 Significance and Impact: Adverse birth outcomes related to the length of gestation preterm birth are recognized as one of the most significant disorders in maternal-child health at a global scale. In the developed world, the preterm birth rate approximates 7. In Malawi, the investigators have recently demonstrated that this rate more than triples to approximate 26.1. Of the 4 million newborn deaths annually, nearly 13 27 are directly attributable to prematurity with another 36 secondary to related opportunistic infections sepsis, pneumonia, gastrointestinal. 75 of the 4 million deaths occur within the first week of life, with the vast majority occurring in the first 48 hours. For those that do survive, there are persistent and lifelong risks due to stunted growth, chronic infection, retinopathy of prematurity, and bronchopulmonary dysplasia. The link between maternal oral health periodontal disease in particular and risk of preterm birth has been demonstrated across all populations rural and urban, in both industrialized and developing regions studied to date. However, in multiple randomized controlled trials treatment of active periodontal disease with scaling and planning during pregnancy has failed to demonstrate a significant benefit in preventing preterm birth. 