Association between Maternal Periodontal Health Status and Health Status of New Borns

Aims : Mothers play primary role in the health of their children and the oral health of the mother is a crucial part of her general health and could have an effect on the baby’s health. The study aimed to determine the relationship between maternal periodontal disease and the health status of newborns using Apgar scores in relation to maternal oral/periodontal parameters (loss of attachment, pocket depth, and bleeding on probing). Materials and Methods : The case group included 100 pregnant women with periodontal disease, while the control group included 100 pregnant women without periodontal disease. In both groups, periodontal parameters such as loss of attachment (LoA), pocket depth (PD), bleeding on probing (BoP), and Apgar scores were recorded. Mann-Whitney Test and Spearman’s correlation coefficient were used investigate the relationship between periodontal parameters LoA, PD, and BoP on one hand and Apgar score on the other. Results : No significant associations between Apgar scores and maternal periodontal index scores were discovered. Conclusions : Within all limitations of this study, it was concluded that there was no direct relationship between maternal periodontal health and infant health status was found.


INTRODUCTION
During pregnancy changes in hormone levels promote an inflammatory response, increasing the risk of developing gingivitis and periodontitis, two types of periodontal disease involving the gingivae and alveolar bone, respectively (1) .The term "periodontal diseases" refers to a group of chronic inflammatory conditions affecting the gingiva (or gums, the soft tissue surrounding the teeth), bone, and ligament (the connective tissue collagen fibers that anchor a tooth to alveolar bone) that support the teeth (2,3) .Many of the probable periodontal pathogens are Gram-negative bacteria, and it has been observed that systemic exposure to derived endotoxin increases the risk of premature birth in women with generalized periodontal infection (4,5) .
This study aims to determine the relationship between maternal periodontal disease and the health status of newborns using Apgar scores in relation to maternal oral/periodontal parameters (loss of attachment, pocket depth, and bleeding on probing).

MATERIALS AND METHODS
The study was approved by the

Sample Collection
The study sample consisted of young females their ages were between 18-35 years old.Two hundred pregnant females were included in the study, (one hundred) pregnant females with periodontal disease and (one hundred) pregnant females without periodontal disease.All the females had no history of medical or genetic problems.

Criteria for Selection of the Sample
Inclusion and Exclusion Criteria were: The Inclusion Criteria 1. Women between the ages of 18 and 35 who are pregnant.
2. There is no history of abortion.
4. Females agree to share in the study (7) .

The Exclusion Criteria
1.A history of a medical condition.
2. Use of corticosteroids in the past.
4. The first pregnancy.

5.
A history of giving birth to many children.
6. Consumption of alcoholic beverages or cigarette smoking.
7. Females refuse to share in the study (8) .

Clinical Examination
Data were collected using a standardized specially designed case sheet that included maternal variables such as name, age, weight, height, body mass index before and during pregnancy, and educational level of the mother which was administered via a questionnaire by the investigator.
Pocket depth was measured in millimeters with a Williams Michigan periodontal probe which has special markings from the base of the pocket to the free gingival margin and was graded as according to the system adapted from Offenbacher (5) namely: 1. Absent (< 3 mm).

Sever (> 7 mm).
The mean pocket depth was calculated by summing the measurements per tooth and dividing it by 2 (which is the number of the measurements per tooth) (12) .
Bleeding on probing (BoP) was assessed and recorded after PD was measured, by the dichotomous index (presence or absence of bleeding).
For newborns, the total number of two hundred newborns were examined for the Apgar score at 1,5 and 10 minutes after birth which done by the investigator and the supervision of the same gynecological permenant doctor and baby's vital signs were recorded.

RESULTS
We did Spearman correlation coefficient for both groups (cases and controls) and a false-positive relations began to appear in the control group due to the repeating the 0 and 1 numbers which lead to making fake relations between the variables in control group, so the control group results were not taken into consideration.
Table (1) shows that the mean scores ± standard deviation of the three periodontal parameters (LoA, PD, and BoP) between the case and control groups by using the Mann-Whitney test.All the three parameters examined showed a highly statistical significant difference in the case group in comparison with the control group (P ≤0.01).According to many previous studies, the pathogens of periodontal disease and their virulence factors can disseminate and induce both local and general changes in addition to systemic inflammatory responses in the host and the periodontal disease may have an impact on tissues other than periodontal tissues (5,13) .
The current study compared between case and control groups in many variables and according to our results, it was noticed that the mean loss of attachment, pocket depth, and bleeding on probing between case and control groups were all higher in cases than in controls and can be said that there was a highly significant difference between the two groups due to many reasons like the lack of care about oral hygiene, neglecting daily brushing and little or no visits to dental clinic among cases females which is in agreement with the theory that said large proportion of pregnant women knowing of the importance of dental care during pregnancy did not receive care due to many possible causes (14) .
The results of the current study confirmed there was no direct relationship between periodontal parameters and infant Apgar score which agrees with previous study (8) in which they found some type of difficulty of determining that if there was any relationship between periodontal parameters and Apgar score.all pieces of evidence agree with that there was no strong, direct relationship between maternal periodontal parameters (LoA, PD, and BoP) and infant Apgar score.

Declaration of interest
The authors declare that there are no conflicts of interest regarding the publication of this manuscript
examination was done at a chairside during the admittance to the hospital for delivery with adequate artificial light attached to the head of the investigator.Maternal oral health status was determined by measuring the clinical indices and periodontal condition only two surfaces which were the mesial and distal surfaces of the Ramfjord teeth (teeth that are regularly used in investigations) of the periodontal disease

Figure ( 1 ):
Figure (1): Michigan Williams Probe Periodontal pathogens can enter the placenta via the bloodstream, membranes, and amniotic fluid, resulting in many pregnancy outcomes but its effect on Apgar score itself is undetermined.As a result, the critical question of "if the permenant observation of pregnant females oral health can change the adverse problematic pregnancy outcomes??" should be keep into our minds, because some studies have shown an improvement in child's health and an increase in Apgar value while others have not.Considering the findings of this study and other studies in this subject, it is suggested that prenatal health programs, mothers should be encouraged to receive dental treatments, including periodontal treatment, before deciding to have children.CONCLUSION Based on the findings of this study and within the all clinical limitations of the current study like limited sample size and difficulty in recruitment of the pregnant females to participate in the current study;

Table 1 :
Comparison Between Mean Values of Periodontal Parameters (LoA, PD, and BoP) Between the Two Groups.

Table 2 :
The Relationship Between Apgar Score and Mother's Periodontal Parameters for the Cases.