The Effect of Non-surgical Periodontal Therapy on Adverse Birth Outcomes Randomized Controlled Trial

Approximately two-thirds of pregnant Pakistani women suffer from periodontal disease a common inflammatory disease of the soft tissues surrounding the tooth. It was demonstrated that periodontitis among pregnant women is significantly associated with preterm birth and low birth weight. Pakistan has a high prevalence of these adverse birth outcomes therefore; identifying an intervention is of prime importance and may have social and economic benefits.

Non-surgical periodontal therapy is affordable and amenable to people and thus seems to be an intervention which may prove to be of benefit in a population where the dental services are available. It has been recommended in systematic reviews and Meta analysis that Randomized Controlled Trials are now required to establish whether the removal of inflammatory factors by scaling and root planning are effective in reducing adverse pregnancy outcomes such as preterm birth and low birth weight.

• NSPT plus oral hygiene (Procedure), also known as scaling, dental scaling, de-scaling, periodontal prophylaxis, periodontal debridement: Non-surgical periodontal therapy under local anesthesia to remove plaque and calculus
• Oral hygiene alone (Other): It includes pregnant women (with periodontal disease) who will not be given any mechanical treatment such as non-surgical periodontal therapy during pregnancy. However, oral hygiene instructions will be given.

Primary outcomes

• Premature birth [To be assessed at birth]: less than 37 weeks

Secondary outcomes

• Birth weight [To be assessed at birth]: less than 2500grams
• Still birth [To be assessed at birth]: To be assessed by the birth attendant/ Obgyne

Sex: Female, ages: 18 Years to 35 Years, accepts healthy volunteers

Inclusion Criteria:

* Pregnant woman presenting to the Obstetric clinic at the Aga Khan Hospital for Women, Karimabad or the Aga Khan Hospital for Women and Children, Kharadar.
* Participant should be between the ages of 18 and 35 years
* Exhibiting at least 2 sites with 2mm or more periodontal probing depth.
* Planning to deliver the baby at the above mentioned facilities so that the outcome can be observed and measured.
* Singleton pregnancy.
* Willing to get NSPT done between 20 to 28 weeks of gestation.
* At least 20 teeth present in the mouth so that periodontal scoring could be done.

Exclusion Criteria:

* Tobacco or alcohol use.
* Genitourinary tract infection or any systemic infection.
* Obstetric disorders such as gestational diabetes or placenta previa or pre-eclampsia or eclampsia etc.
* Chronic disease such as diabetes or blood pressure.

• Zaubina U Kazi, BDS, MSc, Principal investigator, Aga Khan University