Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 7857
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents 
Year : 2020  |  Volume : 9  |  Issue : 8  |  Page : 4396-4400  

Self-perception on oral health and related behaviours among antenatal mothers attending a public antenatal clinic – Kerala

Department of Public Health Dentistry, Government Dental College, Kottayam, Kerala, India

Date of Submission04-May-2020
Date of Decision11-Jun-2020
Date of Acceptance25-Jun-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Dr. Bindu V Bhaskar
Department of Public Health Dentistry, Government Dental College, Gandhinagar P.O, Kottayam, Kerala - 686 008
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_765_20

Rights and Permissions

Background and Aims: Antenatal oral care has been given least priority on a global scale. The study assesses self-perception of oral health knowledge and related behaviors among antenatal mothers. Method: A cross-sectional study was done among 400 pregnant women attending antenatal care clinic of a tertiary care center in Kerala, India. Details regarding knowledge, attitude, and practice were obtained, after getting an informed consent. The dental caries experience and gingival status were measured. To test the significance (p ≤ 0.05) between variables, Chi-square test was used. Results: Poor oral health knowledge was observed among 75.5% of the pregnant mothers. Oral health problems were reported by 63.2% of them. Low priority for oral health (59.4%) and fear for fetal safety (17.5%) were the reasons for delaying dental services. Oral examination showed that more than half of the study subjects had a high prevalence of dental caries (67.5%) and low gingival bleeding status (26.2%). The study highlights that more than half of the study population (60.8%) were influenced by the elderly in the family to avoid certain food items. A better oral health knowledge was observed among the upper middle class (OR - 2.8) who had visited dentists within the last six months (OR - 3.6) and child bearing mothers (OR- 0.46) (p ≤ 0.05).

Keywords: Antenatal, barriers, behavior, dental caries, knowledge, oral health, self-perception, utilization

How to cite this article:
Bhaskar BV, Thomas S, Kumar JK, Gomez MS. Self-perception on oral health and related behaviours among antenatal mothers attending a public antenatal clinic – Kerala. J Family Med Prim Care 2020;9:4396-400

How to cite this URL:
Bhaskar BV, Thomas S, Kumar JK, Gomez MS. Self-perception on oral health and related behaviours among antenatal mothers attending a public antenatal clinic – Kerala. J Family Med Prim Care [serial online] 2020 [cited 2021 Jul 24];9:4396-400. Available from: https://www.jfmpc.com/text.asp?2020/9/8/4396/293084

  Background Top

Pregnancy is a unique time in a woman's life where she is motivated to care for her own health as well as for her baby. Every mother has a responsible role as a care giver during the early years of her child. The prevalence of dental problems is reported to be high among the antenatal mothers than the general population where the mother's oral health has an impact on their children's health.[1] The oral health of pregnant mothers is greatly influenced by hormonal variation and dietary changes. Poor oral hygiene along with hormonal changes can aggravate the risk of periodontal disease and its adverse pregnancy outcomes such as premature birth and low birth weight babies.[2] Dental caries can be transmitted from mothers directly through their infected saliva while sharing the same spoon and kissing her baby.[3]

Craving for certain foods like sweets, pickles and sour food items are common during pregnancy. However, such habits may lead to systemic diseases like hypertension and diabetes mellitus which have direct link to dental caries and gingivitis.[4],[5]

Globally, the use of dental service utilization during pregnancy is low as a result of poor attitude and lack of oral health knowledge.[6] The low utilization and delay in dental services has been linked to various barriers such as financial burden, time constraints, unawareness, concerns related to mother and fetal safety, along with lack of emphasis from antenatal care providers.[7]

India is a young, low middle income and the second most populous country in the world, with a diverse geography, society and tradition. To provide safe motherhood and accessible quality care, national public health programs like Janani Suraksha Yojna (JSY) and Pradhan Mantri Surakshit Matritva Jojana (PMSMJ) have been implemented by the Govt. of India. The geographical vastness and enormous sociocultural diversity indicate these antenatal programs varies across the country especially in the maternal health care utilization. Hence, uniform health sector reforms are a real challenge to implement in the country. The effectiveness of these program envisages several instrumental changes in the health sector but does not quantify oral health. The present study assesses the self-perception on oral health knowledge and related behaviors among pregnant women receiving antenatal care.

Relevance to practice of primary care physician

During pregnancy, women are at a greater risk of experiencing poor oral health and this can affect pregnancy outcome.[8] Misconceptions on oral health and delay in utilizing dental care can have consequences on maternal and fetal health.[9] With increasing links between oral and general health problems it is essential for the physician to know the impact of dental caries and periodontal diseases and its associated risk factors on women's overall health.[10]

This can help the physician to make appropriate decisions regarding timely and effective oral health intervention. Thus the combined and coordinated preventive oral health care approaches by the dentists and the physicians are important for a healthy motherhood.

  Methods Top

A cross sectional study was conducted at the antenatal clinic of the Obstetrics and Gynecology Department of a tertiary care center after getting informed consent among expectant mothers who were willing to participate. The Institutional Ethics and Review Board at the Government Dental College, Kottayam, approved the study (date of approval 15-11-2017). A pilot study was carried out and the sample size was estimated to be 400.

Data collection

Information on socio demographic factors like age, type of family, gestational period, parity status and self-perception on oral health and related behaviors were recorded. Kuppuswamy Scale (2016) was used to assess the socio economic status.[11] Each correct response on knowledge was marked as “one” and the incorrect as “zero” and the overall knowledge was assessed by adding the scores. Questions were translated to local language (Malayalam) with the help of two language experts proficient in both English and Malayalam. An independent evaluator compared both the versions and finalized a Malayalam version which was then back translated. The dental caries experience and gingival status were also assessed using WHO criteria; DMFT Index and gingival bleeding on probing.[12]

Data analysis

The data was analyzed using the Statistical Package for the Social Sciences (SPSS) for windows (version 16; SPSS Inc; Chicago IL, USA). Descriptive statistics and Chi square test were done. Associations and differences were considered significant when the P value was less than 0.05.

  Result Top

Demographic details of antenatal mothers are provided in [Table 1], where the majority of participants belonged to the age group 25-30 years (mean age-27 years). More than half of the participants were in the third trimester, nulliparous and belonged to the lower socio-economic class.
Table 1: Demographic Details of antenatal mothers

Click here to view

Three fourth of the antenatal mothers had poor oral health knowledge as shown in [Table 2], whereby questions related to time of eruption of baby's first tooth, time to commence dental care and the importance to care for milk tooth was reported by less than 40% of the study population. According to 20% of the participants, the second trimester was considered safe for dental treatment. More than half (56%) of the participants were of the opinion that oral health has an influence on overall health.
Table 2: Oral health knowledge and attitude of antenatal mothers

Click here to view

Self-perception of good oral health was reported by 64.5% of the antenatal mothers. The self-perceived oral health problems were tooth ache, altered taste, sensitivity, food lodgment and gingival bleeding [Figure 1]. Among those who reported (63.2%) oral health problems, only 18% had visited the dentist [Figure 2]. The response to the reasons indicated for delay in treatment were low oral health priority and the safety of their fetus (17.5%) [Table 2]. Oral examination showed that more than half of the study subjects had a high prevalence of dental caries (67.5%) and low gingival bleeding status (26.2%), Fluoridated toothpaste (90%) and toothbrush (95.7%) were used twice daily (75.2%) by most of the subjects, whereas 24.2% expressed difficulty in maintaining oral hygiene, especially while using toothbrush. More than half of them (60.2%) regularly changed their toothbrush within a span of 3 months [Table 3]a.
Figure 1: The self perceived oral health problems among the antenatal mothers

Click here to view
Figure 2: Remedy for the reported oral health problems

Click here to view
Table 3: Oral Hygiene and Dietary Practices

Click here to view

Majority of study subjects had no diet preferences, whereas 85.8% of them were willing to change to a healthy diet. Craving for spicy, sour and sweet diet were reported by 61.2% of them while 60.8% of the participants were advised by the elderly in the family to avoid certain food items [Table 3]b.

Participants from the upper middle class (OR - 2.8) who had visited dentists within the last 6 months (OR - 3.6) and child bearing mothers (OR- 0.46) had better awareness on oral health (p ≤ 0. 05) [Table 4].
Table 4: Comparing knowledge with gravida status, SES, Previous dental visit, Willingness for dental treatment during pregnancy

Click here to view

  Discussion Top

Kerala, the southernmost Indian state with the highest human development index, has acquired good overall health indicators well ahead of other states in the country.[13] Being the most literate state with high female literacy rate, the present study shows more than three-fourth of the study population had poor oral health knowledge similar to the studies done by Leelavathi et al. and Sedky N A.[14],[15]

According to Barbieri W et al., socioeconomic status is known to influence health awareness, wherein greater social deprivation tend to have lower responsiveness and higher magnitude of inequalities.[16] A good oral health knowledge was seen among the upper middle-class mothers (OR - 2.8), however oral health awareness did not show any improvement irrespective of the level of education. Proportion of those who had utilized the dental services within six months and child bearing mothers showed a better oral health knowledge in our study (OR– 0.46). The nurturing/parenting experiences could have made them competent to perceive good oral health knowledge. Antenatal mothers reported poor knowledge about deciduous teeth as they believed that caring for the primary teeth is unimportant, as it will eventually shed off.[14],[15]

Al-Swuailem AS et al. conducted a study in Saudi Arabia where they found that pregnant mothers had greater dental need than common populace of the same age group, whereby 72% of the sampled antenatal mothers experienced at least one dental problem which might need a dental intervention.[17] Furthermore, a similar experience was noted in the present study among 63.2% of the participants, suggesting a greater treatment need.

The most common self-reported problem was tooth ache whereas oral clinical examination recorded a high prevalence of dental caries, similar to the findings concluded by Norkhafizah Sedki in Malaysia.[15] Frequent snacking of refined carbohydrates and delay in dental treatment could be the reason for high prevalence of untreated dental caries.

The prevalence of gingival bleeding was low and was contrary to an Australian study by A George et al. with high gingival problems.[18] This could be because of proper oral hygiene measures as observed in our study. However some antenatal mothers experienced nausea and vomiting which are normal physiological changes.[19] Nausea and vomiting aggravated while using toothbrush and they were unaware of any appropriate measures to maintain their oral hygiene.

Traditional beliefs and cultural practices are common in India.[20] The elderly in the family normally influence the decision making with regard to health care and household activities.[21] The antenatal mothers were often advised by the elderly to restrict certain food items like dates, papaya, pineapple and coffee to ensure safe motherhood. Anecdotal evidence shows that common dental problems did not affect the routine activities and strong cultural and family influences might be the reason why some of the antenatal mothers were reluctant to utilize the dental services. Other reasons for the low utilization could be lack of emphasis from their antenatal care providers, fear that the treatment can be harmful to the fetus and financial burden.[22]

  Conclusion Top

Antenatal mothers are a special group that need specialized oral care and monitoring. There is a need to bring out oral health awareness among the antenatal care givers and encourage their patients for regular oral health services. Early prevention and prompt intervention can be achieved by integrating oral health programs in the existing national antenatal care programs. This can ensure a desirable healthy motherhood.

Key points

  • Poor oral health knowledge was observed among 75.5% of the pregnant mothers
  • Low priority for oral health (59.4%) and fear for foetal safety (17.5%) were the reasons for delaying dental services.
  • Combined and coordinated preventive antenatal oral health care approaches by the dentists and the physicians are important for a healthy motherhood.


The authors appreciate the support from Dr C.P Vijayan, Professor & Head, Department of Obstetrics and Gynecology, Government Medical College, Kottayam.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Olak J, Nguyen MS, Nguyen TT, Nguyen BBT, Saag M. The influence of mothers' oral health behaviour and perception thereof on the dental health of their children. EPMA J 2018;9:187-93.  Back to cited text no. 1
Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: A systematic review. BJOG 2006;113:135-43.  Back to cited text no. 2
Virtanen JI, Vehkalahti KI, Vehkalahti MM. Oral health behaviors and bacterial transmission from mother to child: An explorative study. BMC Oral Health. 2015;15:75.  Back to cited text no. 3
Olatona FA, Onabanjo OO, Ugbaja RN, Nnoaham KE, Adelekan DA. Dietary habits and metabolic risk factors for non-communicable diseases in a university undergraduate population. J Health Popul Nutr 2018;37:21  Back to cited text no. 4
Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutr 2004;7:201-26.  Back to cited text no. 5
Oral health care during pregnancy and through the life span. Committee opinion number 569. Obstet Gynecol 2013;122 (2 Pt 1):417-22.  Back to cited text no. 6
Rocha JS, Arima L, Chibinski AC, Werneck RI, Moysés SJ, Baldani MH. Barriers and facilitators to dental care during pregnancy: A systematic review and meta-synthesis of qualitative studies. Cadernos de Saúde Pública 2018;34:e00130817.  Back to cited text no. 7
Agarwal A, Chaturvedi J, Seth J, Mehta R. Cognizance & oral health status among pregnant females- A cross sectional survey. J Oral Biol Craniofac Res 2020;10:393-5.  Back to cited text no. 8
The Aga Khan University and SZABIST., Sattar FA, Khan AH. Prenatal Oral health care and dental service utilization by pregnant women: A survey in four maternity centers of Gulshan Town, District East, Karachi. J Pak Dent Assoc 2020;29:60-5.  Back to cited text no. 9
Bakhshi M, Tofangchiha M, Bakhtiari S, Ahadiyan T. Oral and dental care during pregnancy: A survey of knowledge and practice in 380 Iranian gynaecologists. J Int Oral Health. 2019;11:21-7.  Back to cited text no. 10
Shaikh Z, Pathak R. Revised Kuppuswamy and B G Prasad socio-economic scales for 2016. Int J Community Med Public Health 2017;4:997-9.  Back to cited text no. 11
World Health Organization. Oral Health Surveys: Basic Methods. 5th ed. Geneva: World Health Organization; 2013. p. 125.  Back to cited text no. 12
NHP 2018.pdf.  Back to cited text no. 13
Leelavathi L, Merlin TH, Ramani V, Suja RA, Chandran CR. Knowledge, attitude, and practices related to the oral health among the pregnant women attending a government hospital, Chennai. Int J Community Dent 2018;6:16-20.  Back to cited text no. 14
  [Full text]  
Sedky NA. Assessment of knowledge, perception, attitude, and practices of expectant and lactating mothers regarding their own as well as their infants' oral health in Qassim Province, Kingdom of Saudi Arabia. Pereira R, editor. J Contemp Dent 2016;6:24-37.  Back to cited text no. 15
Barbieri W, Peres SV, Pereira C de B, Peres Neto J, Sousa M da LR de, Cortellazzi KL. Sociodemographic factors associated with pregnant women's level of knowledge about oral health. Einstein (São Paulo) 2018;16:eAO4079.  Back to cited text no. 16
Al-Swuailem AS, Al-Jamal FS, Helmi MF. Treatment perception and utilization of dental services during pregnancy among sampled women in Riyadh, Saudi Arabia. Saudi J Dent Res 2014;5:123-9.  Back to cited text no. 17
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.  Back to cited text no. 18
Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician 2003;68:121-8.  Back to cited text no. 19
Kumar M, Kumar A. Elderly decision making autonomy at household level: An empirical study in Eastern Uttar Pradesh, India. Int J Dev Res 2017;7:5.  Back to cited text no. 20
Upadhyay P, Liabsuetrakul T, Shrestha AB, Pradhan N. Influence of family members on utilization of maternal health care services among teen and adult pregnant women in Kathmandu, Nepal: A cross sectional study. Reprod Health 2014;11:92.  Back to cited text no. 21
Khalaf SA, Osman SR, Abbas AM, Ismail TA-AM. Knowledge, attitude and practice of oral healthcare among pregnant women in Assiut, Egypt. Int J Community Med Publ Health 2018;5:890  Back to cited text no. 22


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
   Article Figures
   Article Tables

 Article Access Statistics
    PDF Downloaded117    
    Comments [Add]    

Recommend this journal