Oral health challenges in pregnant women: Recommendations for dental care professionals

Pain, anxiety, and catastrophizing among pregnant women with dental pain, undergoing root canal treatment

This prospective study aims to evaluate dental pain, anxiety, and catastrophizing levels in pregnant women undergoing root canal treatment. Sixty pregnant and non-pregnant women presenting dental pain and an indication for root canal treatment were included in the study. Dental anxiety and catastrophizing were investigated using validated questionnaires. The endodontic intervention was performed, and a numerical scale measured preoperative and postoperative dental pain. The results were analyzed using STATA software 12.0. Unadjusted analyses assessed the association between pregnancy and pain, anxiety, and catastrophizing levels. Multiple linear regression models using 'forward stepwise' entry procedures were used to assess the independent effects of variables on pain scores. The significance level was set at 0.05. Initially, most patients experienced intense dental pain. The levels of dental pain, dental anxiety, and catastrophizing did not differ between pregnant and non-pregnant women. Logistic regression showed that postoperative pain was associated with irreversible pulpitis diagnosis (OR = 4.78; 95%CI 1.55-13.55) and high catastrophizing levels (OR = 1.96; 95%CI 1.01-3.84). Preoperative and postoperative pain rates and anxiety and catastrophizing were similar between pregnant and non-pregnant patients. Postoperative pain was associated with irreversible pulpitis diagnosis and high catastrophizing levels. The similarity between pregnant and non-pregnant women regarding preoperative and postoperative dental pain and catastrophizing and anxiety levels supports the indication of root canal treatment during the gestational period whenever necessary.

Pregnancy-related dental problems: A review

Introduction

The goal of this review is to highlight the significance of dental health during pregnancy, carefully investigate how it affects the health of both the mother and the fetus, and provide practical prevention strategies and therapeutic choices. The main goal is to increase awareness of potential dental problems during pregnancy, understand their effects on the expectant mothers and the fetus's health, and outline practical prevention and management techniques.

Data sources

Conduct a rapid literature search using databases focusing on papers published in English within the last ten years, such as PubMed, Google Scholar, and other relevant platforms from 1st September to 1st October 2023. Use appropriate keywords and search terms related to dental problems, pregnancy, dental care in Bangladesh, and related topics. Include articles published in peer-reviewed journals, books, reports, and official documents.

Study selection

Studies selected on common pregnancy-related dental issues include gingivitis, periodontitis, tooth erosion, xerostomia, tooth decay, and pregnancy tumours. The prevention measures are conditions include regular dental check-ups, maintaining good oral hygiene, and professional cleanings. Treatment options range from scaling and root surface instrumentation to dental restorations and surgical removal, if necessary.

Conclusion

The different dental problems that may develop during pregnancy along with their possible effects on oral health and general wellbeing. Underscores the importance of prioritizing dental care during pregnancy to ensure the well-being of both the mother and the developing baby.

Clinical significance

Dental issues that arise during pregnancy affect both the mother and the fetus, and if left untreated, can result in pain, swelling, and even tooth loss. Recent studies suggest a connection between periodontal disease and unfavourable pregnancy outcomes, emphasizing the importance of precise dental care throughout pregnancy. To minimize hazards and advance general well-being, it is essential to give oral health priority throughout pregnancy. For effective management, routine exams, preventative measures, and oral hygiene practices are crucial. Dental professionals are crucial in helping expecting mothers maintain their best oral health for the sake of both the mother and the unborn child.

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.

Knowledge, attitudes, and practices of healthcare professionals on oral care of pregnant women in Brunei Darussalam

OBJECTIVE

To examine nationwide the knowledge, attitudes, and practices of healthcare professionals on oral/dental care of pregnant women in Brunei Darussalam.

MATERIALS AND METHODS

A descriptive cross-sectional study conducted using an online survey of eligible healthcare professionals in all Government Maternal and Child Health Care Clinics, Dental Clinics and Obstetrics and Gynecological Clinics in four hospitals covering the whole of Brunei Darussalam. Participants were given seven days to complete the survey. Sub-group analysis using Chi-square test for independence and one-way Analysis of Variance (ANOVA) was used to determine the significant association between domains of oral care practices and demographic factors. P values less than 0.05 was considered statistically significant.

RESULTS

A total of 346 healthcare professionals participated in this online study. Most participants (94.3%) responded that they perceived oral health to be of high importance. However, less than two thirds of the participants (59.0%) included oral health questions during antenatal health assessments. Moreover, only 16.2% of participants frequently discussed the importance of oral care with their antenatal patients.

CONCLUSIONS

In this survey, most healthcare professionals viewed oral health to be of high importance for prenatal/antenatal patients. However, not all put those views into practice with regard to oral care in pregnant women.

Correlation of the Oral Health Scoring-based Pregnant Oral Self-Care – package (POSC-p) Model with the Motivation to Seek Oral Health Treatment in Pregnant Women

Background:

Uncomprehensive oral health evaluation instruments and measurement and the low motivation for seeking dental and oral treatment for pregnant women; all require comprehensive measurement instruments that will increase the motivation for seeking oral health treatment for pregnant women. POSC-p model was developed for the Oral Health Scoring (OHS) to assess pregnant women's perceived needs, clinical examination, and salivary state.

Objectives:

The research objective was to analyse the correlation between the POSC-p model with the motivation for seeking oral health care in pregnant women.

Methods:

Cross-sectional research was conducted by a non-probability sampling technique using the consecutive sampling method. The sample size was determined based on the correlation analysis sample size calculation formula. The study variables were POSC-p model built with three dimensions; POSC-p score section 1 was felt needs, POSC-p score section 2 was normative needs, and POSC-p score section 3 was saliva condition. In addition, motivation to seek treatment with intrinsic and extrinsic motivation dimensions. All data were analysed using the Spearman rank correlation test.

Results:

A significant correlation was found between the POSC-p model with intrinsic and a combination of treatment-seeking motivation (p=0.026); a combined score of the POSC-p model with intrinsic (p=0.008) and a combination of treatment-seeking motivation (p=0.032).

Conclusion:

There is a correlation between the POSC-p with motivation for seeking oral health treatment in pregnant women.

Knowledge, Attitude and Practices among Gynecologists Regarding Oral Health of Expectant Mothers of South Bengaluru, Karnataka

Background

To evaluate the knowledge perspective and trainings among gynecologists’ considering oral health of pregnant mothers of South Bengaluru city, by questionnaire.

Materials and methods

A total of 60 gynecologists are included in the study. Prior to the study, the questionnaire was pretested by Pedodontist. The questionnaire was administered on the first day of visit, and on the next day it was collected back.

Results

The research unveiled that a greater number of gynecologists had satisfactory knowledge attitude and training concerning oral health of expectant mothers.

Conclusion

The predominance of gynecologists has satisfying knowledge perspective as well as practices, but still there is a demand for better effective attendance and involvement of medical specialists like gynecologists and pediatricians in continuing the education programs and forums on dentistry.

How to cite this article

Popli HP, Kumar VD, Khatib MS, et al. Knowledge, Attitude and Practices among Gynecologists regarding Oral Health of Expectant Mothers of South Bengaluru, Karnataka. Int J Clin Pediatr Dent 2022;15(1):85-89.

Literature search strategies in dental education and research

A well-organized literature search is a fundamental requirement for research-based dental education. The execution of a literature search is not beneficial unless researchers possess basic knowledge about it. In this article, all basic strategies and research tools essentially required for a literature search, including Boolean operators, correct use of keywords, database selection, and the evaluation of filtered data and limitations, are discussed. The present article offers vital information and literature search guidelines for early career dental researchers and dental students. In addition, it contains a collection of all the essential information related to the generally used electronic databases in dentistry research. This will be helpful for dental students, residents, consultants, and allied science researchers.

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.

Hydrogeochemistry and health hazards of fluoride-enriched groundwater in the Tarim Basin, China

Fluoride (F^-) enrichment reduces the availability of groundwater resources in the arid region, and it is thus important to investigate the hydrogeochemistry and health hazards of fluoride-enriched groundwater. Seventy-two groundwater samples (20 unconfined samples from the piedmont plain, 22 unconfined samples and 30 shallow confined samples from the alluvial plain) were collected in the Tarim Basin of China to illustrate the geochemical processes driving the F^- enrichment and the incidence of dental fluorosis. The patterns of average ions contents in groundwater are Na⁺ > Ca²⁺ > Mg²⁺ > K⁺ and SO₄^2- > Cl^- > HCO₃^- > NO₃^- > F^-. The highest F^- concentration (average 2.16 mg/L) is observed in unconfined groundwater in the alluvial plain, while the lowest (average 0.63 mg/L) is recorded in unconfined groundwater in the piedmont plain. Approximately 5.0% of unconfined groundwater in the piedmont plain, 90.9% of unconfined groundwater and 33.3% of shallow confined groundwater in the alluvial plain contain F^- concentrations exceeding 1.0 mg/L (Chinese drinking water standard). Mineral dissolution, cation exchange, and evaporation play a significant role in the formation of solutes in groundwater. High-F^- groundwater is mostly associated with SO₄·Cl-Na·Ca, SO₄·Cl-Na·Mg, and SO₄·Cl-Na types water. Thermodynamic simulations reveal that the dissolution of F-bearing minerals (e.g., fluorite) significantly controls the F^- contents in groundwater. High concentrations of F^- are closely related to high HCO₃^-, high Na⁺, high salinity, cation exchange, and evaporation. This demonstrates that high F^- concentrations are caused by the increase in fluorite solubility due to high ionic strength, Ca²⁺ consumption and the desorption of F^- from solid surfaces under alkaline conditions. Mixing with the upper unconfined groundwater plays a vital role in the enrichment of F^- in shallow confined groundwater in the alluvial plain. The health risk assessment based on Dean's classification indicates that the percentage prevalence of fluorosis for boys aged 6 to 18 is 15.5% for Yecheng (YC), 18.4% for Zepu (ZP), 33.3% for Shache (SC), 29.8% for Maigaiti (MG), and 44.9% for Bachu (BC), while that for girls of the same age is 14.3% for YC, 24.3% for ZP, 42.2% for SC, 41.4% for MG, and 45.3% for BC. For male and female adults aged between 19 and 68, the percentage prevalence of fluorosis is: YC (11.5%, 12.0%), ZP (18.3%, 20.0%), SC (35.4%, 35.0%), MG (32.5%, 39.7%), and BC (42.4%, 44.3%). It is obvious that younger generation, especially girls, suffers from more severe dental fluorosis. This study has implications for the effective management of high-F^- groundwater in arid regions.

Dental Anxiety Amongst Pregnant Women: Relationship With Dental Attendance and Sociodemographic Factors

Introduction

: Access to oral care during pregnancy is important for the maintenance of optimal oral health.

Objective

: The aim of this study was to estimate dental anxiety (DA) and its association with previous dental visits and sociodemographic factors amongst pregnant women.

Methods

: A cross-sectional study was conducted (June through August 2019) amongst pregnant women (N = 825) attending hospitals and health centres in Dhahran, Khobar, and Dammam cities in the Eastern province of Saudi Arabia. The Modified Dental Anxiety Scale (MDAS) was used to assess DA and the World Health Organization Oral Health Survey for Adults was administered to evaluate patterns of dental attendance.

Results

: DA was found in 90.9% of the pregnant women. The mean DA score of the sample was 12.53 ± 5.33 (range, 5 to 25) and it was significantly higher amongst non-Saudi (13.21 ± 5.24) vs Saudi women (12.15 ± 5.34) (P = .006), those who had negative dental experience (13.99 ± 5.62) vs those without such experience (12.2 ± 5.21) (P < .001), and those with dental pain or discomfort (13.18 ± 5.46) vs without pain or discomfort (11.94 ± 5.14) (P = .001). The study found a significant relationship between DA and reasons for dental attendance before pregnancy (P = .002) and time since the last dental visit (P = .009). Multiple logistic regression analysis showed significantly increased odds (OR, 1.69; 95% CI, 1.25 to 2.27) of experiencing moderate to extreme DA amongst pregnant women who visited the dentist after a year/never visited compared to those who visited in less than a year. Similarly, participants with negative dental experience were significantly more likely to have moderate to extreme DA (OR, 1.49; 95% CI, 1.02 to 2.20) than those without negative experience after adjusting for sociodemographic factors.

Conclusions

: DA was highly prevalent amongst pregnant women, which was significantly associated with negative dental experience, dental pain or discomfort, and reasons for and time since the last dental visit.

An ADePT evaluation for incorporating the TIPPS periodontal health intervention into primary care antenatal programmes to enhance infant birth weight in Palestine: a feasibility study

Background

A feasibility study was conducted to implement the Talk, Instruct, Practice, Plan and Support (TIPPS) intervention for pregnant women to enhance infant birth weight in a conflict area in Low- and Middle-Income Countries (LMIC). The decision tool, A process for Decision-making after Pilot and feasibility Trials (ADePT), examines the methodological factors identified in a feasibility study, that may require modification for a full trial. Thus, this study aimed to use the ADePT decision tool to evaluate if the feasibility study had achieved its objectives and to identify the need for intervention, clinical context and trial design modification.

Methods

A one-arm, pretest–posttest feasibility study recruited 25 pregnant women in their first trimester and clinic staff from a primary healthcare clinic located in Gaza City, Palestine. The TIPPS periodontal health intervention was delivered by antenatal care nurses to the pregnant women during their regular follow-up appointments. The ADePT framework was applied to evaluate the findings from the feasibility study. The ADePT checklist demonstrated sample size estimation, recruitment, consent, intervention adherence, intervention acceptability, costs and duration, completion and appropriateness of outcome assessments, retention, logistics, and synergy between protocol components.

Results

All recruited pregnant women (25, aged 16–35 years old) consented to participate in the study, and the adherence to the intervention was 88% (22 women). The TIPPS intervention was acceptable, but there was ambivalence over who should deliver it in the clinic. Only the cost of toothbrushing and TIPPS information materials was calculated, while the cost of nurses’ time was not included. The missing values of data were few (12% of gingival bleeding data and 22% from infant birth weight data). This intervention significantly reduced the mean percentage of plaque and bleeding scores after 3 months. The sample size for future randomised controlled trial was estimated around 400 participants. The participants stated the value of the intervention. The clinic staff voiced concerns regarding time and the cost of nurses providing the TIPPS intervention. This allowed suggestions to be made regarding the modification of trial design and context of implementation.

Conclusions

The ADePT evaluation showed it was possible to progress to full trial with modifications in the trial design.

Antibiotic Therapy in Dentistry

Dental caries, pulpal necrosis, trauma, and periodontal diseases can result in dental infections which could have severe consequences that affect both soft and hard tissues of the oral cavity. Dental infections commonly present with symptoms of pain, fever, and swelling. Surgical and endodontic treatments are the early management of infected teeth, followed by antibiotic therapy. Some alternative methods also exist for treating infection such as low-level laser therapy and photodynamic therapy. Antibiotics are generally used in dental procedures to treat odontogenic infections, nonodontogenic infections, local infection, focal infection, and prophylaxis. Antibiotic prophylaxis is prescribed for patients with immunosuppressed conditions, infective endocarditis, metabolic disorders, and patients with prosthetic joints. To reduce the complications of unnecessary antibiotic prescriptions especially bacterial resistance, comprehensive guidelines should be established. It has been noted that only about 12% of dentists adequately and correctly prescribe antibiotics, which shows the importance of comprehensive guidelines. Antibiotics prescription may result in some adverse effects such as hypersensitivity reactions and dermatological and allergic disorders. Furthermore, unnecessary prescription of antibiotics could result in several serious sequelae, for example, bacterial resistance, gastric and hematological problems, and diversion of bacterial microbiota. The present review attempts to summarize the indications of antibiotic therapy in dentistry and discuss the common types of antibiotics that are routinely used in dental practice based on pharmacologic classes. Moreover, types of antibiotics that are considered safe during pregnancy and childhood are also reviewed.

Association of maternal periodontal health with preterm birth and a low birth weight among newborns: A cross-sectional study

BACKGROUND

Despite numerous advancements in prenatal and natal care, complications arising in pregnancy and related to child-birth are major concerns in public health. Various risk factors responsible for poor outcomes include - life-style, biological, social, infectious, hormonal, and metabolic conditions. Oral diseases have been identified as a risk factor for low birth weight both under preterm and at-term states.

AIM

The aim of this study was to find an association of maternal periodontal health with preterm births and low birth weight among newborn infants.

MATERIALS AND METHODS

This was a cross-sectional observational study comprising of 300 pregnant females who had underwent child deliveries within the past 24 h with an age range of 21-30 years. Study participants were selected after interviewing for gestational history and obtaining prior informed consent. Postpartum female subjects following delivery within a time period of 24 h were included in the study. Gingival index (by Loe and Silness) was calculated for the evaluation of bleeding from gingival tooth surfaces. All data tabulations were done by performing statistical analysis into Microsoft Excel Worksheet 2007.

RESULTS

Mean age group of study participants was calculated to be 25 years. On analyzing brushing frequency, it was observed that approximately 40% brushed three times daily whereas 35% used to brush twice daily while the remaining, 25% brushed only once daily. No statistical significance was obtained on comparing brushing frequency with gingival health (P = 0.8). Similarly, no association was found between periodontal health and preterm low weight child births.

CONCLUSION

This study found no association between maternal periodontal health and preterm and low-birth weight births among newborns.

Fluoride contamination, health problems and remediation methods in Asian groundwater: A comprehensive review

In low concentration, fluoride is considered a necessary compound for human health. Exposure to high concentrations of fluoride is the reason for a serious disease called fluorosis. Fluorosis is categorized as Skeletal and Dental fluorosis. Several Asian countries, such as India, face contamination of water resources with fluoride. In this study, a comprehensive overview on fluoride contamination in Asian water resources has been presented. Since water contamination with fluoride in India is higher than other Asian countries, a separate section was dedicated to review published articles on fluoride contamination in this country. The status of health effects in Asian countries was another topic that was reviewed in this study. The effects of fluoride on human organs/systems such as urinary, renal, endocrine, gastrointestinal, cardiovascular, brain, and reproductive systems were another topic that was reviewed in this study. Different methods to remove fluoride from water such as reverse osmosis, electrocoagulation, nanofiltration, adsorption, ion-exchange and precipitation/coagulation were introduced in this study. Although several studies have been carried out on contamination of water resources with fluoride, the situation of water contamination with fluoride and newly developed technology to remove fluoride from water in Asian countries has not been reviewed. Therefore, this review is focused on these issues: 1) The status of fluoride contamination in Asian countries, 2) health effects of fluoride contamination in drinking water in Asia, and 3) the existing current technologies for defluoridation in Asia.

Maternal and child oral health interventions in Middle East and North Africa regions: a rapid review

OBJECTIVES

To conduct a rapid review to identify any maternal and/or child oral health interventions implemented and/or tested in Middle East and North Africa (MENA) countries generally, and Lebanon, Palestine and Syria specifically, and to compile information on the relative effectiveness of these interventions.

METHODS

A systematic search was conducted for primary and secondary literature indexed in five online databases, and the websites of the World Health Organisation (WHO), the International Union for Health Promotion and Education (IUHPE), the United Nations Children's Fund (UNICEF), United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), and the United Nations Refugee Agency (UNHCR).

RESULTS

Two independent researchers reviewed 1,180 records from the online databases, and 3,120 reports from the WHO, UNRWA, UNICEF and UNHCR. Four unique studies were included and conducted in Syria, Saudi Arabia and Iran. No systematic reviews were found for targeted interventions in MENA regions. However, interventions using fluoridated toothpaste (Syria), preventive treatment and fluoridated chewing gum (Saudi Arabia), and oral health education with oral health reminders (Iran) were significantly effective in reducing early child caries (ECC) experience. In Syria and Iran, mother and child oral health promotions integrated into ongoing vaccination programmes were effective in reducing ECC. These interventions formed part of WHO and Ministry of Health programmes.

CONCLUSION

Further investigation is essential to verify the effectiveness of incorporating multi-disciplinary, theory-driven oral health interventions into ongoing WHO maternal and child health programmes in MENA countries to assist in promoting oral health and wellbeing.

Oral Health Status and Treatment Needs of Pregnant Women Attending Antenatal Clinics in KwaZulu-Natal, South Africa

During pregnancy, the oral cavity is characterised by an acidic environment and an inflammatory response brought about by vomiting and changes in hormonal levels, respectively, thereby increasing the mother's risk of developing caries. Although evidence exists to support an association between pregnancy-associated periodontal disease and adverse pregnancy outcomes, there is a paucity of studies which focus on the caries prevalence and other oral manifestations of pregnant women. The aim of this study was to assess the oral health status and treatment needs of pregnant women attending antenatal clinics in KwaZulu-Natal, South Africa. Randomly selected mothers (n=443) attending a maternal obstetrics unit participated in the study. A questionnaire elicited demographic information about the participants, while the measurement of decayed, missing, and filled indices (DMFT) determined their caries status. Oral lesions were noted if present. Descriptive statistics for independent variables described frequencies in the various categories of race, location, pregnancy stage, etc., with the association between 2 independent variables tested by chi-square. Dependent variables such as DMFT were expressed as means and standard deviations, and ANOVA was used to examine whether independent variables significantly influenced the DMFT. The mean DMFT was 7.18 (±4.22) with significant correlations observed between DMFT, D, M, and age. F scores differed significantly between races, location, and educational levels and showed a significant correlation with pregnancy stage. Pregnancy epulis was diagnosed in 38 (8.5%), oral lesions in 65 (14.7%), and tooth mobility in 26 (5.9%) mothers. Early oral health screening during pregnancy can ensure the overall well-being of both the mother and the foetus.

Oral health status of pregnant women in Ilorin, Nigeria

Oral diseases have been shown to negatively affect pregnancy outcomes, yet, routine oral health care is not a component of the antenatal care package in Nigeria. This study was designed to describe the pattern of the oral conditions in pregnancy compared to the non-pregnant controls. Two hundred and twenty-five pregnant women and 166 non-pregnant controls were studied from two healthcare facilities in Ilorin. Oral-related complaints were assessed in the pregnant population while both of the groups had an oral cavity examination. The mean age of the respondents was 28.24 years ±4.77 and 80% had at least a secondary school level of education. The prevalence of oral complaints among the pregnant women was 19.1%. Gingivitis was more common among the pregnant women than the non-pregnant women, and more demonstrable on examination. Oral healthcare should be a component of the antenatal care in our environment. Impact statement What is already known on this subject? Women experience oral disorders in pregnancy, which may be worsened by the physiological changes in pregnancy. What do the results of this study add? This study has demonstrated a higher prevalence of gingivitis in the pregnant women than in the non-pregnant women on oral examination. The signs of gingivitis were higher than its related complaints. What are the implications of these findings for clinical practice and/or further research? Therefore, dental care and an examination should be part of a routine antenatal care package to prevent the unwanted pregnancy outcomes that are related to oral disorders.

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.

Efficacy of metformin in the management of periodontitis: A systematic review and meta-analysis

Periodontitis is characterized by inflammation of the periodontium and leads to loss of teeth if untreated. Although a number of surgical and pharmacological options are available for the management of periodontitis, it still affects a large proportion of population. Recently, metformin (MF), an oral hypoglycemic, has been used to treat periodontitis. The aim of this review is to systematically evaluate the efficacy of MF in the treatment of periodontitis. An electronic search was carried out using the keywords 'metformin', 'periodontal' and 'periodontitis' via the PubMed/Medline, ISI Web of Science and Google Scholar databases for relevant articles published from 1949 to 2016. The addressed focused question was: 'Is metformin effective in reducing bone loss in periodontitis? Critical review and meta-analysis were conducted of the results obtained in the selected studies. Following the removal of the duplicate results, the primary search resulted in 17 articles and seven articles were excluded based on title and abstract. Hence, 10 articles were read completely for eligibility. After exclusion of four irrelevant studies, six articles were included. The topical application of MF resulted in improved histological, clinical and radiographic outcomes. Additionally, results from the meta-analysis indicated that application of metformin improved the clinical and radiographic outcomes of scaling and root-planing, but at the same time heterogeneity was evident among the results. However, because of a lack of histological and bacterial studies, in addition to short follow-up periods and risk of bias, the long-term efficacy of MF in the treatment of bony defects is not yet ascertained. Further studies are needed to envisage the long-term efficacy of MF in the management of periodontitis.

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.

The Role of Nutrition in Periodontal Health: An Update

Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition. Many studies have observed that a balanced diet has an essential role in maintaining periodontal health. Additionally, the influences of nutritional supplements and dietary components have been known to affect healing after periodontal surgery. Studies have attempted to find a correlation between tooth loss, periodontal health, and nutrition. Moreover, bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements. The aim of this review is to critically appraise the currently available data on diet and maintenance of periodontal health and periodontal healing. The effects of nutritional intervention studies to improve the quality of life and well-being of patients with periodontal disease have been discussed.

Advances of Proteomic Sciences in Dentistry

Applications of proteomics tools revolutionized various biomedical disciplines such as genetics, molecular biology, medicine, and dentistry. The aim of this review is to highlight the major milestones in proteomics in dentistry during the last fifteen years. Human oral cavity contains hard and soft tissues and various biofluids including saliva and crevicular fluid. Proteomics has brought revolution in dentistry by helping in the early diagnosis of various diseases identified by the detection of numerous biomarkers present in the oral fluids. This paper covers the role of proteomics tools for the analysis of oral tissues. In addition, dental materials proteomics and their future directions are discussed.