Periodontal Disease and Birth Outcomes: Are We Missing Something?

Purpose of Review Periodontal disease is a widespread inflammatory disorder influenced by microbial, genetic, and environmental factors. Dr. Robert J. Genco was a pioneer in recognizing the connection between periodontal disease and systemic diseases. His early work reported a “two-way street” with respect to diabetes mellitus such that those with diabetes are more susceptible to periodontal disease and the severity of diabetes increases in those with periodontal disease. Dr. Genco also proposed that periodontal disease could impact cardiovascular and pulmonary diseases as well as oral cancers. Here, we review the recent literature on the potential role of periodontal disease on another health concern, that of adverse birth outcomes including preterm birth, fetal growth restriction, low birth weight, pre-eclampsia, and gestational diabetes. Recent Findings Risks associated with the development of periodontal disease and risks posed by periodontal disease are discussed, including that of adverse birth outcomes, with attention to potential confounding variables in different study populations and conflicting reports on the efficacy of intervention during pregnancy. Suggested mechanisms whereby periodontal disease contributes to adverse pregnancy outcomes include infection and inflammation of the uterus, placenta, and fetus induced by bloodborne pathogenic microorganisms and/or bacterial products. The potential role of genetic and epigenetic factors influencing the response to infection and the potential for long-term sequelae in those born to mothers with periodontal disease are considered. Summary To identify the specific effects of periodontal disease on birth outcomes, future studies should continue to parse out confounding variables including genetic, epigenetic, and environmental influences. Standardizing the definitions of periodontal disease is critical to establishing cause and effect. Understanding the role of the microbiome on fetal development and pregnancy outcomes, and further consideration of mechanisms contributing to poor birth outcomes should be explored with the expectation of developing interventions. Recognizing his fundamental insights into the importance of oral health on systemic health, we dedicate this narrative review to Dr. Genco, a visionary and an advocate for oral health.