Third Molars and the Efficacy of Mechanical Debridement in Reducing Pathogen Levels in Pregnant Subjects: A Pilot Study
Purpose
To assess the impact of mechanical debridement (scaling and root planing), without adjunctive therapy, on reducing the numbers of periodontal pathogens detected in pregnant subjects with and without visible third molars.
Patients and Methods
Sixty-seven subjects in the second trimester of pregnancy were enrolled in an institutional review board-approved study. Full mouth periodontal exams of all teeth were conducted at baseline and postpartum. Presence or absence of third molars was noted. Subgingival biofilm samples were obtained from the mesiobuccal of all first molars at enrollment and postpartum. Subjects' total counts for periodontal pathogens in biofilm samples were determined by DNA-DNA checkerboard hybridization. We analyzed data from a subsample of 26 subjects. All subjects in the study were treated at enrollment by mechanical debridement of all teeth, including third molars. Differences between subjects' baseline and postpartum demographic and clinical characteristics were analyzed by χ2 and t tests by presence or absence of third molars. Statistical significance for differences in pathogen levels was determined by Rank analysis of covariance. Significance was set at 0.05 without correction for multiple comparisons.
Results
Most of the 26 subjects were African American (61%), on Medicaid (92%), and did not smoke during pregnancy (88%). The 15 subjects with visible third molars were significantly older (28.0 years [SD 6.4] vs 23.7 years [SD 3.9]). In the 11 subjects with no third molars noted, all pathogen counts were reduced postpartum. In the 15 subjects with visible third molars, total counts for each pathogen analyzed were higher postpartum as compared with subjects with no visible third molars, and their bacterial counts were increased for 5 of the 8 pathogens, including all “red cluster” pathogens. Differences between study groups were observed by the presence or absence of third molars for T. forsythia and P. nigrescens (P = .04), and for P. gingivalis, F. nucleatum, total “orange cluster” bacteria, and total pathogens (P < .06).
Conclusion
The efficacy of mechanical debridement to lower periodontal pathogen counts during pregnancy was limited by the presence of visible third molars and should be analyzed further in larger scale trials.
⁎Research Applications Specialist, Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC.
†Senior Resident, Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC.
‡OraPharma Distinguished Professor, Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC.
§Kenan Distinguished Professor, Department of Dental Ecology, and Associate Dean for Research, School of Dentistry, University of North Carolina, Chapel Hill, NC.
¶Dalton L. McMichael Distinguished Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Address correspondence and reprint requests to Dr White: Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, CB 7450, Chapel Hill, NC 27599-7450
Supported in part by Phillips Oral Health Care, NIDCR R01 DE-012453, GCRC RR-00046, OMSF, AAOMS.
ABSTRACT