Source: Am J Obstet Gynecol. 2008 Apr;19(4):389.e1-5.
Title: Maternal periodontal disease, systemic inflammation and preeclampsia.
Authors: Ruma M, Moss K, Jared H, Murtha A, Beck A, Offenbacher S.
Preeclampsia is a toxic condition of late pregnancy characterized by high blood pressure and excess protein in the urine after 20 weeks of gestation. Modest increases in blood pressure occur frequently; however, left untreated, preeclampsia can be fatal for mother and baby.
Summary of research:
• 775 pregnant women underwent exam for perio disease, C-reactive protein (CRP) levels and delivery follow-up.
• Preeclampsia defined as high blood pressure (>140/90) and excess protein in urine.
• Periodontal disease defined as present or absent.
Results and conclusions:
• Women with high CRP were more likely to develop preeclampsia than women with low CRP.
• Women with periodontal disease and high CRP levels had increased risk for preeclampsia compared to women without perio disease and either high or low CRP levels.
• Maternal periodontal disease with systemic inflammation is associated with an increased risk for preeclampsia.
Key take-aways:
Preeclampsia occurs in 5-8% of pregnancies and is rapidly progressive. Globally preeclampsia and other hypertensive disorders of pregnancy are the leading cause of maternal and infant illness and death. This study demonstrated that pregnant women with systemic inflammation, as indicated by high CRP levels, were more likely to develop preeclampsia than those women with lower CRP levels. When periodontal disease is considered in this population; however, pregnant women with periodontal disease and high CRP levels were more likely to develop preeclampsia than are those without perio disease and either high or low CRP levels. This indicates that in this study, maternal periodontal disease contributes to the likelihood of preeclampsia.
Implementation Strategies:
As with all of the research on periodontal disease during pregnancy and the potential negative effects, the single best way to impact these statistics is through one on one patient intervention. The dental team must take it upon themselves to educate and communicate to all women in child bearing years the importance of good periodontal health prior to conception.
PerioFrogz suggests that you compile data on periodontal disease during pregnancy and the potential negative effects into a packet to give as handouts to your patients, both men and women who are expecting a child. Choose a simple paper folder with business cards slits on the pockets and print your own labels with your dental practice name, address, phone & website to attach to the outside of the folder. Be sure to include business cards for the dentist and hygienist.
Get started with your content by using the two articles reviewed to date by PerioFrogz located on the pperioeducation.com website. You will want to eliminate the implementation strategies when you reproduce the summaries since that data is not pertinent to the patient. You will also want to supplement your patient education folders with a brochure from the AAP titled Maintaining Periodontal Health Throughout a Woman's' Life and check out the insert: Pregnancy & Periodontal Disease. Visit www.perio.org to order these brochures.
PerioFrogz also highly recommends that you distribute a few of these folders to OBGYNs in your immediate area. These folders should include an introductory letter from the dentist explaining the purpose of the folder and how you are utilizing them in your office. You may also want to include a new patient offer in the folder with the assumption that the OBGYN will hand a few of them out to their patients who may need dental care and a caring quality dental practice to deliver it.
The following checklist is provided as a quick and easy way to get organized and make this doable rather than a cumbersome project. Get your entire team involved and spread out the duties…no one should have to do the entire project on their own.
• Decide how these folders will be used and get a team agreement to the project.
• Compile a list of OBGYNs in your immediate geographic area.
• Purchase inexpensive paper folders with inside pockets and business card slits.
• Purchase printer friendly adhesive labels for the outside of the folders (3"x 2").
• Design your label — keep it simple — include:
a) Practice name
b) Address
c) Phone
d) Web site
e) Optional would be to print a logo or design on the label. Should you decide to do that, most practices have that artwork in an electronic format that should drop easily onto the label when you print.
• Print your labels and attach them to the folders.
• Insert business cards into the slits on the inside pockets.
• Stuff your folders with the two summaries and the patient education article attached here.
• Include one brochure and a cover letter as needed.
Keep a list of patients that you have distributed folders to and provide a follow up call to answer any questions they may have. This is most appropriately done by the hygienist. Also highly recommended is a personal follow up call to the patient's OBGYN by the dentist to initiate rapport and develop a potential referral source which is certainly a good idea in this current economy.
