Laos is one of the country with high rate of maternal deaths. Does Laotians get adequate dental care?


GLOBAL: Dental care or die

DAKAR, 18 March 2010 (IRIN) - Women with gum disease are almost three times more likely to give birth prematurely than those with healthy gums, according to more than a decade of research. But scientists are still uncertain how significant a risk dental bacteria is to healthy pregnancies - or how to save foetuses from potentially deadly exposure.

Because of hormonal changes, women are prone to develop gum disease - generally treatable - during pregnancy. "The old wives' tale about losing a tooth for each baby - we have shown how with periodontal [gum] disease and other underlying conditions [mother's health], you may lose more than just the tooth, but also the baby," Yiping Han, a periodontics researcher at US-based Case Western Reserve University, told IRIN.

Gum bleeding can carry bacteria to the placenta - which it can penetrate and kill the foetus if the mother's immune system does not fight back, according to recent research Han conducted of a woman who had severe gingivitis during her pregnancy. "The mother delivered her full-term baby dead at 39 weeks," Han told IRIN. The researcher found the same bacteria in the mother's dental plaque as was in the baby's infected lungs and stomach.

Even if dental germs do not result in death, they can contribute to delivery complications and long-term health problems for the child, said Steven Offenbacher, director of Center for Oral and Systemic Diseases at the University of North Carolina. "Forty percent of foetuses are exposed to dental bacteria. These babies are three times more likely to be born early, to spend more time in neonatal units and to have long-term disability," he told IRIN.

Countries with high rates of premature births also tend to have a high prevalence of gum disease, Han told IRIN. "Oral health care is typically seen as a luxury in poor countries, when in fact, it is the gateway to overall health. The closed mouth hides the often overlooked threat of oral bacteria on a pregnancy."

Each year an estimated 13 million babies - mostly in sub-Saharan Africa - are born before 37 weeks of pregnancy; one million of these die, according to the World Health Organization (WHO). More than three million full-term stillbirths occur annually worldwide. 

A 2007 analysis by dental epidemiologists from Toulouse, France, of 17 studies dating to 1996 on periodontal disease and preterm births - tracking more than 7,000 pregnant women - found a "likely association" between gum disease and preterm births, but concluded that more research is needed.

Offenbacher said preterm deliveries and stillbirths have many causes and it is difficult to isolate one risk from another.

Treatment

But there is mounting research that successful periodontal treatment can reduce premature births, according to the University of Pennsylvania, which recently presented its study of 872 pregnant women with and without the disease. 

Twenty-three percent of those with gum disease delivered before 35 weeks versus 7 percent without the condition. Those who received treatment had a medically "significant" lower incidence of preterm births, lead researcher, Marjorie Jeffcoat, told IRIN. "We believe the results would be applicable to babies worldwide and would be happy to work with any doctor who would like to study this effect in their country."

Sierra Leone

In Sierra Leone, which has one of the world's highest infant mortality rates - 159 for every 1,000 live births based on the most recent government data from 2006 - the Health Ministry has not considered periodontal disease a major risk in pregnancy. S.A.S. Kargbo , the ministry's reproductive health specialist, said the association between periodontal disease and pregnancy complications is a "hypothesis" and he does not know of any cases.

But without epidemiological studies or enough human resources, it is hard to prove the link between gum disease and pregnancy complications, researcher Han told IRIN. "And without that data in hand, it is hard to convince countries to devote more resources to periodontal care in an effort to reduce their infant mortality rate."

Sierra Leone had five dentists - about one for every one million residents - in 2004, according to the most recently available government records.

"If a country is determined to bring down its infant mortality rate, periodontal disease is a well-documented risk that can derail a healthy pregnancy and deserves further examination," Han said.