Women's attitudes to and perceptions of oral health and dental care during pregnancy

Adverse childhood experiences and dental cleaning during pregnancy: Findings from the North and South Dakota PRAMS, 2017-2021

OBJECTIVE

Research demonstrates that adverse childhood experiences (ACEs)-that is, experiences of abuse, neglect, and household dysfunction-are related to lower preventive dental care utilization in childhood and adolescence. However, limited research has explored the connection between ACEs and preventive dental care utilization in adulthood, and no research has examined this relationship during pregnancy. The current study extends existing research by investigating the relationship between ACEs and dental cleaning and dental care utilization during pregnancy among a sample of women who delivered live births in North Dakota and South Dakota.

METHODS

Data are from the 2017 to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS) in North Dakota and South Dakota (n = 7391). Multiple logistic regression is used to examine the relationship between the number of ACEs (0, 1, 2, 3 or 4 or more) and dental cleaning during pregnancy.

RESULTS

Relative to respondents with 0 ACEs, those with 4 or more ACEs were significantly less likely to report having dental care during pregnancy (OR = 0.757, 95% CI = 0.638, 0.898). By racial and ethnic background, the results showed that the significant associations are concentrated among White and Native American respondents.

CONCLUSIONS

The results suggest that exposure to 4 or more ACEs is associated with a significantly lower likelihood of dental cleaning during pregnancy among women who delivered a live birth in North Dakota and South Dakota. Further investigations are necessary to understand the mechanisms underlying the relationship between ACEs and dental cleaning during pregnancy and replicate the findings in other geographic contexts.

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

Purpose

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

Methods

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

Results

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

Conclusion

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

Adverse Childhood Experiences and Dental Care Utilization During Pregnancy: Findings from the North and South Dakota PRAMS, 2017-2021

Background

Research demonstrates adverse childhood experiences (ACEs)-i.e., experiences of abuse, neglect, and household dysfunction-adversely impact healthcare utilization over the life course. Several studies demonstrate that ACEs are related to lower dental care utilization in childhood and adolescence. However, limited research has explored the connection between ACEs and dental care utilization in adulthood, and no research has examined this relationship during pregnancy. The current study extends existing research by investigating the relationship between ACEs and dental care utilization during pregnancy.

Data

Data are from the 2017-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) North Dakota and South Dakota (n = 7,391). Multiple logistic regression is used to examine the relationship between the number of ACEs and dental care utilization.

Findings

Relative to respondents with 0 ACEs, those with 4 or more ACEs were significantly less likely to report having dental care during pregnancy (OR = 0.745, 95% CI = .628, .883). By racial and ethnic background, the results showed that the significant associations are concentrated among White and Native American respondents.

Conclusions

The results suggest that exposure to 4 or more ACEs is associated with a significantly lower likelihood of dental care utilization in adulthood, and this relationship is concentrated among White and Native American respondents. Further investigations are necessary to understand the mechanisms underlying the relationship between ACEs and dental care utilization and replicate the findings in other geographic contexts.

Social and Preventive Factors That Explain Oral Health among Pregnant Women in the Canton of Cuenca, Ecuador

(1) Background: pregnant women in underprivileged areas may face challenges that affect their oral health. The analysis of these issues such as toothaches or cavities, among others could be crucial for them. However, no studies have been conducted in Cuenca, Ecuador. Thus, this study aimed to create a model explaining how social factors and healthy habits impact oral health in Cuenca, Ecuador. (2) Methods: An observational study was performed using a questionnaire developed from scratch. Principal component factor analysis was performed to calculate the oral disease index based on the oral health issues reported by women during pregnancy. (3) Results: 1971 women participated in the research. In total, 88% reported at least one oral health problem, with cavities (34%) and bleeding gums (33%) as the most prevalent. The rate of preventive visits and frequent brushing were the two variables that most impacted the oral disease index. The consumption of sweets, age, and the belief that visiting the dentist harms their unborn child were also important factors. However, income, education, and ethnic background showed little to no effect. (4) Conclusions: The most beneficial determinants of oral health factors in pregnant women in Cuenca, Ecuador, are preventive dentist visits, frequent brushing, and a contained consumption of sweets. The main harmful factors are age and the misconception that dental visits can harm their unborn child. Surprisingly, income, education, and ethnic background have little effect. This study can be replicated in other countries and cultures.

The association of employment status and unwanted job loss with maternal oral health experiences: findings from the pregnancy risk assessment monitoring system

BACKGROUND

Oral health is an essential component of a healthy pregnancy. While most women work full-time while pregnant, research has overlooked the impact of occupational status and job loss on oral health experiences during pregnancy. To examine the impact of employment status and job loss on oral health experiences during pregnancy in the United States.

DATA

Data are from eight sites (Georgia, Massachusetts, Minnesota, Missouri, North Carolina, New York State, New York City, and Wisconsin) of the Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2016-2020 (n = 31,362). Multiple logistic regression is used to assess the relationship between occupational status (including employment status and unwanted job loss) during pregnancy and oral health.

FINDINGS

Women who experienced an unwanted job loss in the prenatal period were at elevated risk of not having dental insurance, not receiving a dental cleaning during pregnancy, having an oral health problem, and having unmet dental care needs.

CONCLUSION

Experiencing unwanted job loss around the time of pregnancy is an important life event that corresponds to worse oral health experiences. There is a need for greater focus on adverse life events, such as job loss, especially during pregnancy, as a mechanism for oral health issues and challenges with proper access to dental health systems.

Relationship between Oral Health Knowledge and Maternal Oral Health with Obstetric Risk and Breastfeeding

The relationship between maternal gingival health status and low birth weight or preterm delivery is controversial. The aim of this study was to analyze the association between maternal oral knowledge and the level of oral health during pregnancy with the risk of obstetric complications and breastfeeding. A descriptive cross-sectional study was conducted after an oral health educational intervention in a consecutive sample of 97 pregnant women. Data collection consisted of a validated questionnaire, oral examination, the Caries Index (CAOD) and the Simplified Oral Hygiene Index (IHOS). The participants had a mean age of 32.5 ± 5.19 years and a predominantly university education (57.1%). The level of knowledge regarding oral health was fair (12.5 ± 3.56 correct answers). Older pregnant women (33.0 ± 4.80 years) practiced breastfeeding and had a higher number of correct answers to the questionnaire. Adequate IHOS was associated with higher birth-weight newborns (3333 ± 0.3), whereas poor oral hygiene control was associated with lower birth-weight newborns (2960 ± 0.1) (p < 0.05). A lower level of academic education was associated with worse oral hygiene (p < 0.05). In addition, the greater the number of children, the higher the CAOD. Finally, among non-smoking women, the weight of infants was 437 mg higher. Maternal oral hygiene and the week of delivery were associated with newborn weight (p < 0.05) in a multiple linear regression model. Smoking was also related to low birth weight (p < 0.05). Educational interventions in pregnancy are necessary to decrease the incidence of obstetric adverse effects and improve the oral health of mothers and their children.

Oral health knowledge, attitude, and practice of pregnant women in Deccan, South India: a cross-sectional prenatal survey

Pregnancy is a unique condition for women, associated with physiological and emotional changes in the body. Various research showed an association between periodontal disease and adverse pregnancy outcomes. Importance to hygiene maintenance should be given during pregnancy and improve the wellbeing of the mother and child. This study assessed oral health knowledge, attitude, and practices among pregnant women in Hyderabad. The study design was cross-sectional and included 445 women who responded and completed the survey. Subjects were selected using a random sampling technique in gynecology clinics. The questionnaire form consisted of four sections: demographic data, knowledge, attitude, and oral hygiene practice. Out of the 482 pregnant females invited to participate in the study, 445 women completed the survey, giving a response rate of 92%. The majority of women showed good knowledge and attitude regarding oral hygiene and its relation to pregnancy. However, the participants showed poor compliance with the recommended protocol. There are certain myths and barriers to dental treatment that need to be considered in the prenatal education of women. If explained by the gynecologist, the importance of oral health and its correlation with systemic health will play a crucial role in improving oral hygiene practice and regular dental visits.

Factors Associated With Self-Perception in Oral Health of Pregnant Women

Background

Health perception is a subjective predictor of long-term morbidity and mortality. Few studies address the perception that pregnant women have of their oral health.

Objective

The objective of this study was to explore the relationship between socioeconomic factors and self-assessment of oral health in pregnant women from Cali, Colombia.

Method

A cross-sectional study was carried out with a sample of 998 pregnant women, calculated using the formula to estimate a proportion in finite populations, with a confidence level of 95%. A questionnaire was applied for sociodemographic characterization, as well as to enquire about oral health perception, knowledge, and practices of oral health.

Results

The mean age of the surveyed mothers was 24.7, with a standard deviation of 6.1, of which 23.6% were adolescents. The perception they had about their oral health status was considered good by 60.8%. Of the 82.9% who reported having attended dentistry, more than half perceived good oral health. Pregnant women with no history of oral problems, with a perception of medium or high income, and with good oral hygiene practices tend to have a good perception of their oral health.

Conclusion

Pregnant women with no history of oral problems, with a perception of medium or high income, and with good oral hygiene practices tend to have a good perception of their oral health.

Relationship between DMFT index and number of pregnancies: a cross-sectional study on enrollment phase of the Tabari Cohort Study

Background

People of all age and gender groups are at risk of dental diseases; however, some groups, such as pregnant women, are more vulnerable than others due to their specific physiological situations. The protection of maternal and fetal is critical. Therefore, the present study intended to investigate the relationship between the Decayed, Missing, and Filled Teeth (DMFT) index and the number of pregnancies.

Methods

The present cross-sectional study was performed using the Tabari Cohort Study (T.C.S.) data. Data of 5,496 women enrolled in the T.C.S. were included in the study. After obtaining the approval of the Ethics Committee, the related data on the variables of age, age at the first pregnancy, number of pregnancies, total number of teeth at the time of examination, number of DMFT, employment status, socioeconomic status, educational level, residence location, body mass index, and the status of diabetes mellitus, hypertension, and cardiovascular diseases were extracted. Finally, data analysis was performed in the STATA software (version 14).

Results

The mean DMFT index in women with 1, 2, 3, 4, 5, 6, and more than six pregnancies were obtained at 12.74 ± 7.11, 13.09 ± 7.06, 14.80 ± 7.81, 17.07 ± 8.11, 19.82 ± 9.02, 22.89 ± 8.98, and 26.17 ± 8.01, respectively (P < 0.001). Using the multivariate linear regression and adjusting the effect of potential confounding variables, it was found that the DMFT index increased by 34% for each unit increase in the number of pregnancies (β = 0.34, P < 0.001).

Conclusions

According to our results, there was a significant relationship between the DMFT index and the number of pregnancies. The DMFT index was increased with an increased number of pregnancies. Therefore, oral healthcare promotion should receive special attention in healthcare planning and related policies by raising awareness and providing easy access to dental services for women of childbearing age, especially pregnant women.

Validation of an instrument to determine oral health knowledge, attitudes, and practices during pregnancy

BACKGROUND

Oral health of the mother-infant dyad is important to preserve general health. However, there are few instruments in Spanish for the evaluation of knowledge, attitudes and practices that determine this construct. Therefore, this research aimed to develop and evaluate the psychometric properties of the Maternal Oral Health Knowledge, Attitudes and Practices Questionnaire (CAPSOM in Spanish).

METHODS

In this instrument development study that carried out in 2018-2019, involving pregnant women between the ages of 18 and 45 in the city of Leon, Guanajuato, Mexico. The sample size was calculated based on 10 women per questionnaire item (n = 10 k). The study used Cronbach's alpha, the modified Lawshe test of validity criteria, factor analysis, and the level of difficulty and discrimination of the items.

RESULTS

207 women took part with their signed, informed consent (25 ± 6 years). The internal consistency of the instrument, both total and by dimension was α = 0.70, α = 0.66 knowledge, α = 0.74 attitudes, and α = 0.66 practices. Values of Content Validity Ratio' ≥ 0.60 were obtained for the final 10 items and Content Validity Index' = 0.90. The average difficulty index of items was 0.40, and there were significant differences (Kruskall-Wallis, p < 0.001) in the discrimination test. Factor analysis demonstrated three main components.

CONCLUSIONS

A valid and reliable 10-item Spanish questionnaire was designed to measure pregnant women's oral health knowledge, attitudes, and practices.

Anxiety/fear of dental treatment during pregnancy: use of the Modified Dental Anxiety Scale (MDAS)

BACKGROUND

Despite advances in the control of anxiety and fear, dental treatment (DT) continues to be a stressful event, especially during pregnancy. There are several instruments to measure anxiety and fear about DT (AFDT). However, few are validated for use in Brazil. Our objective was to validate the Modified Dental Anxiety Scale (MDAS) for use in Brazil and to evaluate the association between AFDT and the use of oral health services (OHS) during pregnancy.

METHODS

This is a cross-sectional study nested in a prospective cohort. We conducted a face, content, and construct validation. The Visual Analogue Scale (VAS) was the comparison instrument with MDAS. Sociodemographic and behavioral characteristics were also assessed. Associations were estimated by odds ratios (OR) and 95% confidence intervals (95%CI) in multiple logistic regression analysis (alpha=5%).

RESULTS

There were no difficulties in the translation/back-translation process. The reproducibility of the instrument was 0.54 (P=0.01). The correlation of MDAS with VAS was 0.71 (P=0.003). The reliability of the instrument was high (Cronbach's alpha: 0.79 to 0.87). After validation, the instrument was administered to 486 women. Mild or moderate AFDT was reported by 81.3% of pregnant women and at higher levels, by 8.2%. There was no association between the use of OHS and AFDT at moderate levels (OR=2.03; 95%CI: 0.45-9.09) or high (OR=1.35; 95%CI: 0.20-9.13).

CONCLUSIONS

MDAS is a valid instrument for measuring AFDT. The prevalence of AFDT among pregnant women is high, but this event does not seem to be associated with the use of OHS.

Pregnant women utilization of dental services: still a challenge in low resource setting

Background

Poor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low.

Methods

This was a questionnaire-based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu. The information obtained was analyzed using SPSS version 22. A p-value of less than 0.05 was considered statistically significant.

Results

Only 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pain as well as swelling of the gum (33.3%). The most common reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (< 0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, < 0.001 respectively) were statistically significant.

Conclusion

The prevalence of dental consultation during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultation with oral health counseling and check-up incorporated as part of routine antenatal care.

Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

OBJECTIVES

To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.

DESIGN AND SETTING

The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.

PARTICIPANTS

Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.

COST MEASURES

Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.

OUTCOME MEASURES

Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.

RESULTS

Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario.

CONCLUSIONS

The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.

TRIAL REGISTRATION NUMBER

ACTRN12612001271897; Post-results.

Factors Related to Maternal Oral Health Status: Focus on Pregnant and Breastfeeding Women

Oral health management is vital for pregnant women and their fetuses. This study analyzed the factors affecting maternal oral health status. It used secondary data obtained from the 2019 Korean Community Health Survey. Data were analyzed using SPSS 21.0 for complex descriptive statistics, independent t-test, Pearson’s correlation coefficients, and multiple regression analysis. Multiple regression analysis revealed that age (β = −0.01, p < 0.001), maternal characteristics (β = −0.10, p < 0.001), education (β = −0.06, p = 014), subjective health status (β = 0.27, p < 0.001, sleep duration (β = 0.07, p = 0.003), breakfast frequency (β = −0.16, p < 0.001), unmet dental care needs (β = 0.35, p < 0.001), and depression (β = −0.02, p < 0.001) are key factors of maternal oral health status. Furthermore, oral health status is associated with mental health factors, such as depression. Therefore, the importance of maternal oral health among pregnant and breastfeeding women must be highlighted to promote the health of mothers and their babies.

Sociodemographic and behavioural determinants of early childhood caries knowledge among expectant mothers in Kuwait

PURPOSE

Early Childhood Caries (ECC) is a highly prevalent disease in Kuwait. It poses health, economic, and social implications affecting patients, their families and communities. ECC awareness campaigns targeting expectant mothers hold a promising potential as primary prevention tools. Understanding the baseline of ECC knowledge (ECC-K) is an important foundational step in planning such interventions. The aim of this study was to assess the level of ECC-K in a sample of expectant mothers, and to identify the sociodemographic and behavioural determinants of that knowledge.

METHODS

A multiple-choice questionnaire was distributed to 430 expectant women from one maternity hospital in Kuwait. The questionnaire gathered information on the demographics, ECC-K, and the oral health behaviours of the participants. Bivariate analysis assessed the relationship between ECC-K scores and the different socio-demographic variables and oral health practices of the participants. A multiple linear regression model was developed to identify the predictors of ECC-K scores RESULTS: The response rate was 94% (n = 405). The mean ECC-K score was 6.4 [standard deviation (SD) = 2.5] out of a maximum score of 14. Age, education, number of children, frequency of dental visits, and flossing frequency were significantly associated with ECC-K levels (p < 0.05).

CONCLUSIONS

ECC-K among this cohort of expectant mothers was inadequate. Educational interventions are needed to foster better ECC preventive practices.

Prevalence of myths regarding oral health among pregnant women in North India

OBJECTIVES

To study the prevalence of myths regarding oral health care in pregnant women in North Indian population.

METHODS

This cross-sectional study used a self-administered closed-ended questionnaire to assess oral healthcare related beliefs and practices in 400 pregnant women who reported for prenatal checkup in a tertiary healthcare centre in North India. The questionnaire included questions to elicit information on socio-demographic factors, beliefs and practices of oral hygiene during pregnancy, attitude towards dental problems occurring during pregnancy and the reasons associated with a specific belief. Prevalence of various myths was observed, and its associations with various socio-demographic factors, adverse pregnancy outcomes and dental symptoms were analysed.

RESULTS

84.2% of the respondents harboured at least one oral healthcare related myth. 63.4% of respondents deferred brushing for many days after delivery. 36.6% of respondents avoided consumption of hot/cold food and drinks during pregnancy due to fear of tooth loss. 24.5% of respondents believed local anaesthesia could affect baby's developing organs, and 21.8% of the studied population believed tooth extraction might cause miscarriage. Females possessing more myths were more likely to experience severe oral health problems during pregnancy. Education was depicted as a significant negative predictor of the prevalence of myths. No significant correlation between myths prevalence and history of adverse pregnancy outcomes was found.

CONCLUSION

Neglect of oral health due to myths about oral hygiene practices and dental treatment during pregnancy is a serious concern. A very high prevalence of these myths is an obstacle to goal of optimal maternal and child health.

Global application of oral disease prevention and health promotion as measured 10 years after the 2007 World Health Assembly statement on oral health

OBJECTIVES

The WHO World Health Assembly established in 2007 a Resolution (WHA60.17) on oral health, which called upon countries to ensure that public health actions for disease prevention and health promotion are established. The objective of the present survey undertaken 10 years later (2017-2018) was to measure the application of such programmes for key population age groups in low-, middle- and high-income countries.

METHODS

Oral health focal points of ministries of health worldwide (n = 101) answered a structured questionnaire on existing national oral health systems and the actual public health activities. The response rate was 58.4%. The questionnaire was used to collect information about structural factors, country workforce, financial models, provision of preventive services and promotion for oral health, school health programmes, administration of fluoride, national oral health targets and oral health surveillance. The countries were classified by national income for analysis of data.

RESULTS

Coverage of population groups by primary oral health care and emergency care varied by national income. The gap between countries in delivery of preventive care was strong since low-income countries less often reported preventive activities than middle-income countries and particularly when compared to high-income countries. School oral health programmes were less frequent in low-income than other countries. Moreover, population methods of fluoridation and use of fluoridated toothpaste were unusual in low-income countries. Health education, mass communication and community events were often essential elements in health promotion. In disease prevention, many countries considered the link between oral health and general health conditions and intervention towards shared risk factors of NCDs. The health concern for the consumption of tobacco, unhealthy diet and sugars was particularly emphasized by high-income countries but less highlighted by low-income countries. Finally, while national oral health targets for children and surveillance systems were frequently reported by countries, similar systems for adolescents, adults and older people were rare.

CONCLUSIONS

The inequities between countries in oral disease prevention and health promotion were substantial. Limited financial resources for preventive care and health promotion; inadequate workforce for oral health, and insufficient coverage in primary health care were observed in low-resource countries. The results of the survey demonstrate the need for building effective oral health systems oriented towards oral disease prevention and health promotion.

Effect of a health-education program using motivational interviewing on oral health behavior and self-efficacy in pregnant women: a randomized controlled trial

Oral health problems are common among pregnant women. The objective of this study was to examine the effectiveness of motivational interviewing (MI) as a behavior-change technique to enhance self-efficacy and oral health among pregnant women. A randomized controlled trial was conducted with 112 pregnant Iranian women. Women in the intervention group received an education program on oral health using MI during two face-to-face sessions, along with routine health education (two 1-h lectures on oral health changes and needs during pregnancy presented as a lecture by an oral health technician over a 2-wk period). Those in the control group received two 1-h lectures on oral health changes and needs during pregnancy. Oral health behaviors, oral health self-efficacy, and general self-efficacy, were assessed, along with gingival and dental health from baseline to the 3-month follow-up. Analysis of covariance was used to determine differences between intervention and control groups. Scores for both general and specific self-efficacy and for healthy behaviors increased in the intervention group, whereas there was no significant change within controls from baseline to follow-up. Between-group analyses also indicated a significant difference in the scores for self-efficacy and behavior favoring the intervention group. Scores on the gingival inflammation index decreased, as did the number of decayed teeth in the intervention group relative to the control group. The number of filled teeth increased significantly in the intervention group. Health education interventions using MI techniques may help to improve oral health-related self-efficacy and behaviors among pregnant women.

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university

OBJECTIVE

Although guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students.

DESIGN

Pre-test post-test study (2015-2017).

SETTING

An undergraduate midwifery program within an Australian university.

PARTICIPANTS

All first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56).

METHODS

Oral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion.

RESULTS

44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module.

CONCLUSIONS

The module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.

Utilization of dental services among low and middle income pregnant, post-partum and six-month post-partum women

Background

This study aims to explore the difference in the utilization pattern of dental services among pregnant, post-partum and six-month post-partum women.

Methods

This cross-sectional questionnaire survey was performed at two maternity and child care hospitals in India that primarily cater to middle and low income communities. Data were collected from 3 groups: 1) pregnant women in their first trimester; 2) post-partum women (< 48 h after delivery); and 3) six-month post-partum women. The primary outcome of interest was dental service utilization during pregnancy. Self-perceived oral health (SPOH) was calculated based on the four global dimensions- knowledge, function, quality of life and social. Multiple logistic regression analysis was carried out to assess the effect of each independent variable after adjustment for the effect of all other variables in the model.

Results

Responses of 450 (150 pregnant, 150 post-partum and 150 six-month post-partum) women were analyzed (response rate = 72%). Significant differences in the dental attendance pattern was observed between the study groups (p < 0.01). Dental attendance among pregnant and six-month post-partum women were 60 and 75%, respectively, however, only about 15% of the post-partum women reported to have sought dental care within the 6 months prior to the study. Post-partum women had the highest SPOH scores, indicating poor self-perceived oral health, followed by pregnant and then six-month post-partum women, which was statistically significant (p < 0.05). A significantly higher percentage of post-partum women reported to have poor oral and general health, as compared to both, pregnant and six-month post-partum women (p < 0.01). Higher percentage of women reporting ‘good’ oral and general health had sought dental care compared with others (p < 0.01). After adjusting for all the other variables in the model, women with lower levels of education (OR^a = 1.42; 95% CI: 1.01–2.00), women with poor self-perceived oral health (OR^a = 1.08; 95% CI: 1.02–1.14) and post-partum women (OR^a = 0.15; 95% CI: 0.09–0.24) were found to be less likely to seek regular dental care.

Conclusion

Pattern of dental service utilization among women in this population varied according to their pregnancy status, level of education and self-perceived oral health.

Knowledge, Attitudes and Practice Behaviour of Midwives Concerning Periodontal Health of Pregnant Patients

Maternal gum disease is associated with adverse pregnancy outcomes such as preterm birth and low birthweight. This study aims to evaluate the knowledge, attitudes and practice behaviour of Australian midwives regarding the periodontal health of pregnant women to inform interprofessional antenatal care. This was an observational, cross-sectional study. We circulated an online questionnaire to Australian midwives from August 2018 to February 2019. Key outcome variables were knowledge, attitudes, and practice behaviours related to oral health. Key predictor variables were years of practice, practice location, and dental history. We summarized responses with frequency tables and assigned tallied scores for analysis using non-parametric statistical tests. 100 responses were analysed, including from rural (n = 23) and urban (n = 77) midwives. Eighty percent of midwives agreed that maternal dental care can positively affect pregnancy outcomes. Fluoridated toothpaste use (19.1%) was incorrectly answered to prevent gum disease more often than psychological stress control (7.9%), a correct answer. Rural midwives demonstrated a significantly higher knowledge score (p = 0.001) and significantly more positive practice behaviours towards oral health (p = 0.014) than urban midwives. Australian midwives have positive attitudes towards antenatal oral health but misunderstand gum disease aetiology and prevention. This study highlights areas to improve interprofessional education for optimal oral health and pregnancy outcomes.

Getting ahead of the oral health game: it starts before we're born?

Dental caries is one of the most common chronic diseases affecting individuals of all ages. Caries in the primary dentition is one of the main risk factors for caries in the permanent dentition. Preventing the development of the first carious lesion is fundamental not only to long term health and wellbeing but to reducing the burden of this disease on individuals, families and the community. Described as the developmental origins of health and disease, events from the prenatal period are increasingly recognised as having a significant impact on later health outcomes. While social and behavioural factors from this period have long been linked with oral health, emerging evidence of the influence of epigenetics and early life programming of microbiome and host response suggests that the prenatal period provides a timely opportunity for preventive interventions. Pregnancy is an ideal time to focus on health promoting activities as most women have regular interaction with health care professionals who can target risk factors before the onset of disease. This paper summarizes contemporary understanding of the role of pre- and perinatal factors on child oral health and describes how this evidence might be used by all health professionals to ensure infants start life ahead in the oral health game.

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.

Periodontal disease: Repercussions in pregnant woman and newborn health-A cohort study

The periodontal disease during pregnancy triggers an exacerbated immune response with high local and systemic concentrations of inflammatory markers.

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

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

Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of dental professionals

ISSUE ADDRESSED

All pregnant women should have a comprehensive oral health evaluation. Unfortunately, many pregnant women seldom seek dental care and some dentists are hesitant to treat during pregnancy. To address these issues, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in Australia. The aim of this study was to undertake a process evaluation and explore the perceptions of dental professionals involved in the program to determine the acceptability, feasibility and effectiveness of the program if it were to be upscaled.

METHODS

A qualitative approach using content analysis was conducted on data from two focus groups involving 12 dental professionals.

RESULTS

All participants were supportive of the MIOH-DS program. They thought pregnant women were receptive to their care, and reported markedly improved oral health. The provision of free dental care and the involvement of midwives were cited as major factors that improved the uptake of the program. Some of the challenges encountered were the prevailing misconceptions about the safety of dental treatment and pregnancy-related impairments.

CONCLUSIONS

Dental professionals found the MIOH-DS to be acceptable, feasible and effective in improving oral health of pregnant women and their uptake of dental services. However, some challenges need to be addressed as the MIOH-DS program is upscaled into a cost-effective model. SO WHAT?: Dental professionals are important stakeholders in the MIOH-DS model. The process evaluation of the successful dental intervention is necessary to understand how and why such interventions work, and is an important step in scaling up to a population-wide intervention.

Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women

BACKGROUND

Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial.

METHODS

A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program.

RESULTS

All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment.

CONCLUSIONS

The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney, Australia

BACKGROUND

Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives.

AIMS

To undertake a process evaluation and explore perceptions of midwives involved in the MIOH-DS program to determine its practicability, acceptability and feasibility if it were to be up-scaled and implemented into clinical practice.

METHODS

Qualitative content analysis was undertaken on data from three focus groups with 21 midwives.

FINDINGS

Midwives generally found the MIOH-DS to be acceptable and feasible with potential for widespread scalability. The trust women had in midwives was an important factor in gaining women's attention about oral health in pregnancy. The program assisted in increasing midwives' knowledge and awareness, though some felt it was outside their scope of practice. The oral health assessment tool was acceptable to midwives but some concerns were expressed about undertaking a visual oral inspection. Most midwives stated they were now confident with referring individuals to a dentist. Significant barriers to widespread implementation included the cost of dental care and the continued lack of awareness and misconceptions pregnant women had towards oral health.

CONCLUSION

Midwives found the MIOH-DS to be acceptable and feasible which are two important barriers to potential implementation at scale. Misconceptions over the importance of oral health by women and cost of accessing dental services still need resolving.

Midwives' and women's views on accessing dental care during pregnancy: an Australian qualitative study

BACKGROUND

Maternal behaviours during pregnancy are likely to play a significant role in the development of dental caries in children. Although midwives are well placed to discuss oral health and provide information to women, dental attendance by women during pregnancy is minimal. This study aimed to explore midwives' experience of facilitating pregnant women's access to dental care and to document women's experience of receiving dental information and care during pregnancy.

METHODS

Focus groups with midwives and telephone interviews with women who were referred to Monash Health Dental Services were conducted to explore their perspectives and experiences. The qualitative data was thematically analysed.

RESULTS

Three focus groups with 13 midwives and telephone interviews with eight women who recently gave birth were conducted. Three key themes were identified: maternal oral health knowledge; barriers to accessing dental information and care during pregnancy; and suggested recommendations.

CONCLUSIONS

This study highlighted the barriers that exist for midwives to discuss oral health with women and refer women to dental care, and women's experiences of accessing dental care during pregnancy. Ongoing collaboration between the maternity and dental services is required to strengthen midwives' knowledge, confidence and practise in supporting women to access dental care during pregnancy.

Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial

BACKGROUND

Oral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.

OBJECTIVES

To assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.

DESIGN

Multi-centre randomised controlled trial.

SETTING

Three large metropolitan public hospitals in Sydney, Australia.

PARTICIPANTS

Pregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.

METHODS

638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.

RESULTS

Substantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02-58.53, p < 0.001), women's oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.

CONCLUSIONS

The Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.

Dental caries and preterm birth: a systematic review and meta-analysis

OBJECTIVES

The primary objective of this systematic review was to evaluate the association between dental caries and preterm birth (PTB). The secondary objective was ascertaining the difference between women with dental caries who experienced PTB and those who did not with regard to decayed, missing and filled teeth (DMFT), and decayed, missing and filled surfaces (DMFS) indices.

METHODS

MEDLINE, Embase, CINAHL and Cochrane databases were searched initially in November 2015 and repeated in December 2016. We included observational cohort and case-control studies. Only studies reporting the risk of PTB in women affected compared with those not affected by dental caries in pregnancy were included. Random-effect meta-analyses were used to compute the summary OR of PTB among women with caries versus women without caries, and the mean difference in either DMFT or DMFS indices between women experiencing PTB and those without PTB.

RESULTS

Nine observational studies (4826 pregnancies) were included. Women affected by dental caries during pregnancy did not show a significantly higher risk of PTB (OR: 1.16, 95% CI 0.90 to 1.49, P=0.25, I2=35%). Also, the women with PTB did not show significantly higher DMFT or DMFS indices (summary mean differences: 1.56, P=0.10; I2=92% and -0.15, P=0.9, I2=89%, respectively).

CONCLUSION

Dental caries does not appear to be a substantial risk factor for PTB.

TRIAL REGISTRATION NUMBER

NCT01675180; Pre-results.

Determinants of Dental Care Attendance during Pregnancy: A Systematic Review

Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to identify and analyze the determinants of dental care attendance during pregnancy. We performed a systematic literature search in the electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, Cumulative Index to Nursing and Allied Health Literature, and Medline using relevant keywords. Studies were filtered by publication year (2000-2016) and language (English, Portuguese, Spanish, and French). The included studies were assessed for quality. Their characteristics and statistically significant factors were reported. Fourteen papers were included in the review. The prevalence of dental service usage during pregnancy ranged from 16 to 83%. Demographic factors included women's age, marital status, parity, and nationality. The socioeconomic factors were income, educational level, and type of health insurance. Many psychological and behavioral factors played a role, including oral health practices, oral health and pregnancy beliefs, and health care maintenance. Referred symptoms of gingivitis, dental pain, or dental problems were perceived need. Demographic, socioeconomic, psychological, behavioral factors and perceived need were associated with the utilization of dental services during pregnancy. More well-designed studies with reliable outcomes are required to confirm the framework described in this review.

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.

Salud oral en mujeres embarazadas atendidas en un hospital de Manizales, Colombia. 2013

Introducción. Un factor de riesgo durante el embarazo es la patología dental, la cual puede traer consecuencias patológicas sobre la madre y el feto.Objetivo. Describir la salud oral y los eventos patológicos relacionados en mujeres embarazadas que asistieron a controles prenatales y odontológicos en Assbasalud Empresa Social del Estado (ESE) en Manizales, Colombia, durante 2013.Materiales y métodos. Se realizó un estudio descriptivo que revisó 502 historias clínicas de gestantes que asistieron a controles prenatales y odontológicos en Assbasalud ESE en Manizales.Resultados. 75.1% de las pacientes tuvo de 1 a 3 controles odontológicos y 93.2% presentó patologías dentales durante la gestación, donde las más frecuentes fueron gingivitis (75.4%) y caries (67.6%). 21.1% no tenía dientes cariados y 30.4% contaba con dientes perdidos. Al 79% se le realizó obturación dental durante el embarazo y el 9.9% no asistió a controles odontológicos.Conclusión. En Assbasalud ESE hay buena cobertura de odontología durante los controles prenatales, con eficiente promoción y prevención de las patologías dentales durante la gestación. En consecuencia, existe baja relación entre la patología oral y las enfermedades sistémicas. Asimismo, hay un correcto plan de remisión a servicios de tercer nivel de las gestantes con riesgo de complicaciones perinatales.

[Self-assessment of opinions, habits and oral health status by pregnant women in the south of Galicia, Spain]

An association has been found between oral health problems and obstetric complications during pregnancy. The main aim of this study was to assess the perception by pregnant women on their oral health and related habits and beliefs. A questionnaire was designed in order to obtain information from 96 pregnant women attending the Valdeorras Local Hospital and the primary health dental practice in the Valle Inclan Health Center. It was found that many pregnant women perceived they were suffering from some kind of problem affecting their mouth. It was shown that pregnant women had adequate habits regarding oral health, but they believed that their pregnancy would implicitly cause them to have mouth problems. Pregnant women are able to understand the impact of their oral health on their general well-being and the health of their unborn child. It has been detected that a series of habits and beliefs would ideally need to be acted upon in order to reduce health problems.

Aspectos relacionados con el número de citas odontológicas a las que asisten las mujeres embarazadas en Santander

Introducción. La salud bucal es más que recibir atención odontológica. Por eso, si la mujer embarazada registra patologías bucales, es fundamental atenderlas estas condiciones para evitar complicaciones en la mujer y su bebé.Objetivo. Describir el número de citas odontológicas a las que asisten las mujeres embarazadas en Santander según factores sociales, demográficos y patologías orales.Materiales y métodos. Estudio observacional descriptivo de corte transversal que involucró a 8 695 mujeres embarazadas. Se estableció una relación entre el número de consultas odontológicas a las que estas mujeres asistieron y variables demográficas, patologías orales, municipio, zona de residencia y vinculación al sistema atención en salud. Para ello, se aplicó prueba t de Student, test Rangos de Wilcoxón, ANOVA y test de Kruskal-Wallis dependiendo de la distribución de los datos y considerando un nivel de significancia de α≤0.01.Resultados. Se registraron bajos promedios de asistencia a la consulta odontológica en las embarazadas menores de 20 años y las mayores de 40, las que residen en municipios de bajo nivel económico, en zona rural y las atendidas en el régimen subsidiado o vinculadas.Conclusión. El número de citas odontológicas a las que asisten las mujeres embarazadas puede estar influido por las patologías que afectan a las mujeres y por factores sociales y demográficos.

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.

'We are all scared for the baby': promoting access to dental services for refugee background women during pregnancy

Background

Vulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for ‘priority’ care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women’s knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women.

Methods

One agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data.

Results

Four community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men’s perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the ‘priority of access’ policy that entitles pregnant women to receive dental care cost-free.

Conclusion

This study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-015-0787-6) contains supplementary material, which is available to authorized users.

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

BACKGROUND

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

AIM

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Midwives' perspectives of their ability to promote the oral health of pregnant women in Victoria, Australia

BACKGROUND

Midwives have a potential role in promoting the oral health of pregnant women although they have little formal training in this area. The aim of this study was to explore the perspectives of midwives in Victoria towards incorporating oral health promotion into their antenatal practice after undergoing training through the Midwifery Initiated Oral Health (MIOH) online education program.

METHODS

A purposive sample of thirty-nine midwives from maternity services across Victoria, Australia were invited to participate in an online MIOH education program in October 2012. The program included three self-paced modules covering oral health screening, referral processes, and theoretical and practical skill assessments. A mixed methods design was used to capture midwives perspectives. Evaluation questionnaires, completed pre- and post-training, captured knowledge and confidence (confidence likert scale), and also included five opened-ended questions post-training. Open-ended questions, feedback forms and unsolicited emails formed the data for qualitative analysis. Data were analysed using content and thematic analysis and descriptive statistics.

RESULTS

Thirty-three midwives completed the MIOH education program and demonstrated a significant increase (51.5%) in their confidence to promote oral health. All participants viewed the program as suitable, acceptable and useful for their practice and were happy to recommend the course to other Victorian midwives. Participants indicated that it would be feasible to incorporate oral health into the first antenatal booking visit and recognised that oral health promotion was within their scope of practice.

CONCLUSIONS

This study has shown that the MIOH education program is a valued resource that can assist midwives to increase their confidence and skills to incorporate oral health promotion into their practice. A key barrier identified was time constraints during antenatal care booking visits. However, it is evident that with relevant training it would be feasible and acceptable for Victorian midwives to incorporate oral health promotion within their practice. The current engagement with midwives in Victoria and other parts of Australia provides an opportunity to continue to explore and define the role of antenatal health care professionals in oral health promotion at a state and national level.

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

BACKGROUND

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

METHODS/DESIGN

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

DISCUSSION

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

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612001271897.

Developing and Testing of an Oral Health Screening Tool for Midwives to Assess Pregnant Woman

Maternal oral health is important, and midwives are encouraged to screen women for dental problems. We aimed to develop and test a midwifery oral health screening tool. A three-item tool was tested as part of a trial involving 300 women in Southwestern Sydney. A two-item combination showed better sensitivity (98%) and had a positive predictive value of 88%. Specificity was 40%, and negative predictive value was 80%. A two-item screening tool has been identified that is sensitive to identifying dental problems and facilitating referrals. Further validation using a larger sample is required to reassess the tool's specificity.

Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives

ISSUES ADDRESSED

Oral health during pregnancy is important, yet is often neglected by women. A program is currently being developed for midwives in Australia to promote maternal oral health. The aim of this study was to record the views of pregnant women in Australia towards dental care and midwives promoting oral health.

METHODS

Using convenience sampling, a cross-sectional survey was undertaken of 241 pregnant women attending a metropolitan hospital in South Western Sydney in 2010.

RESULTS

Only 10% of women received oral-health promotional material during pregnancy. More than 50% reported dental problems, yet only 17% had discussed this with their midwives and less than half (44.6%) had sought dental treatment. The main barriers to obtaining dental care were: lack of awareness, safety concerns about dental treatment and dental costs. Pregnant women were more likely (P<0.05) to see a dentist if they had received information about oral health (odds ratio (OR) 3.25, 95% CI 1.34-7.90) and had private health insurance (OR 2.47, 95% CI 1.26-4.85). Most women (>90%) were receptive to midwives providing oral-health education, assessments and referrals to affordable dental services.

CONCLUSION

This study has shown that pregnant women are receiving limited dental advice and are concerned about dental costs. It has also confirmed for the first time in Australia that women are very positive about receiving oral-health advice from midwives during their pregnancy. SO WHAT?: Oral-health promotion programs during pregnancy should consider using midwives to increase dental awareness among women and provide pathways to affordable dental services.

Association between parity and dentition status among Japanese women: Japan public health center-based oral health study

BACKGROUND

Several studies have shown that parity is associated with oral health problems such as tooth loss and dental caries. In Japan, however, no studies have examined the association. The purpose of this study was to determine whether parity is related to dentition status, including the number of teeth present, dental caries and filled teeth, and the posterior occlusion, in a Japanese population by comparing women with men.

METHODS

A total of 1,211 subjects, who participated both in the Japan Public Health Center-Based (JPHC) Study Cohort I in 1990 and the dental survey in 2005, were used for the study. Information on parity or number of children was collected from a self-completed questionnaire administered in 1990 for the JPHC Study Cohort I, and health behaviors and clinical dentition status were obtained from the dental survey in 2005. The association between parity or number of children and dentition status was analyzed, by both unadjusted-for and adjusted-for socio-demographic and health behavioral factors, using a generalized linear regression model.

RESULTS

Parity is significantly related to the number of teeth present and n-FTUs (Functional Tooth Units of natural teeth), regardless of socio-demographic and health behavioral factors, in female subjects. The values of these variables had a significantly decreasing trend with the rise of parity: numbers of teeth present (p for trend = 0.046) and n-FTUs (p for trend = 0.026). No relationships between the number of children and dentition status were found in male subjects.

CONCLUSION

Higher-parity women are more likely to lose teeth, especially posterior occluding relations. These results suggest that measures to narrow the discrepancy by parity should be taken for promoting women's oral health. Delivery of appropriate information and messages to pregnant women as well as enlightenment of oral health professionals about dental management of pregnant women may be an effective strategy.

Piloting of an oral health education program and knowledge test for midwives

Abstract Research shows limited emphasis being placed on oral health by midwives in Australia and the need for further education in this area. The study aim was to pilot a midwifery oral health education program and knowledge test and identify any flaws in its content and design. Twenty two midwives from an antenatal ward in South-western Sydney completed the program and 12 feedback forms/knowledge tests were returned. Data was analysed using descriptive statistics and content analysis. Feedback data showed all midwives appreciated that the program was available online and self-paced. Most found the program extremely informative and following completion were more confident in promoting maternal oral health. The mean correct responses in the knowledge test was 79 % (SD=12.3) which suggests most items were suitable for assessing knowledge improvement. However, in 3 items midwives had low correct responses. Various aspects that could be improved or clarified were identified and suggestions discussed.