Effect of Periodontal Disease Treatment on the Preterm Birth Rate: An Integrative Review of the Literature
Sandy G. Langheld
The University of North Carolina in Greensboro
NUR-601-01D

“We have abided by the UNCG Academic Integrity Policy on this assignment.”
Sandy G. Langheld and Dara D. Swift 11-26-13
Abstract
The purpose of this integrative review is to analyze and synthesize published research on the effects of periodontal disease treatment on the rate of preterm birth to identity implications for women’s health nurses. The question that guided the review process was: What effect does periodontal disease treatment have on the rate of preterm birth? A total of 9 randomized control trials were selected for the review after searching the literature. A search of research papers between January 2008 and September 2013 was conducted via CINAHL (Cumulative Index for Nursing & Allied Health Literature), PubMed, Google Scholar, and the Cochrane Library. The following keywords were combined: “periodontal disease” or “periodontal treatment” or “periodontal therapy” or “periodontitis” and “preterm birth” or “preterm births” or “pre term birth” or “pre term births” or “pregnancy outcomes”. The studies were examined according to the following five elements: principal focus of the study, sample size and subjects, methodology, conclusions, and recommendations. The final synthesis resulted in three findings: periodontal treatment is a safe and effective measure in the prevention of periodontal disease during pregnancy, periodontal disease treatment showed statistically significant improvement in oral health of pregnant women, and that periodontal disease treatment has confounding results on the effect of the preterm birth rate.

An Integrative Review of the Literature on Periodontal Disease Treatment’s Effect on the Preterm Birth Rate
Introduction
Preterm birth (PTB) is an unsolved problem in perinatal medicine. Prematurity is the most common cause of infant morbidity and mortality in the United States and worldwide (Iams, Romero, & Creasy, 2009). PTB affects one out of ten pregnancies, or nearly half a million pregnancies a year in the United States (U.S.) according to the Center for Disease Control (2013). Worldwide, fifteen million babies are born each year prematurely, and prematurity is the second leading cause of death in children under five according to Gravett & Rubens (2012). PTB can have long term consequences for the infant, including neurological impairments, developmental delays, behavior disorders, and chronic health conditions (Huck, Tenenbaum, & Davideau, 2011) and can have profound economic impacts related to medical care. The PTB rate across the United States fell to 11.72 % in 2011, down from 11.99% in 2010, according to birth data from the National Vital Statistics Report (Hamilton, Martin, & Ventura, 2013). Although this is the lowest PTB rate in five straight years, it is still higher than the rate of preterm birth reported during the 1980’s and most of the 1990’s (Hamilton, Martin, & Ventura, 2013). PTB can be defined as any birth occurring before the 37th week of pregnancy (Lowdermilk, Perry, & Cashion, 2010). However, an appropriate lower gestational age limit must be considered to separate preterm birth from miscarriage. A 20 week boundary is consistently used in the U.S. (Iams et al., 2009) for the lower limit of the gestational age to be defined as a PTB. PTB can also be divided into two major subcategories, spontaneous and medically indicated. Medically indicated PTB’s account for approximately 25% of the PTB’s in the US (Iams et al., 2009). Risk factors associated with spontaneous preterm birth are many, including: history of PTB, multiple gestation, race, (twofold higher among black women) (Iams et al., 2009), teen pregnancy, low socioeconomic status, lower educational levels, short inter-conceptual spacing, progesterone deficiency, uterine anomalies, maternal