Use of mouth rinse during pregnancy to improve birth and neonatal outcomes: a randomized controlled trial

Hong Jiang, Xu Xiong, Pierre Buekens, Yi Su, Xu Qian, Hong Jiang, Xu Xiong, Pierre Buekens, Yi Su, Xu Qian

Abstract

Background: Poor oral health, such as periodontal (gum) disease, has been found to be associated with an increased risk of adverse pregnancy outcomes including preterm birth, low birth weight, and neonatal and infant mortality, especially in low-and middle-income countries. However, there is little or no access to preventive dental care in most low-and middle-income countries. We propose to develop and test a "Mouth Rinse Intervention" among pregnant women to prevent the progression of periodontal disease during pregnancy and reduce adverse birth and neonatal outcomes in a rural county of China.

Methods/design: This is a randomized controlled clinical trial. A sample of 468 (234 in each arm of the study) women in early pregnancy with periodontal disease will be recruited for the study. Periodontal disease will be diagnosed through the methods of Periodontal Screening and Recording. All women diagnosed with periodontal disease will be randomly allocated into the intervention or control group. Women assigned in the intervention group will be provided with non-alcohol antimicrobial mouth rinse containing cetylpyridinium chloride throughout the pregnancy and oral health education. Women in the control group will receive a package of tooth brush and paste, plus oral hygiene education. Women will be followed-up to childbirth until the 42nd day postpartum. The main outcomes include mean birthweight (gram) and mean gestational age (week).

Discussion: Compared with conventional mechanical 'scaling and root planning' periodontal treatment during pregnancy, our proposed mouth rinse intervention could be a simple, cost-effective, and sustainable solution to improve both mother's oral health and neonate outcomes. If the mouth rinse is confirmed to be effective, it would demonstrate great potential for the application in other low- or middle-income countries to prevent adverse birth outcomes such as preterm birth and low birth weight and to reduce neonatal and infant mortality.

Trial registration: This trial was registered with Chinese Clinical Trial Registry (ChiCTR): ( #ChiCTR-TRC-13003768 ) on November 06, 2013.

Figures

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Research flow chart

References

    1. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–2172. doi: 10.1016/S0140-6736(12)60820-4.
    1. The United Nations Children’s Fund and World Helth Organization Low birth weight: country, regional and global estimates. New York: UNICEF; 2004. (available at: ; accessed on 18th April,2015)
    1. Halfon N, Larson K, Lu M, Tullis E, Russ S. Lifecourse health development: past, present and future. Matern Child Health J. 2014;18(2):344–365. doi: 10.1007/s10995-013-1346-2.
    1. Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering T 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900. doi: 10.1016/S0140-6736(05)71048-5.
    1. Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006;113(2):135–143. doi: 10.1111/j.1471-0528.2005.00827.x.
    1. Xiong X, Buekens P, Vastardis S, Yu SM. Periodontal disease and pregnancy outcomes: state-of-the-science. Obstet Gynecol Surv. 2007;62(9):605–615. doi: 10.1097/01.ogx.0000279292.63435.40.
    1. Corbella S, Taschieri S, Francetti L, De Siena F, Del Fabbro M. Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case–control studies. Odontology. 2012;100(2):232–240. doi: 10.1007/s10266-011-0036-z.
    1. Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review. J Periodontol. 2013;84(4 Suppl):S181–S194.
    1. Nugent JL, Baker PN. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006;113(7):848. doi: 10.1111/j.1471-0528.2006.00969.x.
    1. Kawar N, Alrayyes S. Periodontitis in pregnancy: the risk of preterm labor and low birth weight. Dis Mon. 2011;57(4):192–202. doi: 10.1016/j.disamonth.2011.03.005.
    1. Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc. 2006;137(Suppl):7S–13S. doi: 10.14219/jada.archive.2006.0403.
    1. Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med. 2006;355(18):1885–1894. doi: 10.1056/NEJMoa062249.
    1. Newnham JP, Newnham IA, Ball CM, Wright M, Pennell CE, Swain J, et al. Treatment of periodontal disease during pregnancy: a randomized controlled trial. Obstet Gynecol. 2009;114(6):1239–1248. doi: 10.1097/AOG.0b013e3181c15b40.
    1. Offenbacher S, Beck JD, Jared HL, Mauriello SM, Mendoza LC, Couper DJ, et al. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstet Gynecol. 2009;114(3):551–559. doi: 10.1097/AOG.0b013e3181b1341f.
    1. Xiong X, Buekens P, Goldenberg RL, Offenbacher S, Qian X. Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy? Am J Obstet Gynecol. 2011;205(2):111 e111–116.
    1. Mohangi GU, Singh-Rambirich S, Volchansky A. Periodontal disease: Mechanisms of infection and inflammation and possible impact on miscellaneous systemic diseases and conditions. SADJ. 2013;68(10):462.
    1. Jiang H, Xiong X, Su Y, Zhang Y, Wu H, Jiang Z, et al. A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes. BMC Pregnancy Childbirth. 2013;13:228. doi: 10.1186/1471-2393-13-228.
    1. Saparamadu KD. Prevention of oral diseases in developing countries. Int Dent J. 1984;34(3):166–169.
    1. Pack AR. Dental services and needs in developing countries. Int Dent J. 1998;48(3 Suppl 1):239–247. doi: 10.1111/j.1875-595X.1998.tb00712.x.
    1. World Health Organization. Oral health service. (available at:; accesed on 21st April, 2015)
    1. Jeffcoat M, Parry S, Gerlach RW, Doyle MJ. Use of alcohol-free antimicrobial mouth rinse is associated with decreased incidence of preterm birth in a high-risk population. Am J Obstet Gynecol. 2011;205(4):382 e381–386.
    1. Landry RG, Jean M. Periodontal Screening and Recording (PSR) Index: precursors, utility and limitations in a clinical setting. Int Dent J. 2002;52(1):35-40.
    1. Landry RG, Jean M. Periodontal Screening and Recording (PSR) Index: precursors, utility and limitations in a clinical setting. Int Dent J. 2002;52(1):35–40. doi: 10.1111/j.1875-595X.2002.tb00595.x.
    1. Covington LL, Breault LG, Hokett SD. The application of Periodontal Screening and Recording (PSR) in a military population. J Contemp Dent Pract. 2003;4(3):36–51.
    1. Gupta SK. Intention-to-treat concept: A review. Perspect Clin Res. 2011;2(3):109–112. doi: 10.4103/2229-3485.83221.

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