Self-reported oral health, oral hygiene habits and dental service utilization among pregnant women in United Arab Emirates

Oral Health Literacy Status, Knowledge Levels, Beliefs, and Behaviors of Pregnant Women

CONTEXT

Pregnancy may exacerbate the frequency and severity of some dental problems. However, most pregnant women avoid going to the dentist.

AIMS

To examine the oral hygiene and dental care behaviors of women during pregnancy, to measure their knowledge levels, to reveal their oral and dental health literacy status, and their beliefs about treatment.

SETTINGS AND DESIGN

The study was conducted for a period of 1 month with pregnant women over the age of 18 who presented to the obstetrics outpatient clinic and agreed to participate in the study and who had no known anomalies or complications.

METHODS AND MATERIAL

A survey was completed by face-to-face interviews with 317 pregnant women of different ages and gestational weeks. Participants were asked questions regarding their sociodemographic characteristics, pregnancy characteristics, oral hygiene-related beliefs, behaviors, and knowledge levels.

STATISTICAL ANALYSIS USED

The data obtained in the study were analyzed with SPSS 21.0 program. Since the kurtosis and skewness values were between +3 and -3, parametric tests were used.

RESULTS

In total, 317 pregnant women between the ages of 18 and 43 participated in the study. The most common beliefs are listed as; babies receive the necessary calcium from the teeth, antibiotics given during dental treatment harm the baby, and panoramic radiography taken during treatment harms the baby. 91.5% of the participants did not visit the dentist after planning a pregnancy, and 89% of them did not visit the dentist during pregnancy. The most common reason not to visit the dentist is not having a dental problem. The rate of knowing that dental infections during pregnancy will affect the baby is 50.5%.

CONCLUSIONS

In the present study, it is seen that pregnant women do not have adequate oral hygiene. The reasons were listed as various false beliefs and lack of sufficient knowledge. Health professionals should provide information about oral hygiene to pregnant women and direct them to the dentist.

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.

Enhancing Oral Hygiene in Children With Hearing Impairment: The Impact of Skit Video Interventions -A Randomized Controlled Trial

Aim. This study aimed to assess the effectiveness of 3 interventions-skit video, pictorial, and sign language-in improving the oral hygiene of children with hearing impairment. Materials and Methods. Sixty children randomly divided into 3 groups: Skit video, Pictorial, and Sign language. The mean gingival and Oral Hygiene Index scores were recorded before and after interventions. A 1-way ANOVA was used for statistically significant difference between pre and post intervention scores. Results. A significant difference in mean oral hygiene and gingival index scores before and after interventions was found in Group A (P < .005). A statistically significant difference was also found between group A and B in inter group comparison of OHI and GI scores post intervention (P < .004). Conclusion. Skit video and pictorial intervention effectively improves oral health resulting in reduced mean oral hygiene and gingival scores.

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

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

Awareness of Periodontal Health among Pregnant Females in Government Setting in United Arab Emirates

OBJECTIVE

 Periodontal disease is one of the most common infectious diseases. Several factors are associated with increased susceptibility of periodontal disease such as hormonal changes during pregnancy. Although pregnancy does not directly cause gingivitis, it can aggravate preexisting periodontal disease. This study aimed to evaluate knowledge of the association between periodontal disease and pregnancy in pregnant females.

MATERIALS AND METHODS

 A convenience sample of pregnant females attending two United Arab Emirates government hospitals was recruited for this study. A 23-item questionnaire was developed with four sections, covering sociodemographic details, oral hygiene, oral symptoms during pregnancy, and knowledge of periodontal health during pregnancy. The study was conducted between April and October 2017. All participants consented to the survey.

RESULTS

 A total of 100 participants with a mean age of 31 years (± 5.9) completed the survey. Most respondents brushed their teeth 2 to 3 times a day (65%), used a manual toothbrush (93%) but only visited the dentist when in pain (62%). Few respondents self-reported any gingival signs and symptoms during pregnancy; 38% had bleeding gums, 27% had no gum swelling, and 34% had bad odor/taste/smell. Only 21% of pregnant females lost a tooth/teeth during pregnancy, 15% believed that pregnancy increased the likelihood of gum disease, and 66% of gynecologists did not advise a visit to the dentist.Housewives were significantly less knowledgeable about periodontal health than students/employed respondents (p = 0.01). Quality of knowledge was not associated with educational attainment (< 0.06). Respondents > 30 years of age were more likely to believe in "a tooth for a baby" than younger participants aged < 30 years (p < 0.05). A logistic regression model showed that educational attainment was not a predictor for the belief in "a tooth for a baby" but age was a significant predictor (odds ratio = 2.0).

CONCLUSION

 Protocols should be developed in antenatal clinics in order to improve periodontal health in pregnant females and to prevent complications that can result in adverse pregnancy outcomes.

Perceptions, knowledge, and practices related to oral health in a group of pregnant women: A qualitative study

BACKGROUND

It is well known that the prevalence of dental caries and periodontal disease is increasing in pregnant women. Dental care is mostly sufficient to prevent oral diseases and perform timely interventions. However, few pregnant women go to the dental office during this period due to a lack of knowledge. The perceptions, knowledge, and oral health practices of pregnant women have been scarcely explored and should be taken into account to propose positive interventions in this population.

OBJECTIVES

To identify and explore the perceptions, knowledge, and practices of oral health in a group of pregnant women in Colombia.

MATERIAL AND METHODS

Twenty-four semistructured interviews were conducted in different areas of Colombia. The interviews were conducted via telephone, and the calls were recorded with the consent of the participants. The recordings were transcribed in Word® and checked for typing and transcription errors. The transcripts were analyzed using a hybrid approach combining inductive and deductive coding. The information was organized and encoded using NVivo12 ®software. We followed the Standards for Reporting Qualitative Research (SRQR) checklist.

RESULTS

Pregnant women reported having good oral health. One barrier mentioned for occupation (Job) was pregnancy. The appearance of the oral cavity has not negatively affected the relationships of pregnant women.

CONCLUSIONS

The pregnant women had good oral hygiene habits but did not receive dental check-ups. Knowledge in this group was limited and diverse. The information given by health professionals should be standardized, and some beliefs should be demystified.

RELEVANCE TO CLINICAL PRACTICE

In general, few pregnant women were aware of bleeding gums during pregnancy. Empower pregnant women to take care of themselves through regular dental check-ups with the aim of preventing and treating oral diseases. Oral hygiene education and healthy nutritional habits should be intensified during this stage.

PATIENT OR PUBLIC CONTRIBUTION

The participation in the study included a semistructured interview by telephone with the prior consent of the pregnant woman authorizing her involvement and the recording of the interview.

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.

Predictors of oral health literacy in pregnant women

We determined factors associate with oral health literacy of pregnant women. A total of 203 pregnant women attending Hospital Universiti Sains Malaysia (USM) for antenatal care participated in this cross-sectional study. The Malay version of Oral Health Literacy Instrument (OHLI-M) and a structured self-administered questionnaire were used to obtain variables of interest. The mean OHLI-M score was 73.6 (SD 12.59). Only slightly more than half of our participants had adequate oral health literacy (54.2%), while others were marginal (31.0%) and inadequate (14.8%). Our findings revealed that women with adequate oral health literacy were more likely to be those with higher education qualification and were very satisfied or satisfied with their oral health status. The identification of these predictors highlighted the importance to keep oral health education messages simple and clear for the benefit of individuals with low educational attainment.

How much do pregnant women know about the importance of oral health in pregnancy? Questionnaire-based survey

BACKGROUND

Although pregnancy is a physiological process it causes hormonal changes that can also affect the oral cavity. Pregnancy increases the risk of gum disease inflammation and tooth caries which could affect the health of the developing baby. Proper oral health is crucial both for mother and her babies and is related with mothers' awareness of this connection. The aim of this study was the self-assessment of women's both oral health and oral health literacy as well as mothers' awareness of the connection of oral health and pregnancy.

MATERIAL AND METHODS

In the study anonymous questionnaire was prepared and provided to be filled in by 200 mothers at the age from 19 to 44 y.o. who gave birth in the gynecological clinic. The questionnaire included demographic, and concerning the areas of oral health before and during pregnancy and after the childbirth questions.

RESULTS

Only 20% of the investigated women underwent the oral examination before the pregnancy and the next 38.5% underwent it intentionally when the pregnancy had been confirmed. As much as 24% of women pointed out lack of awareness of the importance of proper oral hygiene during pregnancy. 41.5% of investigated women declared complaints during the pregnancy concerning teeth or gums and 30.5% underwent dental treatment; 68%, brushed their teeth properly-twice a day; 32% of women observed deterioration of oral health state during the pregnancy. The knowledge of the importance of oral health during pregnancy presented by the majority of mothers was relatively proper, which was strongly connected with higher education status and living in big cities. A significant correlation between higher birth weight and more frequent daily tooth brushing was observed. Both higher frequency of problems concerning the oral cavity and dental treatment during pregnancy were significantly related to the younger age of mothers.

CONCLUSIONS

The knowledge of women concerning of oral health on the management of pregnancy and development of fetus is still insufficient. Gynecologists should inquire pregnant women if they have done dental examination, and provide wider education about importance of oral health in pregnancy.

Pain Relief Effects and Safety of Transitional Therapy in the Treatment of Posterior Teeth of Pregnant Women with Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis

Purpose

To assess the pain relief effects and safety of transitional therapy (TT) in the treatment of posterior teeth of pregnant women with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

Methods

A prospective cohort clinical study was conducted in the Department of Stomatology at Shenzhen Maternity & Child Healthcare Hospital, China, from January 2017 to December 2019. We enrolled 62 pregnant women with acute dental pain caused by posterior teeth with symptomatic irreversible pulpitis or symptomatic apical periodontitis. Among the 62 participants, 34 received TT, and 28 chose nontreatment during pregnancy. We evaluated the pain relief with the verbal numerical rating scale (VNRS) scores of pain perception in the clinical study, as well as the anti-bacterial medicament filling conditions of canals of in vitro models. Moreover, we investigated the safety outcomes, such as gestational age, neonatal head circumstance, birth weight, and body length.

Results

The VNRS scores of the participants treated with TT were significantly lower than those of the nontreatment group 2 days after treatment (P<0.001). TT treated pregnant women experienced significantly more pain decreases in VNRS scores than their counterparts(P<0.05). The optimal anti-bacterial medicament filling conditions of canals of in vitro models by TT method were comparable with those of canals instrumented with traditional RCT method. Moreover, no significant differences of safety outcomes were observed between pregnant women of these two groups.

Conclusion

The transitional therapy is efficient in alleviating acute dental pain of posterior teeth of pregnant women with symptomatic irreversible pulpitis and symptomatic apical periodontitis, and maintaining painless chains throughout pregnancy with no adverse effects on neonatal birth outcomes.

Antibiotic use in endodontic treatment during pregnancy: A narrative review

More than half of pregnant women are usually affected by odontogenic pain affects. Pain often accompanies periapical or pulp infections and increases the risks to pregnant patients and their fetuses. The American Dental Association, in partnership with the American College of Obstetricians and Gynecologists, has offered a strong declaration reaffirming the significance of suitable and timely oral health care as an indispensable constituent of a healthy pregnancy. However, there is lack of knowledge about the use of antibiotics in endodontic treatment. Therefore, the present study would review the researches done in this area and tries to provide comprehensive and complete information about the use of antibiotics in endodontic treatment during pregnancy. Based on the results, it can be said that using antibiotics during pregnancy are allowed, and they can be used normally and safely by pregnant women.

Oral Hygiene Practices and Awareness of Pregnant Women about the Effects of Periodontal Disease on Pregnancy Outcomes

Objectives

Adverse pregnancy outcomes, such as preterm low birth weight (PTLBW), is a severe public health issue that needs to be dealt with by educating the general female population, dental practitioners, and gynecologist. One of the major contributing factors is periodontal disease, which accounts for about 18.2% of all PTLBW cases worldwide, and prevention of the same could reduce the occurrence of PTLBW babies. This study aimed to assess the oral hygiene practices and awareness of pregnant women about the effect of periodontal disease on pregnancy outcomes.

Methods

A descriptive cross-sectional study was conducted where 400 pregnant women after consent were requested to complete an anonymous, self-administered, structured questionnaire with twenty-one close-ended questions.

Results

Only 5% of participants in this study reported that gum diseases during pregnancy lead to preterm labor or low birth weight babies. About 70.7% of pregnant women mentioned that they did not use any interdental cleaning aids, and 54.5% did not use mouthwashes.

Conclusion

Tooth brushing practices among pregnant women were good; however, there was an overall lack in the use of adjunctive aids. The study highlighted a deficiency in the awareness of pregnant women regarding the association between periodontal disease and adverse pregnancy outcomes.

Generalized Anxiety Disorder and Its Relationship with Dental Anxiety among Pregnant Women in Dammam, Saudi Arabia

Objective

To assess the relationship between generalized anxiety disorder (GAD), dental anxiety (DA), and other factors among pregnant women.

Methods

The Generalized Anxiety Disorder (GAD-7) scale and the Modified Dental Anxiety Scale (MDAS) were used to evaluate GAD and DA, respectively. Hard copies of self-administered questionnaires were distributed among 780 pregnant women attending hospitals/health centers in Dammam, Saudi Arabia.

Results

About 31.7% of the participants demonstrated minimal anxiety, 37.9% mild anxiety, 19.7% moderate anxiety, and 10.6% severe anxiety. The mean GAD score of the sample was 7.53 ± 5.16 which differed significantly among women in the first (7.74 ± 5.47), second (6.82 ± 4.64), and third trimesters (8.13 ± 5.37) (P=0.029). Pregnant women who performed routine dental visits demonstrated lower GAD (6.98 ± 5.23) than those who visited dentists for consultation, pain, or treatment (7.58 ± 5.07). The mean GAD score was significantly higher among participants with dental pain or discomfort during the last 12 months (8.12 ± 5.05) than among those without pain or discomfort (7.02 ± 5.2) (P 0.003). Similarly, the participants with DA showed a significantly higher mean GAD score (7.69 ± 5.17) than those without DA (5.93 ± 4.71) (P 0.006). Multivariate linear regression showed that GAD significantly correlated with DA (B = 0.225, P < 0.001).

Conclusion

In the present study, GAD was common among pregnant women which significantly correlated with DA. Pregnant women with DA and dental pain demonstrated high GAD. Preventive and therapeutic measures should be taken to reduce GAD and DA during pregnancy.

Association between Perceived Oral Symptoms and Presence of Clinically Diagnosed Oral Diseases in a Sample of Pregnant Women in Malaysia

The integration of oral health into primary health care denotes the important role of medical counterparts as the front liners in antenatal care to help screen mothers for oral symptoms and refer them to dentists accordingly. However, the validity of self-perceived oral health status is inconclusive. This study determined the association between self-perceived oral symptoms and the presence of clinically diagnosed oral diseases in a sample of pregnant women. A total of 192 pregnant women participated in this cross-sectional study. Clinical oral examinations were performed to record dental caries experience, gingival health and periodontal health. The women were also asked about their oral symptoms. Most women had at least one oral symptom (84.9%): cavitated tooth (62.0%), bad breath (38.5%), bleeding gums (28.6%), and toothache (22.9%). About half of the women had untreated dental caries (58.9%), and the odds were significantly higher in women who complained of having cavitated tooth. About half of the women had moderate to severe gingivitis (53.7%), and the odds were significantly higher in women who complained of bleeding gums. About half had periodontal pockets (46.3%), and the odds were higher in women who complained of bleeding gums and bad breath although lower in women who complained of swollen gums. In conclusion, the prevalence of dental caries and periodontal disease among pregnant women in this study were relatively high. The presence of untreated dental caries, moderate and severe gingivitis, and periodontal pockets were significantly associated with their corresponding oral symptoms.

Pharmacotherapy during Pregnancy: An Endodontic Perspective

Odontogenic pain affects up to 54.9% of pregnant women^1-3. This pain is often associated with pulpal and/or periapical infections that pose risks to women and their fetus. The American Dental Association in collaboration with the American College of Obstetricians and Gynecologists developed a consensus statement to affirm the importance of timely and appropriate oral health care as a critical component of a healthy pregnancy⁴. However, limited knowledge of endodontic procedure safety and related medication use often result in the avoidance of treatment during pregnancy. This article, a collaborative effort by specialists from endodontics, pediatric dentistry, and obstetrics, reviews the current evidence on the safety of medications commonly used in endodontics including local anesthetics, analgesics, anxiolytics, and antibiotics.

Access and use of dental services by pregnant women: an integrative literature review

The objective of this article is to identify the scientific productions on the access and use of dental services by pregnant women. A search was carried out on the BVS and MEDLINE/PubMed online databases to produce this integrative literature review. In the BVS database, the Portuguese descriptors were: "acesso aos serviços de saúde", "saúde bucal" and "gestantes", and in PubMed: "Health services accessibility", "oral health" and "pregnant women", all associated with each other by the Boolean operator "AND". We identified five studies that met the inclusion and exclusion criteria and were systematized into two empirical and co-related categories: the significant number of pregnant women who do not perform prenatal dental care and the importance of educational measures that signal the need to receive dental care during prenatal visits. Further studies on the subject are required to support public health policies that consider this theme. Existing research shows low adherence to prenatal dental care and that the main factors hindering the access to and use of dental services were related to socioeconomic, cultural and educational aspects.

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

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

A Cross-Sectional Analysis of Dental Care Utilization Among Pregnant Women in Saudi Arabia

BACKGROUND:

Oral and systemic problems are common among pregnant women. Routine dental visits are important for the maintenance of optimal oral health which is linked with systemic health.

AIM:

To evaluate dental care utilization and related factors among pregnant women in the Eastern province of Saudi Arabia.

METHODS:

This cross-sectional study was conducted in hospitals and healthcare centers in the cities of Khobar, Dammam, and Qatif in the Eastern province of Saudi Arabia. A piloted tested self-administered questionnaire available in Arabic and English languages was distributed among a calculated sample of 341 pregnant women. Pearson’s chi-square test and multiple logistic regression analyses were performed.

RESULTS:

In the study, 270 questionnaires were analyzed giving a response rate of 79.2%. Mean age of the participants was 29 ± 5.9 years. There were 43.7% pregnant women who received dental treatment when they have a dental problem and only 13.7% performed routine dental visit. Half the sample (52.6%) avoided dental visits during pregnancy and dental treatment being unsafe was the most common reason for avoiding dental visits. After adjustment, routine dental visits during pregnancy were 7.38 times higher among Saudis compared with non-Saudis women (p 0.05). The participants who had a negative perception about the safety of dental treatment had significantly lower odds (OR 0.31, p 0.036) of dental attendance for routine dental visits.

CONCLUSION:

Routine dental visits were low among pregnant women and many visited dentists when they had a dental problem. Negative perception about the safety of dental treatment was associated with reduced regular dental visits during pregnancy. Pregnant women should be educated about the importance of receiving dental care for the maintenance of optimal oral health.

Awareness of Dental Interns to Treat Pregnant Patients

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Influence of Pregnancy on the Inflammatory Process Following Direct Pulp Capping: a Preliminary Study in Rats

The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

[Dental care utilization of immigrants in Chengdu, China]

OBJECTIVE

This study considered Chengdu, Sichuan, China as an example to investigate the dental service utilization by foreigners and its influencing factors. Results of the study can be referred by dental practitioners to explore international development of dental services and can be provided for health policy makers to formulate oral health policies for immigrants.

METHODS

A simple random sampling method with a questionnaire was designed based on Anderson's health utilization model and "Oral Health Questionnaire for Adults" by the World Health Organization. Oral health condition, consciousness, and demographic data were collected. Binary Logistic regression and stratified analysis with SPSS 20.0 were performed.

RESULTS

A total of 654 immigrants repre-senting 75 countries participated in the study. Among all participants, 102 (15.6%) experienced dental problems while in residence in China but paid no visit to dentists. Female immigrants, who spent considerable time living in Chengdu, experienced oral problems in a year, used dental floss, and reported family members in Chengdu, were more likely to visit Chinese dentists. Participants who lived in Chengdu for at least 10.5 months were the threshold distinguishing differences in dental visits in the country.

CONCLUSIONS

The policymakers in Chengdu should consider creating a convenient and conducive dental care environment for immigrants. Additional information related to urgent oral and routine care should be provided to short- and long-term living immigrants in China. Dental practitioners in China should also contemplate on collaborating with foreign dental insurance companies to ensure better dental care access for immigrant patients.

The Effect of Health Education Program Based on Health Belief Model on Oral Health Behaviors in Pregnant Women of Fasa City, Fars Province, South of Iran

Aims and Objectives:

Pregnant women are at risk of dental caries and periodontal disease. The purpose of this study was to assess the effectiveness of health education program based on health belief model (HBM) on oral and dental hygiene behaviors in pregnant women in Fasa city.

Materials and Methods:

This is a clinical trial study carried out on 110 pregnant women selected using random sampling method from health centers in Fasa city in 2016 (55 patients in the experimental group and 55 individuals in control group). Data collection with questionnaire was based on construct HBM, as well as their performance about oral health. At first, two groups completed the questionnaires. And then, the intervention was conducted for the experimental group based on HBM. Four months after intervention, two groups completed the questionnaires twice. To analyze the collected data, the researchers used SPSS version 22 and descriptive and analytical statistics tests such as independent t-test and Chi-square and Mann–Whitney test.

Results:

The age of the pregnant mothers was 28.25 ± 3.02 years in the experimental group and 27.8 ± 4.20 years in the control group. Compared to the control group, the experimental group showed a significant increase in their knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, cues to action, and performance and decrease in perceived barriers 4 months after the intervention.

Conclusion:

Applying the HBM is very effective for developing an educational program for oral health in pregnant women. Moreover, in the implementation of these programs, control, monitoring, and follow-up educational are recommended.

Factors affecting oral health determinants in female university students: a cross-sectional survey in Saudi Arabia

Objective This study aims at investigating factors affecting oral health patterns, attitudes and health risk behaviors among female university students. Methods An online questionnaire was distributed to female university students in Al Madinah in the western region of Saudi Arabia. Students were requested to answer questions on demographic data, oral hygiene practices, dental attendance, smoking history, practice of sports and body weight and height. Results Two hundred and fourteen students participated with age range of 18-31 years (mean = 21.64 ± 1.72 years). Oral hygiene habits were reported by a percentage of 97.2%, 34.6%, 30.8% and 19.2% who used a tooth brush, dental floss, mouthwash, and a miswak (a teeth cleaning twig made from the Salvadora persica tree), respectively. The only factor that was significantly associated with a good oral hygiene level was a university major of non-healthcare specialties (p = 0.009). Conclusion It is concluded that female university students use various oral hygiene methods, however, dental attendance is poor and a number of health risk factors are noticed like smoking, lack of practicing sport and unhealthy body mass index (BMI).

The effect of dental health education on pregnant women's adherence with toothbrushing and flossing - A randomized control trial

OBJECTIVES

In a three-arm randomized control trial, this study compared the efficacy of dental health education (DHE) with or without a planning intervention on adherence to oral health-related behaviours.

METHODS

Women (N=154) in their second trimester of pregnancy attending three maternal healthcare clinics in Kuwait completed an assessment of social cognitions and oral health behaviours before a debris and gingival assessment (Plaque Index [PI], Gingival Index [GI]) was undertaken; this was repeated at 1 month. In addition to treatment as usual (TAU), which was a demonstration of OH practices, intervention participants received one of two interventions: (i) DHE, which targeted social cognitions; or (ii) DHE and planning (DHE&P), which targeted social cognitions and intentions to undertake oral health behaviours. The TAU group was given a standard oral hygiene leaflet.

RESULTS

At Time one (T1) 154 women were eligible and randomly allocated to the three groups, respectively: treatment as usual (TAU)=53; DHE=53; DHE and planning=48. At Time two (T2), the number of women in each group completing the intervention (N=90) was, respectively, as follows TAU=28; DHE=30; DHE&P=32. There were no demographic differences between the groups at baseline. The mean age of women was 27.80±SD 5.40; 43% (n=38) had a high school level education. A mixed factor ANOVA analysis demonstrated that all women improved their PI (F=94.343 df=1 P=.001) and GI (F=73.138 df=1 P=.001) scores. There were no differences in self-reported oral hygiene and PI and GI by intervention group. The social cognition models (SCM) constructs changed over time in all women (N=90) except barriers to attendance (F=1.067 df=1 P=.305). There were no statistically significant differences in SCM constructs by intervention group at T2. All women reported increasing the frequency of toothbrushing and flossing.

CONCLUSIONS

The provision of information using a simple leaflet improved the adherence of Kuwaiti pregnant with toothbrushing and flossing advice, while the addition of DHE targeting social cognitions and planning conferred no additional benefits.

What do expectant mothers need to know about oral health? A cohort study from a London maternity unit

Objective:

To determine the oral health knowledge of pregnant women and to report their future plans to provide dental care for their expected child.

Design and setting:

Prospective cohort study; Ultrasound maternity services at St Thomas’ Hospital, London, 2014. Pregnant women attending for a routine ultrasound scan completed a questionnaire.

Results:

Women did not know that milk, dried fruit or fruit juices can cause caries. Most women knew about the benefit of fluoridated toothpaste, dental floss and sugar-free chewing gum, but only a minority knew about fluoride varnish. Most pregnant women planned to read or seek advice before purchasing their child’s first toothpaste. There was no difference regarding knowledge of prevention tools (diet and fluoride supplements) for dental caries (P>0.05) between first-time mothers and those who had children already. Though the latter knew more about toothpaste dose and timing of starting toothbrushing (P<0.05).

Discussion:

Oral health knowledge among pregnant women was deficient with respect to the cariogenicity of prolonged night-time milk feeding, dried fruits and fruit juice consumption. There was also limited knowledge of the benefit of fluoride varnish and timing of starting toothbrushing.

Conclusions:

Oral health knowledge amongst pregnant women is still deficient in many aspects. In this study population the need to improve maternal knowledge was shown.

Oral Health Knowledge, Attitudes, and Perceptions of Pregnant Kuwaiti Women

Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women’s understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists’ purported incorrect beliefs about providing dental treatment to pregnant women and the women’s lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women.

Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.

Effect of Educational Intervention on Perceived Susceptibility Self-Efficacy and DMFT of Pregnant Women

Background

The World Health Organization identifies oral health as a necessity for public health through the entirety of life. This issue has been considerably addressed due to susceptibility to tooth decay during pregnancy and maternal and fetal health.

Objectives

Investigate the effect of educational intervention on perceived susceptibility, self-efficacy, and DMFT of pregnant women.

Patients and Methods

A quasi-experimental survey (pretest, posttest, and control group) was implemented in 88 primiparous women in the first trimester of pregnancy who attended private clinics in Delfan city, Iran. It was conducted using random sampling and then assigned to intervention and control groups. Data were collected using a questionnaire that included demographic characteristics, a DMFT checklist, and some health belief model (HBM) constructs. After collecting baseline information, an educational intervention consisting of 4 training sessions for the intervention group was scheduled. In the sessions, lecture, focus-group discussion, video, and role-playing were used as the main educational strategies. Four months after the intervention, a post-test questionnaire and DMFT checklist were conducted. Data were analyzed using SPSS (ver20) software and Chi-square, independent t-test, and repeated measure ANOVA at the significant level of α < 0.05.

Results

According to the independent t-test, the mean score of knowledge, perceived susceptibility, self-efficacy, and DMFT was not different between the two groups before the education (P > 0.05), during the intervention, or after intervention. Repeated measure ANOVA explained that the aforementioned score was different in the three cases (pretest, 2 months after intervention, and 4 months after intervention) after intervention (P < 0.05). Paired t-test also showed that the DMFT mean increased 4 months after intervention in the control group (P < 0.001). It was not, however, augmented in the intervention group (P = 0.92).

Conclusions

Results showed that education on some of the HBM constructs resulted in increased knowledge of oral health, perceived susceptibility, and self-efficacy of pregnant women. It is also possible to prevent increased DMFT during pregnancy.

Dental pain and associated factors among pregnant women: an observational study

The present study aimed to determine the prevalence of dental pain during pregnancy and its association with sociodemographic factors and oral health conditions among 315 pregnant women in South Brazil. Participants were interviewed to obtain sociodemographic data, such as age, educational level, employment status, family income, and marital and parity status. Medical and dental histories were also collected, including the occurrence of dental pain and the use of dental services during pregnancy. Clinical examinations were performed to assess the presence of visible plaque and gingival bleeding and to calculate the decayed, missing, and filled teeth index. Means and standard deviations of continuous variables and frequencies and percentages of categorical variables were calculated. Independent variables were included in a multivariate logistic regression analysis. A total of 173 (54.9 %) pregnant women reported dental pain during pregnancy. After adjustment of the analysis, caries activity remained the main determinant of dental pain (odds ratio 3.33, 95 % CI 1.67-6.65). The prevalence of dental pain during pregnancy was high and the presence of caries activity was a determinant of dental pain. Moreover, access to oral health care was low, despite pregnant women's increased need for dental assistance.

Comparative Evaluation of Oral Health Knowledge, Practices and Attitude of Pregnant and Non-Pregnant Women, and Their Awareness Regarding Adverse Pregnancy Outcomes

BACKGROUND

Adverse pregnancy outcomes are undesirable events occurring during pregnancy and childbirth in mother or child, such as Preterm Low Birth Weight (PLBW) and preeclampsia. There is growing evidence that periodontitis may be a risk factor for preterm birth even after adjusting for known risk factors.

AIM

1. To determine the knowledge and attitude of pregnant females about oral health. 2. To evaluate the oral hygiene practices of pregnant females. 3. To evaluate their awareness regarding effect of oral health on adverse pregnancy outcomes. 4. To assess whether there was any significant difference from their non pregnant counter parts. 5. To evaluate whether their awareness towards dental treatment had increased after conceiving.

MATERIALS AND METHODS

200 pregnant and 200 non-pregnant women filled up a validated questionnaire which comprised of questions on personal data, oral hygiene knowledge, attitude, oral hygiene practices and their awareness regarding the correlation of oral health to adverse pregnancy outcomes.

STATISTICAL ANALYSIS

Analyses were conducted using SPSS for Windows (version 15.0; SPSS Inc., Chicago, IL, USA).

RESULTS

The results indicate no statistically significant differences in the variables assessed in both the groups, indicating that no further knowledge had been imparted to the women after they conceived. 96% women of both groups (p>0.05) had received no knowledge from the gynaecologist regarding the impact of oral health on pregnancy outcomes. 93.9% of pregnant women, and 89.5% of non pregnant women (p>0.05) did not go for routine dental check-ups. Only 3% of pregnant women were aware of oral health having a correlation with adverse pregnancy outcomes.

CONCLUSION

In our study, pregnancy did little to change future attitudes to dental care. To provide better oral health care, more knowledge needs to be made available to the pregnant women and the medical community.

Gynecologists' knowledge and attitudes regarding oral health and periodontal disease leading to adverse pregnancy outcomes

Objectives:

A cross-sectional study was conducted to evaluate the knowledge and practiced behaviors of gynecologists regarding oral health care during pregnancy and the association of periodontal disease with adverse pregnancy outcomes.

Materials and Methods:

A questionnaire consisting of 16 questions was designed and pilot tested. One hundred and fifty gynecologists practicing in the private sector of United Arab Emirates (UAE) were approached to voluntarily participate and fill up the questionnaire during February–March 2014. Data retrieved were entered into Excel database and analyzed using SPSS.

Results:

Of the 150 gynecologists approached, 108 filled the questionnaire, yielding a response rate of 72%. The majority (95.4%) acknowledged a connection between oral health and pregnancy and 75.9% agreed that periodontal disease can affect the outcome of pregnancy. Moreover, most of the gynecologists (85.2%) advised their pregnant patients to visit the dentist during pregnancy. Almost three-quarter of the participants (73%) regarded dental radiographs to be unsafe during pregnancy and more than half (59.3%) considered administration of local anesthesia to be unsafe during pregnancy.

Conclusion:

The present study demonstrated that gynecologists have a relatively high degree of knowledge with respect to the relationship of periodontal disease to pregnancy outcome. However, there clearly exist misconceptions regarding the provision of dental treatment during pregnancy. To provide better oral health care, more knowledge needs to be made available to the pregnant women and the medical community, and misconceptions regarding the types of dental treatments during pregnancy should be clarified.

Midwifery students training in oral care of pregnant patients: an interventional study

OBJECTIVE

Midwives may play an important role in oral health promotion of pregnant women, whom they are in close contact with. Our aim was to evaluate an educational intervention on the oral health attitude and practices among the junior midwifery students of Tehran University of Medical Sciences in 2010.

MATERIALS AND METHODS

The junior midwifery students were divided into intervention (n=29) and control (n=33) groups. The intervention group was first educated about general oral health, oral hygiene practices during pregnancy, and tooth brushing and flossing on models. Subsequently, the students performed role playing to ensure they understood the aforementioned lessons correctly. Before and three months after the training course the students filled out a validated self-administered questionnaire and a simplified plaque index was recorded. Statistical analysis was done by Mann-Whitney test and linear regression models.

RESULTS

Before the intervention, the mean scores of attitude in general oral health for the intervention and control groups were 5.8 and 5.4, respectively, which improved to 8.9 and 5.4 after the intervention (P<0.001). The mean score of oral health attitude in pregnancy was 20.4 in the intervention group and increased to 30.9 (P<0.001). The intervention group demonstrated much better oral health practices in pregnancy and lower plaque index score after the intervention.

CONCLUSION

The promising finding about attitude and practice improvement in midwifery students after participating in a short course on oral health promotion in pregnancy shows the necessity to enrich their training program by including this subject.

Dental considerations in pregnancy-a critical review on the oral care

Pregnancy is a dynamic physiological state which is evidenced by several transient changes. These can develop as various physical signs and symptoms that can affect the patients health, perceptions and interactions with others in the environment. The patients may not always understand the relevance of the adaptations of their bodies to the health of their foetuses. A gestational woman requires various levels of support throughout this time, such as medical monitoring or intervention, preventive care and physical and emotional assistance. The dental management of pregnant patients requires special attention. Dentists, for example, may delay certain elective procedures so that they coincide with the periods of pregnancy which are devoted to maturation versus organogenesis. At other times, the dental care professionals need to alter their normal pharmacological armamentarium to address the patients' needs versus the foetal demands. Applying the basics of preventive dentistry at the primary level will broaden the scope of the prenatal care. Dentists should encourage all the patients of the childbearing ages to seek oral health counseling and examinations as soon as they learn that they are pregnant. This article has reviewed some of the physiologic changes and the oral pathologies which are associated with pregnancy, and how these alterations can affect the dental care of the patient.