{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T19:00:20Z","timestamp":1782932420140,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,3,13]],"date-time":"2018-03-13T00:00:00Z","timestamp":1520899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID\u2010OAA\u2010A\u201012\u201000005"],"award-info":[{"award-number":["AID\u2010OAA\u2010A\u201012\u201000005"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003125","name":"Suomen Kulttuurirahasto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005634","name":"Suomen Hammasl\u00e4\u00e4k\u00e4riseura Apollonia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005634","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Oral Diseases"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Maternal dental periapical infections are associated with preterm birth and intrauterine growth restriction. This study investigates whether the association is mediated through bacterial spread from periapical lesions to placenta (direct pathway) or systemic inflammatory reaction (indirect pathway).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We compared birth outcomes in Malawian mothers with and without periapical infection. As markers of a direct pathway, we identified placental bacteria using a 16S <jats:styled-content style=\"fixed-case\">rDNA<\/jats:styled-content> approach and assessed histological evidence of inflammation in the placenta and amniotic membranes. We measured C\u2010reactive protein, alpha\u20101\u2010acid glycoprotein, and salivary cortisol as markers of an indirect pathway. We used regression models to associate the predictor variables with duration of pregnancy and newborn size.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1,024 women, 23.5% had periapical infection. There was no association of periapical infection with either bacterial <jats:styled-content style=\"fixed-case\">DNA<\/jats:styled-content> or histological inflammation in placenta or membranes. Periapical infection was associated with C\u2010reactive protein, alpha\u20101\u2010acid glycoprotein, and cortisol concentrations in a dose\u2010dependent manner at 36\u00a0weeks. Addition of alpha\u20101\u2010acid glycoprotein or cortisol concentration into regression models attenuated the association between periapical infection and pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There was no evidence of direct spread of periapical bacteria to the placenta. Periapical infections and adverse pregnancy outcomes are in part mediated through systemic inflammation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/odi.12817","type":"journal-article","created":{"date-parts":[[2017,12,12]],"date-time":"2017-12-12T08:01:18Z","timestamp":1513065678000},"page":"847-855","source":"Crossref","is-referenced-by-count":19,"title":["Periapical infection may affect birth outcomes via systemic inflammation"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0598-3918","authenticated-orcid":false,"given":"U","family":"Harjunmaa","sequence":"first","affiliation":[{"name":"Center for Child Health Research University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital  Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Doyle","sequence":"additional","affiliation":[{"name":"Microbiology, Virology &amp; Infection Control Great Ormond Street Hospital NHS Foundation Trust  London UK"},{"name":"Institute of Child Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"J\u00e4rnstedt","sequence":"additional","affiliation":[{"name":"Department of Radiology Medical Imaging Center Tampere University Hospital  Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Kamiza","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Malawi College of Medicine  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JM","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Program in International and Community Nutrition Department of Nutrition University of California, Davis  Davis CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CP","family":"Stewart","sequence":"additional","affiliation":[{"name":"Program in International and Community Nutrition Department of Nutrition University of California, Davis  Davis CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Shaw","sequence":"additional","affiliation":[{"name":"Institute of Child Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Hallamaa","sequence":"additional","affiliation":[{"name":"Center for Child Health Research University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital  Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Center for Child Health Research University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital  Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Klein","sequence":"additional","affiliation":[{"name":"Institute of Child Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KG","family":"Dewey","sequence":"additional","affiliation":[{"name":"Program in International and Community Nutrition Department of Nutrition University of California, Davis  Davis CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Maleta","sequence":"additional","affiliation":[{"name":"Department of Community Health University of Malawi College of Medicine  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Center for Child Health Research University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital  Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3008599"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.114.088617"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2014.00136"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19990330)18:6<681::AID-SIM71>3.0.CO;2-R"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61856-X"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0722.1996.tb00139.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0180167"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-302X.2009.00534.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2009.01034.x"},{"issue":"2","key":"e_1_2_9_11_1","first-page":"425","article-title":"Systemic inflammation in cardiovascular and periodontal disease: Comparative study","volume":"9","author":"Glurich I.","year":"2002","journal-title":"Clinical and Diagnostic Laboratory Immunology"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2013.06.014"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513487559"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12579"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jobcr.2015.08.006"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anaerobe.2013.09.001"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.3164526"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1213566"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70006-8"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60560-1"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513490168"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-302x.2000.150301.x"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/154411130401500604"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi323"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1251816"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60136-1"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034509346549"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000069014"},{"issue":"1","key":"e_1_2_9_30_1","first-page":"35","article-title":"Oral inflammatory process and general health. Part 2: How does the periapical inflammatory process compromise general health?","volume":"15","author":"Somma F.","year":"2011","journal-title":"European Review for Medical and Pharmacological Sciences"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0793-8"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0378(01)00067-5"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0378(02)00085-2"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-59602-4.00002-2"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1300\/J013v20n02_02"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"}],"container-title":["Oral Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fodi.12817","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/odi.12817","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/odi.12817","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/odi.12817","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T17:40:39Z","timestamp":1695490839000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/odi.12817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,13]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1111\/odi.12817"],"URL":"https:\/\/doi.org\/10.1111\/odi.12817","archive":["Portico"],"relation":{},"ISSN":["1354-523X","1601-0825"],"issn-type":[{"value":"1354-523X","type":"print"},{"value":"1601-0825","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,13]]}}}