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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 131-135

Knowledge, Attitude, Practice, and Perception toward Maintenance of Oral Health among Pregnant Women in Eastern Nepal


1 Department of Public Health Dentistry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
2 Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
3 Family Health Center, Itahari, Nepal
4 Department of Community Dentistry, M. B. Kedia Dental College, Birgunj, Nepal

Date of Submission09-Dec-2021
Date of Decision06-May-2022
Date of Acceptance07-May-2022
Date of Web Publication22-Aug-2022

Correspondence Address:
Abanish Singh
Department of Community Dentistry, M. B. Kedia Dental College, Birgunj
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_186_21

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  Abstract 


Introduction: Oral health maintenance during pregnancy is an important public health issue worldwide. Research has shown that there is an association between gum disease and low birth weight, premature births as well as mothers with untreated dental caries will also pass on cariogenic bacteria to their children. The purpose of the present study was to determine the knowledge, attitude, practice, and perception toward the maintenance of oral health among pregnant women in Eastern Nepal. Methods: It was a descriptive, cross-sectional questionnaire survey of pregnant women. Ethical approval was obtained from the Institutional Ethical Review Committee and written informed consent was obtained from all participants. A convenience sample of 600 pregnant women was obtained. The data were analyzed using the SPSS software. Mean, standard deviation, and percentage were calculated. Results: Although 95% of the pregnant ladies said that oral health is very important or important, 45.4% had one or more dental problems including bleeding gums, tooth decay, loose teeth, and sensitivity. Only 43.8% had visited the dentist. Time, cost, and safety of treatment during pregnancy were the major constraints. Majority (>90%) of them brushed their teeth at least once daily using fluoridated toothpaste. Most of them were aware that they should go for dental checkup, preserve their natural teeth and that gum problems are more during pregnancy. Conclusions: Most of them had good knowledge regarding oral health care but they avoided dental care due to various constraints.

Keywords: Attitude, knowledge, oral health, perception, practice, pregnant women


How to cite this article:
Bhagat T, Shrestha A, Agrawal SK, Rijal P, Aryal M, Singh A. Knowledge, Attitude, Practice, and Perception toward Maintenance of Oral Health among Pregnant Women in Eastern Nepal. J Dent Res Rev 2022;9:131-5

How to cite this URL:
Bhagat T, Shrestha A, Agrawal SK, Rijal P, Aryal M, Singh A. Knowledge, Attitude, Practice, and Perception toward Maintenance of Oral Health among Pregnant Women in Eastern Nepal. J Dent Res Rev [serial online] 2022 [cited 2022 Oct 7];9:131-5. Available from: https://www.jdrr.org/text.asp?2022/9/2/131/354198




  Introduction Top


Oral health maintenance during pregnancy is an important public health issue worldwide. Hormonal change during pregnancy increases the risk of gingivitis and periodontitis,[1],[2],[3] Gingivitis is an inflammatory condition of the gingival tissue, whereas periodontitis is an inflammatory disease of the supporting tissues of the teeth resulting in the progressive destruction of periodontal ligament and alveolar bone with pocket formation, recession, or both. Several studies also recommend that all pregnant women should receive a comprehensive oral health evaluation and risk assessment.[4],[5],[6],[7] High level of progesterone causes imbalance resulting in the increased number of oral bacteria that leads to gingivitis and further neglect leads to periodontitis.[5]

According to the American Academy of Periodontology (AAP), half of all women experience gingivitis during pregnancy. The AAP recommends that women visit the dentist for a periodontal evaluation before pregnancy and that they maintain oral hygiene during pregnancy.[7] Pregnancy gingivitis was first recorded by Pinard in 1877.[4] Pregnancy gingivitis is characterized by erythema, edema, hyperplasia, pain, and increased bleeding. Minor cases show enlargement of marginal gingival, but severe cases might show tumor-like gingival enlargements. Periodontal health affects the systemic health resulting in low birth weight and preterm baby. Current evidence highlights the importance of oral health during pregnancy.[2],[3],[7] However, there is the lack of data regarding the oral health of pregnant women in Nepal.

Hence, the purpose of the present study was to determine the knowledge, attitude, practice, and perception toward the maintenance of oral health during pregnancy among patients attending obstetrics and gynecology ward in a tertiary health center and family health center in Eastern Nepal.


  Methods Top


A descriptive cross-sectional survey of pregnant women attending the obstetrics and gynecology ward (B.P. Koirala Institute of Health Science), Dharan, and family health center, Itahari, Sunsari was conducted. Ethical approval was obtained from the Institutional Review Committee and written informed consent was obtained from all the participants. A convenience sample of 600 pregnant women was obtained. The sample size was calculated at 95% confidence interval and considering 5% error with reference to the study by George et al.[7] The calculated sample size was 570.

A structured questionnaire was administered that contained items relating to oral health care (including questions of dental problems), dental visits frequency, barriers to seeking dental care, oral hygiene habits, oral health perceptions, knowledge about oral health, and access to dental care. The questionnaires were translated and back-translated by independent subject experts. Subsequently, face and content validity of the structured questionnaire was done by subject experts. To check for the reliability of the structured questionnaire, 25 pregnant women were selected before conducting the main study. These study participants were not included in the main study. Test re-test reliability check was done using interclass correlation coefficient (0.76). Sociodemographic data including age, education, ethnicity, employment, household income, and period of gestation were also collected.

Statistical analysis

The survey data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 11.5 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics such as mean and standard deviation for the continuous variables and frequency and percentage for categorical variables was calculated and tabulated. The Chi-square test was used to compare the profiles of pregnant women who had visited a dentist in the last 6 months with those who did not. The level of significance used was P < 0.05.


  Results Top


Six hundred pregnant women were surveyed, where the mean age of the participants was 25.45 ± 4.60 and ranged from 17 to 46 years. Almost half, 298 (49.70%) of the surveyed women had secondary level of education. Majority of the pregnant women were homemaker; 503 (83.80%) and 497 (82.90%) of pregnant women had one or no children. Among the surveyed pregnant women, almost equal number was present in all the three trimesters [Table 1].
Table 1: Sociodemographic characteristics and obstetric characteristics of participants (n=600)

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The majority of the women claimed that their oral health status was good or average (91.80%). More than half of the women had no any self-reported oral health problems. Bleeding gums 137 (45.40%) followed by decayed tooth 98 (32.50%) were common problems reported by the pregnant women, whereas about half (49.70%) of them reported that they did not have any problems. More than 95% of the pregnant women noted that there is the importance of oral health for overall general health [Table 2].
Table 2: Perceived oral health status of pregnant women (n=600)

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More than half of the surveyed women had never visited a dentist. Among the women who visited dentist, only 14.40% had visited the dentist in the last 6 months. 14.80% women did not seek dental treatment due to safety concerns regarding the treatment during pregnancy. More than 50% of the surveyed women brushed once a day. Almost all the women brushed their teeth with fluoridated toothpaste, whereas very few used “datiwan” (0.5%) and “ash” (0.5%) to clean their teeth [Table 3].
Table 3: Dental care of pregnant women

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More than one third of the surveyed women (34.7%) did not know about the best time for a baby to have the first dental visit. 87.7% of women said it is true that routine dental visits help keep teeth and gums healthy but less than a third (30.5%) said it is true that a mother's poor oral health may contribute to low birth weight children. More than two third of the surveyed pregnant women knew that the first tooth usually appears at around 6 months of age [Table 4].
Table 4: Knowledge and attitude of pregnant women about oral health (n=600)

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More than one third of the surveyed pregnant women believed that pregnancy leads to gingival problems. 62.8% disagreed that it is useless to do dental checkup during pregnancy. Majority (79.7%) disagreed, when asked it is not necessary to preserve one's own teeth. More than half of the women believed that fruits and vegetables have good effect on teeth [Table 4].

A comparison of pregnant women who visited dentist and who did not is shown in [Table 5]. The result showed a statistically significant difference in the uptake of dental service based on education of respondent (P < 0.001), their employment status (P < 0.001), duration of pregnancy (P = 0.025), and self-reported oral health problems (P < 0.001). There was no difference in use of dental service based on oral health status (P = 0.155).
Table 5: Comparison of pregnant women profiles (who visited dentist vs. those who did not)

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  Discussion Top


The present study revealed the knowledge, attitude, practice, and perception toward maintenance of oral health during pregnancy. Hormonal change during pregnancy has seen to degrade the gingival and periodontal health. Furthermore, poor maternal oral health has been linked to birth defects. Majority of the women (91.80%) claimed that their oral health status was good to average but 45.40% had bleeding gums and 32.50% had decayed teeth. More than 95% of the surveyed women noted the importance of oral health for overall general health. Similar results were obtained by study conducted by Atarbashi Moghadam et al.[6] and George et al.[7]

The dental visit by the pregnant women is very low worldwide.[8] It is now established fact that dental treatment during pregnancy is extremely safe and free from any adversities.[9] However, still, dental anxiety, time constraints, and safety concerns regarding treatment during pregnancy are few common barriers in seeking dental treatment among pregnant women. This study revealed that more than half of the surveyed women did not visit the dentist, whereas only 6.30% had a dental visit in the past 6 months. Time constraints (29.20%) followed by safety concerns regarding treatment during pregnancy (14.80%) and dental cost (13.0%) were the barriers in seeking dental treatment. The finding by George et al.[7] reveals similar barriers but safety concerns were reported by more pregnant women followed by dental cost and time constraints. Keirse et al.[10] reported cost as a major treatment barrier. Cost as a dental treatment barrier is common in low-income countries in contrast to the developed countries where dental treatment is reimbursed through insurance.[7],[10]

Good knowledge and attitude about oral health helps in attaining better oral health status. This study revealed that 87.7% knew that routine dental visits helps keep teeth and gums healthy but only 34.7% knew the best time for a baby to have first dental visit and 30.5% said mother's poor oral health contributed to low birth weight children. Similar results were reported by the study conducted by Atarbashi Moghadam et al.[6] and Nogueira et al.[11] Nogueira et al.[11] found that only 22.44% knew when to make a dental visit for the baby.

A study on the oral health practices of pregnant Australian women reported that 99% of the subjects felt that brushing their teeth was essential.[12] A study on the periodontal status and oral hygiene practices of pregnant and nonpregnant women where they reported the prevalence of gingival bleeding was 89% among pregnant women.[13] In contrast, our study revealed that 45.40% had gum problems.

37.7% of surveyed pregnant women believed that pregnancy leads to gingival problems. They had positive attitude regarding preserving their own teeth, visiting a dentist and consumption of fruits and vegetables for good oral health. 70.5% did not want their painful teeth to be extracted. 62.2% believed that it would be useful for them to get a dental checkup during pregnancy. The results were similar to the findings by George et al.[7] and Abiola et al.[14] Abiola et al. reported 79.2% disagreed that pregnancy is a cause of gum problems, 71.3% disagreed that dental visits are unnecessary during pregnancy, and 63.8% disagreed fruits and vegetables have no effect on the teeth and gums.[14] In a study by Togoo et al.,[15] it was seen that 25.89% believed that pregnancy leads to pregnancy gingivitis.

There is a strong association between oral health with education and employment status.[14] There was a statistically significant difference in the use of dental services based on education of the respondent, their employment status, duration of pregnancy, and self-reported oral health problems. George et al.[7] also found statistically significant difference in the uptake of dental services based on annual household income (P = 0.015) and health insurance (P = 0.015), but self-reported oral health problems (P = 0.15) and education (P = 0.08) were not statistically significant. Similar results were reported by Byanaku and Rwakatema.[16] Similarly, in an assessment by Muralidharan and Merrill.,[17] there was statistically significant difference among pregnant women who visited dentist and who did not visit dentist based on their level of education and their income status.

There are few limitations of the study. One limitation is self-reported data, which often subject to biases inherent to questions being asked such as recall and social desirability biases. The other limitation is the use of convenient method of sampling. In addition, the high proportion of the educated women in the survey is not a reflection of general population. This limits to generalize of the result to the larger population. Nonetheless, the finding of this study can serve as a tool for designing appropriate oral health programs for pregnant women.


  Conclusions Top


This study provided valuable insight into the oral health knowledge and attitude of pregnant women visiting for antenatal care at maternity care center of Eastern Nepal. Most of the surveyed pregnant women had good knowledge and attitude regarding oral health care but they avoided dental care due to various constraints such as cost of dental treatment, time constraints, and safety regarding treatment during pregnancy.

Ethical clearance

Ethical Clearance was obtained from the Institutional Review Committee. Ethical clearance letter reference no: 637/070/071.

Acknowledgment

We would like to thank Dr. Sirjana Dahal for her help in conducting the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ressler-Maerlender J, Krishna R, Robison V. Oral health during pregnancy: Current research. J Womens Health (Larchmt) 2005;14:880-2.  Back to cited text no. 1
    
2.
George A, Shamim S, Johnson M, Ajwani S, Bhole S, Blinkhorn A, et al. Periodontal treatment during pregnancy and birth outcomes: A meta-analysis of randomised trials. Int J Evid Based Healthc 2011;9:122-47.  Back to cited text no. 2
    
3.
Shub A, Wong C, Jennings B, Swain JR, Newnham JP. Maternal periodontal disease and perinatal mortality. Aust N Z J Obstet Gynaecol 2009;49:130-6.  Back to cited text no. 3
    
4.
Yost J, Li Y. Promoting oral health from birth through childhood: Prevention of early childhood caries. MCN Am J Matern Child Nurs 2008;33:17-23.  Back to cited text no. 4
    
5.
Gussy MG, Waters EG, Walsh O, Kilpatrick NM. Early childhood caries: Current evidence for aetiology and prevention. J Paediatr Child Health 2006;42:37-43.  Back to cited text no. 5
    
6.
Atarbashi Moghadam F, Haerian Ardakani A, Rashidi Meybodi F, Khabazian A. Evaluation of periodontal health knowledge, attitude and oral hygiene practice of pregnant women in Yazd in 2011. J Periodontol Implant Dent 2014;5:71-4.  Back to cited text no. 6
    
7.
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. 7
    
8.
Jared H, Boggess KA. Periodontal diseases and adverse pregnancy outcomes: A review of the evidence and implications for clinical practice. Am Dent Hyg Assoc 2008;82 Suppl 1:24.  Back to cited text no. 8
    
9.
Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. Oral health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system. J Am Dent Assoc 2001;132:1009-16.  Back to cited text no. 9
    
10.
Keirse MJ, Plutzer K. Women's attitudes to and perceptions of oral health and dental care during pregnancy. J Perinat Med 2010;38:3-8.  Back to cited text no. 10
    
11.
Nogueira BM, Nogueira BC, Fonseca RR, Brandão GA, Menezes TO, Tembra DP. Knowledge and attitudes of pregnant women about oral health. Int J Odontostomatol 2016;10:297-302.  Back to cited text no. 11
    
12.
Thomas NJ, Middleton PF, Crowther CA. Oral and dental health care practices in pregnant women in Australia: A postnatal survey. BMC Pregnancy Childbirth 2008;8:13.  Back to cited text no. 12
    
13.
Nuamah I, Annan BD. Periodontal status and oral hygiene practices of pregnant and non-pregnant women. East Afr Med J 1998;75:712-4.  Back to cited text no. 13
    
14.
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.  Back to cited text no. 14
    
15.
Togoo RA, Al-Almai B, Al-Hamdi F, Huaylah SH, Althobati M, Alqarni S. Knowledge of pregnant women about pregnancy gingivitis and children oral health. Eur J Dent 2019;13:261-70.  Back to cited text no. 15
    
16.
Byanaku AK, Rwakatema DS. Oral health of pregnant women. Prof Med J 2013;20:365-73.  Back to cited text no. 16
    
17.
Muralidharan C, Merrill RM. Dental care during pregnancy based on the pregnancy risk assessment monitoring system in Utah. BMC Oral Health 2019;19:237.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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