Revisões sistemáticas sobre os efeitos da terapia periodontal não-cirúrgica sobre biomarcadores inflamatórios e desfechos gestacionais adversos

Abstract

Studies performed with the intention of treat periodontal disease during pregnancy, aiming at reducing adverse pregnancy outcomes showed conflicting results, and some hypotheses were in search of explanations. Possibly periodontal treatment during pregnancy is delayed to control the effects of local and systemic inflammation triggered by pathogenic microorganisms, or perhaps lacking the clinical or laboratory evidence of the effectiveness of periodontal therapy on inflammation installed. In these cases, measurement of inflammatory biomarkers, locally or systemically, may be used to determine the state of periodontal inflammation, and the result of non-surgical periodontal therapy. Objectives: To conduct two systematic reviews, the first of them with meta-analysis to determine the effect of periodontal therapy nonsurgical in the preconception period or during pregnancy on adverse pregnancy outcomes, particularly premature birth, low birth weight and preeclampsia; and the second to analyze the effects of non-surgical periodontal therapy during pregnancy on inflammatory biomarkers and adverse pregnancy outcomes. Methods: Systematic reviews were performed according to the protocol described by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), from July 2015 to March 2016. We evaluated randomized controlled trials and non-randomized pregnant women with periodontitis chronic, treated before or after conception, compared with pregnant women without treatment, besides the evaluation of inflammatory biomarkers before and after periodontal treatment nonsurgical relating to adverse pregnancy outcomes. The effect of periodontal therapy was evaluated in pregnant women considering the following adverse outcomes: prematurity (birth < 37 weeks or < 35 weeks), low birth weight (< 2,500g) and preeclampsia. Results: In each review conducted we found four studies that met the inclusion criteria, in which women who received nonsurgical periodontal therapy (scaling and root planing) during pregnancy were compared with women who received no treatment or received prophylaxis and oral hygiene care. In the first study, the meta-analysis showed no XIV reduction in preterm birth < 37 weeks (1.11; 95% CI: 0.89 - 1.37; p = 0.36), preterm birth < 35 weeks (0.93; 95% CI: 0 , 77 - 1.13; p = 0.46), low birth weight (1.3; 95% CI: 0,74 - 1.43; p = 0.87) and preeclampsia (1.25; 95% CI: 0,58 - 2.70; p = 0.56) between the test and control groups. There were no clinical trials examining the effect of preconception periodontal treatment. In the second systematic review, non-surgical periodontal therapy during pregnancy reduced levels of periodontal inflammatory biomarkers in gingival crevicular fluid (GCF) and some blood serum, but was ineffective in reducing the biomarkers in blood umbilical cord, showing no clear relationship with the pregnancy outcomes. Conclusion: Non-surgical periodontal therapy during pregnancy does not reduce the occurrence of adverse pregnancy outcomes, although better periodontal clinical parameters; decrease periodontal of inflammatory biomarkers levels present in gingival crevicular fluid and reduce CPR and IL-6 RS levels in serum. The effect of preconception periodontal treatment on adverse pregnancy outcomes remains unanswered in the literature. Possibly periodontal treatment during pregnancy is delayed to control the effects of local and systemic inflammation triggered by pathogenic microorganisms.