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Patient Celia Flores Avila being treated by Anthony DiAngelis, with Bryan Michalowicz and Virginia Lupo in the background.

Patient Celia Flores Avila is treated by Anthony DiAngelis, while Bryan Michalowicz and Virginia Lupo discuss the study, for which they are investigators. DiAngelis and Lupo are adjunct University faculty and chiefs of dentistry and of obstetrics and gynecology, respectively, at Hennepin County Medical Center.

Healthy gums, healthy babies?

By Mary Hoff

From eNews, January 27, 2005

Eat well, don't smoke, take your vitamins... Pregnant women get plenty of advice on how to give their babies the best start on life. A study led by Bryan Michalowicz, director of the Oral Health Clinical Research Center in the U's School of Dentistry, may add yet another, surprising recommendation: Take care of your teeth and gums.

Pregnant women with periodontal (gum) disease may be more likely than those with healthy gums to have premature babies, research has shown. But, Michalowicz says, a direct causal connection has not been proved. Scientists have speculated that oral bacteria invading gum tissues could cause the immune system to provoke changes in tissues and organs elsewhere in the body that lead to premature labor. But because periodontal disease also is associated with poverty and smoking, which in turn may be linked to other risk factors such as poor diet and inadequate prenatal care, the link could be purely coincidental. In 2002, Michalowicz launched a three-year, $7.5 million National Institute of Dental and Craniofacial Research clinical trial to determine whether poor oral health contributes to poor birth outcomes. The effort, a collaboration with colleagues at the University of Minnesota, Hennepin County Medical Center, the University of Mississippi, the University of Kentucky, Columbia University, and Harlem Hospital, provides treatment for gum disease during pregnancy to women who otherwise would receive none, then compares their babies at birth to those in a control group.

"If periodontal disease is one of the causes of preterm birth, then treating women with the disease should decrease the incidence of preterm birth," Michalowicz says.

"Because patients tend to see their dentist more regularly than they see a physician, today's dentist is well positioned to play an important role in maintaining a patient's overall health and wellness," says Patrick Lloyd.

The researchers began enrolling patients in April 2002 at clinics in Minneapolis; Lexington, Ky.; Jackson, Miss., and New York City. Half of the 820 participants, chosen randomly, receive periodontal care during their second trimester of pregnancy. The other half receives the same care shortly after their babies are born. All women receive prenatal care and care for other dental problems. The study focuses on birth outcomes like length of pregnancy and birth weight. Investigators also perform regular dental examinations and collect dental plaque and blood samples from women during the study to document the effect of treatment on the gums, on oral bacterial linked to gum disease, and on markers of inflammation in other parts of the body.

Michalowicz and colleagues expect to finish enrolling patients next June and collecting data on outcomes in December when the last babies are born. Results of the research should be available in early 2006.

If the study shows that treating periodontal disease reduces a woman's chance of experiencing premature birth or another poor birth outcome, it could have "significant implications for developing public health policy as it relates to the delivery of routine prenatal care," Michalowicz says. Preterm and low birth-weight births are major causes of sickness and death in newborns and result in tragic numbers of long-term health problems and disabilities in children. A causal connection would indicate that straightforward and relatively inexpensive periodontal therapy delivered during pregnancy could give babies a healthier start in life. It would also "help reduce the substantial societal and financial costs associated with prematurity," Michalowicz says.

The research is part of a longstanding interest within the School of Dentistry in exploring the connections between oral health and other health issues, such as diabetes and heart disease.

"Oral health is an integral part of overall health and wellness," says Patrick Lloyd, dean of the School of Dentistry. "What affects the mouth can affect general health and vice versa. For example, many early symptoms of diseases--like leukemia and diabetes--are often manifest in the mouth. Because patients tend to see their dentist more regularly than they see a physician, today's dentist is well positioned to play an important role in maintaining a patient's overall health and wellness."