jurnal skenario 2

8/10/2019 jurnal skenario 2

1/6

Association between Pregnancy or Parity, and OralDisease

Amr Abou Zeid, Homam Albaghdadi, YouRee Lim, Han Shao, Kyle Shaw, Irina SkosirevaUniversity of Toronto, Faculty of Dentistry, April 2012

Abst rac t

Background: An old saying--Every child costs the mother one tooth-- pervades many culturesaround the world. It is evident that pregnancy is associated with profound biological processes as aresult of hormonal interactions within the mothers body, both reversible and irreversible physiologicalchanges. However, whether pregnancy does have adverse effects on oral tissues has not beencredibly explored. Objective: In order to investigate the possibility and credibility of the oral healthconsequences resulting from pregnancy, a systematic review in the literature regarding parity andtooth diseases was thoroughly conducted. Search Method: The search strategy involved the reviewof two electronic databases, Pubmed and SCOPUS. A total of 54 articles limited to the specified

search criteria were peer reviewed, and 7 studies were selected to be included in the final review. Theliterature delved into the potential pathways between parity and tooth loss, the effect of pregnancy onperiodontal health, parity and caries in pregnant women, and the relationship between general dentalhealth and parity. Result: There are a number of limitations in the study designs as the majority ofthem are cross-sectional in nature, rendering insufficient information regarding the associationbetween parity and tooth diseases. While there may be a variety of mechanisms that could contributeto the deteriorated yet reversible changes in the oral health of pregnant women, the possibility of toothloss is yet to be conclusively demonstrated in the studies. Conclusion: Based on the review of thecollected information, it appears that there is an association between parity and tooth loss and/ordisease. However, the link is more socioeconomical and less biological in nature. Multiparous womenpresent more dentally-related socioeconomic elements that may contribute to the apparent increasedloss in tooth number and/or structure. Future research should be directed at conducting studies thatexamine the various plausible mechanisms that are contributive to tooth diseases in women.

Keywords: parity, pregnancy, periodontal disease, tooth disease, tooth loss

Plain language summary:Every child costs the mother one toothis a widespread notion in many cultures around the world. A numberof studies looked at the changes that accompany the number of births and their effect on oral tissues. In thisreport, the authors surveyed 6 relevant studies and concluded that the more children a woman has, the poorerthe condition of their teeth.

1. Background According to an old folk saying translation, every child costs the mother one tooth (Russell et al.2008) 1. Inarguably, pregnancy warrants a number of intricate physiological changes that may manifestin the female body. This can include an increased secretion of female sex hormones, namely,estrogen and progesterone, which are important in providing the fetus with an ideal environment forgrowth as well as preparing the mother for delivery (Suresh & Radfar, 2004) 2. In addition to the mainsystemic changes induced by pregnancy as observed in the cardiovascular, respiratory, endocrine,renal systems, local physical changes may also occur, including changes in the oral cavity.


2/6

There are a variety of oral and facial changes that occur in pregnant women. These include gingivitis,gingival hyperplasia, pyogenic granuloma and salivary changes (Suresh & Radfar, 2004) 2. One of themain causes of the observed changes is due to the elevation of circulating estrogen, which causesincreased capillary permeability, predisposing pregnant women to gingivitis and gingival hyperplasia(Suresh & Radfar, 2004) 2. Moreover, salivary estrogen increases the proliferation and desquamationof the oral mucosa and an increase in subgingival crevicular fluid levels. These changes provide an

ideal environment for bacteria to flourish, which increases susceptibility to dental caries (Suresh &Radfar, 2004) 2. However, there has been conflicting evidence regarding the association betweenparity (number of live born children a woman has delivered) and tooth loss.

In this evidence-based review, current literature that investigates the plausible association betweenparity and tooth diseases was critically appraised. The literature was analyzed to determine the qualityof available evidence on the factors that might be involved in parity and tooth loss. Recommendationsto future research that may be invaluable to oral management of pregnant women were consideredshould there be a valid association between parity and tooth loss.

2. Objectives

The primary objective of this evidence-based review of the literature was to determine whether parityhas negative effects on the oral health of females after giving birth. The secondary objective was todetermine whether there was a consistency among the researchers regarding the factors, if any, thatpromote tooth loss in women with every child born. Specifically, factors such as biological,socioeconomical and age-related factors were considered in this literature review.

3. Search methodsData Sources and Search Strategy

A systematic approach was utilized to investigate the association between pregnancy and parity withoral health in women. A variety of keywords were compiled based on the original search question.MeSH keywords were then determined under population/intervention/compa-rison/outcome criteria

(Table 1). A comprehensive literature search was conducted using two main search engines--Pubmedand SCOPUS--from December 2011 to March 2012.

The search was conducted as Parity OR Parturition OR Pregnancy, Multiple AND Female ANDPeriodontal Diseases OR Tooth Diseases. The search was limited to studies that were in English,females and human studies. Based on the search results, the original search question was modified(Table 1). Refworks was used as the citation management strategy to document the search.

Table 1. PICO KeywordsOriginal Question : Is there an association between the parity and tooth/dental loss and mediatingfactors?

Modified Search Question : Is there an association between pregnancy or parity, and oral disease?

Population Intervention/exposure Comparison Outcome

Female ParityPregnancy, multipleParturitionPregnancy

*no keywords were used in thesearch as keywords underintervention/exposure encompassthose that would be listed here.

PeriodontaldiseasesTooth diseases


3/6


4/6

frequency of dental care visits. Russell et al. (2008) reported that women in lower socioeconomicposition had higher parity and more tooth loss 1. This observation was somewhat consistent with thestudy of Meisel et al. (2008) which demonstrated the differential relationship between parity and toothloss in different socioeconomic position 5.

Another study by Russell et al. (2010) demonstrated that parity was inversely related tosocioeconomic status 6. While women with the highest parity levels exhibited similar numbers of filled

and decayed surfaces, they had more untreated decay compared to women of lower parity.Furthermore, parity was correlated with more decayed teeth than filled. Path analysis demonstratedthat higher parity leads to more decayed not filled surfaces when using dental insurance andfrequency of dental visits as standardization variables.

In a study by Christensen et al. (1998), the researchers examined Danish twins ages 73 or olderduring the years 1995 and 1997 7. Participants included 367 women of high social status and 1454women of low social status. It was found that regardless of the socioeconomic status, there was anegative correlation between the number of teeth remaining and the number of children. However,women with low socioeconomic status lost an additional tooth with every child born (linear regressionestimates: 0.77, p


5/6

The results of a cross-sectional study by Christensen et al. (1998) were suggestive of a positivecorrelation between the number of teeth lost in women and parity 7. The researchers used an adequatesample size of 1821 Danish female twins that were divided into four groups. The sample was not agestratified as all interviewed participants were of age 73 or older. The authors did not assess thenumber of teeth lost after giving birth to each additional child, but instead they reported the overallnumber of teeth lost in the lifetime of the mother. On the other hand, due to the use of the twins, the

study lacked external validity since the participants were not representative of the whole population.The employment of a cross-sectional study design permits the evaluation of the correlation betweenparity and tooth loss in women but no casual relationship could be inferred. Nevertheless, thecorrelations found should be considered significant as all the comparisons had p-values of less than0.001. Furthermore, the researchers controlled for a low and high socioeconomic factor of theparticipants. The association between the number of teeth lost and the socioeconomic status of thewomen was identified. However, no details on the females socioeconomic status (e.g., income,education, occupation) were provided, contributing to one of the weaknesses of the study. Finally,within each comparison, the number of participants between most parity groups was unequal.

The study by Scheutz et al. (2002) was a cross-sectional study and therefore did not show any causalrelationship between parity and tooth loss 8. The authors did not find it justified to carry out a long term

cohort study, although this should be considered in the future. The study consisted of a good samplesize of 500 individuals of a homogenous population. The population was considered representative ofTanzanian women since nearly 100% of the female populations attend the same clinic. In terms ofconfounders, the current age and age at first child birth were controlled for. All examinations werecarried out by the same fourth year Danish dental student along with a Tanzanian dentist.

Additionally, in order to assess reliability, the dental student re-examined 10 women at the beginningof the study and 10 women at the end of the study. There was no evidence uncovered to support thehypothesis that the more children a woman has, the more teeth she will lose (OR: 0.7-0.8 and 95% Cl:0.3, 1.5) nor was there evidence that parity was associated with dental caries (OR: 1.0-1.1 and 95%CI: 0.4, 1.9). The authors did find an association among women who gave birth to more than fourchildren with increased periodontal attachment loss compared to woman who had fewer than fourchildren (OR: 1.5-1.7 and 95% CI: 1.0, 2.7). However, whether attachment loss will actually lead to

further loss of teeth can only be speculated and needs to be studied further.

The studies of Meisel et al. (2008) and Russell at al. (2008, 2010) were all cross-sectional studies,thus they could not establish the causal relationship between parity and tooth loss 1,5-6 . The samplesizes of the studies were large, however, they did not provide information regarding power of sample.Meisel et al. (2008) performed some degree of sample randomization by assessing half of the mouthson the left and right side in alternate participants 5. Samples were stratified by gender into three groupsand each gender group was further stratified by age into twelve 5-year strata. This enhanced therepresentativeness of the sample. Furthermore, Russell et al. (2008, 2010) stratified by socioeconomicstatus and parity 1,6 . Meisel et al. (2008) assessed intraclass correlation and interrater correlation forattachment level and probing depth every 6 months to maintain the consistency of resultmeasurement 5. Therefore, this improved the validity of their results. In addition, in order to adjust the

effect of confounding variables such as age, caries, periodontitis and others, they used linear multipleregression analyses. The study of Russell et al. (2008) provided the first evidence of the associationbetween parity and tooth loss in a large, heterogeneous US women sample 1. However, the findingscannot be generalized because their sample was only limited to Black and non-Hispanic Whitewomen. In addition, they did not perform a weighted analysis from NHANES III and it had beenobserved that their sample was demographically dissimilar from the general US population.


6/6

6. Conclusi ons All seven studies reviewed were cross-sectional in nature. Therefore, causality could not be inferred.Only the study by Scheutz et al. (2002) did not establish the association between parity and oralhealth while the remaining studies did 8. Four studies, namely those by Meisel et al (2008), Russell etal. (2008; 2010) and Christensen et al. (1998), showed a strong correlation between parity and toothloss 1,5-7 , while the studies by Rundgren and Osterberg (1987) and Halling and Bengtsson (1988)demonstrated weak to moderate correlation 3,4 . Overall, the association between parity and tooth loss

appears to be strongly influenced by socioeconomic status. Furthermore, socioeconomic status alsoinfluences other factors that may affect the oral health status of the individual such as, access to care,dental health damaging behavior and psychological factors. Biological factors were considered indiscussion but the specific mechanisms were not elucidated. Future studies should employ moreretrospective cohort and/or case control designs to strengthen the internal validity of association.Furthermore, studies should include biological markers to address the question related to theunderlying biological mechanisms behind parity that may affect oral health.

7. Acknowl edgements:The authors wish to thank Dr. Amir Azarpazhooh at the University of Toronto, Faculty of Dentistry forthe opportunity to carry out this evidence-based review, Dr. Sonica Singhal for her support and

guidance, and Librarian Helen He for her assistance helping us gather information for this project.

8. References1. Russell SL., Ickovics JR., Yaffee RA. (2008) Exploring potential pathways between parity and toothloss among American women. American Journal of Public Health 2008; 98(7):1263-1270.

2. Scheutz F. , Baelum V. , Matee MI. , Mwangosi I. Motherhood and dental disease. Community DentHealth 2002; 19(2):67-72.

3. Rundgren A. and Osterberg T. Dental health and parity in three 70-year-old cohorts. Community

Dent Oral Epidemiol 1987; 15:134-136.

4. Halling A. and Bengtsson C. The number of children, use of oral contraceptives and menopausalstatus in relation to the number of remaining teeth and the periodontal bone height. A population studyof women in Gothenburg, Sweden. Community Dent Health 1989; 6(1):39-45.

5. Meisel P., Reifenberger J., Haase R., Nauck M., Bandt C. Kocher T. Women are periodontallyhealthier than men, but why dont they have more teeth than men. Menopause 2008; 15(2):270-275.

6. Russell SL., Ickovics JR., Yaffee RA. Parity & untreated dental caries in US women. J Dent Res 2010; 89(10):1091-1096.

7. Christensen K., Gaist D., Jeune B. Vaupel J. W. A tooth per child? The Lancet 1998; 352:204.

8. Suresh L. and Radfar L. Pregnancy and lactation. Oral Surgery Oral Medicine Oral Pathology 2004;97(6):672-682.
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Scheutz%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Baelum%20V%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Matee%20MI%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mwangosi%20I%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed/12146584http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mwangosi%20I%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mwangosi%20I%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mwangosi%20I%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Matee%20MI%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Matee%20MI%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Matee%20MI%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Baelum%20V%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Baelum%20V%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Baelum%20V%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Scheutz%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Scheutz%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Scheutz%20F%22%5BAuthor%5D

jurnal skenario 2

Documents