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

Design and psychometric evaluation of organizational determinants of prenatal dental services questionnaire in Iran

AIMS

The quality of prenatal dental services is essential for improving the oral health of both mothers and children. However, a lack of a reliable tool to assess the quality of prenatal oral care has hindered research in this area. To address this gap, the study aimed to validate the Organizational Determinants of Prenatal Dental Services Questionnaire (OD_PDS) in Iranian pregnant women.

METHODS

Literature reviews, interviews, and a cross-sectional survey with 300 pregnant women were conducted. To evaluate the validity; face, content and construct validity were assessed. Cronbach's alpha coefficient and the Test-retest method were used for reliability assessment.

RESULTS

The final version of the OD_PDS comprises 12 items, and four subscales, which are Costs (four items), Access to Equipment and services (three items), Review of the service delivery process (two items), and Professional Behavior (three items). Questions with a factor loading of less than 0.3 were excluded. The obtained fit indices were acceptable (X2/pdf = 3.383, RMSEA: 0.089, CFI = 0.869, and TLI = 0.820). The content reliability was demonstrated by Cronbach's α  = 0.702 and 0.713 and the ICC  =  0.724.

CONCLUSION

The current study indicates that the OD_PDS is a valid and reliable tool for Prenatal Dental Services assessment in health centers.

Race, Ethnicity, and Other Barriers to Access Dental Care During Pregnancy

BACKGROUND

Historically, women of color showed poorer oral health and lower dental service utilization in the USA. These barriers to dental care during pregnancy included dental coverage, primary language, dental provider availability, safety concerns, affordability of dental care, and perceived oral health benefits during pregnancy.

METHODS

The purpose of this study is to examine whether race/ethnicity modified the associations between barriers to accessing dental care and dental service utilization during pregnancy. This cross-sectional study sample included 62,189 women aged 20 and older with a recent birth history in 21 states from the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019. We introduced a race/ethnicity by barrier interaction term to our multiple logistic regression models.

RESULTS

After adjusting for other confounders, dental insurance during pregnancy and perceived oral health benefits were associated with 4.0- and 5.6-fold higher odds, respectively, of dental service utilization during pregnancy. Statistically significant effect modification by race/ethnicity was observed in crude and adjusted analyses of the relationship between dental service utilization for all barriers included in the interaction analyses with all adjusted p-values < 0.001.

CONCLUSION

The interaction analysis found that racial/ethnic disparity in visiting dentists during pregnancy was significant among women who reported these dental barriers. In contrast, such racial/ethnic disparity was substantially attenuated among women who did not report such barriers.

PRACTICAL IMPLICATIONS

The observed racial/ethnic disparities could be mitigated by such supporting mechanisms: dental coverage, provider availability and willingness to treat pregnant women, oral health education on the safety of dental care during pregnancy, and affordable dental care costs.

Exploring the experiences and perspectives of women on oral health during pregnancy: A qualitative study in Tasmania, Australia

OBJECTIVE

To explore women's oral health experiences and barriers to dental care and identify potential strategies to improve oral health during pregnancy.

METHODS

A qualitative descriptive study design was used. Purposively elected antepartum and postpartum women ≥18 years of age from Tasmania, Australia, were recruited using maximum variation sampling. Semi-structured interviews were conducted, and all qualitative data were analysed using an inductive thematic approach.

RESULTS

Fifteen women were interviewed with a mean ± SD age of 32.3 ± 4.5 years. Three key themes were generated from the data that described women's perceived changes in their oral health during pregnancy; barriers to oral health care during and after pregnancy; and perceived strategies to improve access to care. Most women acknowledged the importance of maintaining good oral health but reported a decline in their oral health status during pregnancy. Women also identified several barriers to dental care, including treatment costs, competing maternal priorities, limited oral health knowledge and negative perceptions towards dentistry. The provision of preventative oral health care by ANC providers was also limited. Community awareness, patient education resources and assessment tools could support the promotion of oral health care. Women also perceived that interprofessional collaboration between antenatal and dental providers played a key role in promoting oral health.

CONCLUSION

This study explored women's varied oral health experiences and perceptions during pregnancy and highlighted critical barriers and enablers to dental care. Policy-level strategies that promote interprofessional collaboration between antenatal and dental providers and expand dental care access are suggested to overcome barriers to oral health for women during pregnancy.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Predictors of oral health literacy in pregnant women

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

Physiology of pregnancy and oral local anesthesia considerations

Background

Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients.

Methodology

An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment.

Results

Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied.

Conclusions

Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

Behavior patterns and influencing factors: Health information acquisition behavior of Chinese senior adults on WeChat

Due to the gradual adoption of WeChat by older adults in China and their interest in health information, Chinese older people started to acquire health information through WeChat. We explored the specific patterns and influencing factors of the elderly's health information acquisition behavior senior adults. The cross-sectional study collected self-reported data with survey (N = 336) in the southeast of China, Zhejiang province. The findings of this study extend the previous research by suggesting that elderly adults' health information acquisition behavior has three patterns (actively seeking, passively browsing, and long-term collecting). These findings contribute to a better understanding of digital literacy, three dimensions of health literacy and their relationship with three specific patterns of health acquisition behavior. This study also provides practical insights related to narrow the technological gap of the older adults, improve their e-Health literacy of the elderly, and purify the health information environment in the network.

Oral hygiene and oral health behavior, periodontal complaints and oral health-related quality of life in pregnant women

Objectives

This questionnaire-based cross-sectional study aimed in the evaluation of oral hygiene and oral health behavior, periodontal complaints and oral health-related quality of life (OHRQoL) in pregnant women in southwest-Saxony, Germany.

Materials and methods

Consecutive patients attending the clinics for Obstetrics and Gynecology, Heinrich-Braun-Klinikum Zwickau, Germany, were recruited in the years 2020 and 2021. The evaluation consisted of three parts: (I) dental and oral hygiene behavior, (II) periodontal complaints and (III) German short form of oral health impact profile (OHIP G14) to assess OHRQoL.

Results

853 out of 1056 participants were included in the study. The pregnant women reported that they have received information on oral health during pregnancy more often from gynecologists than from dentists. Slightly more than half of the participants (51.5%) rated to regularly undergo a professional tooth cleaning. Similarly, nearly half of the women stated to perform interdental cleaning (55.8%). The most common periodontal complaint was bleeding of the gums (45.4%). The OHIP G14 findings of all questions as well as sum scores showed a median of 0. Regression analysis revealed that regular professional tooth cleaning was a predictor of better OHRQoL (β – 0.698, CI95 0.049–1.299; p < 0.04).

Conclusion

Oral hygiene and oral health behavior of pregnant women in southwest-Saxony requires improvement. While the overall OHRQoL of the cohort was not reduced, professional tooth cleaning and thus professional preventive measures can support OHRQoL during pregnancy. Improved interdisciplinary oral health care concepts for pregnant women should be fostered. These concepts can also positively influence OHRQoL issues.

Bibliometric Analysis of the Global Scientific Production on Oral Health during Pregnancy

AIM

To analyze the bibliometric characteristics of the global scientific production indexed in Scopus on oral health during pregnancy.

MATERIALS AND METHODS

Cross-sectional study with bibliometric methodology, using scientific publications indexed in Scopus as a unit of analysis. For the search, MESH terms, Boolean operators ("AND" and "OR"), and search topics (TITLE and ABSTRACT) were used. SciVal was the tool selected for the analysis of bibliometric parameters.

RESULTS

Most of the articles were published in Q1 (30.2%) and Q2 (29.6%) quartile journals. The country with the most scientific publications was the United States (451 articles), while Spain had only 14 publications. The University of Sydney, with 16 articles, was the most productive institution and the one with the most citations per publication was Saveetha University (19.7). The author with the most articles and citations related to the topic was George Ajesh with 13 and 136, respectively. Johnson Marre had the highest impact (15.1) and expected citations with respect to the global average (FWCI: 2.49).

CONCLUSIONS

The scientific production on oral health in pregnancy has increased, with a greater preference by authors for scientific journals in the Q1 and Q2 quartile. The United States is the country with the most publications, although Australia has a greater number of institutions among the most productive.

CLINICAL SIGNIFICANCE

The clinical relevance could be addressed later in relation to oral health during pregnancy, however, analyzing the bibliometric characteristics of the global scientific production is essential to understand the dynamics of scientific publications on this topic.

Dental Visits during Pregnancy: Pregnancy Risk Assessment Monitoring System Analysis 2012-2015

OBJECTIVES

This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status.

METHODS

This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015.

RESULTS

Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80-0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52-0.58).

CONCLUSION FOR PRACTICE

Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds.

KNOWLEDGE TRANSFER STATEMENT

The current study updated the previous findings with more recent multiyear PRAMS data (2012-2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.

A Concise Review on Qualitative Research in Dentistry

Qualitative research collects non-numerical data that explores human behaviour, attitudes, beliefs and personality characteristics unamendable to quantitative research. The qualitative research questions are open-ended, evolving and non-directional. The study design is flexible and iterative. Purposive sampling is commonly used. The sample size is determined by theoretical saturation. Data collection is generally through in-depth interviews, focus groups and observations. Qualitative research commonly uses thematic analysis and framework analysis, although there is no consensus on analysing qualitative data. The reporting format can be comprehensive, a summary, developmental or selective, subject to the research question. Qualitative research’s potential functions are to describe the form or nature of what exists (contextual), to examine the reasons for or associations between what exists (explanatory), to appraise the effectiveness of what exists (evaluative), and to aid the development of strategies (generative). Qualitative research can be time consuming to conduct because it explores evolving questions; difficult to generalise because it recruits limited participants; and arduous when it comes to making systematic comparisons because responses are subjective. However, qualitative research can provide depth and detail, create openness, simulate people’s individual experiences and avoid pre-judgements. This concise review provides an overview and suggestions for dental researchers when conducting a qualitative study.

Evaluating factors associated with fear and anxiety to dental treatment-A systematic review

Introduction

Dental anxiety refers to a set of complex psychological issues bearing a significant impact in individual's lives reflecting in the form of dental visit avoidance, poor dental health status and decreases oral health related quality of life. Hence, it is imperative to consider those factors associated with dental anxiety so as to treat and promote better oral health. The review aimed to assess various factors associated with dental fear and anxiety.

Materials and Methods

Literature search was done from Pubmed and Google scholar search engines to identify publications which explored factors associated with dental fear and anxiety.

Results

Research evidence pointed a significant relationship of age, gender, maternal anxiety, previous dental experience, and number of siblings with dental fear and anxiety (DFA).

Conclusion

Findings of the review clearly suggest that a better understanding of factors causing dental anxiety and phobia will help preventing dental avoidance and providing better care.

Information seeking behaviour of dental trauma patients and their parents

BACKGROUND AND AIM

Dental trauma is a common public health issue that can be associated with high costs and lifelong treatment. Children and parents should have the correct information regarding its management to reduce the potential long-term sequelae. Understanding their information seeking behaviour is therefore important to ensure that they are able to access, understand and retain the relevant information. The aim of this study was to investigate (a) the different ways that patients undertaking treatment for dental trauma, and their parents, look for relevant information, (b) their information needs, and (c) their preferred format of information.

MATERIAL AND METHODS

This was a two-phase study: Phase I involved in-depth interviews with 10 patients who were currently undergoing treatment for dental trauma, and 11 parents. In phase II, the themes and sub-themes identified from the interviews were used to develop patient and parent questionnaires, which were distributed to all trauma patients and parents who fulfilled the inclusion criteria and who were attending the dental clinics from March to May 2014.

RESULTS

Patients and parents had different concerns immediately following the trauma, during treatment and in the long term, and they wanted different forms of information to answer their concerns. Reliability was the main issue about trusting the information available in the Internet, social media and other online sources. Therefore, patients preferred to obtain information verbally from their dentist, while parents preferred written information.

CONCLUSION

Patients and parents have different information needs, and these also vary at different stages of treatment. It is therefore important to customize the way information is provided for each group accordingly.

Dental Phobia among Pregnant Women: Considerations for Healthcare Professionals

Objective

To report the prevalence of dental phobia and associated factors among pregnant women.

Materials and Methods

This cross-sectional study included pregnant women visiting hospitals in Dhahran, Khobar, and Dammam in Saudi Arabia. The Modified Dental Anxiety Scale (MDAS) was used to assess dental anxiety and phobia. The score of MDAS ranges from 5 to 25, and a cutoff value of 19 was used to identify participants with dental phobia.

Results

The study analyzed data of 825 participants with mean age of 29.08 ± 5.18 years. The prevalence of dental phobia was 16.1%. About 46.9% of the sample believed that dental treatment should be avoided during pregnancy, and the importance of regular dental checkup was recognized by 16.4% of the participants. Dental phobia was associated with the perception of the health of teeth (P 0.004) and gums (P 0.016). Multiple logistic regression showed that being under the age of 30 years (OR 0.63, P 0.019) and updating knowledge about oral health (OR 0.49, P 0.006) were significantly associated with reduced likelihood of dental phobia. However, having bad dental experience (OR 2.13, P 0.001) and being in first trimester of pregnancy (OR 1.57, P 0.033) were significantly associated with increased odds of dental phobia.

Conclusions

A considerable proportion of pregnant women reported dental phobia. The bad dental experience was associated with increased dental phobia. However, reduced likelihood of dental phobia was associated with updating oral health knowledge. Healthcare professionals may consider these factors to reduce dental phobia and improve oral health of pregnant women.