Date of Award

Fall 12-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program/Concentration

Health Services Research

Committee Director

Abdullah Al-Taiar

Committee Member

Denise McKinney

Committee Member

Anwar Merchant

Abstract

Preterm birth (PTB) and low birth weight (LBW) are leading causes of neonatal morbidity and mortality. Maternal periodontal disease (PD) has been increasingly linked to these adverse birth outcomes (ABOs), yet questions about causality and treatment effectiveness persist due to study design heterogeneity and potential unmeasured confounding. These gaps hinder the development of clear clinical and public health guidelines. This dissertation addresses these gaps through three interconnected studies assessing the relationship between maternal oral health and ABOs.

The first study employed a meta-epidemiological analysis of 62 original studies from nine systematic reviews to evaluate the impact of unmeasured confounding on associations between maternal PD and PTB or LBW. The second study conducted a systematic review and meta-analysis of nine randomized controlled trials (RCTs) involving 3,985 women to assess the effect of periodontal treatment, specifically scaling and root planing (SRP) combined with mouthwash use, on the risks of PTB and LBW. The third study analyzed Virginia Pregnancy Risk Assessment Monitoring System (PRAMS) data from 8,820 women (2012–2022) to examine the association between dental cleaning during pregnancy and ABOs using weighted logistic regression.

Findings from the first study revealed that most associations between maternal PD and ABOs remained robust even under hypothetical unmeasured confounding scenarios, supporting a plausible causal link. The second study demonstrated that SRP with mouthwash significantly reduced the risk of PTB (RR = 0.44; 95% CI: 0.22–0.88) and LBW (RR = 0.33; 95% CI: 0.13–0.84), despite notable heterogeneity and some evidence of publication bias. The third study found that dental cleaning during pregnancy was associated with lower odds of PTB and LBW in unadjusted models. Although these associations lost statistical significance after adjustment for confounders, the consistent direction of effect highlights the potential protective role of routine dental care in prenatal settings.

Together, these studies strengthen the evidence linking maternal oral health to birth outcomes. They highlight the potential benefit of integrating preventive dental care into prenatal services and underscore the need for larger, methodologically rigorous trials and public health strategies to reduce oral health disparities among pregnant women.

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DOI

10.25777/2cd9-e704

ISBN

9798276042572

ORCID

0000-0002-1637-407X

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Available for download on Monday, August 17, 2026

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