Obstetricians' knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight

Exploring medical and dental practitioner perspectives and developing a knowledge attitude and practice (KAP) evaluation tool for the common risk factor approach in managing non-communicable and periodontal diseases

BACKGROUND

The Common Risk Factor Approach (CRFA) is one of the methods to achieve medical-dental integration. CRFA addresses shared risk factors among major Non-communicable Diseases (NCDs). This study aimed to explore the perspectives of dental and medical practitioners concerning CRFA for managing NCDs and periodontal diseases and to create and validate a tool to evaluate the Knowledge, Attitude, and Practice (KAP) of medical and dental practitioners in relation to utilization of CRFA for management of NCDs and Periodontal diseases.

METHODS

This research employed a concurrent mixed-method model and was carried out from January 2021 to February 2022, focusing on medical and dental practitioners in South India. In the qualitative phase, online interviews were conducted with dental and medical practitioners, recorded, and transcribed. Thematic analysis was applied after achieving data saturation. In the quantitative phase, a KAP questionnaire was developed. The sample size was determined by using the G power statistical power analysis program. A sample size of 220 in each group (dentists and medical practitioners) was estimated. Systematic random sampling was used to recruit the potential participants. The data obtained through the online dissemination of KAP tool was analysed and scores were standardized to categorize the KAP.

RESULTS

Qualitative thematic analysis identified four major themes: understanding of common risk factors, risk factor reduction and disease burden, integrating CRFA into clinical practice, and barriers to CRFA. In addition, thematic analysis revealed seventeen subthemes. For the quantitative phase, standardization was applied to a 14-item KAP questionnaire for medical practitioners and a 19-item KAP questionnaire for dental practitioners. The total KAP score for medical practitioners in the study was 21.84 ± 2.87, while dental practitioners scored 22.82 ± 3.21, which indicated a high level of KAP regarding CRFA. Meta integration of qualitative and quantitative data identified eight overarching themes: four were concordant, three were discordant, and one theme provided the explanatory component.

CONCLUSION

The study's structured, validated questionnaire showed that both medical and dental professionals had a high knowledge of CRFA. However, they were not appreciably aware of the risk factors that are shared between NCDs and periodontal disease. Both groups were interested in the idea of using CRFA in integrated medical and dental care.

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.

Knowledge and Attitude of Midwifery Students on Oral Health Care

Midwifery students can have an important role in transferring oral health care information to expecting mothers. The aim of this study was to assess the effect of an educational intervention on knowledge and attitudes of midwifery students on oral health in pregnancy. Study population consisted of 60 midwifery students in a Midwifery School in Iran who were randomly allocated into case and control groups. Self-administered questionnaires were distributed before, immediately after the intervention and also three months later. The validity and reliability of the questionnaire was confirmed at the beginning. Mean total pre-test knowledge scores from total 10 in the interventional and control groups were 4.63 ± 0.25 (Standard Error, SE) and 4.79 ± 0.31 (SE) respectively. After three months scores reached to 8.87 ± 0.15 (SE) in the interventional and 5.57 ± 0.29 (SE) in the control groups. Mean attitude pre-test scores in the interventional group was 27.23 ± 0.75 (SE) and after the intervention reached to 31.13 ± 0.25 (SE). Lecture-based educational intervention improved the knowledge and attitudes of midwifery students on oral health care in pregnancy. Incorporating courses on oral health in pregnancy into the curricula of midwifery programs can be effective in promoting oral health care in pregnant women.

Awareness of the Relationship between Systemic and Periodontal Diseases among Physicians and Dentists in Saudi Arabia and Kuwait: Cross-sectional Study

Background:

Previous studies have shown possible association between periodontal diseases and Diabetes Mellitus (DM), Cardiovascular Disease (CVD) and Adverse Pregnancy Outcomes (APO). Increasing the knowledge of physicians and dentists regarding the association between periodontal disease and systemic diseases should improve their ability to provide a high standard of treatment for the disease and prevent its consequences. In our study, we sought to identify knowledge gaps in the awareness of the relationship between systemic and periodontal diseases among dentists and physicians from the Kingdom of Saudi Arabia and the State of Kuwait.

Methods:

A cross-sectional study was performed with a convenient sample of selected physicians and dentists in Saudi Arabia and Kuwait using a self-developed structured questionnaire. Physicians’ and dentists’ awareness were assessed regarding current evidence of the relationship between systemic diseases and conditions (DM, CVD, APO) and periodontal diseases.

Results:

A total of 134 (21.5%) of the identified physicians and 485 (78%) of the identified dentists participated in this study. More than half of the participants (52.1% physicians and 67.5% dentists) agreed that there is a relationship between periodontal diseases and DM, CVD and APO. Dentists had a statistically higher level of awareness compared with the physicians. The findings related to the awareness of the dentist sub groups highlighted that periodontists were significantly more likely to have a good level of knowledge.

Conclusion:

Within the limitations of this study, we concluded that the awareness of physicians and dentists regarding the relationship between periodontal diseases and systemic diseases (DM, CVD, APO) is generally low, Therefore, improved collaboration between medical and dental health providers is recommended.

Knowledge, awareness, and practice among gynecologists, medical practitioners and dentists in Madurai regarding association between periodontitis and pregnancy outcomes

Background:

The prevalence of oral disease during pregnancy affects the health of the fetus and mother. The interdisciplinary protocol between general dentists (GDs), gynecologists, and general medical practitioners (GMPs) is proved to reduce the incidence of maternal and neonatal complications.

Aim:

The aim of the present survey is to assess the knowledge, awareness, and attitude of practicing gynecologists, GMPs, and GDs regarding the association of periodontitis and adverse pregnancy outcomes.

Materials and Methods:

This cross-sectional study was conducted among 150 health-care professionals in Madurai. A well-structured pretested questionnaire consisted of 12 questions which were used to assess the awareness of association regarding maintaining oral health during pregnancy among GMPs, GDs, and gynecologists. The knowledge, awareness, and practice scores were calculated for the correct answers to the questions. A software program (SPSS 12) was used for statistical analysis.

Results:

The mean age of participants was of 33.14 ± 1.5, 32.58 ± 2.80, and 37.7 ± 9.7, respectively. Majority of the participants agreed the importance of dental examination and maintaining oral health during pregnancy GMPs (96%), GDs (100%), and gynecologists (92%). About 92% of gynecologists and GMPs supported that providing dental treatment during pregnancy improved pregnancy outcomes. About 64%, 76%, and 68% of GMPs, GDs, and gynecologists, respectively, confirmed the association between periodontal disease and adverse pregnancy outcomes.

Conclusion:

In this study, knowledge and awareness of gynecologists and GMPs are appreciable; however, their attitude toward bringing the facts into clinical practice needs to be improved through integrated programs.

Effectiveness of an Oral Health Education Program for Obstetrician/Gynecologist Residents at Tufts Medical Center

Aim and Objectives:

To assess Tufts Medical Center obstetrician/gynecologist (OB/GYN) residents' knowledge, beliefs, and previous training in oral health and to assess the effect of an oral health educational seminar on their knowledge and beliefs.

Materials and Methods:

A preseminar questionnaire was distributed to the residents. The same questionnaire was distributed immediately after the seminar and 3 months later. SPSS Version 21 was used for the data analysis.

Results:

Convenience sample of 25 residents were included in the study. The mean (standard deviation) age of participants was 29.08 (2.47) years. Only 1 (4%) participant reported receiving >8 h previous training in oral health and 7 (28%) reported receiving <1 h of training. The nonparametric Friedman test showed a statistically significant difference between administrations in terms of total score on knowledge-based questions (P < 0.001) and some of the belief-based questions. The post hoc Wilcoxon signed-rank test with Bonferroni correction showed statistically significant improvement in the knowledge-based questions between pre- and post-seminar questionnaire (P = 0.002) and between preseminar and 3-month follow-up (P = 0.003).

Conclusions:

OB/GYN residents at Tufts Medical Center received limited training in oral health. Their knowledge improved significantly following the oral health educational seminar. Similar training modules can be brought to other OB/GYN residencies and OB/GYNs in an effort to enhance the symbiotic relationship between medical and dental professionals.

A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics

INTRODUCTION

Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics.

METHODS

At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki.

RESULTS

Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p < 0.0001). BANA showed sensitivity and negative predictive values of 87% and 91%; 75% and 78%; 87% and 94% in detecting low birth weight, preterm delivery, and preterm low birth weight delivery respectively.

CONCLUSION

This study confirms that BANA may indicate the need for periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.

What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia

BACKGROUND

There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area.

METHODS

A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics.

RESULTS

A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4-21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women.

CONCLUSION

The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states.

Percepções e atitudes sobre relações interprofissionais na assistência odontológica durante o pré-natal

RESUMO O estudo descreve percepções e atitudes de profissionais da atenção primária sobre as relações interprofissionais na assistência odontológica durante o pré-natal. Trata-se de um estudo analítico, observacional transversal, utilizando registros administrativos e entrevistas semiestruturadas abordando questões sobre hierarquia, habilidade para evitar conflitos e colaboração interprofissional. Conclui-se que, apesar da percepção geral favorável à colaboração interprofissional, recursos formais e organizacionais não estão sendo empregados, refletindo um distanciamento entre o potencial percebido pelas entrevistas e a prática apoiada pelos instrumentos utilizados nas ações de atenção ao pré-natal.

Knowledge of medical doctors in Turkey about the relationship between periodontal disease and systemic health

Understanding the relationship between periodontal disease (PD) and systemic health (SH) is necessary for the accurate diagnosis and treatment of both. The aim of this study was to evaluate the knowledge of medical doctors in Turkey with regard to the association between PD and SH. This study was carried out using self-reported questionnaires that were sent to medical doctors who work at various universities and public and private hospitals in different cities in Turkey. The questionnaires consisted of questions about the demographic information of the medical doctors, as well as the knowledge of those doctors about the relationship between PD and SH. In total, 1,766 responses were received and 90.8% of the participants agreed that there was a relationship between PD and SH. Diabetes mellitus was the most frequent systemic disease (66.8%) known to be related to PD. Of the participants, 56.5% of the medical doctors referred their patients to periodontists for different reasons. Gingival bleeding was the most frequent reason for patient referrals, with 44% of doctors giving such referrals. Doctors who worked in basic medical sciences were significantly less aware of the relationship between PD and SH than the doctors in other specialties. Although the vast majority of the medical doctors reported that they knew the relationship between PD and SH, the findings of this study showed that this awareness was not supported by precise knowledge, and often failed to translate into appropriate clinical practice.

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.

Obstetric knowledge, attitude, and behavior concerning periodontal diseases and treatment needs in pregnancy: influencing factors in France

BACKGROUND

Many studies have shown that periodontal diseases are risk factors for adverse pregnancy outcomes. The aim of this study is to assess the knowledge and clinical attitude of French obstetricians and/or gynecologists regarding periodontal diseases.

METHODS

A cross-sectional study was performed on randomly selected French obstetricians and/or gynecologists using a self-administered, structured questionnaire during an annual French professional congress.

RESULTS

The questionnaire was completed by 190 French obstetricians and/or gynecologists. Among respondents, 88% were aware of the inflammatory and infectious nature of periodontal diseases. Furthermore, 74.7% of respondents were conscious of its negative impact on pregnancy outcomes. Few obstetricians and/or gynecologists (26.3%) interviewed patients about oral health. Information on oral health was systematically provided to patients by 10.5% of the practitioners. However, 55.6% addressed this issue if they considered the patient at risk for pregnancy. Only 33.2% of practitioners systematically referred the patient to a dentist. Periodontal disease knowledge and consideration levels increased in more experienced practitioners with a private practice and a personal history of periodontal disease.

CONCLUSIONS

Periodontal knowledge of the French obstetricians and/or gynecologists surveyed seemed satisfyingly apparent and influenced by levels of professional experience and personal history. However, clinical behavior did not adequately correlate with this knowledge.

Evaluation of knowledge and practice behaviours of a group of Iranian obstetricians, general practitioners, and midwives, regarding periodontal disease and its effect on the pregnancy outcome

Background

Periodontal disease is considered as a risk factor for poor pregnancy outcomes, including preterm birth and low birth weight. Only few studies have assessed the knowledge and practice behaviours of healthcare providers, concerning oral health during pregnancy, periodontal diseases and their role in adverse pregnancy outcomes. The present study aimed to compare the knowledge and practice behaviours of a group of Iranian obstetricians, general practitioners, and midwives about periodontal disease.

Design and methods

A cross-sectional study was conducted using a self-administered, structured questionnaire that was previously used in North Carolina. The questionnaire was translated into Persian language and was randomly distributed among 200 obstetricians, general practitioners, and midwives participating in an international congress. Data were analysed by Chi-square and spearman correlation tests using SPSS statistical software (version PASW 18).

Results

A total of 150 completed the questionnaires, achieving a response rate of 75%. Totally, the knowledge of the obstetricians was more accurate compared to the two other groups and the midwives were the worst. More experienced general practitioners (P=0.002) and obstetricians (P=0.049) did less dental examinations for their patients during their first visit or periodically. More experienced obstetricians also referred their patients for dental examinations during pregnancy less than their less experienced colleagues (P<0.001).

Conclusions

Although the participants had some knowledge about periodontal disease and its association with adverse pregnancy outcomes, there is much space for improvements. The participants’ attitude and knowledge were consistent.

[Oral infections and pregnancy: knowledge of health professionals]

OBJECTIVE

The abundance of recent studies on the relationship between oral diseases and complications of pregnancy leads to questions on knowledge of health professionals. This study aims to establish an inventory of knowledge and practice of health professionals in France on this issue.

PATIENTS AND METHODS

A questionnaire on knowledge of the relationship between oral diseases and complications of pregnancy was referred to gynaecologists and obstetricians, midwives and dentists. This study was conducted at the University Hospital of Nantes and Le Mans General Hospital.

RESULTS

Eighty-seven professionals of pregnancy and 259 dentists responded to the survey. Bleeding gums and pregnancy gingivitis are the oral manifestations most cited by all practitioners. There is however a difference concerning the epulis and caries risk. The most cited Pregnancy complications are risk of premature delivery and chorioamniotitis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point to the lack of continued education on this topic.

DISCUSSION AND CONCLUSION

There is a good knowledge of the pregnancy complications associated with oral disease despite the lack of training of pregnancy, but the attitudes of care are not still in adequacy. It appears necessary to strengthen the training of all practitioners in this field. The design and implementation of a specific questionnaire on oral health status could allow better identification of the patients at risk by the professionals of pregnancy, and optimize so the care of pregnant women.

Oral care during pregnancy: attitudes of Brazilian public health professionals

There is little information about health professionals’ behavior regarding oral health care during pregnancy. We evaluated attitudes of obstetricians/gynecologists, nurses, and dentists working at a public community service towards pregnant women’s oral health. Health professionals responded to a self-applied questionnaire. Cluster analysis identified two clusters of respondents; Chi-square, Student’s t test, and logistic regression were used to compare the two clusters in terms of the independent variables. Respondents were categorized into cluster 1 ‘less favorable’ (n = 159) and cluster 2 ‘more favorable’ (n = 124) attitudes. Professionals that had attended a residency or specialization program (OR = 2.08, 95% CI = 1.15–3.77, p = 0.016) and worked exclusively at the public service (OR = 2.15, 95% CI = 1.10–4.20, p = 0.025) presented more favorable attitudes. Obstetricians/gynecologists (OR = 0.22, 95% CI = 0.09–0.54, p = 0.001) and nurses (OR = 0.50, 95% CI = 0.29–0.86, p = 0.013) showed less favorable attitudes than dentists. Health care providers’ attitudes regarding pregnant women’s oral health were related to their occupation, qualification, and dedication to the public service.