Periodontal and Periapical Inflammation and Pregnancy
Periodontal and Periapical Inflammation and Pregnancy
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.
Inclusion Criteria:

 -  Female

 -  Child bearing age or above

 Exclusion Criteria:

 -  Male

 -  Very young children (before child-bearing age)