今回は妊娠中のSRPを伴う歯周治療が
早産の減少に有効であるか調べています。
歯周病の妊婦に対して
SRPを行う群と非治療の群に分けて比較しています。
To examine whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate.
Systematic review and meta-analysis of randomised controlled trials.
Cochrane Central Trials Registry, ISI Web of Science, Medline, and reference lists of relevant studies to July 2010; hand searches in key journals.
Randomised controlled trials including pregnant women with documented periodontal disease randomised to either treatment with scaling and root planing or no treatment.
Data were extracted by two independent investigators, and a consensus was reached with the involvement a third. Methodological quality of the studies was assessed with the Cochrane’s risk of bias tool, and trials were considered either high or low quality. The primary outcome was preterm birth (<37 weeks). Secondary outcomes were low birthweight infants (<2500 g), spontaneous abortions/stillbirths, and overall adverse pregnancy outcome (preterm birth <37 weeks and spontaneous abortions/stillbirths).
11 trials (with 6558 women) were included. Five trials were considered to be of high methodological quality (low risk of bias), whereas the rest were low quality (high or unclear risk of bias). Results among low and high quality trials were consistently diverse; low quality trials supported a beneficial effect of treatment, and high quality trials provided clear evidence that no such effect exists. Among high quality studies, treatment had no significant effect on the overall rate of preterm birth (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15). Furthermore, treatment did not reduce the rate of low birthweight infants (odds ratio 1.07, 0.85 to 1.36; P=0.55), spontaneous abortions/stillbirths (0.79, 0.51 to 1.22; P=0.28), or overall adverse pregnancy outcome (preterm births <37 weeks and spontaneous abortions/stillbirths) (1.09, 0.91 to 1.30; P=0.34).
Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.
結果は、低い水準の臨床研究は、歯周治療の効果を支持したが
高い水準の臨床研究では歯周治療は早産に
影響しなかった。
更には低体重児出産、自然流産、死産も
減少しなかった。
結論として、SRPを伴う歯周治療は早産
及び低体重児出産の発症率を減少しないということです。
.
歯周治療を歯周組織の健全化の為に行うということでは
もちろん妊婦に対して治療を行うことに
大きな意味が有りますが
早産・低体重児出産の予防目的となると
その為の効果はないという結論で、勉強になりました。
.
引用文献
Polyzos NP1, Polyzos IP, Zavos A, Valachis A, Mauri D, Papanikolaou EG, Tzioras S, Weber D, Messinis IE.
Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis.
BMJ. 2010 Dec 29;341