Fluoride Action Network


Objectives: Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established.

Methods: This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n?=?9234, weighted response rate?=?64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC-CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth?<?37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs).

Results: During 2009-2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR?=?0.74 [95% CI 0.55-0.98]), and DC-CWF and preterm birth (aRR?=?0.74 [95% CI 0.57-0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR?=?0.81 [95% CI 0.63-1.05]), compared to women without dental cleaning and CWF.

Conclusions for Practice: This study shows that the prevalence of preterm birth was lower among women with DC only and DC-CWF.

This work was supported by the Centers for Disease Control and Prevention Grant #DP006202.

Supplementary material: 10995_2018_2659_MOESM1_ESM.docx (80 kb)


  1. Agueda, A., Ramon, J. M., Manau, C., Guerrero, A., & Echeverria, J. J. (2008). Periodontal disease as a risk factor for adverse pregnancy outcomes: A prospective cohort study. Journal of Clinical Periodontology, 35(1), 16–22.  https://doi.org/10.1111/j.1600-051X.2007.01166.x.CrossRefPubMedGoogle Scholar
  2. Allukian, M., & Horowitz, A. M. (2002). Effective community prevention programs for oral diseases. In G. Gluck & W. M. Morganstein (Eds.), Jong’s community dental health (pp. 237–276). St. Louis: Mosby Press (Reprinted from: Fifth).Google Scholar
  3. American College of Obstetricians and Gynecologists. (2013). Committee Opinion 569 Oral Health care during pregnancy and through the lifespan. Retrieved from https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Oral-Health-Care-During-Pregnancy-and-Through-the-Lifespan.
  4. American Dental Association (ADA). (2016). Survey: More pregnant women in U.S. visiting a dentist. ADA News. Retrieved from https://www.ada.org/en/publications/ada-news/2016-archive/may/survey-more-pregnant-women-in-us-visiting-a-dentist.
  5. American Dental Association (ADA) Division of Science. (2013). Tackling tooth decay. The Journal of the American Dental Association, 144(3), 336.  https://doi.org/10.14219/jada.archive.2013.0121.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (1999). Ten great public health achievements—United States, 1900–1999. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.
  7. Centers for Disease Control and Prevention. (2014). Fluoridation statistics. Retrieved from https://www.cdc.gov/fluoridation/statistics/2014stats.htm.
  8. Centers for Disease Control and Prevention. (2017). Preterm birth. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm.
  9. Denney, J. M., Culhane, J. F., & Goldenberg, R. L. (2008). Prevention of preterm birth. Womens Health (London), 4(6), 625–638.  https://doi.org/10.2217/17455057.4.6.625.CrossRefGoogle Scholar
  10. Genco, R. J., Falkner, K. L., Grossi, S., Dunford, R., & Trevisan, M. (2007). Validity of self-reported measures for surveillance of periodontal disease in two western New York population-based studies. Journal of Periodontology, 78(Suppl 7), 1439–1454.  https://doi.org/10.1902/jop.2007.060435.CrossRefPubMedGoogle Scholar
  11. Heimonen, A., Rintamaki, H., Furuholm, J., Janket, S. J., Kaaja, R., & Meurman, J. H. (2008). Postpartum oral health parameters in women with preterm birth. Acta Odontologica Scandinavica, 66(6), 334–341.  https://doi.org/10.1080/00016350802307620.CrossRefPubMedGoogle Scholar
  12. Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes, R. E. Behrman, & A. S. Butler (Eds.). (2007). Preterm birth: Causes, consequences, and prevention. Washington, DC: National Academies Press.Google Scholar
  13. Massachusetts Department of Public Health (MDPH). (2010). Pregnancy Risk Assessment Monitoring System (PRAMS) 2007/2008. Surveillance Report. Massachusetts. Retrieved from https://www.mass.gov/files/documents/2016/07/nc/prams-report-07-08.pdf.
  14. McDonagh, M. S., Whiting, P. F., Wilson, P. M., Sutton, A. J., Chestnutt, I., Cooper, J., et al. (2000). Systematic review of water fluoridation. BMJ, 321(7265), 855–859.CrossRefPubMedCentralPubMedGoogle Scholar
  15. Newbrun, E. (1989). Effectiveness of water fluoridation. Journal of Public Health Dentistry, 49(5), 279–289.  https://doi.org/10.1111/j.1752-7325.1989.tb02086.x.CrossRefPubMedGoogle Scholar
  16. Oral Health Care During Pregnancy Expert Workgroup. (2012). Oral health care during pregnancy: A national consensus statement. Washington, DC: National Maternal and Child Oral Health Resource Center.Google Scholar
  17. Pihlstrom, B. L., Michalowicz, B. S., & Johnson, N. W. (2005). Periodontal diseases. Lancet, 366(9499), 1809–1820.  https://doi.org/10.1016/S0140-6736(05)67728-8.CrossRefPubMedGoogle Scholar
  18. Pollick, H. F. (2004). Water fluoridation and the environment: Current perspective in the United States. International Journal of Occupational and Environmental Health, 10(3), 343–350.  https://doi.org/10.1179/oeh.2004.10.3.343.CrossRefPubMedGoogle Scholar
  19. Shulman, H. B., Gilbert, B. C., & Lansky, A. (2006). The Pregnancy Risk Assessment Monitoring System (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74–83.  https://doi.org/10.1177/003335490612100114.CrossRefPubMedCentralPubMedGoogle Scholar
  20. Silk, H., Douglass, A. B., Douglass, J. M., & Silk, L. (2008). Oral health during pregnancy. American Family Physician, 77(8), 1139–1144.PubMedGoogle Scholar
  21. Taylor, G. W., & Borgnakke, W. S. (2007). Self-reported periodontal disease: Validation in an epidemiological survey. Journal of Periodontology, 78(Suppl 7), 1407–1420.  https://doi.org/10.1902/jop.2007.060481.CrossRefPubMedGoogle Scholar
  22. U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. (2015). US Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Reports, 130(4), 318–331.CrossRefPubMedCentralGoogle Scholar
  23. Wagle, M., D’Antonio, F., Reierth, E., Basnet, P., Trovik, T. A., Orsini, G., et al. (2018). Dental caries and preterm birth: A systematic review and meta-analysis. British Medical Journal Open.  https://doi.org/10.1136/bmjopen-2017-018556.CrossRefGoogle Scholar
  24. Xiong, X., Buekens, P., Vastardis, S., & Yu, S. M. (2007). Periodontal disease and pregnancy outcomes: State-of-the-science. Obstetrical & Gynecological Survey, 62(9), 605–615.  https://doi.org/10.1097/01.ogx.0000279292.63435.40.CrossRefGoogle Scholar