***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Poor oral health , such as periodontal ( gum ) disease , has been found to be associated with an increased risk of adverse pregnancy outcomes including preterm birth , low birth weight , and neonatal and infant mortality , especially in low- and middle-income countries . However , there is little or no access to preventive dental care in most low- and middle-income countries . We propose to develop and test a “ Mouth Rinse Intervention ” among pregnant women to prevent the progression of periodontal disease during pregnancy and reduce adverse birth and neonatal outcomes in a rural county of China . Methods / Design This is a r and omized controlled clinical trial . A sample of 468 ( 234 in each arm of the study ) women in early pregnancy with periodontal disease will be recruited for the study . Periodontal disease will be diagnosed through the methods of Periodontal Screening and Recording . All women diagnosed with periodontal disease will be r and omly allocated into the intervention or control group . Women assigned in the intervention group will be provided with non-alcohol antimicrobial mouth rinse containing cetylpyridinium chloride throughout the pregnancy and oral health education . Women in the control group will receive a package of tooth brush and paste , plus oral hygiene education . Women will be followed-up to childbirth until the 42nd day postpartum . The main outcomes include mean birthweight ( gram ) and mean gestational age ( week ) . Discussion Compared with conventional mechanical ‘ scaling and root planning ’ periodontal treatment during pregnancy , our proposed mouth rinse intervention could be a simple , cost-effective , and sustainable solution to improve both mother ’s oral health and neonate outcomes . If the mouth rinse is confirmed to be effective , it would demonstrate great potential for the application in other low- or middle-income countries to prevent adverse birth outcomes such as preterm birth and low birth weight and to reduce neonatal and infant mortality . Trial registration This trial was registered with Chinese Clinical Trial Registry ( ChiCTR ) : ( # ChiCTR-TRC-13003768 ) on November 06 , 2013 BACKGROUND One hypothesis to explain the association between periodontal disease ( PD ) preterm/low birth weight ( PT/LBW ) is that PT/LBW may be indirectly mediated through translocation of bacteria or bacterial products in the systemic circulation . Transient bacteremias occur in subjects with marginal periodontitis or with gingivitis , and it is possible that bacteria and their products may reach the placental membranes hematogenously and provide the inflammatory effect to induce preterm labor . The effect of gingivitis as a potential risk factor for PT/LBW has still not been studied . A r and omized controlled trial was undertaken to determine the effect of routine plaque control and scaling on the pregnancy outcomes in women with gingivitis . METHODS Eight hundred seventy ( 870 ) pregnant women with gingivitis , aged 18 to 42 , were enrolled while receiving prenatal care in Santiago , Chile . Women were r and omly assigned in a two-to-one fashion to either a treatment group ( N = 580 ) , receiving periodontal treatment before 28 weeks of gestation or to a control group ( N = 290 ) , receiving periodontal treatment after delivery . Periodontal therapy consisted of plaque control , scaling , and daily rinsing with 0.12 % clorhexidine . Maintenance therapy was provided every 2 to 3 weeks until delivery , and consisted of oral hygiene instruction and supragingival plaque removal by instrumentation , as needed . The primary outcomes assessed were delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g. RESULTS Of the 870 women enrolled , 36 women ( 27 in the treatment group and nine in the control group ) were excluded from the analyses for different reasons . The incidence of PT/LBW in the treatment group was 2.14 % ( 12/560 ) and in the control group , 6.71 % ( 19/283 ) ( odds ratio [ OR ] 3.26 ; 95 % confidence interval [ CI ] 1.56 to 6.83 ; P = 0.0009 ) . Multivariate logistic regression analysis showed that , after adjusting for several known risk factors for PT/LBW , women with gingivitis were at a higher risk of PT/LBW than women who received periodontal treatment ( OR 2.76 ; 95%CI 1.29 to 5.88 ; P = 0.008 ) . CONCLUSIONS Periodontal treatment significantly reduced the PT/LBW rate in this population of women with pregnancy-associated gingivitis . Within the limitions of this study , we conclude that gingivitis appears to be an independent risk factor for PT/LBW for this population Periodontal disease ( PD ) in pregnancy is associated with an increased risk of adverse pregnancy outcomes including miscarriage and preterm birth . Evidence exists that periodontal disease treatment may reduce inflammatory mediators in gingival crevicular fluid ( GCF ) and the risk of inflammation-associated pregnancy complications . The aim was to determine if periodontal disease treatment during mid-pregnancy alters local inflammation in GCF and has beneficial effects on clinical dental parameters . Eighty pregnant women with clinical ly diagnosed PD were recruited from a r and omised controlled trial on the treatment of periodontal disease in pregnancy conducted in Perth , Australia . The treatment group underwent intensive PD treatment ( 20 - 28 weeks ' GA ) , while the control group underwent the same treatment postnatally . GCF was collected at 20 and 28 weeks ' gestation and concentrations of cytokines determined by multiplex assay : IL-1β , IL-6 , IL-8 , IL-10 , IL-12p70 , IL-17 , TNF-α and MCP-1 . Periodontal treatment significantly reduced the GCF levels of IL-1β , IL-10 , IL-12p70 and IL-6 at 28 weeks ' GA compared with controls , while levels of MCP-1 , IL-8 and TNF-α exhibited a significant gestational age-dependent increase , but no treatment response . Post-treatment clinical parameters improved with significant reductions in bleeding on probing , clinical attachment loss , and probing depth . No changes in pregnancy-related outcomes were observed , although the severity of periodontal disease was significantly associated with an increased risk of infants born small for gestational age . PD treatment in pregnancy reduces the levels of some inflammatory mediators in the GCF and improves dental parameters , with no overt effects on pregnancy outcome Periodontitis has been associated with  adverse pregnancy outcomes .  Results from intervention studies are few and controversial . The present study assessed the effects of non-surgical periodontal treatment in the occurrence of adverse pregnancy outcomes .  Two hundred forty-six eligible women were r and omly divided into two groups : periodontitis intervention ( n = 122 ; undergoing non-surgical treatment during gestation ) and periodontitis control ( n = 124 ; not treated during gestation ) . Univariate analysis was performed and estimates of relative risk were reported . Data from 225 women were analyzed . No differences for preterm birth ( p = 0.721 ) , low birth weight ( p = 0.198 ) , and preterm low birth weight ( p = 0.732 ) rates were observed . Relative risk estimates for preterm birth , low birth weight , and preterm low birth weight in the periodontitis intervention group were 0.915 ( 95 % CI 0.561–1.493 ) , 0.735 ( 95 % CI 0.459–1.179 ) , and 0.927 ( 0.601–1.431 ) , respectively . Non-surgical periodontal treatment during the second semester of gestation did not reduce the risk for preterm birth , low birth weight , and preterm low birth weight BACKGROUND Maternal periodontal disease has been associated with an increased risk of  preterm birth and low birth weight .  We studied the effect of nonsurgical periodontal treatment on preterm birth . METHODS We r and omly assigned women between 13 and 17 weeks of gestation to undergo  scaling and root planing either before 21 weeks ( 413 patients in the treatment group ) or after delivery ( 410 patients in the control group ) . Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene . The gestational age at the end of pregnancy was the prespecified primary outcome . Secondary outcomes were birth weight and the proportion of infants who were small for gestational age . RESULTS In the follow-up analysis , preterm birth ( before 37 weeks of gestation ) occurred in 49 of 407 women ( 12.0 % ) in the treatment group ( result ing in 44 live births ) and in 52 of 405 women ( 12.8 % ) in the control group ( result ing in 38 live births ) . Although periodontal treatment improved periodontitis measures ( P<0.001 ) , it did not significantly alter the risk of preterm delivery ( P=0.70 ; hazard ratio for treatment group vs. control group , 0.93 ; 95 % confidence interval [ CI ] , 0.63 to 1.37 ) . There were no significant differences between the treatment and control groups in birth weight ( 3239 g vs. 3258 g , P=0.64 ) or in the rate of delivery of infants that were small for gestational age ( 12.7 % vs. 12.3 % ; odds ratio , 1.04 ; 95 % CI , 0.68 to 1.58 ) . There were 5 spontaneous abortions or stillbirths in the treatment group , as compared with 14 in the control group ( P=0.08 ) . CONCLUSIONS Treatment  of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth , low birth weight , or fetal growth restriction . ( Clinical Trials.gov number , NCT00066131 [ Clinical Trials.gov ] . ) Objective This study aim ed to investigate a relationship between maternal periodontal disease and preterm birth , low birth weight and late miscarriage .  Design Prospect i ve study in a single centre . Setting Guy 's and St Thomas ' Hospital Trust , London , UK between August 1998 and July 2001.Subjects and Methods Pregnant women were recruited on attending an ultrasound scan at approximately 12 weeks of pregnancy . Subjects completed a question naire and underwent periodontal examination . Main outcome measures Plaque and bleeding scores , pocket probing depth and loss of attachment . Pregnancy outcome data was collected retrospectively , including gestational age and birth weight at delivery . Results Data were collected for 3,738 subjects . Regression analysis indicated that there were no significant relationships between the severity of periodontal disease and either preterm birth ( PTB ) or low birth weight ( LBW ) . In contrast , there did appear to be a correlation between poorer periodontal health and those that experienced a late miscarriage . Conclusions There was no association between either preterm birth or low birth weight and periodontal disease in this population . There is evidence of a correlation between markers of poorer periodontal health and late miscarriage Considering the high prevalence of preterm birth ( PTB ) and low birth weight ( LBW ) and their complications as well as the role played by periodontal disease in their incidence and the lack of any report of periodontal therapy on these problems in Iran , the goal of the present research was to determine the effects of periodontal treatment on PLBW incidence among women with moderate or advanced periodontitis who were referred to Javaheri hospital ( 2004 - 2005 ) . This clinical trial research was conducted on 30 pregnant women age ranging from 18 - 35 years old , with moderate or advanced periodontitis . Fifteen subjects r and omly underwent the first phase of periodontal treatment including scaling , root planning and the use of 0.2 % chlorhexidine mouth rinse for one week . None of these steps were taken for the controls . After necessary follow ups , the effect of periodontal treatment on birth term and birth weight were analyzed statistically . This research was conducted on 30 subjects , 15 controls and 15 cases in study group . In the control group , the observed rate of PLBW was 26.7 % whereas among periodontally treated group , phase I , PLBW infant was not observed ( P < 0.05 ) . Infants birth weight were ( 3059.3 - 389.7 ) gms in study group and ( 3371 - 394.2 ) gms in the control group and respectively ( P < 0.05 ) . Periodontal therapy , phase I , results in a reduction in PLBW incidence rate . Therefore , the application of such a simple method among periodontally diseased pregnant women is recommended BACKGROUND The purpose of the present study is to investigate the potential link between maternal periodontitis and pregnancy outcomes , including  preterm birth ( < 37 weeks ) and low birth weight ( < 2,500 g ) . METHODS Ninety nine pregnant females with mild/moderate periodontitis were r and omly allocated to a control ( n = 50 ) or test ( n = 49 ) group . Test group participants received intrapregnancy non-surgical periodontal treatment , whereas this was deferred until after delivery for controls  . Demographic and baseline clinical data were obtained for all participants at initial assessment pretreatment . Clinical data were rerecorded for test participants at review 8 weeks after treatment . Birth outcomes were completed at delivery by midwives who also collected cord blood sample s when possible ; the latter were analyzed to determine the presence/levels of cytokines interleukin (IL)-1β , IL-6 , and IL 
    Output:
    
Maternal mortality and adverse effects of the intervention did not occur in any of the studies that reported on either of the outcomes .
AUTHORS ' CONCLUSIONS It is not clear if periodontal treatment during pregnancy has an impact on preterm birth ( low- quality evidence ) .
There is insufficient evidence to determine which periodontal treatment is better in preventing adverse obstetric outcomes .