Original Article EXPECTING MOTHERS - HOW AWARE ARE YOU OF YOUR ORAL HEALTH? Monica GS 1, Nabeesa SP 2, Breena RK 3, Ilango P 4 1 Post graduate student, Dept of Periodontology and Oral Implantology, Maharaja Ganga Singh Dental College & Research Centre, Sriganganagar, Rajasthan, 2 Consultant, NG Multispeciality Dental Clinic, Chennai, 3 Post graduate student, Dept of Orthodontics and Dentofacial Orthopaedics, Maharaja Ganga Singh Dental College & Research Centre, Sriganganagar, Rajasthan, 4 Prof. and Head, Department of Periodontology and Oral Implantology, Priyadarshini dental college and Hospital, Thiruvallur, Tamil Nadu. ABSTRACT Background and objectives: A lot of studies have shown poor oral health and periodontal diseases as a risk factor for adverse pregnancy outcomes. Considering the importance of dental health during pregnancy, this study was conducted to assess the knowledge and attitude of oral and dental health care among pregnant women in Chennai and Thiruvallur districts of Tamilnadu, India. Methods: The study was conducted among 1000 pregnant women in Chennai and Thiruvallur districts of Tamilnadu, through a pre-tested, structured and validated questionnaire. Knowledge and attitude were recorded on a scale, graduated in percentage. Results: Out of 1000 questionnaires delivered, only 19% of pregnant women were aware of dental care during pregnancy (p=0.004). Among these, majority were from urban area with good socio-economic status and had been educated on health awareness. Interpretations and conclusions: Dental awareness among pregnant women was very poor and only 19% of them had actually practised it. This raises serious concern since pregnant women may need extra oral care during pregnancy due to their susceptibility to periodontal diseases during the gestation, which may contribute to low birth-weight babies and preterm births or much worse, infection to the new born child. Key words: Dental check-up, Dental hygiene, Dental treatment, Periodontal problems, Pregnant women. Corrseponding Author:Dr. Monica GSAddress: B-16 Emerald Nagar, Sipcot Housing Plots,Ranipet,Vellore,Tamilnadu. How to cite:monica GS, Nabeesa SP, Breena RK, Ilango P.Expecting mothers - How aware are you of your oral health? IDA Lud J le Dent 2017;1(2):32-37. IDA Ludhiana s Journal ledentistryvol.1 issue2 2017 32
INTRODUCTION Pregnancy is the unique period in women s life. It is accompanied by a variety of physiological, anatomical and hormonal changes that affects the whole of her body including oral health. There is an old saying You lose one tooth for every child. It originated years ago that pregnant women are more susceptible to gum disease. Since the hormonal changes in a pregnant woman increase the sensitivity of the tissues, it makes them to react more severely to the irritations that are present when compared to a non-expecting woman. Hence, it leads to a greater incidence of periodontal/gum diseases. Many women fail to understand the importance of dental care during pregnancy. The dental literature strongly supports the fact that poor oral health practices and inadequate attention towards oral health during pregnancy has a greater impact on the developing foetus and significant adverse postnatal effects 1. Research suggests that the bacteria that cause inflammation in the gums can actually get into the bloodstream and target the foetus through amniotic fluid, potentially leading to premature and low birth-weight babies. These risks increase in women who smoke, who experience nutritional deficiencies or have less frequent visits to the dentist 2.The available data indicate moderate to poor knowledge related to oral health and adverse pregnancy outcomes, which proves poor dental attendance and oral health related practices among gestating women 3. Therefore this study was conducted to assess the dental awareness among pregnant women. MATERIALS AND METHODS This study was conducted among pregnant women in Chennai and Thiruvallur districts of Tamilnadu as these represent both the urban and rural prospects in the state of Tamil Nadu. This study was approved by the Institutional Review Board of Priyadarshini Dental College and Hospital,Thiruvallur, Tamil Nadu and the permission to conduct the study was obtained from Institutional Ethical Committee of Priyadarshini Dental College and Hospital, Thiruvallur, Tamil Nadu.. Cross sectional data were collected from direct interviewing of the subjects through a questionnaire. About 1000 pregnant women were taken as sample population for this study. A close ended questionnaire with 20 questions related to awareness of oral health, utilization of dental health services, habits and use of medications during pregnancy, gingival conditions was prepared to assess their knowledge and attitude towards dental awareness. Questions had multiple options which was pretested and validated as per the statistical analysis (Cronbach s alpha = 0.92). A number of Obstetrics & Gynaecology Centres in Chennai and Thiruvallur district, Tamilnadu were chosen randomly and duly approached to conduct the survey. After a brief introduction, the questionnaire was distributed among the sample population and was collected immediately after completion. The collected data was subjected to analysis and the following results were obtained. Chi square test was used for comparing the observed and expected frequencies of response. RESULTS On the appraisal of the response rates, the following results were obtained as shown in Fig1. It was seen that only 19% of the women were aware regarding dental care during pregnancy. The difference was found to be statistically significant (p = 0.004). Demographic Characteristics. According to the demographic data collected, majority of the women surveyed IDA Ludhiana s Journal ledentistryvol.1 issue2 2017 33
were from the age group of 21years to 40years with socio-economic status ranging from low to high. Theexpecting mothers FIG: 1: AWARENESS REGARDING DENTAL CARE DURING PREGNANCY DENTAL AWARENESS AMONG PREGNANT WOMEN AWARE(19%) NOT AWARE(81%) who had some form of tertiary education and from good socio-economic status (about 38%) were shown to have a better knowledge and attitude towards the dental heath during pregnancy when compared to their counterparts. Older women or women into their second and third pregnancy accepted that they noticed some changes in their oral health during their gestation whereas mothers into their first pregnancy answered that they are unaware of the changes their mouth went in particular during pregnancy, concluding that they are unaware of the oral health and its association with pregnancy adversities. Knowledge on Oral Hygiene Practices and Dental Changes during Pregnancy. Though majority of the participants had a good understanding of good oral hygiene, with 99% women agreeing brushing their teeth would help prevent gum disease, only 31% of the pregnant women brushed twice daily and only about 36% of pregnant women used medium or soft bristled tooth brush for brushing.more than two thirds (n= 730) were not even aware of the use of auxiliary dental aids like floss and mouthwash in preventing gum disease. Table 1 shows the awareness regarding dental changes among women during pregnancy. It was seen that almost half the women enrolled (n= 470) accepted that they have experienced some signs of gum disease, but they have never visited a dentist for the treatment. Table 1: DENTAL CHANGES DURING PREGNANCY CHANGES DURING PREGNANCY Yes (%) No (%) p - value Do you experience bad breath during pregnancy 32% 68% 0.022 Bleeding gums while brushing? 47% 53% 0.044 Have you noticed enlargement or swelling in gums during pregnancy? 22% 88% 0.018 Had sensitivity during pregnancy? 18% 82% 0.026 Color changes during pregnancy 9% 91% 0.005 Noticed local deposits in your teeth? 32% 68% 0.012 IDA Ludhiana s Journal ledentistryvol.1 issue2 2017 34
Table 2: AWARENESS BASED QUESTIONS AWARENESS BASED QUESTIONS Yes (%) No(%) p-value Do you think poor oral hygiene affects your baby? 26% 74% 0.028 Are you aware of hormonal changes during pregnancy affects 14% 86% 0.004 oral health? Are you aware of alcoholic and nonalcoholic mouth wash and 5% 95% 0.022 its effects? Do you think medication that you take for dental pain will 43% 57% 0.046 affect your baby? Do you think dental treatment during pregnancy is necessary? 17% 83% 0.043 Do you think it s safe to take X-rays during pregnancy? 9% 91% 0.002 ATTITUDE TOWARDS GETTING A DENTAL CHECK-UP DONE DURING PREGNANCY When questioned about their thoughts on dental check-up during pregnancy, 83% of the women thought that dental visit during pregnancy is not necessary and 24% of them answered that they fear dental treatment during pregnancy. About 43% of the women thought that having their teeth cleaned by professionals is only optional during pregnancy and only 10% of the entire sample population had actually visited a dental clinic during pregnancy for dental check-up. DISCUSSION The present study findings clearly show that the knowledge of pregnant women about association of oral health and adverse pregnancy outcomes was poor. Over 90% of the women who were surveyed revealed they did not visit the dentist in the previous months, and only 10% visited during their most recent pregnancy. This is in consistency with a study conducted in 2001 by scientists at the Centre for Disease Control and Prevention. The researchers found that although roughly a quarter of pregnant women surveyed reported having dental problems, only half of them sought treatment. Also maximum of respondents, about 83% thought that dental treatment during pregnancy is not necessary and 60% of pregnant women thought that OTC medication taken for dental pain doesn t affect the foetus.the present study also showed that majority of women examined were unaware of local deposits and color changes in gingiva during pregnancy. Also, regarding dental awareness among pregnant women, many women surveyed reported signs suggestive of periodontal disease during the previous months in the form of bleeding, sore gums and a persistent bad taste in their mouth. Our findings confirm that bleeding and sore gums are common among pregnant women as shown in previous studies. 4 Hence the professional dental care during pregnancy is deemed necessary. In the present survey, when dental fear was considered a factor preventing them from visiting a dentist, 76% respondents didn t fear to take dental treatment during pregnancy. Although respondents answered that dental treatment is not necessary during pregnancy, more than half of participants thought that professional dental attendance will give IDA Ludhiana s Journal ledentistryvol.1 issue2 2017 35
better outcomes.another study conducted on dental awareness of pregnant women suggested that better knowledge of dental hygiene and practices were found in women who had some form of tertiary education and were from a higher socio-economic status 5. It was also found that educating and motivating women to maintain good oral hygiene and providing affordable dental health care is fundamental in reducing dental disease. Improving dental education may need to become a priority in antenatal care to educate women at risk. This study outlines the importance of maintaining oral health 6 during pregnancy, as it is, like always taking time to educate yourself. Periodontal disease and treatment during pregnancy is a valuable investment in one s own health, as well as the health of the unborn baby. CONCLUSION Predominantly, most of the women were found to have no knowledge of the dental diseases and their effects on pregnancy. However, this survey showed associations between lack of knowledge of dental health and dental hygiene during pregnancy. Even though most women appeared to be informed about dental hygiene practices, majority of them did not attend any dental clinic during their pregnancy. Increasing awareness among the women about dental problems, especially periodontal disease, especially during pregnancy and their potential adversities will result in improved health and better pregnancy health outcomes. Better education on dental health in pregnancy or making dental attendance compulsory during pregnancy can lead to improved dental practices, which in turn can prevent unfortunate complications like premature births, low birth weight babies or pre-eclampsia. ACKNOWLEDGEMENT: We would like to express our gratitude to our Honourable Chairman, Dean and the Principal of the Institution for enabling us to conduct this survey. We would also like to extend our thanks to the Obstetrics & Gynaecology Centres for allowing us to conduct the study with their patients. A hearty thanks to the women who took part in the survey. A special mention to the statistician for helping us out with the sample size and also the statistical analysis. REFERENCES 1. Sajan P, Pattansetti J, Padmini C, Nagathan VM, Sajjanar M. Oral health related awareness and practices among pregnant women in Bagalkot district, Karnataka, India. J Int Oral Health 2015;7(2):1-5. 2. Moss KL, Beck JD, Oftenbacher S. Clinical risk factors associated with incidence and progression of periodontal conditions in pregnant women. J Clin Periodontol 2005;32(5):492-8. 3. Christensen LB, Jeppe-Jensen D, Petersen PE. Self-reported gingival conditions and self-care in the oral health of Danish women during pregnancy. J Clin Periodontol 2003;30(11):949-53 4. Tanni DQ, Habashneh R, Hammad MM, Batieha A. The periodontal status of pregnant women and its relationship with socio-demographic and clinical variables. J Oral Rehab 2003,30:440-445. 5. Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2006 Feb 1;113(2):135-43.. 6. Hirsh R and Clarke N. Has small-scale audio-visual dental health education a viable future? Community Dent Oral Epidemiol.1977,5:160-163. IDA Ludhiana s Journal ledentistryvol.1 issue2 2017 36
Conflict of Interest:NoneSource of Support: NiL This work is licensed under a Creative Commons Attribution 4.0 International License IDA Ludhiana s Journal ledentistryvol.1 issue2 2017 37