Oral health status of women with high-risk pregnancies

Factors related to orientation of search for dental care in high risk pregnancy

Abstract Objectives: to relate the search for dental care during pregnancy to sociodemographic, gestational and dental characteristics. Methods: quantitative approach study with cross-sectional design carried out with high-risk pregnant women, from January to May 2018. Statistical analysis was performed using Pearson's chi-square association test and Fisher's exact test, followed by logistic regression analysis and odds ratio calculation. Results: the final sample was composed of 190 pregnant women and the guidance for seeking dental care was significantly related to issues related to Prenatal Dental Care, regarding safety (p = 0.025), effective search (p < 0.0001) and the Unit Basic Health Care as a place of assistance (p = 0.0018). Pregnant women who did not receive search guidance are 19.6 more likely to not seek this service (p <0.001), when they seek it without guidance, they have 6.3 more chances to seek private services (p = 0.014) and when they do not receive guidance, they are 4.5 more likely to not feel secure in relation to this assistance (p = 0.005). Conclusion: the guidance and encouragement provided by the health team is paramount in pregnant woman's decision to seek assistance, especially in the context of Primary Health Care, and is characterized as a strategic tool in reducing insecurities related to dental treatment during pregnancy.

Oral microflora and pregnancy: a systematic review and meta-analysis

Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.

Effect of socioeconomic status on dental caries during pregnancy

Background and Objective:

It is generally agreed that people with low socioeconomic status have a significantly worse oral and general health compared to people with higher socioeconomic status. The aim of the study was to find out the role of socioeconomic status of pregnant women on their oral health by evaluating the dental caries risk factor, the salivary Streptococcus mutans count and DMFT index.

Materials and Methods:

A total of 50 first time pregnant women were randomly sampled and were divided into different socioeconomic strata following the Kuppuswamy socioeconomic status scale. DMFT index and microbiological assessment of dental caries risk factor parameter, the salivary Streptococcus mutans colony forming units, were carried out during the three trimesters and postpartum period. The observations were compared with 50 non-pregnant women of same age group.

Results:

Of the randomly sampled subjects, majority of the pregnant women (28/50) of the study group were of middle/lower middle class, 11 pregnant women were of upper middle class, and 11 were of the lower/upper lower class. When followed in their three trimesters and postpartum period, statistically significant increase in the salivary Streptococcus mutans colony forming units was noted in 2^nd trimester, 3^rd trimester and postpartum period (P value < 0.05) of all pregnant women. Comparison of the caries risk factor between the pregnant women of three socioeconomic strata, however, revealed that no particular class was at a higher risk for dental caries.

Conclusion:

This study gives an insight into the possible changing trends towards awareness for oral hygiene in various socioeconomic strata of pregnant women.

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.

Knowledge, Attitude, and Practice of Pregnant Women regarding Oral Health Status and Treatment Needs following Oral Health Education in Pune District of Maharashtra: A Longitudinal Hospital-based Study

INTRODUCTION

Pregnancy is a natural process that may create some changes in different parts of the body including the oral cavity. These changes will lead to oral diseases if enough and timely care of oral cavity is not taken. Women may experience increased gingivitis or pregnancy gingivitis beginning in the second or third month of pregnancy that increases in severity throughout the duration of pregnancy. To motivate the patient toward oral health and implement the needed prophylactic measures, a longitudinal study was planned to observe the effect of oral health education during pregnancy on knowledge, attitude, practice, oral health status, and treatment needs (TNs) of pregnant women belonging to different socioeconomic groups.

MATERIALS AND METHODS

A longitudinal study was conducted among 112 pregnant women belonging to different socioeconomic groups to assess the effect of oral health education on knowledge, attitude, practice, oral health status, and TNs. The demographic details, knowledge, attitude, and practice of pregnant women, and oral health status were collected through a predesigned questionnaire by a principal investigator through an interview. Oral health examination was carried out to assess oral health status using revised World Health Organization Proforma 1997, and oral health education was given through PowerPoint presentation to the participants in local language, i.e., Marathi, after collecting the baseline data. Reinforcement of oral health education and blanket referral was done at 14th week, and follow-up data were collected at 28th week of gestation. The demographic details, such as age, sex, education, occupation, income, and the questions based on knowledge, attitude, and practice among participants were analyzed using number, percentage, and mean.

RESULTS

At baseline, knowledge was limited, attitude was positive, while the practice was poor regarding oral health care during pregnancy in pregnant women belonging to different socioeconomic groups. After oral health education and blanket referral, at 28th week of gestation, knowledge regarding oral health care improved drastically, attitude toward oral health became more positive, whereas practice did not change much among all the pregnant women belonging to different socioeconomic groups, probably indicating sociocultural influences.

CONCLUSION

Intensive oral health education during pregnancy leads to drastic improvement in knowledge and attitude. Practice, gingival health, and the number of filled teeth also improved to some extent.

CLINICAL SIGNIFICANCE

Regular oral health education programs should be conducted at community level among pregnant woman to reduce the burden of oral diseases.

Estimation of DMFT, Salivary Streptococcus Mutans Count, Flow Rate, Ph, and Salivary Total Calcium Content in Pregnant and Non-Pregnant Women: A Prospective Study

INTRODUCTION

Pregnancy, a period from conception till birth, causes changes in the functioning of the human body as a whole and specifically in the oral cavity that may favour the emergence of dental caries. Many studies have shown pregnant women at increased risk for dental caries, however, specific salivary caries risk factors and the particular period of pregnancy at heightened risk for dental caries are yet to be explored and give a scope of further research in this area.

AIM

The aim of the present study was to assess the severity of dental caries in pregnant women compared to non-pregnant women by evaluating parameters like Decayed, Missing, Filled Teeth (DMFT) index, salivary Streptococcus mutans count, flow rate, pH and total calcium content.

MATERIALS AND METHODS

A total of 50 first time pregnant women in the first trimester were followed during their second trimester, third trimester and postpartum period for the evaluation of DMFT by World Health Organization (WHO) scoring criteria, salivary flow rate by drooling method, salivary pH by pH meter, salivary total calcium content by bioassay test kit and salivary Streptococcus mutans count by semiautomatic counting of colonies grown on Mitis Salivarius (MS) agar supplemented by 0.2U/ml of bacitracin and 10% sucrose. The observations of pregnant women were then compared with same parameters evaluated in the 50 non-pregnant women. Paired t-test and Wilcoxon sign rank test were performed to assess the association between the study parameters.

RESULTS

Evaluation of different caries risk factors between pregnant and non-pregnant women clearly showed that pregnant women were at a higher risk for dental caries. Comparison of caries risk parameters during the three trimesters and postpartum period showed that the salivary Streptococcus mutans count had significantly increased in the second trimester, third trimester and postpartum period while the mean pH and mean salivary total calcium content decreased in the third trimester and postpartum period. These changes reflected on the DMFT score which increased in the third trimester and postpartum period.

CONCLUSION

The results of this study suggest that there is a definite correlation between pregnancy and dental caries. We conclude that the third trimester and postpartum period of pregnancy are the periods during which the pregnant women are at a higher risk for development of dental caries.