Oral health and dental care during pregnancy

Assessment of Oral Health Status and Pregnancy Outcomes Among Women in Saudi Arabia

Purpose

Pregnant women witness many changes in the body as well as in the oral cavity with many factors influencing these changes. This study evaluated the relationship between oral health status, perceptions, and pregnancy outcomes.

Methods

A cross sectional study design was implemented to recruit a convenience sample of women attending Obstetrics and gynecology department in public hospitals in East and capital city of Saudi Arabia. To collect data, a validated self-administered questionnaire in English and Arabic was used. The questionnaire covered background information, perceived oral health status, and dental visits.

Results

About 64.4% of the 481 women recruited had dental problems, 49.7% reported deterioration in their oral health during pregnancy, and 17.5% reported adverse pregnancy outcomes. Only 40.7% of pregnant women rated their oral health as good, and only 22% visited a dentist during their pregnancy. Dentists were the most common source of oral health information (44.1%), followed by social media (38.9%). Dental problems during pregnancy were significantly associated with adverse outcomes (P=0.007). Oral health perceptions of pregnant women, not visiting the dentist during pregnancy, and gingival problems were also significantly associated with adverse pregnancy outcomes (P=0.001). Those with fair to poor oral health were twice as likely to experience adverse pregnancy outcome. Those who intended to visit the dentist during their pregnancy but did not do so, as well as those who did not visit the dentist at all were 12 and 9 times more likely to experience adverse pregnancy outcomes respectively.

Conclusion

Dental complaints during pregnancy, oral health perceptions, and a lack of dental visits were all linked to increased likelihood of adverse pregnancy outcomes. There is a need for interprofessional collaboration to dispel myths and encourage oral health care and regular dental visits during pregnancy.

Treatment Perception and Utilization of Dental Care During Pregnancy Among Women Visiting Antenatal Clinics in King Abdulaziz Medical City & Primary Healthcare, National Guard, Jeddah, Saudi Arabia

Objectives To identify how readily accessible dental care is to a sample of pregnant women in King Abdulaziz Medical City (KAMC), Jeddah, and to determine any potential obstacles to receiving dental care while pregnant. Methodology Female patients visiting antenatal clinics in KAMC in Jeddah, Saudi Arabia were the target group for this cross-sectional study. The age range was limited to childbearing age (18-48 years old). Both pregnant and non-pregnant women were established in obstetrics and gynecology clinics. The pattern of dental service use and attitude toward dental treatment during pregnancy were assessed using a self-administered questionnaire. Other data were gathered, such as demographics, education, employment status, and the number of live births. Results This study included 361 participants in the survey with an 80% response rate. A large proportion of participants was in the age group of 19 to 35 years old (75.07%; p-value < 0.0001), holding undergraduate degrees (58.17%; p-value < 0.0001), housewives (77.56%; p-value < 0.0001), married (99.45%; p-value < 0.0001), non-pregnant women (75.07%; p-value < 0.0001), and have three or more children (42.94%; p-value < 0.0001). About two-thirds of the participants reported using private hospitals for their dental services (65.37%; p-value < 0.0001), while 22.03% (p-value < 0.0001) of the participants reported visiting a dentist in the last six months and 7.2% (p-value < 0.0001) visited a dentist during pregnancy. In terms of awareness questions, 72.02% (p-value < 0.0001) reported that if the mother did not eat well, the baby takes calcium from the mother's teeth, 43.77% (p-value < 0.0001) reported brushing teeth at least three times a day, and 42.94% (p-value < 0.0001) of women reported that they do not have an idea about what they need to do if a pregnant woman needs treatment that requires taking X-rays. Similar patterns were observed in other awareness answers. Conclusion Based on the study's findings, there is a significantly low rate of dental care utilization in the sample of pregnant women. We conclude that educated women are more likely to maintain good oral hygiene and are more satisfied with their oral health. However, a large proportion of participants reported dental problems during their pregnancy. In general, a lack of knowledge about the safety of dental care during pregnancy is the main obstacle to seeking dental care. Limitations The selected sample was from antenatal clinics in KAMC & Primary Healthcare, National Guard, Jeddah, Saudi Arabia. As a result, the findings of this study cannot be applied to the total female population of Jeddah, Saudi Arabia. Because the information was self-reported, which is a common issue with self-administered questionnaires, and because participation in the study was voluntary and participant confidentiality was maintained, there is a low chance that the data may be subject to recall or response bias.

Oral health status and barriers to utilization of dental services among pregnant women in Sunsari, Nepal: A cross-sectional study

OBJECTIVES

This study was conducted to assess oral hygiene practices, oral health status and barriers to utilization of oral health care services among pregnant mothers attending two family health care clinics in Sunsari, Nepal.

METHODS

A cross-sectional study was conducted among 139 women using a purposive sampling technique. The data collection was done using a pretested standard semi-structured questionnaire. Face-to-face interviews of the participants were done by a single investigator in the local language (Nepali). The examination was done using a mouth mirror and CPI probe for periodontal status, loss of attachment and dentition status, and treatment needs.

RESULTS

The majority of pregnant mothers brushed their teeth once a day or less than once a day (n = 106, 76.3%) and self-reported perceived oral health status was poor/fair (n = 93, 66.9%). The prevalence of dental caries was found to be 69.8%. Bleeding on probing was present in all participants. DMFT, presence of bleeding on probing and increased periodontal pocket was significantly high among women who had self-reported their oral health problems in comparison to those who had not reported any problem. The most common barriers reported by the participants were a lack of knowledge of dental checkups and a lack of perceived need for dental care during pregnancy.

CONCLUSIONS

There was a high prevalence of dental caries and periodontal disease. Lack of knowledge and perceived need for dental care were the major barriers found in this study. Hence, this directs towards the utmost need for improvement in awareness level as well as oral hygiene practices.

Oral and general health conditions involved in periodontal status during pregnancy: a prospective cohort study

PURPOSE

Pregnancy is a period in a woman's life that has important consequences on oral health, particularly for gingival health. Present study aims to identify women at higher risk of developing periodontal disease (gingivitis and periodontitis) during late pregnancy and evaluate how this condition evolves during this period.

METHODS

Prospective cohort study was designed with pregnant women who were assessed during the first and third trimesters of gestation in a southern Spanish public hospital. Data regarding gingival and periodontal health, oral hygiene, and overall health status (obesity and diabetes mellitus) were collected. Reporting followed STROBE checklist.

RESULTS

Significantly higher number of women had the periodontal and gingival disease in the third trimester of gestation compared with in early pregnancy. In the third trimester of gestation, 42 (28.6%) and 63 (42.9%) of women presented symptoms of periodontal disease and gingival disease, respectively. Obesity (OR 2.834; 95%CI 0.919-8.741), worse oral hygiene during the first trimester of gestation (OR: 4.031; 95%CI 2.12-7.65), and periodontal disease during early pregnancy (OR: 15.104; 95%CI 3.60-63.36) most effectively predicted periodontal disease during late pregnancy.

CONCLUSIONS

Pregnancy is associated with exacerbated periodontal and gingival disease symptoms throughout the different trimesters of gestation. Obesity and oral hygiene during early pregnancy were the risk factors that most contributed to the aforementioned changes in periodontal disease.

Latest Concepts in Endodontic Management of Pregnant Patients

Pregnant patients and how to manage their treatments is one of the most important challenges in endodontic practice. Endodontic treatment on pregnant women is sometimes an emergency condition to control toothache due to irreversible pulpitis and odontogenic infection. Tooth decay, oral health, local and general anesthesia, analgesics, antibiotic prescription, drug interactions, and X-ray radiation are the most important considerations that may impact treatment planning and endodontic practice in pregnancy. The aim of this article is to notify and explain the latest concepts in the endodontic management of pregnant patients.

The effects of social media (Snapchat) interventions on the knowledge of oral health during pregnancy among pregnant women in Saudi Arabia

BACKGROUND

There is growing interest in using social media to improve pregnant women's well-being. This study aimed to evaluate the effects of social media (Snapchat) dissemination of health-promoting interventions on knowledge of oral health during pregnancy among pregnant women in Saudi Arabia.

MATERIALS AND METHODS

Using a single-blinded parallel group randomized controlled trial design, 68 volunteers were assigned to either a study group (SG) or a control group (CG). The SG received information about oral health during pregnancy via Snapchat, while the CG received the same information using WhatsApp. The participants were assessed three times: T1 prior to the intervention, T2 immediately following the intervention, and T3 as a follow-up 1 month later.

RESULTS

A total of 63 participants completed the study in the SG or CG. According to paired t-test, total knowledge scores in the SG and CG increased significantly from T1 to T2 (p < 0.001) and from T1 to T3 (p < 0.001), but there was no significant change from T2 to T3 in either the SG or CG (p  =  0.699 and p  =  0.111, respectively). Using t-test, no significant differences were found between the SG and CG at T2 (p  =  0.263) or T3 (p  =  0.622). Also using t-test, no significant differences were found in the scores of the SG and CG from T2 to T1 (p  =  0.720), T3 to T2 (p  =  0.339), or T3 to T1 (p  =  0.969).

CONCLUSIONS

Using social media (e.g., Snapchat and WhatsApp) as a health-promoting intervention is a promising method for improving women's knowledge about oral health during pregnancy for short term. However, further studies are needed to compare social media with conventional standard lecturing methods. also, to assess the longevity of the impact (short or long term).

Knowledge, attitudes and practices of undergraduate students and dentists about dental prenatal care

INTRODUCTION

Prenatal care is a fundamental moment for health promotion to be carried out, since at that moment women are more receptive to new knowledge, with the aim of providing better healthcare for the baby. This study aimed to evaluate the knowledge, attitudes and practices of undergraduate students and professionals, both from the public and from private sectors in Brazil, regarding dental prenatal care.

MATERIALS AND METHODS

This study corresponded to an online questionnaire survey, via Google Forms, consisting of 17 general questions for undergraduates (n = 103) and 16 for professionals (n = 227) for demographic and school mapping, and 18 specific questions about the importance and protocol of dental prenatal care. T-test, Mann-Whitney U-test and multiple linear regression were adopted (p < .05).

RESULTS

The average total score of the questionnaire for students and professionals was 12.40 and 15.65, respectively (p < .0001), indicating moderate knowledge. Professionals showed a higher prevalence of moderate (77%) and high (2%) knowledge of the subject when compared to undergraduate students (51% and 0% respectively). The graduation period in which the students were enrolled was a predictor of the total score of the questionnaire [F (1, 101) = 21.21; p < .0001; R²  = .165]. The female gender and the lower weekly workload were the main predictors of the total score of the questionnaire for professionals [F (3, 223) = 6.74; p < .0001; R²  = .083].

CONCLUSIONS

Although professionals have greater knowledge about dental prenatal care than students, there are still deficiencies in the knowledge and practices of them in respect of dental management during pregnancy. Higher education institutions need to change the teaching-learning plan regarding the holistic dental approach for women during pregnancy.

Knowledge and Attitudes of Pregnant Women with and without Children about Fluoride and Herbal Toothpastes

Objective: Objective: Pregnant women may be vulnerable to dental caries due to their inability to fully implement oral hygiene practices. Toothpastes are main component of oral hygiene and the most important tool for the primary prevention of caries. The study aimed to examine the knowledge and attitudes of pregnant women with children (PC) and without children (PNC) about fluoride and herbal toothpastes. Methods: A self-administered and validated 20-item questionnaire was completed by a total of 219 pregnant participants, 85 PC and 134 PNC. Statistical analyses were performed using the SciPy v1.2.3. program. Results: Most of the PC (57.65%; 69.41%) and PNC (72.39%; 47.76%) participants responded with “no idea” when asked about fluoride sources and the optimal amount of fluoride added to tap water by local health authorities (p= .006). The majority of the PC (62.4%) and the PNC (47.0%) had no preference for herbal toothpastes during pregnancy (p= .03). In addition, 86.6% of the PNC showed low knowledge about the nonfluoride content of herbal toothpastes (p= .023). While 51.5% of the PNC responded with “no idea” about a preference for herbal toothpastes for their children, 56.47% of the PC stated that they might not prefer using herbal toothpastes for their children’s routine oral hygiene. Conclusion: The findings show that both PC and PNC participants had little knowledge of toothpastes and their contents. Considering that toothpastes are the most common self-applied oral hygiene tools, knowledge and awareness of fluoride and herbal toothpastes should be raised via antenatal programs.

Adverse effects following dental local anesthesia: a literature review

Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.

Predictors of periodontal and caries related perinatal oral healthcare, investigation of dentists' practices: a cross-sectional study

Background

The objectives of the study were to assess the knowledge, attitude, and practice of dentists towards providing oral health care to pregnant women and to identify barriers and predictors of periodontal and caries related perinatal oral healthcare practices.

Methods

A cross-sectional analytical survey was conducted on dentists by using a random sampling technique, and a pre-validated questionnaire was delivered to 350 dentists from May 2018 to October 2018. Data were analyzed by utilizing SPSS software. Frequencies and percentages were recorded for descriptive variables. Binary logistic regression was used to analyze the probability of predicting group membership to the dependent variable using different independent variables determined from contingency tables.

Results

Overall response rate was 41%. The mean knowledge score of respondents was 15.86 ± 3.34. The lowest correct responses were noted in the questions related to periodontal health. It was found that the advice to delay dental visits until after pregnancy was eight times more likely to be observed among dentists who lacked the knowledge of importance of oral health during pregnancy (P = 0.04, OR = 8.75). Dentists were more likely to consult obstetricians regarding dental procedures when they fear a risk of labor in the dental practice (P < 0.05, OR = 3.72). Dentists who had the knowledge of periodontal disease association with preterm delivery were about four times more likely to treat periodontal disease during pregnancy (P = 0.01, OR = 3.95). Dentists knowing the association between maternal oral health and childhood decay were more likely to counsel pregnant patients regarding caries prevention (P > 0.05, OR = 3.75).

Conclusions

Collectively the results indicated few gaps in knowledge among some dentists and a need to improve existing attitudes towards perinatal oral health. Dentists failing to recognize the importance of perinatal oral health are more likely to be hesitant in treating pregnant patients. Failing to recognize the link between periodontal disease and obstetric complications increases the possibility of hesitance to counsel pregnant patients regarding the same. The appreciation of the evidence for poor perinatal oral health and risk of early childhood caries increases the likelihood of counseling by dentists on caries prevention.

Knowledge, Attitudes, and Practices of Spanish Midwives and Midwifery Students toward Oral Healthcare during Pregnancy

Pregnancy can affect the mother's oral health, increasing their susceptibility to oral diseases that have been associated with harmful effects on the newborn. Despite the severity of oral diseases during pregnancy, the demand for dental care during the gestational period is low, which may improve with the participation of midwives in promoting oral health activities. The objectives of this study were: (i) to determine the knowledge, attitudes, and practices of Spanish midwives and midwifery students regarding oral health in pregnant women; and (ii) to identify the barriers faced by these healthcare professionals in addressing oral health promotion during pregnancy. An observational cross-sectional descriptive study was conducted. A total of 128 midwives and/or midwifery students ≥ 18 years old and of both sexes were invited to self-complete a questionnaire between January and April 2020. A total of 85 people participated in the study. Participants had a regular level of knowledge about oral health during pregnancy (overall knowledge score: 6.53), and although they were interested in activities that promote oral healthcare, their oral healthcare practices during pregnancy were limited. As midwives play an important role in promoting health, their training in oral healthcare could help to improve pregnant women's oral health.

Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures

Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.

Integrating oral health into prenatal care: a scoping review

Purpose

Integrating preventive oral care into prenatal care is suggested as a strategy for reducing the burden of oral diseases among pregnant women and their offspring. This scoping review sought to synthesize available information and identify knowledge gaps on integrating oral health into prenatal care.

Design/methodology/approach

The scoping review was conducted based on the Joanna Briggs Institute scoping review framework using the following databases: CINAHL, Cochrane Database of Systematic Reviews, Medline, ProQuest Dissertation and theses Global, Psychinfo and Web of Science®. No search limits were used. Content analysis of the included articles was performed to identify conceptual frameworks, types of integration used, study designs, study objectives and outcomes.

Findings

Overall, 2,861 references were obtained from the databases search; and based on the inclusion and exclusion criteria 35 references were included in the final analysis. Of these 35 references, one document presented a conceptual model, six documents reviewed guidelines for integrating oral health in prenatal care, two were policy documents aimed at interprofessional collaboration for oral health during pregnancy, eight documents described programs focused on providing oral care during pregnancy, five of the references were literature reviews and the remaining 13 evaluated the impact of integration. Linkages between healthcare professionals were the most common type of integration used.

Research limitations/implications

Despite advances in understanding integrated care concepts for healthcare delivery, there is little evidence available on the impact of the various types of, and strategies for, integrating oral health into prenatal care. Future research to bridge the identified gaps is recommended.

Originality/value

The originality of this study is to provide evidence on integrated oral healthcare during pregnancy.

Hyperglycaemia and factors associated with dental caries in immediate postpartum women

Objective: Dental caries and hyperglycaemia share common risk factors. The aim of this study was to identify factors associated with dental caries in women in the immediate postpartum period. It also verified whether women with hyperglycaemia presented more dental caries than those with normal glycaemia.Material and Methods: This cross-sectional study was performed on 297 women recruited from a teaching hospital in Brazil (from October 2011 to November 2012). Dental caries and oral biofilm were evaluated by oral examination. The blood glucose was accessed by Haemoglobin A1c test. Information on socioeconomic characteristics, harmful habits and oral health habits was also gathered.Results: More than half (66%) of the women had carious lesions. Univariate analysis showed no association between hyperglycaemia and dental caries (p = .39). The hierarchical logistic regression model showed that the following variables were associated with dental caries: maternal education level ≤8 years (ORadjusted = 2.40 [CI 1.19-4.82]), previous children (OR_adjusted = 1.81 [CI 1.08-3.03), use of dental floss (OR_adjusted = .48 [CI 0.27-0.86]), and visible plaque index ≥30% (OR_adjusted = 1.83 [CI 1.05-3.20]).Conclusions: These findings call attention to the need to implement effective public policies directed at avoiding tooth decay in pregnancy and in the postpartum period.

Oral Health Knowledge and Related Factors among Pregnant Women Attending to a Primary Care Center in Spain

Our aim was to assess the knowledge of pregnant women in terms of oral health and prevention, correlating it with socio-sanitary and educational factors, as well as self-care and oral health state referred. A total of 139 women from a Health Department in Comunidad Valenciana (Valencia, Spain) participated in the study. They underwent an auto-administered survey which included socio-economic and educational factors, self-care in terms of oral hygiene, referred oral health state, and general knowledge on prevention and oral health. Chi-squared test (χ2 test) and ANOVA (p < 0.05) were performed for the analysis. Variables significantly associated with general knowledge were included in a logistic regression analysis. Variables which explained general knowledge in terms of oral health were Spanish nationality (Exp B = 3.59 p = 0.017), secondary/bachelor or equivalent level of education (Exp B = 0.23 p = 0.010), medium or high level of self-care (Exp B = 0.146 p = 0.024 and Exp B = 0.208 p = 0.046, respectively), and medium or high knowledge on prevention (Exp B = 0.092 p = 0.003 and Exp B = 0.280 p = 0.017, respectively). Level of education, nationality, self-care, and knowledge on prevention and oral health were the factors that determined a greater level of general knowledge on oral health from the pregnant women.

Dental care during pregnancy based on the pregnancy risk assessment monitoring system in Utah

BACKGROUND

Although receiving dental care is recommended for women during pregnancy, getting such care remains low. This study will identify the level of dental care received during pregnancy and factors associated with care for a group of pregnant women in Utah.

METHODS

Analyses were based on 2793 pregnant women completing the 2014-2015 Utah PRAMS survey. Descriptive and bivariate techniques were used.

RESULTS

Approximately 91.2% knew it was important to care for their teeth and gums during pregnancy, yet only 58.8% had their teeth cleaned during pregnancy. Those who knew such care was important were 1.4 (95% CI 1.1-2.0) times more likely to have their teeth cleaned during pregnancy. Although 18.8% needed to see a dentist for a problem, only 74.5% of them received treatment for the problem during pregnancy. Approximately 76.0% had dental insurance during pregnancy. Those with dental insurance were 1.9 (95% CI 1.5-2.4) times more likely to have their teeth cleaned and 1.6 (95% CI 1.2-2.2) times more likely to go to a dentist for needed treatment during pregnancy. Approximately 51.4% had a dental/health care worker talk with them about how to care for their teeth and gums. These women were more likely to know it was important to care for their teeth and gums during pregnancy (97.4% vs 87.6%, p < 0.0001). For women who received care for a problem during pregnancy, 70.0% had a dental/health care worker talk with them about how to care for their teeth and gums. These women were more likely to know it was important to care for their teeth and gums during pregnancy (95.2% vs 82.8%, p < 0.0001). Women who had their teeth cleaned the year prior to pregnancy were more likely to have their teeth cleaned during pregnancy (78.5% vs 21.5%, p < 0.0001).

CONCLUSIONS

A large proportion of women knowing of the importance of dental care during pregnancy did not receive care. Knowledge of its importance during pregnancy, having a dental/health care worker talk with them about how to care for their teeth and gums, and having dental insurance during pregnancy are positively associated with dental care during pregnancy.

Awareness of Dental Interns to Treat Pregnant Patients

BACKGROUND

Pregnancy causes major changes in maternal physiology and metabolism, which may lead to increased susceptibility to oral infection.

AIM

Aim of this study is to assess the awareness of dental interns regarding the management of the dental needs of pregnant patients.

METHODS

A cross-sectional questionnaire survey was conducted among 188 interns of a private dental college in Saudi Arabia. The questionnaire comprised of 14 knowledge-based questions regarding their training, awareness and practice management of the pregnant patient in dental clinics. Four questions to record and evaluate their training, the number of pregnant patients treated by them and their confidence level in the dental management of the pregnant patient. Excel spreadsheet was used for mathematical calculations.

RESULTS

Almost 62% of our participants never treated a pregnant female during their training. About 65% of the interns knew using antibiotics, almost 55% have a clear idea of the safest NSAIDS, and 43% regarded local anaesthesia to be safe when used among pregnant females. Conversely, about 50% of the participants had no clear knowledge of the FDA category of drugs. Only 24% considered dental radiographs to be safe in pregnant patients. 57% thought to postpone the dental treatment in an acute active dental infection in expecting mothers. Results also showed a lack of confidence among interns to provide dental care to gestating female.

CONCLUSION

On analysing the results, we found that there is a need to improve the knowledge, awareness and confidence levels among the interns who are the future dentists treating these patients.

Dental Care-Seeking and Information Acquisition During Pregnancy: A Qualitative Study

Background: Pregnant women are at risk of oral health problems. This qualitative study aims to understand dental care-seeking behaviours of pregnant women and their oral health-related information acquisition, to identify barriers to and motivators for, dental visits, and further explore their expectations and possible strategies to improve oral health care during pregnancy. Methods: Semi-structured interviews were conducted with 30 pregnant women (after 32 gestational weeks) enrolled in the antenatal care programme in a public hospital in Hong Kong. Two main areas of interest were probed: Dental care-seeking behaviour and oral health information acquisition. Their expectations and suggestions on oral health care service for pregnant women were also explored. An inductive thematic approach was adopted to analyse the data. Results: Pregnant women’s dental care-seeking behaviour was deterred by some internal factors, such as misunderstandings on oral health, and priority on other issues over oral health. External factors such as inconvenient access to dental service during pregnancy also affected their care-seeking behaviours. Oral health information was passively absorbed by pregnant women through mass media and the social environment, which sometimes led to confusion. Oral health information acquisition from antenatal institutions and care providers was rare. Greater attention was paid to dental visit when they obtained proper information from previous dental visit experience or family members. A potential strategy to improve oral health care suggested by the interviewees is to develop a health care system strengthened by inter-professional (antenatal-dental) collaboration. Efficient oral health information delivery, convenient access to dental service, and improved ‘quality’ of dental care targeting the needs of pregnant women were identified as possible approaches to improve dental care for this population. Conclusion: Dental care-seeking behaviour during pregnancy was altered by various internal and external factors. A lack of, or conflict between, information sources result in confusion that can restrict utilisation of dental service. Integrating dental care into antenatal service would be a viable way to improve dental service utilisation.

Oral hygiene, prevalence of gingivitis, and associated risk factors among pregnant women in Sarlahi District, Nepal

BACKGROUND

The oral health status of pregnant women in low-resource communities such as Nepal has not been well characterized. This sub-population is also of specific interest given associations between poor oral health and adverse pregnancy outcomes previously documented in other settings. We explored relationships between gingivitis and risk factors among pregnant women in rural Nepal.

METHODS

The design was a community-based, cross-sectional study in a sub-area of Sarlahi District, Nepal. Pregnant women < 26 weeks gestation underwent clinical periodontal exams conducted by community-based oral health workers. Exams included a full mouth assessment measuring bleeding on probing (BOP), probing depth (PD) (six sites per tooth), and gingival recession, the distance from the cemento-enamel junction to the free gingival margin (two direct sites per tooth). Data on participant risk factors were collected through household surveys, including demographic characteristics, oral health behaviors, care seeking, and health attitudes. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors.

RESULTS

We enrolled 1452 participants, of which 40% (n = 582) had signs of clinical gingivitis and 60% (n = 870) clinical health. Average participant age was 23. Most participants (88%) had never received oral health care. Participants averaged 10% of sites with BOP with most (79%) having ≥1 site with BOP. Nine percent of participants had ≥1 site with PD ≥4 mm, although very few participants (0.7%) had sites with PD ≥5 mm. Few participants (13%) had any recession (≥1 mm). In the final adjusted model, odds of gingivitis increased by 3% for each year of age (aOR 1.03, 95% CI 1.00, 1.06) and were higher for women of short maternal stature (< 150 cm) (aOR 1.43, 95% CI: 1.14, 1.79) and among women reporting cost to be a barrier to seeking dental care (aOR 2.13, 95% CI: 1.09, 4.15).

CONCLUSIONS

Gingivitis was common and associated with age, maternal stature, self-reported high cost of dental care, and other risk factors among pregnant women in rural Nepal.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

Characterizing the Subgingival Microbiome of Pregnant African American Women

OBJECTIVE

To generate preliminary data about the subgingival microbiome of pregnant African American women to calculate power for a future larger study and to explore associations among the microbiome, periodontal inflammation, and preterm birth.

DESIGN

Comparative descriptive pilot study design.

SETTING

Urban area in the southeastern United States.

PARTICIPANTS

Thirty-four African American women in the third trimester of pregnancy.

METHODS

Based on visual assessment, participants were placed in two groups: healthy gingiva and gingivitis. Saliva samples were analyzed for interleukin-1β (IL-1β), matrix metalloproteinase-8 (MMP-8), and C-reactive protein (CRP). DNA was extracted from subgingival plaque samples, and amplicons of the fourth hypervariable region were sequenced.

RESULTS

We found no differences in overall microbiome diversity between the healthy gingiva (n = 22) and the gingivitis (n = 12) groups although significant differences were found among the bacterial taxa present. The gingivitis group had greater levels of salivary IL-1β and MMP-8, whereas CRP was not different between groups. Overall microbiome diversity was positively associated with the CRP level. We found no significant relationships among the subgingival microbiome, periodontal inflammation, and preterm birth.

CONCLUSION

Gingivitis in pregnancy did not appear to shift the overall composition or diversity of the subgingival microbiome although differences in several bacterial taxa suggest that inflamed gingiva in pregnant women are associated with a disruption in the stability of the subgingival microbiome. A correlation between the abundance of bacteria and CRP also suggests an association between the microbiome and systemic inflammation. These findings provide support for future research about how the oral microbiome and progression of periodontal disease in pregnant women link with adverse pregnancy outcomes.

A low cost minimally invasive adhesive alternative for maxillary central incisor replacement

OBJECTIVE

The beneficial mechanical properties of zirconia, together with the adhesive techniques, provide a wide range of clinical applications, including the construction of thin structures and minimally invasive adhesive restorations.

CLINICAL CONSIDERATIONS

A periodontal disease-related missing maxillary central incisor, in a pregnant patient with chronic periodontal disease in the first trimester of pregnancy, and with type II diabetes treated with resin-bonded fixed partial denture using the missing tooth cemented to a zirconia framework and then bonded to the abutment teeth.

CONCLUSIONS

According to the systemic conditions presented in this case report, using a low-cost technology and the missing tooth it was possible to obtain an easier and satisfactory esthetic and functional result.

CLINICAL SIGNIFICANCE

The mechanical properties of zirconia made it possible to treat a pregnant patient with chronic periodontal disease in the first trimester of pregnancy, and with type II diabetes with a thin zirconia framework and minimally invasive adhesive restorations.

Oral Health in Pregnant Chinese Women in Singapore: A Call to Go beyond the Traditional Clinical Care

Objective: To examine the correlations among oral health knowledge, attitude, practices and oral disease among pregnant Chinese women in Singapore. Methods: A descriptive correlational study was conducted in pregnant Chinese women in Singapore. A questionnaire was used to collect data of oral health knowledge, attitude and practices. Plaque index scores were used to assess the oral health of subjects. Results: A total of 82 pregnant women participated in the study, out of whom 38% showed adequate oral health knowledge, nearly half of them achieved adequate and oral health attitude and practice scores while 34% had good Plaque index scores. The lower income group had higher experience of self-reported dental problems during pregnancy than those in the higher income group (p = 0.03). There were significant positive correlations between scores of oral health practice, attitude and oral health knowledge levels. The plaque index scores negatively correlated with the oral health practice scores (p = 0.02). Conclusions: Our findings provided evidence that oral health knowledge, attitude and practices among Chinese pregnant women were not optimal which implies the importance of promoting their oral health during pregnancy through the improvement of knowledge and attitudes. This would facilitate formulation and implementation of appropriate oral health promotion policies.

Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes

This article reviews maternal prenatal risk factors for caries in children and intergenerational transmission of caries, emphasizing early interventions for pregnant women and mother-infant pairs. A growing body of evidence focuses on maternal interventions. Studies suggest that early prenatal clinical and educational interventions are effective at reducing mother-child mutans streptococci (MS) transmission and delaying colonization and caries in young children. Dental screenings and anticipatory guidance about maternal and infant oral health should be included in prenatal care and pediatric well visits. Dental care during pregnancy is safe and recommended and can reduce maternal MS levels. Infants should visit a dentist by age 1.

Interprofessional Collaborative Practice: An Oral Health Paradigm for Women

Interprofessional collaborative practice (IPC) is paramount to the future of oral health education. As such, it is critical that today's health care education continues to expand its curriculum to promote oral health as an essential component in the IPC approach to women's health. This article explores models that can be implemented using an IPC framework to foster better approaches in the delivery of care to female patients.

Qualitative exploration of barriers and facilitators of dental service utilization of pregnant women: A triangulation approach

BACKGROUND

Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women's dental service utilization.

METHODS

Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software.

RESULTS

Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists' unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies.

CONCLUSIONS

Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.

An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes

OBJECTIVE

In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature.

METHODS

A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed.

RESULTS

A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions.

CONCLUSIONS

Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.

Severe odontogenic infection in pregnancy: a timely reminder

Dental practitioners often treat patients that are pregnant. Understanding the altered physiology in the pregnant patient, especially changes in immune function, is vital in effective management of orofacial infections. We present a case of rapidly spreading odontogenic infection in a pregnant patient requiring surgical management. We also discuss the physiological changes of pregnancy relevant to dentistry, and the principles of managing such infections in the gravid patient.

Effect of education based on the theory of planned behavior on adoption of oral health behaviors of pregnant women referred to health centers of Birjand in 2016

OBJECTIVE

Oral health of pregnant women is very important because of the adverse effects of pregnancy on the oral hard and soft tissues and vice versa. The aim of this study was to evaluate the effect of education on oral health behaviors of pregnant women based on the theory of planned behavior in Birjand.

MATERIALS AND METHODS

This quasi-experimental study was carried out among 150 pregnant women admitted to health centers, who were selected using simple sampling (75 females in each case and control group). Educational program through face-to-face training was performed in the case group, and the control group received only usual training through leaflet distribution. Data were collected using a questionnaire and analyzed by the Statistical Package for the Social Sciences version 18 software at 0.05 significance level.

RESULTS

The most frequent age group was 26-30 years. Before the intervention, the mean scores of knowledge, attitude, perceived behavioral control, subjective norms, behavioral intention, and performance of the intervention and control groups showed no significant difference (P ≥ 0.05). After the intervention, the average of all scores in the intervention group showed significant increase compared to the control group (P ≤ 0.05).

CONCLUSION

Face-to-face training using the theory of planned behavior has positive impact on oral health behaviors of pregnant women. Accordingly, training sessions in order to raising awareness and positive attitude and controlling healthcare behaviors can improve oral health behaviors of pregnant women.

The Special Needs of Preterm Children - An Oral Health Perspective

Preterm births are defined as those before 37 weeks of gestation. With advances in fertility medicine and neonatal medicine, the numbers of preterm children in the community have significantly increased. Developmental delays and complications among preterm children are well recognized. Much less consideration is given to the dental complications of preterm children. Manifestations include palatal deformations, enamel defects, tooth size variations and tooth shape deformities, malocclusions, and increased risks of early childhood caries and tooth wear. This article explores orodental risks and orodental needs of preterm children and suggests preventive and management strategies for optimizing the oral health of special needs children.

Oral and vulvovaginal changes in pregnancy

Physiologic alterations of the oral and vulvovaginal mucosal surfaces result from the profound hormonal and immunologic changes of gestation. High estrogen levels are responsible for the vascular changes noted on mucosal surfaces. Gingival hyperemia and edema, gingivitis and pyogenic granuloma are the most common alterations of the oral mucosa during gestation. Physiologic changes of the vulvovaginal area are mainly of vascular nature, and include among others varicose veins. The oral and vulvovaginal mucosal surfaces can be affected by diseases that can worsen or develop in pregnancy. Oral lesions are encountered in a large spectrum of diseases including aphthosis, pemphigus vulgaris, systemic lupus, and Behçet disease. Pregnancy dermatoses such as impetigo herpetiformis and gestational pemphigoid can exceptionally affect the oral mucosa. Infections of the vulvovaginal region by Candida species, Trichomononas vaginalis, human papilloma virus, and herpes simplex virus have been associated with fetal risks. The dermatologist, obstetric medicine physician, and neonatologist should be familiar with the above physiologic changes as well as maternal/fetal risks relevant to disease affecting these mucosal surfaces during gestation.

Knowledge and Attitude of Medical Nurses toward Oral Health and Oral Health Care of Pregnant Women

BACKGROUND

This study assessed the knowledge and attitudes of medical nurses regarding oral health and oral health care of pregnant women.

METHODS

This cross sectional study of 133 nurses in the district of Tumpat, Kelantan (Malaysia) used self-administered questionnaires.

RESULTS

Most nurses knew that dental plaque is associated with periodontal disease (97.7%). However, most nurses erroneously believed that tooth decay (86.5%) and excessive sugar consumption (87.2%) led to periodontal disease. About half of the nurses knew about the relationship between periodontal disease of pregnant women and low birth weight (43.6%) and preterm birth (48.9%). Many nurses had the misconception that the developing foetus draws calcium from the mothers' teeth (78.2%). Most nurses had good attitudes toward improving their oral health knowledge (97.0%) and agreed they should help to deliver oral health education to pregnant women (94.0%). Age, length of service as a nurse, and length of service in antenatal care had no effect on the scores for the nurses' knowledge and attitude regarding oral health and oral health care of pregnant women.

CONCLUSION

Medical nurses had limited knowledge about oral health of pregnant women and had some misunderstandings about oral health, although they had good attitudes. Age, length of service as a nurse, and length service in antenatal care had no effect on the knowledge and attitude scores of the nurses.

The evaluation of an oral health education program for midwives in Australia

BACKGROUND

Antenatal care providers are now recommended to promote oral health during pregnancy and provide dental referrals. However, midwives in Australia are not trained to undertake this role. To address this shortcoming, an online evidence based midwifery initiated oral health (MIOH) education program was systematically developed as a professional development activity.

AIM

This study aimed to evaluate the effectiveness of the program in improving the oral health knowledge of midwives and assess their confidence to promote maternal oral health post training.

METHODS

The program was evaluated using a pre-post test design involving 50 midwives purposively recruited from two states in Australia. The pre-post questionnaire contained 24 knowledge items previously pilot tested as well as items exploring confidence in promoting oral health and perceptions of the program.

FINDINGS

The results showed a significant improvement in the oral health knowledge (↑21.5%, p<0.001) of midwives after completion of the program. The greatest improvement in knowledge occurred in key areas vital in promoting maternal oral health namely the high prevalence of dental problems and its impact on birth and infant outcomes. The majority also reported being confident in introducing oral health into antenatal care (82%) and referring women to dental services (77.6%) after undertaking the education program.

CONCLUSION

The MIOH education program is a useful resource to equip midwives with the necessary knowledge and skills to promote oral health during pregnancy. The program is accessible and acceptable to midwives and can potentially be transferable to other antenatal care providers.

Increased infection with key periodontal pathogens during gestational diabetes mellitus

AIM

Gestational diabetes mellitus (GDM), gingivitis, infection with specific periodontal pathogens and systemic inflammation each increase the risk for poor pregnancy outcome. We set out to monitor the interactions of gingivitis and GDM with respect to oral infection and the systemic inflammatory burden.

MATERIALS AND METHODS

Four case-control groups (n = 117) were recruited, (1) No gingivitis, No GDM (n = 27); (2) Gingivitis, No GDM (n = 31); (3) No gingivitis, GDM (n = 21); and (4) Gingivitis, GDM (n = 38). Oral infection with three key periodontal pathogens was determined by PCR. Systemic inflammation was determined by quantification of CRP by EIA.

RESULTS

Gingivitis during pregnancy was associated with oral infection with Porphyromonas gingivalis, Filifactor alocis and Treponema denticola and combinations thereof (all p < 0.01). GDM was also associated with increased infection with individual and multiple oral pathogens (all p < 0.05). Gingivitis during pregnancy led to a 325% increase in systemic CRP (mean, 2495 versus 8116 ng/ml, p < 0.01).

CONCLUSIONS

Diabetes and gingivitis act in concert to increase risk biomarkers for poor pregnancy outcome.

The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women

BACKGROUND

Evidence is emerging that women's poor oral health and health practices during pregnancy are associated with poor oral health in their children and potentially an increased risk of pre-term or low-birth weight infants.

METHODS/DESIGN

The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) trial is a three arm multicentre randomised controlled trial which will recruit women from three metropolitan hospitals aimed at improving women's oral health and service access and indirectly reducing perinatal morbidity. All three arms of the trial will deliver oral health promotion material, although a midwife oral assessment and referral to private/public/health fund dental services pathway (Intervention Group 1) and the midwife oral assessment and referral to local free public dental services pathway (Intervention Group 2) will be compared to the control group of oral health promotional material only. Midwives will undergo specific oral health education and competency testing to undertake this novel intervention.

DISCUSSION

This efficacy trial will promote a new partnership between midwives and dentists focused on enhancing the oral health of women and their infants. Should the intervention be found effective, this intervention, with existing on-line educational program for midwives, can be easily transferred into practice for large metropolitan health services within and beyond Australia. Further cost-benefit analysis is proposed to inform national health policy.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612001271897.