Adherence to and acceptability of three alcohol-free, antiseptic oral rinses: A community-based pilot randomized controlled trial among pregnant women in rural Nepal

Nomogram prediction for periodontitis in Chinese pregnant women with different sociodemographic and oral health behavior characteristics: a community-based study

BACKGROUND

Periodontitis is associated with poor pregnancy outcomes, indicating periodontal health as an important health concern for pregnant women. Herein, this study identified risk indicators for periodontitis and developed a nomogram for predicting the risk of periodontitis in pregnancy by analyzing periodontitis and associated factors in pregnant women.

MATERIALS AND METHODS

A community-based cross-sectional study was conducted by including 438 pregnant women at 10-36 gestational weeks from Langfang, China. Pregnant women were examined for periodontal status, and their demographic, socioeconomic, and oral health behavior data were collected. Potential influencing factors of periodontitis were analyzed with univariate and multivariate logistic regression analyses. A nomogram was developed, followed by the assessment of its validation and discriminatory abilities.

RESULTS

The prevalence of periodontitis was 59.8% in pregnant women. Periodontitis-associated variables in pregnant women were gestational age, non-first pregnancy, daily tooth brushing frequency of ≤ 1 before pregnancy, and annual frequency of periodontal treatment < 1 (including no periodontal treatment). The risk of periodontitis was positively associated with gestational age (OR = 1.28, 95% CI = 1.17-1.39, p < 0.001). Pregnancy history showed a strong positive association (OR = 6.57, 95% CI = 1.22-35.43, p = 0.03). Daily tooth brushing frequency before pregnancy was also positively associated with periodontitis (OR = 1.54, 95% CI = 1.03-2.79, p = 0.05). Additionally, the annual frequency of periodontal treatment exhibited a positive association, with higher odds observed for those with less frequent treatment (OR = 2.28, 95% CI = 1.25-4.14, p = 0.05; OR = 7.37, 95% CI = 3.04-22.06, p < 0.001). These four factors were used to develop a nomogram for predicting periodontitis in pregnant women. The area under the receiver operating characteristic curve of the nomogram was 0.855 and 0.831 in the training and testing cohorts, respectively, reflecting the superior prediction accuracy of the nomogram. The calibration curve and decision curve analysis demonstrated the good performance and net benefit of the nomogram.

CONCLUSION

Risk factors for periodontitis in pregnant Chinese women include gestational age, non-first pregnancy, lower frequency of daily tooth brushing before pregnancy, and lower frequency of periodontal treatment. An easy-to-use nomogram with acceptable accuracy can allow for the prediction of periodontitis risk in pregnant Chinese women.

CLINICAL RELEVANCE

With the assistance of this nomogram, clinicians can evaluate the risk of periodontitis in pregnancy, thereby offering more tailored oral health education to women of reproductive age.

Satisfaction with government recommended pre-procedural mouth rinses in the mitigation of Covid-19 in Hong Kong SAR: A triple blind randomized controlled clinical trial

OBJECTIVE

To evaluate satisfaction and acceptability with three pre-procedural mouthrinses recommended by the Government of Hong Kong Special Administrative Region (HKSAR) during the COVID-19 pandemic.

MATERIAL AND METHODS

A triple-blind parallel-arm randomised controlled clinical trial was conducted. Following eligibility assessment, participants were block-randomised to the three intervention pre-procedural mouthrinses groups: Povidone-iodine, Hydrogen Peroxide and Chlorhexidine Digluconate. Participants rinsed with one of the mouthrinses assigned prior to any dental treatment. Participants, operators and assessors were blind to the assigned mouthrinses (triple blind). Satisfaction ratings were assessed on a 10 cm visual analogue scale (VAS) and acceptability of the mouthrinses were determined.

RESULTS

Following clinical screening, 228 participants were involved in the trial. The mean overall VAS satisfaction was 7.35 (SD 1.68). There was no significant difference in VAS satisfaction ratings among the three groups (p>0.05) nor in between groups. Acceptability of the mouthrinses was high with the vast majority (89.5 %, 204) willing to use the mouthrinses again if pre-procedural mouthrinsing is required. There was no significant difference in acceptability ratings (p>0.05). There were some aspects such as taste and smell that participants commented on (on average, 24.6 %, 56), although no significant difference in prevalence of reports among groups (p>0.05).

CONCLUSIONS

There were high rates of satisfaction and acceptability of the HKSAR Government recommended pre-procedural mouthrinses for the mitigation of COVID-19 transmission in the dental setting. There was no significant difference in satisfaction and acceptability rates among the three recommended pre-procedural mouthrinses.

CLINICAL RELEVANCE

The high satisfaction and acceptability rates of the HKSAR Government recommended pre-procedural mouthrinses in the mitigation of COVID-19 in this clinical trial lends support for the HKSAR's policy on pre-procedural mouthrinses in the dental setting and this has implications for practice and policy during pandemics.

Clinical Use of Paraprobiotics for Pregnant Women with Periodontitis: Randomized Clinical Trial

Periodontal disease is very common in pregnant women. Paraprobiotics are a subset of probiotics. They can be defined as inactivated microbial cells providing health benefits to the host and are considered particularly safe. The aim of this study was to compare the periodontal health of pregnant women and puerperae after 6 months of home use of paraprobiotics. A total of 30 pregnant women were enrolled and divided into two groups: the test group, who had to use a paraprobiotic-based toothpaste (Biorepair Peribioma Pro, Coswell S.p.A., Funo di Argelato, BO, Italy) and mousse (Mousse Mouthwash Biorepair Peribioma, Coswell S.p.A.) twice a day, and the control group, who had to use only the paraprobiotic-based toothpaste. The time frames of the study were: 1 month (T1), 3 months (T2) and 6 months (T3), and data were collected during pregnancy and in the period immediately following delivery. The following indices were evaluated at T0, T1, T2 and T3: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), plaque control record (PCR), modified marginal gingival index (mMGI), papillary marginal gingival index (PMGI) and recessions (R). All data were subjected to statistical analysis. PCR decreased significantly from T0 to T1 in the control group and from T0 to T2 and from T0 to T3 in the test group. BOP tended to decrease in both groups, but a significant reduction was observed only in the test group. CAL, PPD, PMGI and mMGI tended to decrease gradually in both groups without significant differences between or within groups. The combination of the paraprobiotic-based toothpaste and the paraprobiotic-based mousse significantly reduced BoP and plaque control over time, although there were no significant differences with the use of the paraprobiotic-based toothpaste alone. In addition, the combination of the two products promoted a trend towards the better stabilization of recessions.

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.

Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review

BACKGROUND

Oral conditions such as gingivitis and periodontitis are correlated with adverse pregnancy outcomes such as preeclampsia, preterm birth and low birth weight. Oral health-related unfavourable beliefs can have negative influences on oral health behaviours including hesitation in accessing preventative dental treatments and dental service utilization. The objective of this systematic review was to examine unfavourable beliefs that expectant or new mothers frequently hold about oral health and the safety of dental care during pregnancy.

METHODS

An electronic database search on PubMed, Scopus, CINAHL, and MEDLINE (Ovid) followed by forward and backward citation tracing of the included studies was conducted. All English primary studies regardless of the year of publication were independently screened by two reviewers to identify studies addressing unfavourable beliefs about oral health and dental care during pregnancy. The CLARITY tool was applied to assess the risk of bias in the included studies.

RESULTS

Out of a total of 5766 records, 39 quantitative and six qualitative studies met the inclusion criteria. The commonly held unfavourable beliefs were regarding the safety of dental services utilization and dental treatment procedures, the adverse impacts of pregnancy on oral health, and oral hygiene necessity during pregnancy. The most discussed unfavourable beliefs included "pregnant women lose their teeth because of pregnancy" (n = 18), "dental treatments are not safe and harm the fetus" (n = 17), and "the developing baby absorbs calcium from the mother's teeth" (n = 14).

CONCLUSIONS

Unfavourable beliefs about oral health and dental care utilization are common among pregnant women and new mothers. The literature suggests that a low level of oral health knowledge and seeking information from social networks can contribute to such beliefs. This has implications for health promotion.

Adherence to and acceptability of three alcohol-free, antiseptic oral rinses: A community-based pilot randomized controlled trial among pregnant women in rural Nepal

OBJECTIVES

Antiseptic oral rinses have been evaluated as interventions to reduce the risk of adverse pregnancy outcomes associated with periodontal disease in pregnant women. Oral rinse use is not common in Nepal or other countries in South Asia, where the prevalence of adverse pregnancy outcomes is high. Understanding whether pregnant women in rural communities in this region would incorporate rinse use into their daily teeth cleaning routine is an important prerequisite to future research on this topic in South Asia.

METHODS

We conducted a community-based pilot randomized controlled trial of three alcohol-free, antiseptic oral rinses among pregnant women <22 weeks pregnant in rural Nepal with the aim of assessing rinse acceptability, adherence, and effect on clinical periodontal measures. At baseline, participants underwent a clinical periodontal examination, and then were classified as healthy or having at least mild gingivitis (≥1 site with probing depth (PD) 3 mm and bleeding on probing (BOP) or ≥4 mm (PD)). Participants were stratified by periodontal status and randomized within each exposure category to chlorhexidine (CHX) (0.12%), cetylpyridinium chloride (CPC) (0.05%), salt and water (NaCl), or control (no rinse). Rinse participants were followed weekly for 12 weeks, and all participants underwent a second periodontal examination and answered a questionnaire.

RESULTS

Pregnant women in the rural Terai region of Nepal showed high adherence to (mean weekly rinse use: 185 mL (standard deviation: 66 mL)) a recommended 210 mL and acceptability of all three rinses. Participants reported greater frequency of tooth brushing with toothpaste and improvements in other recommended oral hygiene behaviours. CHX significantly reduced rates of gingivitis (defined as a participant with BOP ≥ 10% of sites) and the extent of BOP (gingivitis at the end of follow-up for CHX vs control: RR 0.37, 95% CI: 0.16, 0.84). CPC and NaCl rinse groups had rates of gingivitis and extent of BOP similar to the control group (gingivitis at the end of follow-up for CPC: RR 0.81, 95% CI: 0.47, 1.38; NaCl: RR 0.92, 95% CI: 0.55, 1.56).

CONCLUSIONS

Adherence to and acceptability of three alcohol-free, antiseptic oral rinses were high among pregnant women in rural Nepal. Among participants with mild gingivitis at baseline, CHX rinse was most effective at reducing signs of disease compared to the control group. Oral rinse should be considered as a supplement to current oral self-care routines for pregnant women in settings where rinse use is uncommon and access to oral health services is limited.