The relationship between maternal periodontitis and congenital cytomegalovirus: A hypothetical model and therapeutic implications.

backgroundThe primary goal of periodontology is to prevent tooth loss and reduce the risk of focal infections. Periodontitis lesions can harbor hundreds of thousands of active cytomegaloviruses (virions), which can easily enter the systemic circulation and potentially infect the fetus of a mother with compromised immunity. The healthy, non-inflamed periodontium contains no PCR-detectable cytomegalovirus. Maternal cytomegalovirus may be linked to cleft lip and cleft palate, prepubertal and juvenile periodontitis, and systemic diseases.

aimThis article presents an anti-cytomegalovirus periodontal therapy aimed at preventing congenital cytomegalovirus disorders. MATERIALS AND

methodsImmunodeficient and periodontitis-affected women in the pre-gestational period or the first trimester of pregnancy are prime candidates for periodontal treatment. The periodontal diagnosis and drug treatment ought to be performed by well-informed dentists (periodontists). Treatment consists of a one-time valacyclovir regimen (1 g BID on days 1 and 2, and 500 mg BID on days 3-7), subgingival and supragingival ultrasonic scaling using a 0.1%-0.2% sodium hypochlorite cooling solution, individually tailored oral hygiene instructions, and patient-administered daily subgingival irrigation with a 0.1%-0.2% sodium hypochlorite solution.

resultsCytomegalovirus in maternal periodontitis likely serves as a critical nidus for fetal infection. The combined treatment of valacyclovir, ultrasonic scaling, and sodium hypochlorite rinses markedly reduces or eliminates the mother's periodontal cytomegaloviruses. CLINICAL RELEVANCE: The proposed noninvasive anti-cytomegalovirus periodontal therapy is highly safe for the pregnant mother and the fetus. The anti-cytomegalovirus periodontal treatment is expected to control the mother's periodontal cytomegalovirus load and, consequently, part of the baby's congenital disease risk. Research is encouraged on the relationship between periodontal cytomegalovirus and congenital diseases.