Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy

What are the mechanisms of effect of group antenatal care? A systematic realist review and synthesis of the literature

BACKGROUND

There is growing interest in the benefits of group models of antenatal care. Although clinical reviews exist, there have been few reviews that focus on the mechanisms of effect of this model.

METHODS

We conducted a realist review using a systematic approach incorporating all data types (including non-research and audiovisual media), with synthesis along Context-Intervention-Mechanism-Outcome (CIMO) configurations.

RESULTS

A wide range of sources were identified, yielding 100 relevant sources in total (89 written and 11 audiovisual). Overall, there was no clear pattern of 'what works for whom, in what circumstances' although some studies have identified clinical benefits for those with more vulnerability or who are typically underserved by standard care. Findings revealed six interlinking mechanisms, including: social support, peer learning, active participation in health, health education and satisfaction or engagement with care. A further, relatively under-developed theory related to impact on professional practice. An overarching mechanism of empowerment featured across most studies but there was variation in how this was collectively or individually conceptualised and applied.

CONCLUSIONS

Mechanisms of effect are amplified in contexts where inequalities in access and delivery of care exist, but poor reporting of populations and contexts limited fuller exploration. We recommend future studies provide detailed descriptions of the population groups involved and that they give full consideration to theoretical underpinnings and contextual factors.

REGISTRATION

The protocol for this realist review was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42016036768).

Oral Health Status and Dental Services Utilisation Among a Vulnerable Sample of Pregnant Women

INTRODUCTION AND AIMS

Oral health conditions during pregnancy can negatively impact both mother and fetus, highlighting the importance of maintaining dental care. In Canada, significant disparities exist between general and dental healthcare access, with limited evidence on oral health status and dental care utilisation among pregnant women. This study aimed to provide initial insights into self-perceived oral health status and dental utilisation patterns among a vulnerable sample of pregnant women in southwestern Ontario.

METHODS

This cross-sectional study recruited a convenient sample of pregnant women referred to the Family Medicine and Obstetrics Clinic, serving those without a family physician. Data were collected using a self-administered questionnaire adapted from the Canadian Health Measure Survey, the Canadian Community Health Survey, and the Survey of Maternal Health. Andersen and Newman's framework for health service utilisation was used as the theoretical framework. Descriptive and univariable analyses were conducted, followed by a forward stepwise selection of variables with p-values < 0.1 from the univariable analyses.

RESULTS

One-hundred-fifty patients were approached and 130 (86.7%) completed the questionnaire. Of these, 96 (73.9%) reported their oral health as good/excellent while 34 (26.2%) reported having poor/fair oral health. Education level and quality of life were the strongest predictors of oral health status. While 101 (77.7%) visited a dentist within the last 2 years, only 35 (26.9%) had a dental visit during pregnancy. Toothbrushing frequency was the main predictor of time since last dental visit, with no other predictive factors once toothbrushing was considered.

CONCLUSION

The study sample showed relatively positive self-perceived oral health and dental visit patterns. However, the low rate of dental visits during pregnancy highlights the need for better integration of dental care into prenatal care. To ensure maternal and child health, pregnant women should be a high priority in policies aimed at improving access to dental care.

Prevalence and social determinants of periodontal disease in Colombian pregnant women

OBJECTIVE

The objective of the study was to identify the prevalence of periodontal disease in pregnant women in the Colombian population and its association with social determinants and medical history based on data from the Fourth National Oral Health Survey (ENSAB IV).

METHODS

A total of 1012 pregnant women from different areas of Colombia were evaluated. A periodontal evaluation was performed using a North Carolina periodontal probe. The following data were recorded: number of teeth, probing depth (PD), the position of the gingival margin (GM) and clinical attachment level (CAL). An ordinal logistic regression analysis was performed for the association between social determinants and the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) classification and logistic regression between social determinants and the European Federation of Periodontology (EFP) classification.

RESULTS

The prevalence of periodontitis was 37.1% using the CDC/AAP criteria and 41.2% according to the criteria of EFP distributed in sensitive (40.2%) and specific cases (0.9%). Age, belonging to a subsidized regime, living in a rural area, having an intermittent water supply and bleeding in medical records were found to be positively associated with periodontitis (mild, moderate, severe).

CONCLUSIONS

The findings of this national study of pregnant women show a high prevalence of periodontitis-using the CDC/AAP and EFP criteria-associated with age, living in rural areas, subsidized regime, intermittent water supply and bleeding in medical records.

Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study

Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

The Salivary Microbiome During Pregnancy: Associations With Clinical and Sociodemographic Characteristics

PURPOSE

Poor oral health has been associated with adverse pregnancy outcomes, and the oral microbiome may play a role in these mechanisms. We aimed to examine the salivary microbiome for alterations in diversity or relative abundance throughout pregnancy and its associations with adverse pregnancy outcomes and sociodemographic characteristics.

STUDY DESIGN AND METHODS

We conducted an ancillary study from a previous cohort study of 37 women during their second and third trimesters of pregnancy using preexisting, participant-collected salivary samples to examine the oral microbiome using 16S rRNA sequencing.

RESULTS

The salivary microbiome demonstrated stability throughout pregnancy, as there were no significant differences in alpha or beta diversity. Individuals who were diagnosed with preeclampsia had differences in beta diversity at the genus level (F = 2.65, df = 1, P = .015). There were also differences in beta diversity at the species level in Hispanic individuals compared with non-Hispanic individuals (F = 1.7183, df = 1, P = .04).

CONCLUSION

The salivary microbiome demonstrated stability throughout the second and third trimesters but may be different in Hispanics or those diagnosed with preeclampsia. As such, clinical providers need to demonstrate culturally competent care during pregnancy and continue to educate women about the importance of oral healthcare during the perinatal period. Future research is needed to examine the mechanisms associated with oral microbiome dysbiosis in Hispanic women during pregnancy and in women with preeclampsia.

Oral Health Knowledge, Attitudes, Practices, and Literacy of Pregnant Women: A Scoping Review

PURPOSE

Pregnancy is a state particularly sensitive to oral pathologies (periodontal and decay). The oral health status of pregnant women can have an impact on the outcome of the pregnancy and the oral health of the child to come. As in the general population, the oral health of pregnant women is socially determined and dependent on psychosocial factors, including factors related to health behaviours. Research into the determinants of oral health in pregnant women will allow a better understanding of the mechanisms of action specific to this period of perinatality.

MATERIALS AND METHODS

The methodology of a scoping review was selected with the objective of investigating the contribution of knowledge, attitudes, practices (KAP) and oral health literacy on pregnant women's oral health.

RESULTS

Of the 67 articles selected, 52 studied the 'knowledge' component, 27 the 'attitude' (including the perception and beliefs concerning health), and 54 the 'practice' component, while 6 articles examined literacy. The KAP components were studied in relation to socioeconomic determinants, oral health status, healthcare utilisation and oral health literacy. The level of oral health literacy of pregnant women is strongly related to their living environment and socioprofessional level which influences their attitudes and practices. Woman's oral health practices before pregnancy can be a predictor of her practices during pregnancy.

CONCLUSION

The complex nature of the attitude component (locus of control, sense of self-efficacy, perceived importance) is little discussed. The heterogeneity and exhaustiveness of topics related to KAP raises the question of how to more accurately assess KAP in pregnant women in a valid, reproducible, and transferable manner and the need to build a structured oral health consensus body of work. This review is a first step towards identifying the psychosocial factors that are essential for developing a model of educational intervention in oral health that combines the process of behavioural change and decision making while taking into account the concept of empowerment, and with the aim of reducing social inequalities in health.

Racial and oral health disparity associated with perinatal oral health care utilization among underserved US pregnant women

OBJECTIVE

The study aims to identify specific determinants of dental care utilization during the perinatal period (prenatal and 1-year postnatal) among underserved US women residing in Upstate New York.

METHOD AND MATERIALS

The prospective cohort study included 186 low-income US pregnant women. Demographic-socioeconomic parameters and medical-dental conditions were obtained from questionnaires, electronic medical-dental records, and dental examinations. Multivariate regression analyses were used to assess factors associated with perinatal dental care utilization. As an exploratory effort, a separate logistic model assessed factors associated with adverse birth outcomes.

RESULTS

The results demonstrated unmet oral health needs among the underserved US pregnant women residing in Upstate New York. Despite an average of 2.7 ± 3.6 untreated decayed teeth per person during pregnancy, only 39.3% and 19.9% utilized prenatal and 1-year postnatal dental care, respectively. Previous dental care utilization was a notable factor contributing to a higher uptake of perinatal dental care at a subsequent period. Prenatal dental care utilization was significantly lower among African American women (odds ratio 0.43 [95% CI 0.19, 0.98], P = .04) and positively associated with dental caries severity (OR 2.40 [1.09, 5.12], P = .03). Postnatal utilization was associated with caries severity (OR 4.70 [1.73, 12.74], P = .002) and prevalent medical conditions (hypertension, diabetes mellitus, and emotional conditions). Pregnant women who achieved prenatal caries-free status had a lower odds of experiencing adverse birth outcomes; however, this was an insignificant finding due to limited adverse birth cases.

CONCLUSION

Racial and oral health disparity is associated with perinatal oral health care utilization among underserved US pregnant women in New York. While both prenatal and postnatal dental care utilization was positively associated with oral health status, specifically, postnatal utilization was driven by existing medical conditions such as emotional condition, hypertension, and diabetes mellitus. The results add to existing information on inherent barriers and postulated needs to improve access to perinatal oral care, thereby informing statewide recommendations to maximize utilization. Considering this is a geographically restricted population, the findings are particularly true to this cohort of underserved pregnant women. However, future more robust studies are warranted to assess effective strategies to further improve perinatal dental care utilization among underserved pregnant women.

Assessment of Periodontal Disease status in Pregnant Women and Related Demographic Factors in arak, Iran

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Subgingival Microbiome in Pregnancy and a Potential Relationship to Early Term Birth

Background

Periodontal disease in pregnancy is considered a risk factor for adverse birth outcomes. Periodontal disease has a microbial etiology, however, the current state of knowledge about the subgingival microbiome in pregnancy is not well understood.

Objective

To characterize the structure and diversity of the subgingival microbiome in early and late pregnancy and explore relationships between the subgingival microbiome and preterm birth among pregnant Black women.

Methods

This longitudinal descriptive study used 16S rRNA sequencing to profile the subgingival microbiome of 59 Black women and describe microbial ecology using alpha and beta diversity metrics. We also compared microbiome features across early (8-14 weeks) and late (24-30 weeks) gestation overall and according to gestational age at birth outcomes (spontaneous preterm, spontaneous early term, full term).

Results

In this sample of Black pregnant women, the top twenty bacterial taxa represented in the subgingival microbiome included a spectrum representative of various stages of biofilm progression leading to periodontal disease, including known periopathogens Porphyromonas gingivalis and Tannerella forsythia. Other organisms associated with periodontal disease reflected in the subgingival microbiome included several Prevotella spp., and Campylobacter spp. Measures of alpha or beta diversity did not distinguish the subgingival microbiome of women according to early/late gestation or full term/spontaneous preterm birth; however, alpha diversity differences in late pregnancy between women who spontaneously delivered early term and women who delivered full term were identified. Several taxa were also identified as being differentially abundant according to early/late gestation, and full term/spontaneous early term births.

Conclusions

Although the composition of the subgingival microbiome is shifted toward complexes associated with periodontal disease, the diversity of the microbiome remains stable throughout pregnancy. Several taxa were identified as being associated with spontaneous early term birth. Two, in particular, are promising targets of further investigation. Depletion of the oral commensal Lautropia mirabilis in early pregnancy and elevated levels of Prevotella melaninogenica in late pregnancy were both associated with spontaneous early term birth.

Hormonal Fluctuations and Periodontal Status in Postmenopausal Women

Introduction. While the short-term effects of hormonal events on gingival inflammation have been well described, their long-term effects on the periodontium have received less attention. Our investigation was aimed at evaluating the correlation between hormonal fluctuations and periodontal status in postmenopausal women from the profile of the Rafsanjan Cohort Study. Material and Methods. We used the data obtained from the profile of the Rafsanjan Cohort Study (RCS) as a part of the prospective epidemiological research studies in Iran (PERSIAN). The RCS includes 10,000 participants aged 35–70 years old. Among this population, the periodontal status data of 4143 women were available. Of these 4,143, the postmenopausal women were included in the study, and those who had a history of gingival treatment during the past 6 months were excluded from the study. Finally, 928 postmenopausal women were included in the present study. Periodontal status was assessed by measuring the clinical attachment loss, pocket depth, and bleeding on probing (BOP). Univariate and multivariate regression analyses were applied using three different models. Results. The results showed that 53.2% of postmenopausal women had periodontitis. There were significant differences between the participants with and without periodontitis in brushing frequency and educational status $\left(P<0.05\right)$ . After adjusting for all potential confounders, no correlation was found between hormonal fluctuations and periodontal status. Conclusion. There was no correlation between hormonal fluctuations and periodontal status.

Food insecurity and oral health care experiences during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Food insecurity has emerged as a salient risk factor for poor oral health in adult populations. A separate area of research also details that both poor oral health and food insecurity during pregnancy can have adverse consequences for maternal and infant well-being. The authors examine the connection between food insecurity and women's oral health care experiences during pregnancy.

METHODS

Data from 2016 through 2019 came from the Pregnancy Risk Assessment Monitoring System (N = 21,080). Multivariable logistic regression analyses were used to assess the association between food insecurity and 6 indicators of oral health care experiences during pregnancy.

RESULTS

Food-insecure women reported worse oral health care experiences during pregnancy, including being more likely to need to see a dentist for a problem, going to see a dentist for a problem, not receiving dental prophylaxis, not talking with an oral health care provider about dental health, not knowing it was important to care for teeth, and having unmet oral health care needs.

CONCLUSIONS

Food-insecure women exhibit worse overall oral health outcomes and unmet oral health care needs during pregnancy.

PRACTICAL IMPLICATIONS

Considering the risk that both food insecurity and oral health problems pose for maternal and infant health, interventions that can reduce food insecurity and improve oral health and oral health care access among pregnant women are important steps in promoting greater health equity.

Dental care utilization during pregnancy by Medicaid dental coverage in 26 states: Pregnancy risk assessment monitoring system 2014-2015

OBJECTIVE

To examine the association between Medicaid dental coverage for adult pregnant women with dental care utilization during pregnancy.

METHODS

Pregnancy risk assessment monitoring system (PRAMS) data (2014-2015) and the Medicaid-SCHIP state dental association (MSDA) national profiles (2014-2015) were used in this study. The study sample included 16,612 Medicaid-enrolled women, for a weighted number of 965,046 women from 26 states and New York City. State Medicaid dental coverage was categorized into (1) no coverage for the dental cleaning, (2) coverage for dental cleaning and fillings, (3) extended dental coverage. The adjusted prevalence ratios (aPR) for dental visits for cleaning during pregnancy were examined by Medicaid dental coverage level.

RESULTS

Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). Compared with women in state without dental coverage, Medicaid-enrolled women in states with extended dental coverage (aPR = 1.20, 95% CI [1.16-1.23]) and women in states with limited coverage (aPR = 1.10, 95% CI [1.06-1.14]) were more likely to visit dentists for cleaning during pregnancy when adjusted for other sociodemographic variables and adequacy of prenatal care. A similar pattern of association was observed for a dental visit to address dental problems during pregnancy.

CONCLUSIONS

This study highlights the importance of Medicaid dental coverage for adult pregnant women related to dental service utilization during pregnancy.

[Adequacy of prenatal dental care: social and geographical inequalities in a metropolitan region of Brazil]

This study set out to analyze social and geographical inequalities in the adequacy of prenatal dental care in the Unified Health System (SUS) of the Greater Vitória Metropolitan Region, Espírito Santo, Brazil. A cross-sectional study was carried out with 1209 postpartum women living in the region admitted to hospital at SUS facilities for childbirth between 2010 and 2011. Data were collected on prenatal medical-dental care, the impact of oral health on the quality of life of pregnant women (Oral Health Impact Profile-14), and predisposing characteristics. Prenatal care was adequate when care corresponded to the recommended treatment. The adequacy of dental care during prenatal care was analyzed using a multivariate logistic model. Oral health was found to have an impact on the quality of life of 102 (8.4%) pregnant women and the adequacy of dental care during prenatal care was only 15.4% (n=156). There was a greater chance of adequacy of prenatal dental care in Vitória (OR=2.44; IC=1.63-3.66), in regions covered by the family health strategy (OR=1.88; IC=1.22-2.89), and in areas with a higher proportion of pregnant women with access to quality prenatal care (OR=3.59; IC=1.64-7.84). Contextual inequalities were decisive for the inadequacy of dental care in prenatal care.

Inequalities in dental prenatal control in Colombia: An analysis based on the IV National Oral Health Study, 2013-2014

Introduction: Dental care is essential in guaranteeing the right to healthy motherhood. In Colombia, prenatal care policies incorporate the promotion, prevention, and care in oral health as part of the comprehensive care that pregnant women must receive within the health system. However, there is no systematic monitoring of compliance with these guidelines. Objective: To explore effective care and social inequalities in the provision and use of prenatal dental control in Colombia. Materials and methods: This was a descriptive study with data on pregnant women reported in the Fourth National Oral Health Study, 2013-2014. Absolute and relative social inequalities were estimated according to the area of residence, ethnicity, education level, health affiliation regime, and socioeconomic stratum. Results: We analyzed the data from 1,050 pregnant women. In total, 88.37% received prenatal control and 57.19%, dental control. We observed a general pattern of social gaps in the effective use of the latter, mainly due to the health insurance regime. The pregnant women with the greatest possibility of having some prenatal dental control, were those with some health insurance (prevalence ratio [RP]=2.62; CI 95%: 2.12-3.12), residents in urban areas (RP= 1,37; CI95%: 1.18-1.56), with higher and/or technical education level (RP=1.20; CI95%: 1.02-1.38) or from mid-high social strata (RP=1.15; CI95%: 1.01-1.29). Conclusions: In Colombia, the effective provision of dental control to pregnant women as part of comprehensive prenatal care continues to be a challenge. Significant efforts are required to comply with regulations and reduce social inequalities in access to this service.

Poor oral health-related quality of life among pregnant women: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to assess the impacts of oral health determinants (eg frequency of brushing < 2 day, poor life style and non-white ethnicity) and clinical oral caries indices (eg Decayed, Missing, and Filled Teeth (DMFT)) and periodontal disease) on Poor Quality of Life (PQoL) among PW.

METHODS

The search strategy was restricted to publications in English before 1 December 2019 in the PsycINFO, PubMed, SciELO, Scopus and Web of Science databases. We only included oral diseases considered as public health issues with a global burden. As a result, investigations reporting the frequency of brushing, poor lifestyle behaviours, non-white ethnicity, DMFT scores and periodontal disease as an outcome were included. The two reviewers resolved any disagreements. Reviewers analysed the full texts, considering the inclusion and exclusion criteria. Also, a manual search of the reference lists was performed on all the selected studies.

RESULTS

In total, 11 publications were included in the meta-analysis. Findings indicate a positive association between non-white ethnicity and PQoL among PW. Among PW, those who had non-white ethnicity were 1.43 times more likely to have PQoL (OR = 1.43, 95% CI = 1.17, 1.70). A positive association between DMFT and poor QoL among PW was also observed. Those who has suffered DMFT were 1.4 times more likely to have poor QoL (OR = 1.4, 95% CI = 1.24, 1.55).

CONCLUSIONS

Results from this meta-analysis support the need for behavioural interventions for improving oral hygiene in expectant mothers. This could help to decrease periodontal conditions and improve their oral and general life quality.

Pregnancy as a Period of Enhanced Risk for Non-Cavitated Caries Lesions

PURPOSE

To investigate if pregnancy represents a period of increased risk of non-cavitated dental caries related to changes in saliva and oral health behaviours.

MATERIALS AND METHODS

A non-randomised longitudinal study was performed with 27 pregnant women and 25 non-pregnant women, who were evaluated twice with the same time gap (24 weeks on average). At the first visit sociodemographic and oral health-related behaviours were assessed through a structured questionnaire. At the second visit changes related to eating sweet snacks and oral hygiene habits were also assessed. In both visits the surface-related caries status was evaluated according to ICDAS II criteria. Calculation of D0 (Sound), D1-2 (visual changes) and D3-4 (precavitated caries lesions) Index was based on data collected from clinical examination. Saliva pH and saliva flow rate were also assessed.

RESULTS

Throughout pregnancy, a statistically significant increase of eating sweet snacks between main meals was reported, with no effective adaptation of oral hygiene habits. In comparison to the non-pregnant group, pregnant women presented a lower saliva pH at both the first and second visit, p < 0.0005. During the follow-up period, a decrease in the frequency of caries-free surfaces was observed in the pregnant women (p = 0.004) and an increase in precavitated caries lesions (p = 0.011).

CONCLUSION

The main results support the hypothesis that during pregnancy women are prone to enamel demineralisation, namely, to exhibiting additional lesions characterised by precavitated caries lesions.

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.

Effects of an oral health program: Community-based education among mothers of young children living in socioeconomically disadvantaged neighborhoods

INTRODUCTION

An oral health program for mothers starting from pregnancy in a disadvantaged district of İzmir was performed in 2013-2016. Dental behaviors and their determinants among intervention and control groups were compared in the third phase of the program.

METHODS

This nonrandomized-controlled study was conducted in Phase 3. The intervention group began with 248 pregnant women; 69.4% (n = 172) of mothers with 6-9-month-old babies participated in Phase 2, 2014. At Phase 3 (18-24 months), 68.6% (n = 118) of mothers in the intervention group and 113 mothers living in another district as controls were included. Sociodemographic characteristics, determinants of behaviors, and outcomes defined as dental behaviors in the last week were assessed using a questionnaire.

RESULTS

Regarding knowledge, perceived severity, and fatalistic beliefs, the intervention group had higher correct answer percentages. The percentage of mothers who could clean their children's teeth before sleep was higher in the intervention group (76.3%; P < 0.05), but the difference was lost by a child's resistance. The significant difference on avoiding bedtime nursing (65.3%) and sugary snacks (74.4%) in the intervention group disappeared with the obstacle of a child's protests or interference from relatives. In the intervention group, 32.2% of the mothers reported that they did not give any sugary snacks, 43.2% had never fed during sleep, and 26.3% cleaned their children's teeth during the last week. The results in the control group were 24.8%, 18.6%, and 8.8%, respectively (P < 0.05).

CONCLUSIONS

The program improved the mothers' views regarding the determinants of dental behaviors, but greater support against obstacles was needed. Social environmental support is planned for the following stages of the program.

Predictors of dental care use, unmet dental care need, and barriers to unmet need among women: results from NHANES, 2011 to 2016

OBJECTIVES

To examine socio-demographic and economic predictors of dental care access among women in the United States.

METHODS

A total of 52,493,940 women at the US national level aged 20-44 years were identified from the National Health and Nutrition Examination Survey, 2011 to 2016. Weighted multivariate logistic regression models were computed to identify predictors of dental care use, unmet dental-care need, and reported reasons for unmet need.

RESULTS

Young, Mexican-American, other minority race-ethnicities, less educated, and uninsured women were independently more likely to have never visited a dental clinic (P < 0.025). Mexican-Americanwomen with a poverty income ratio (PIR) <2.00 and less than excellent health status and those uninsured were independently more likely to have unmet dental need (P < 0.025). Women with PIR <1.00 and those uninsured were independently more likely to have an unmet need because of unaffordable cost (P < 0.0008) or lack of procedure coverage by insurance (P < 0.0008). Younger women were more likely to think that the dental problem would go away (P < 0.0001).

CONCLUSIONS

While young, less educated, and women from minority race-ethnicities were less likely to report ever use of dental care, only low income, poor health, and uninsured women were more likely to report unmet dental care need. Racial-ethnic minority, less educated, and young women may benefit from improved education about the value of dental care. Expanding insurance coverage for dental care and improving access for women with poor health may address racial-ethnic and education-level disparities in unmet dental care need.

Oral health status in relation to socioeconomic and behavioral factors among pregnant women: a community-based cross-sectional study

Background

Oral health of women during pregnancy is an important issue. Not only it can compromise pregnancy outcomes, but also it may affect their newborn’s overall health. The aim of this study was to assess the oral health status and associated factors in pregnant women.

Methods

A cross-sectional study was conducted amongst 407 pregnant women in the second and third trimester of pregnancy in Varamin, Iran. Oral health status was examined, and demographic, socioeconomic status and dental care behavior data were collected. Oral health indices included periodontal pocket, bleeding on probing (BOP) and decayed, missed, filled teeth (DMFT). Regression analysis of DMFT was used to study the association between demographic, dental care behaviors indicators and outcome variables using the count ratios (CR) and 95% confidence intervals (CI).

Results

The mean (SD, Standard Deviation) age of participants was 27.35 (5.57). Daily brushing, flossing habit were observed in 64.1, and 20.6% of mothers, respectively. Mean (SD) of DMFT, D, M, F were 10.34(5.10), 6.94(4.40), 2.22 (2.68) and 1.19(2.23), respectively. Women older than 35 years had significantly more DMFT [CR = 1.35 (95% CI 1.13; 1.60)], less D [CR = 0.75 (95% CI 0.59; 0.94)], and more M [CR = 3.63 (95% CI 2.57; 5.14)] compared to women under 25 years after controlling for education and dental care behaviors. Women with academic education had significantly less decayed teeth [CR = 0.63 (95% CI 0.48; 0.84)], compared to women with under 12 years of education.

Conclusions

Oral health status of pregnant women was not satisfactory, having an average of seven decayed teeth in their mouth.

Dental caries experience and associated risk indicators among Palestinian pregnant women in the Jerusalem area: a cross-sectional study

BACKGROUND

This study described the dental caries experience of Palestinian pregnant women and examined its relationships to their oral health knowledge, beliefs, behavior, and access to dental care.

METHODS

Pregnant women receiving prenatal care at the Ministry of Health (MOH) centers in the Jerusalem Governorate were invited to participate in this study. Structured interviews were conducted to assess pregnant mothers' beliefs about oral health care and their oral hygiene practices. Screening for mothers' dental caries experience was carried out using the Decayed, Missing and Filled Teeth/Surfaces (DMFT/S) index. Univariate, bi-variate and multi-variable analysis were conducted to explain the high level of disease in this population.

RESULTS

A total of 152 pregnant women participated in this study. Mean DMFT in this sample was 15.5 ± 4.5 and an average DMFS of 31.8 ± 21. According the World Health Organization (WHO) criteria, 89% of our sample were categorized in the "Extremely High" dental caries experience. Fifty-eight percent of the DMFT scores among this sample were due to untreated dental decay, while 22% of the same DMFT scores demonstrated restorative care received by this sample. Bivariate analysis showed that mothers who completed a degree after high school had lower DMFT scores than mothers who did not (F = 4, n = 152, p = .024). In addition, mothers who believed they could lose a tooth just because they are pregnant had higher DMFT scores (t = - 4, n = 152, p = .037). The final model found that age, level of education, providers' advice on utilizing dental care during pregnancy, and the belief that a woman can lose a tooth just because she is pregnant explained 22% of the variation in DMFT scores.

CONCLUSIONS

Women in this study had a high prevalence of dental diseases and knew little about dental care during pregnancy. Faulty beliefs about dental care during pregnancy among women and health care providers were major factors in the high levels of disease.

Oral health and quality of life of pregnant women: the influence of sociodemographic factors

This study aimed to evaluate the relationship between sociodemographic factors and the impact on Oral Health-Related Quality of Life (OHR-QoL) in Brazilian pregnant women users of the Unified Health System. This is a cross-sectional epidemiological study developed with pregnant women living in two regions with different sociodemographic characteristics. In total, 1,777 puerperae were interviewed. A structured and previously tested questionnaire collected sociodemographic variables, and the Oral Health Index Profile (OHIP-14) assessed the impact on the OHR-QoL. The statistical analysis was performed using the Chi-square test and multiple logistic regression, both with a significance of 5%. The "psychological discomfort" realm was the only one with a difference between the puerperae of the RMGV and the MRSM (p=0.042). The following variables were associated with the impact on the OHR-QoL: residing in the RMGV (OR=1.69; 95%CI: 1.16-2.47); having a low level of schooling (OR=1.80; 95%CI: 1.03-3.18) and visit to the dentist during pregnancy (OR=2.15, 95%CI: 1.50-3.07). Sociodemographic factors should be considered in the planning of oral health actions of pregnant women, as they influence the impact on the OHR-QoL.

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.

Pregnancy, parity and periodontal disease

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.

Sociodemographic factors associated with pregnant women's level of knowledge about oral health

Objective

To evaluate knowledge on oral health and associated sociodemographic factors in pregnant women.

Methods

A cross-sectional study with a sample of 195 pregnant women seen at the Primary Care Unit Paraisópolis I, in São Paulo (SP), Brazil. For statistical analysis, χ² or Fisher's exact test and multiple logistic regression were used. A significance level of 5% was used in all analyses.

Results

Schooling level equal to or greater than 8 years and having one or two children were associated with an adequate knowledge about oral health.

Conclusion

Oral health promotion strategies during prenatal care should take into account sociodemographic aspects.

Integrating a Nurse-Midwife-Led Oral Health Intervention Into CenteringPregnancy Prenatal Care: Results of a Pilot Study

INTRODUCTION

National and professional organizations recommend oral health promotion in prenatal care to improve women's oral health. However, few prenatal programs include education about oral health promotion. The objective of this study was to determine if women receiving a brief, low-cost, and sustainable educational intervention entitled CenteringPregnancy Oral Health Promotion had clinically improved oral health compared to women receiving standard CenteringPregnancy care.

METHODS

Women attending CenteringPregnancy, a group prenatal care model, at 4 health centers in the San Francisco Bay Area, participated in this nonrandomized controlled pilot study in 2010 to 2011. The intervention arm received the CenteringPregnancy Oral Health Promotion intervention consisting of two 15-minute skills-based educational modules addressing maternal and infant oral health, each module presented in a separate CenteringPregnancy prenatal care session. The present analysis focused on the maternal module that included facilitated discussions and skills-building activities including proper tooth brushing. The control arm received standard CenteringPregnancy prenatal care. Dental examinations and questionnaires were administered prior to and approximately 9 weeks postintervention. Primary outcomes included the Plaque Index, percent bleeding on probing, and percent of gingival pocket depths 4 mm or greater. Secondary outcomes were self-reported oral health knowledge, attitudes (importance and self-efficacy), and behaviors (tooth brushing and flossing). Regression models tested whether pre to post changes in outcomes differed between the intervention versus the control arms.

RESULTS

One hundred and one women participated in the study; 49 were in the intervention arm, and 52 were in the control arm. The control and intervention arms did not vary significantly at baseline. Significant pre to post differences were noted between the arms with significant improvements in the intervention arm for the Plaque Index, bleeding on probing, and pocket depths 4 mm or greater.

DISCUSSION

Providing brief oral health education and skills-building activities within prenatal care may be effective in improving women's oral health during pregnancy. These findings provide support for developing a full-scale randomized clinical trial of the CenteringPregnancy Oral Health Promotion intervention.

Periodontal status during pregnancy and postpartum

Objectives

Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3–6 weeks postpartum in women with initial periodontal alterations.

Materials and methods

Ninety-six pregnant women were examined at 8–10 weeks (pregnancy diagnosis, baseline), 21–23 weeks and 34–36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05

Results

Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21–23 weeks, 42.6%±0.14; 34–36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0–13). Gingival Index increased (p<0.001) throughout pregnancy (baseline, 56.7%±0.20; 21–23 weeks, 66.36%±0.17; 34–36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (p<0.001) throughout pregnancy (baseline, 2.51±0.05; 21–23 weeks, 2.63±0.053; 34–36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (p<0.001) throughout pregnancy (baseline, 17.6%±0.16; 21–23 weeks, 23.9%±0.17; 34–36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (p<0.02) higher than at baseline.

Conclusion

Periodontal status deteriorates during gestation but improves postpartum.

Periodontal Health Status and Associated Factors: Findings of a Prenatal Oral Health Program in South Brazil

Objective. The aims of this study were to evaluate the periodontal health of pregnant women and to investigate the association of periodontal status with demographic and socioeconomic characteristics, as well as medical and dental history. Materials and Methods. A total of 311 pregnant women were interviewed to obtain sociodemographic data along with medical and dental histories. Clinical examinations were performed to record the presence of visible plaque, gingival bleeding, and caries activity. The periodontal condition was evaluated by Community Periodontal Index of Treatment Needs (CPITN) in one tooth of each sextant (16, 11, 26, 36, 31, and 46). Results. After the adjustment analysis, the presence of visible plaque remained the main determinant of gingival bleeding (OR = 2.91, CI = 1.91–4.48). First-trimester pregnancy status was also a predictor, with a lower prevalence of gingival bleeding observed in the second (OR = 0.87, CI = 0.77–0.99) and third (OR = 0.82, CI = 0.73–0.93) trimesters. Conclusion. In pregnant women, the presence of dental plaque and first-trimester pregnancy status were the main implicated factors predicting gingival bleeding.

Salivary and serum inflammatory mediators among pre-conception women with periodontal disease

BACKGROUND

There have been inconsistent conclusions regarding the levels of inflammatory mediators in saliva and serum among people with or without periodontal disease. Although pre-conception has been put forward as the optimal time for the periodontal treatment in order to improving pregnancy outcomes, few studies have been conducted to examine inflammatory mediators in saliva and serum among pre-conception women.

METHODS

Pre-conception women were recruited between January 2012 and December 2014. Women were provided with an oral health examination to detect periodontal disease. Salivary and serum samples were collected at the same of examination. Inflammatory mediators includinginterleukin-1 beta (IL-1β), IL-6, tumor necrosis factor alpha (TNF-α) and beta-glucuronidase (β-glucuronidase) were tested and analyzed among women with overall periodontal disease (n = 442) or moderate/severe periodontal disease (n = 247). Results were compared to that in women with a healthy periodontium (n = 91).

RESULTS

Significantly increased concentrations of inflammatory mediators of IL-1β, IL-6, TNF-α and β-glucuronidase in saliva and IL-1β, β-glucuronidase and TNF-α in serum were found among pre-conception women with moderate/severe periodontal disease, compared with women without periodontal disease. Significantly increased levels were also found in all the above saliva inflammatory mediators and in serum IL-1β and TNF-α among women with overall periodontal disease. The levels of all inflammatory mediators in saliva and almost all inflammatory mediators except IL-6 in serum significantly increased with severity of periodontal disease.

CONCLUSION

Periodontal disease is highly associated with the elevated levels of inflammatory mediators in saliva and some mediators in serum among pre-conception women.

The Association Between Socio-demographic Factors, Dental Problems, and Preterm Labor for Pregnant Women Residing in Hawai'i

Periodontal disease during pregnancy has the potential to increase the risk of adverse perinatal outcomes including preterm labor (PTL), prematurity, and low birth weight (LBW). Despite professional recommendations on the importance and safety of dental assessments and treatments, the rate of dental care utilization during pregnancy remains low. The purpose of this study was to document the utilization of dental services and explore the relationships among socio-demographic factors, dental problems, and PTL in pregnant women residing in Hawai'i. Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) survey results were analyzed from 4,309 women who experienced live births between the years 2009-2011. Results revealed that 2 in 5 women in Hawai'i had their teeth cleaned during pregnancy, while 1 in 5 reported seeing a dentist for a dental problem. Women who reported having a dental problem during pregnancy were more likely to experience PTL (OR=1.46, 95% CI=1.10-1.94, P=.008) compared to women without a dental problem. In addition, Native Hawaiian and Part-Hawaiian women were more likely to experience PTL (OR=1.73, 95% CI=1.22-2.46, P=.002) compared to Caucasian women. These findings document the underutilization of dental services in pregnant women in Hawai'i and reveal an association between poor dental care and PTL. Identification of groups at risk for maternal complications may assist in the development of programs that are sensitive to the diverse cultures and variability of community resources that exist throughout Hawai'i.