Diabetes Clinical Trial
Official title:
Associations Between Periodontal and Periapical Inflammation and Pregnancy Outcomes
This is a retrospective chart review of patient records at the University of Mississippi Medical Center. We are not actively recruiting patients for this study. Recent animal studies we conducted showed that periapical abscesses during pregnancy cause a systemic inflammatory response in the mother. Also due to the increase in TNF-alpha (an inflammatory cytokine) the mother also become insulin resistant and thus developed gestational diabetes. Periodontal inflammation has been shown in the research to lead to low-birth weight and pre-term birth. We are looking retrospectively to see if an association exists in charted data between periapical and periodontal inflammation and adverse pregnancy outcomes.
A. Specific Aims
1. To determine possible associations between periapical oral infection and adverse
pregnancy outcomes in female patients in the School of Dentistry, the Dental/Dental
Emergent Care Clinic (Jackson Medical Mall), and the UMC Hospital.
2. To examine the effects of several confounding variables related to stress from pain
from the periapical infections on these adverse outcomes.
B. Background and Significance
During the past five years there has been increasing evidence for associations between
periodontal infection and adverse pregnancy outcomes in humans, including preterm birth, low
birth-weight babies, gestational diabetes, miscarriage, and preeclampsia. These events
likely result from oral infections because bacteremia and release of pro-inflammatory
cytokines from the diseased oral sites have been described.
Proinflammatory cytokines have been reported to be harmful and destructive to a successful
pregnancy. The adverse fetal inflammatory response to TNF-alpha, IL-6 and C-reactive protein
has been associated with preterm birth. These cytokines are also commonly associated with
oral infections, both periodontal and periapical11. In addition, oral infections often
produce pain and stress, which are considered harmful to a successful pregnancy. Since the
effects of periodontal infections on adverse pregnancy outcomes have been described, it
would be worthwhile to examine the specific effects of oral periapical abscesses on adverse
birth outcomes, to begin to determine whether there is an association between this type of
oral infection and these adverse outcomes.
There is no published information concerning the possible associations of tooth abscesses on
pregnancy outcomes. In addition, there is no known biological mechanism for the direct link
between periodontal infections, pre-term birth and low birth-weight babies. Secondary
factors such as age, race, and life-style likely confound assessment of these associations.
There are some preliminary studies of these variables in regard to the association between
periodontal infections and adverse pregnancy outcomes, but not for periapical lesions. Since
periapical lesions produce pain, these secondary factors could be more important to
pregnancy outcomes than the primary factors (bacteria and proinflammatory cytokines).
C. Data collection. Archived dental records from female patients treated during the past
three years at the University of Mississippi School of Dentistry and the Dental/Dental
Emergent Care Clinic (Jackson Medical Mall) will be examined. Each patient record will be
assigned a study number, and data will be entered on an Excel spreadsheet using that study
number. Since the pregnancy outcome is part of the UMC Hospital record, the principal
investigator will link the dental and hospital records using the patient name. However, the
data collected will use a research number. Following the procedure for linking the patient
records, the patient name will be discarded. Thus, it will not be possible to link an
individual patient to the study data.
The following information will be recorded: age, pregnancy status, number of pulpal
abscesses, number of sites of periodontitis (pocket depth ≥ 4 mm), race, highest level of
education, DMFT (decayed, missing, filled teeth), number of children, past pregnancy
outcomes, diagnosis of diabetes mellitus, and any other known pregnancy related conditions
experienced during previous pregnancies from the records of the Dental/Emergent Dental Care
Clinic. We will define adverse pregnancy outcomes as gestational diabetes, preeclampsia,
pre-term birth, and a low-birthweight infant from the UMC hospital records.
D. Statistical Analysis of data. The data will be analyzed using SPSS v12 using appropriate
statistical tests, including factorial ANOVA with post hoc tests, multivariate logistic
regression, the Spearman correlation test, and chi square analysis.
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Observational Model: Cohort, Time Perspective: Retrospective
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