of folic acid supplements. Additionally, it now appears that all women should also be encouraged to see their dentist to have any gum disease treated before trying to conceive. It is easily treated, usually involving no more than four dental visits.

“The SMILE study was one of the three largest randomised controlled trials performed in Western Australia. It showed conclusively that although treatment of periodontal disease does not prevent pre-term birth in any ethnic group, the treatment itself does not have any harmful effect on the mother or foetus during pregnancy*.”

Prof Hart said that the reason why pregnancies in non-Caucasian women were more affected by gum disease could be because these women appeared to have a higher level of inflammatory response to the condition.

 

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2 COMMENTS

  1. This modifiable risk factor can only be eliminated by the empowerment of our patients in achieving effective home care. Our failure to educate must ,in large part, be due to a lack of explanation of the rationale for brushing as compensation for minimal chewing required by modern diet. Surely now is the time.

  2. As one of the hygienists who was involved with the SMILE study, I am aware that specific time was set aside to teach brushing and flossing techniques as well as explain what periodontal disease was. It was not only this education and time taken to do so which led to improvements in the oral health of most of these patients, but also the regular visits during the pregnancy. If this service was available in maternity hospitals – as part of the routine pregnancy care, wouldn’t this go a long way to educating mothers about their own dental health and that of their children?
    Dental Education is a very important part of oral health care, but in private practise – not billable, so not valued as much as it should be. (an hour hygiene appointment often involves a dental check up, a scale and clean, possible radiographs, plus time to set up and clean up after patients. This leaves little time for specific tooth brushing and flossing education, without the distraction of active treatment.)

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