|Year : 2020 | Volume
| Issue : 6 | Page : 3015-3019
Oral health knowledge among a cohort of pregnant women in south India: A questionnaire survey
S Venkata Lakshmi1, A Srilatha2, D Satyanarayana2, L Swetha Reddy2, Suma B Chalapathi3, S Meenakshi4
1 Department of Public Health Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India
2 Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
3 Department of Prosthodontics, KLRs Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, xyi, India
4 Department of Prosthodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
|Date of Submission||01-Mar-2020|
|Date of Decision||23-Mar-2020|
|Date of Acceptance||09-Apr-2020|
|Date of Web Publication||30-Jun-2020|
Dr. S Venkata Lakshmi
Department of Public Health Dentistry, Vinayaka Mission Sankarachariyar Dental College, Salem, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Aim: To assess oral health knowledge of pregnant women visiting Government Maternity Hospital, Hyderabad. Materials and Method: A cross-sectional survey was carried out among 606 pregnant women aged 18–40 years old. Oral health knowledge of respondents was assessed using the 14-item self-administered questionnaire and responses were recorded on a dichotomous scale (yes/no). The data were analyzed using Statistical Package for Social Sciences (SPSS) package version 20.0. Results: Overall inadequate knowledge regards to oral health was observed among 55.8% pregnant women. Based on knowledge regarding tooth decay, 71.6% of study participants believed that every painful tooth has to be removed and 81% of respondents were unaware of brushing with fluoridated toothpaste prevents tooth decay. Similarly, with respect to gum disease, 77.7% of subjects were not aware of gum disease and around 49.8% unacquainted that bleeding during tooth brushing indicates gum problems. It is enriching to observe, 94.1% of respondents felt oral health is important for general health. On the other hand, a quite alarmingly high percentage (73.9%) of subjects does not know the relationship between oral health and pregnancy. Furthermore, 91.1% and 65.5% of participants were ignorant that pregnancy can increase the tendency of gums to swell or bleed and poor oral health affect their unborn baby, respectively. More than three-fourths of the study participants (84%) had never visited dentist Conclusion: The study highlights limited knowledge allied to oral health among pregnant women and problem-oriented dental visits indicating an urge among this group to scale up their knowledge.
Keywords: India, knowledge, oral health, pregnancy
|How to cite this article:|
Lakshmi S V, Srilatha A, Satyanarayana D, Reddy L S, Chalapathi SB, Meenakshi S. Oral health knowledge among a cohort of pregnant women in south India: A questionnaire survey. J Family Med Prim Care 2020;9:3015-9
|How to cite this URL:|
Lakshmi S V, Srilatha A, Satyanarayana D, Reddy L S, Chalapathi SB, Meenakshi S. Oral health knowledge among a cohort of pregnant women in south India: A questionnaire survey. J Family Med Prim Care [serial online] 2020 [cited 2020 Jul 15];9:3015-9. Available from: http://www.jfmpc.com/text.asp?2020/9/6/3015/287870
| Introduction|| |
Pregnancy is an important milestone in the life course of a female with noteworthy anatomical and physiological changes in the body. Fluctuation in the levels of estrogen and progesterone hormones in expecting mothers increases the risk for oral health issues compared to the normal counterpart of the population., Oral problems seen in pregnancy include pregnancy gingivitis, periodontal infections, and pyogenic granuloma., The reported prevalence of pregnancy gingivitis has ranged from 30 to 100%.,, The early work of Loe and Silness , showed that the first clinical signs of gingival inflammatory changes appear in the 2nd month of pregnancy and continue to progress until the 8th month of pregnancy. Moreover, repeated episodes of gingivitis during pregnancy might exacerbate chronic periodontal disease. Literature search ,, revealed that the prevalence of the periodontal disease in pregnant women ranges from 5 to 20% with about 25% of women showing worsening of periodontal condition. Pyogenic granuloma is a benign growth of gingival tissues and the prevalence as reported ranges 5–10%., Additionally, changes in dietary habits can also increase the risk of tooth decay during pregnancy. A considerable body of research indicated 74% prevalence rate of dental caries among pregnant women., Moreover, pregnant women with high caries might facilitate the establishment of an oral environment that places the newborn at risk of developing caries. Therefore, teeth and periodontal structures represent two specialized tissues which account as great importance in the oral cavity of pregnant women.
Apart from the effect of hormonal changes, it is increasingly acknowledged ,, that other factors such as poor oral hygiene, lack of access to dental care, and low knowledge levels about proper oral hygiene maintenance affirmed to worsened periodontal condition during pregnancy. Further, more recent studies ,, indicated these oral alterations have the potential to affect pregnancy outcomes.
Moreover, mothers being primary caregivers to their young ones, it is high time to unfold the oral health knowledge of pregnant women for nurturing good oral habits and kindle in the right direction on their advent., In light of these findings, it is important to solicit women's perceptions of their oral health for planning preventive programs in order to favorably influence both maternal and infant health. Hence, the present study was designed to ascertain the knowledge about oral health among a cohort of pregnant women visiting Government Maternity Hospital in Hyderabad city, India.
| Materials and Method|| |
A cross-sectional study was carried out among pregnant women in various trimesters aged 18–40 years visiting the out-patient block of Government Maternity Hospital, Hyderabad. The study encompassed a convenient sample of 606 subjects, ensuring a proportionate number of participants from each trimester. Ethical clearance was obtained from the institutional ethical committee before the start of the study (PMVIDS/PHD/0022-18). The permission to carry out the study was obtained from the Medical Superintendent of Maternity Hospital. Women in the first, second, and third trimesters of pregnancy willing to participate were included in the study. Women with the history of systemic disease (such as diabetes mellitus, hypertension, cardiovascular disease, etc.) and those under medication (like antiepileptic, calcium channel blockers, antibiotics, etc.) which have a significant effect on oral health and those who do not wish to participate were excluded from the study. Participation was voluntary and anonymous. The return of the completed questionnaire signified informed consent.
The study was conducted for a period of 4 months dated from June 2018 to September 2018. The pro forma was designed to collect the information of the demographic details (age, education), personal history (number of pregnancies, trimester), perceived oral health status, and previous dental visits. The oral health knowledge of respondents was measured using a 14-item self-administered questionnaire which was developed based on previous studies.,, Of which, five questions were based on understanding and causes of tooth decay, three questions on gum disease, three questions assessing knowledge of the respondent's oral hygiene practices, and three questions on the possible association of poor oral health with adverse pregnancy outcomes. The questionnaire was pretested and validated prior to the commencement of the study (Cronbach's α value of 0.86). All the items in the questionnaire were initially prepared in English followed by translated to local language (Telugu) by Bilingual Scholar. The questionnaire was evaluated by two other subject experts unrelated to study and necessary changes were incorporated. The final version of the Telugu-translated questionnaire was back-translated to English by Bilingual Scholar to verify semantic equivalence between versions. The two English versions proved nearly identical. The questionnaire was designed in both English and local language (Telugu) so that the participants can fill the form in the language they are familiar with. The responses were recorded on a dichotomous scale (yes/no). For each “yes” response it was scored “1” and for each “no” response “0.” The cutoff point for an individual level of oral health knowledge was set at 7. Those who scored at or above cutoff points were considered as having adequate knowledge whereas those who scored below the cutoff point have inadequate knowledge regards to oral health.
The data were analyzed using Statistical Package for Social Sciences (SPSS) package version 20.0. A descriptive analysis was done to calculate the prevalence of each variable. A Chi-square test was used to associate knowledge scores of the study population with variables. P < 0.05 was considered statistically significant.
| Results|| |
A total of 606 pregnant women with a mean age of 22.8 ± 3.09 years constituted the study population. The majority of the study participants completed high school (38%) and primary school (30.9%) education only. A few study subjects (8.7%) possessed a graduation degree. A comparable percentage of women were in the first trimester (33.2%), second (33.5%), and third trimester (33.3%) of pregnancy. The majority (49.7%) of the respondents conceived for the second time and around 71.6% of subjects perceived their oral health status as fair. It was surprising to observe that more than three-fourth of the study participants (84%) had never visited the dentist [Table 1].
When knowledge regarding tooth decay was considered, 81.8% of subjects were cognizant that eating sweets causes tooth decay and 86.3% responded that decayed teeth affect works or other aspects of their everyday life. Almost two-thirds (71.6%) of the participants believed that every painful tooth has to be removed. On the other hand, 81% of respondents were unaware that brushing with fluoridated toothpaste helps to prevent tooth decay. Similarly, with respect to gum disease, 77.7% of study participants were not aware of what gum disease is and around 49.8% unacquainted that bleeding during tooth brushing indicates gum problems. Knowledge based on oral hygiene practices revealed that though 71.8% of subjects regularly change their toothbrush, yet 90.1% of them are unaware of other oral hygiene aids and 99% do not regularly visit a dentist. It is enriching to observe that in the present study, 94.1% of respondents felt that oral health is important for general health. On the other hand, a quite alarmingly high percentage (73.9%) of subjects does not know that there is a relationship between oral health and pregnancy. Furthermore, 91.1% and 65.5% of participants were ignorant that pregnancy can increase the tendency of gums to bleed, swell, or become red and poor oral health affect their unborn baby, respectively [Table 2].
|Table 2: Frequency distribution of study subjects based on response to questions|
Click here to view
Distribution of study subjects based on knowledge score according to variables, 55.8% of them had inadequate knowledge (low <7) on oral health. Statistically significant (P = 0.001) low knowledge scores regards to oral health was noted in the majority of the participants compared to subjects with high knowledge score based on a number of pregnancies. All the variables showed a significant difference with knowledge scores except for age and perceived oral health status [Table 3].
|Table 3: Frequency distribution of study subjects based on knowledge scores according to variables|
Click here to view
| Discussion|| |
Indeed with the increasing global burden of oral disease, it is optimal to know the oral health knowledge of pregnant women as being prime caregivers their level of knowledge, in turn, reflects the care they render to infant oral health. In addition, the mother's role is a corner in shaping a child's oral health behaviors, which has a positive impact on later life. In the present study, overall inadequate knowledge with regard to oral health was observed among 55.8% pregnant women that constitute a considerable proportion of sample indicating that there is an urge to scale up their knowledge. Moreover, illiterates and participants with primary schooling had low knowledge scores which were in accordance with the study done by Avula et al. and Pentapati et al. Reflecting low educational levels lead to low oral health literacy among the study subjects. Among pregnant women, 81% of respondents did not know that brushing with fluoridated toothpaste could prevent dental caries. This finding was comparably high with a study done by Byanaku and Rwakatema  among Morogoro pregnant women, Tanzania (40.3%). The majority of the study subjects (90.1%) were unaware of other oral hygiene aid which was contrary to George et al.'s  study where utilization rate of other oral hygiene aids was 83%. A study by Abiola et al. among Nigerian pregnant women reported that 32% of the subjects agreed that every painful tooth should be removed which was comparatively higher (71.6%) in the present study indicating a need of the hour to enact toward this misconception and admittance to accurate information from reliable sources should be made. In the existing study, 77% and 91.1% of pregnant women were unaware of gum disease and that pregnancy can increase the tendency for gums to bleed or swell, respectively which is similar to a study done by Avula et al. (66% and 75%, respectively). The current study identified participant's lacuna on the interdependent relationships between pregnancy affecting oral health and vise versa poor oral health affecting pregnancy outcomes. This finding was in line with Gupta et al. and Avula et al.'s  studies, thus, an intensified education paves an important insight into the improvement of knowledge and reduces suffering. The majority of the study subjects had low oral health knowledge scores irrespectively of a number of pregnancies which could be attributed to the low mean age of the respondents. The respondents who never visited dentists had low knowledge scores and in congruent with a study conducted by Byanaku and Rwakatema  among Tanzania pregnant women. Lack of green light about the importance and safety of dental care during pregnancy, an overwhelming number of women have a propensity to postpone their treatment depicting lower utilization of dental services. In addition, developing countries like India where dental insurance is in its infancy might be the barrier for not attending to the dentist.
However, we acknowledge that the study has certain limitations as the study was carried out in a single province so the results have to be generalized with caution to the community. The present study was questionnaire-based which necessitates correlating with the subject's oral health status.
| Conclusion|| |
The present study highlights limited knowledge allied to oral health among pregnant women and problem-oriented dental visits sighting that oral health care has not been given sufficient importance. As expecting women are more susceptible to periodontal disease and at a higher risk of tooth decay, failure to treat active infection navigates to pooled factors. Furthermore, in low-income countries, the abysmal gap in oral health knowledge begets to dental neglect which cannot be changed overnight. Thereby, shifting the glance in enriching pregnant women's knowledge has a proactive influence on their oral health behaviors and crucial in transferring healthy habits on the arrival of the little one. The study results signify the need to structure oral health education programs at regular intervals targeting pregnant women about maternal oral changes during pregnancy, self-actualization on the importance of regular dental visits, and the gravity of primary care toward perinatal oral health.
Poor oral health knowledge among pregnant women indicates a high risk of tooth loss in the future. Therefore, oral health care should be a part of regular antenatal care which plays a pivotal role to limit the in-progress epidemic of dental caries and periodontal disease in the budding years.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
The authors wish to thank the staff of the Department of Obstetrics and Gynecology in Osmania Medical College, Hyderabad for their support throughout the study. None the less we like to thank the participants for their support to complete the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Morgan MA, Crall J, Goldenberg RL, Schulkin J. Oral health during pregnancy. J Matern Fetal Neonatal Med 2009;22:733-9.
Karunachandra NN, Perera IR, Fernando G. Oral health status during pregnancy: Rural-urban comparisons of oral disease burden among antenatal women in Sri Lanka. Rural Remote Health 2012;12:1902.
Vogt M, Sallum AW, Cecatti JG, Morais SS. Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women. Reprod Health 2010;7:29.
Geevarghese A, Baskaradoss JK, Sarma PS. Oral health-related quality of life and periodontal status of pregnant women. Matern Child Health J 2017;21:1634-42.
Wandera M, Engebresten IMS, Okullo I, Tumwine JK, Astrom AN. Sociodemographic factors related to periodontal status and tooth loss of pregnant women in Mbale district, Uganda. BMC Oral Health 2009;9:18-29.
Lopez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized controlled trial. J Periodontol 2002;73:911-24.
Gursoy M, Pajukanta R, Sorsa T, Kononen E. Clinical changes in periodontium during pregnancy and post-partum. J Clin Periodontol 2008;35:576-83.
Loe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.
Silness J, Loe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22:121-35.
Laine MA. Effect of pregnancy on periodontal and dental health. Acta Odontol Scand 2002;60:257-64.
Moore S, Ide M, Wilson RF, Coward PY, Borkowska E, Baylis R, et al
. Periodontal health of London women during early pregnancy. Br Dent J 2001;191:570-3.
Moss KL, Beck JD, Offenbacher S. Clinical risk factors associated with incidence and progression of periodontal conditions in pregnant women. J Clin Periodontol 2005;32:492-8.
Kim J, Amar S. Periodontal disease and systemic conditions: A bidirectional relationship. Odontology 2006;94:10-21.
Lieff S, Boggess KA, Murtha AP, Jared H, Madianos PN, Moss K, et al
. The oral conditions and pregnancy study: Periodontal status of a cohort of pregnant women. J Periodontol 2004;75:116-26.
Rakchanok N, Amporn D, Yoshida Y, Harun-Or-Rashid M, Sakomoto J. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand. Nagoya J Med Sci 2010;72:43-50.
Kumar S, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Factors influencing caries status and treatment needs among pregnant women attending a maternity hospital in Udaipur city, India. J Clin Exp Dent 2013;5:72-6.
Irigoyen Camacho ME, Sanchez Perez L, Garcia Perez A, Zepeda MA. Relationship between severe early childhood caries, mother's oral health and mutans streptococci in a low income group: Changes from 1996 to 2007. J Clin Pediatr Dent 2009;33:241-6.
Barman D, Ranjan R, Kundu A. Factors associated with dental visit and barriers to the utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: A cross-sectional study. J Indian Soc Periodontol 2019;23:562-8.
] [Full text]
Taani DQ, Habashneh R, Hammad MM, Batieha A. The periodontal status of pregnant women and its relationship with socio-demographic and clinical variables. J Oral Rehabil 2003;30:440-5.
Vergnes JN, Kaminski M, Lelong N, Musset AM, Sixou M, Nabet C. Frequency and risk indicators of tooth decay among pregnant women in France: A cross sectional analysis. PLoS One 2012;7:1-7.
Mohr S, Amylidi-Mohr SK, Stadelmann P, Sculean A, Persson R, Eick S, et al
. Systemic inflammation in pregnant women with periodontitis and preterm prelabor rupture of membranes: A prospective case-control study. Front Immunol 2019;10:2624.
Radochova V, Stepan M, Kacerovska Musilova I, Slezak R, Vescicik P, Menon R, et al
. Association between periodontal disease and preterm prelabour rupture of membranes. J Clin Periodontol 2019;46:189-96.
Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Mahande MJ, Masenga G. The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: A cross-sectional study. Afr Health Sci 2018;18:601-11.
Bansal K, Kharbanda OP, Sharma JB, Sood M, Priya H, Kriplani A. Effectiveness of an integrated perinatal oral health assessment and promotion program on the knowledge in Indian pregnant women. J Indian Soc Pedod Prev Dent 2019;37:383-91.
] [Full text]
Mayberry ME, Gonik B, Trombly RM. Perinatal oral health: A novel collaborative initiative to improve access, comfort level and knowledge of pregnant women and dental providers. AJP Rep 2020;10:e54-61.
Ganesh A, Ingle NA, Chaly PE, Reddy VC. A survey on dental knowledge and gingival health of pregnant women attending Government Maternity Hospital, Chennai. J Oral Health Comm Dent 2011;5:24-30.
Avula H, Mishra A, Arora N, Avula J. KAP assessment of oral health and adverse pregnancy outcomes among pregnant women in Hyderabad, India. Oral Health Prev Dent 2013;11:261-70.
Byanaku AK, Rwakatema DS. Oral health of pregnant women; Knowledge, attitude and practice at antenatal care clinic in Morogoro Municipal, Tanzania. Prof Med J 2013;20:365-73.
Pentapati KC, Acharya S, Bhat M, Rao SK, Singh S. Knowledge of dental decay and associated factors among pregnant women: A study from rural India. Oral Health Prev Dent 2013;11:161-8.
George A, Johnson M, Blinkhorn A, Ajwani S, Bhole S, Yeo AE, et al
. The oral health status, practices and knowledge of pregnant women in south-western Sydney. Aust Dent J 2013;58:26-33.
Abiola A, Olayinka A, Mathilda B, Ogunbiyi O, Modupe S, Olubunmi O. A survey of the oral health knowledge and practices of pregnant women in a Nigerian teaching hospital. Afr J Reprod Health 2011;15:14-9.
Gupta N, Chhetry M. Knowledge and practices of pregnant women regarding oral health in a Tertiary Care Hospital in Nepal. J Nepal Med Assoc 2019;57:184-8.
[Table 1], [Table 2], [Table 3]