Periodontal disease is very common with estimates of the global population having gingivitis ranging from 50-90% with more than 10% of adults estimated to be affected by severe periodontitis. Periodontal disease rates in pregnancy have been reported to vary between 11- 100%
The aim of this review was to evaluate the prevalence of periodontal disease among pregnant women by uniform diagnostic criteria at the global level.
Methods
A protocol was registered in the PROSPERO database. Searches were conducted in the PubMed, Web of Science, EMBASE, Scopus, and Ovid databases from January 2000 to January 2022. Studies using professional oral examination that reported the periodontal indicators bleeding on probing (BOP), clinical attachment level (CAL) ≥4mm or probing depth (PD) ≥4mm of pregnancy were considered. Two reviewers independently screened and selected papers also extracting data and assessing quality using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Meta-analyses were conducted for the prevalence rates of periodontal disease and three periodontal indicators (BOP (+), CAL≥4 mm, PD≥4 mm).
Results
- 20 studies (14 cross-sectional, 4 cohort studies and 2 RCTs) were included.
- 5 studies were conducted in Brazil, 3 in China, 2 in India and one each in Argentina, Finland, Greece, Indonesia, Iran, Mahajanga, Malaysia, Nepal, Sir Lanka and South Africa.
- 45% of studies used random sampling, 20% cluster sampling and 10% convenience sample the remainder were unclear.
- 11 studies were considered to be at low risk of bias, 7 at moderate risk and 2 at high risk.
| No. of studies | Prevalence (95%CI) | |
| Periodontitis (CDC/AAP criteria) | 3 | 40% (15 to 100%) |
| BOP (+) | 15 | 67% (56 to 80%) |
| CAL ≥4 mm | 15 | 42% (27 to 57%) |
| PD ≥4 mm | 11 | 24% (12 to 37%) |
- Prevalence rates of BOP (+) and PD≥4 mm presented a gradual increase throughout pregnancy, while the highest prevalence rate of CAL≥4 mm was in the 2nd trimester.
Conclusions
The authors concluded: –
Within the limitations of this systematic review, the best estimate of periodontal disease in pregnancy we conducted reported a high level of prevalence as well as the rates on BOP (+), CAL≥4 mm, and PD≥4 mm. The results should be carefully interpreted due to the high heterogeneity. The present findings of this study suggest that there is a wide prevalence of periodontal disease in pregnant women, as reflected in three clinical indicators. More high-quality observational studies on periodontal disease among pregnancy appear to be needed, especially for different subgroups of gestation, education levels, within the different states, and other relevant factors.
Comments
The authors registered a protocol for the review and have searched a good range of databases. Owing to inconsistent definitions of periodontal disease and reporting methods the authors have tried to overcome this by focussing on studies assessing specific periodontal indicators. For their overall estimate of periodontitis in pregnancy they have only used studies employing the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) which mean their estimate of 40% (15 to 100%) is based on only 3 studies. In contrast the estimates for the three periodontal indicators (BOP (+), CAL≥4 mm, PD≥4 mm) are based on 15, 15, and 11 studies respectively. Studies have shown links between pregnancy outcomes and periodontal disease (Dental Elf – 15th Mar 2019, Dental Elf – 27th Oct 2017, Dental Elf – 19th Jun 2017) but evidence on whether periodontal treatment during pregnancy has an impact is of low quality.
Links
Primary Paper.
Chen P, Hong F, Yu X. Prevalence of periodontal disease in pregnancy: A systematic review and meta-analysis. J Dent. 2022 Aug 20;125:104253. doi: 10.1016/j.jdent.2022.104253. Epub ahead of print. PMID: 35998741.
Other references
Dental Elf – 15th Mar 2019
Dental Elf – 27th Oct 2017
Dental Elf – 19th Jun 2017
Periodontal treatment during pregnancy-no evidence of impact on preterm birth
Dental Elf – 6th Feb 2013
