Consideration of Oral Health and Periodontal Diseases During Pregnancy: Knowledge and Behaviour Among French Pregnant Women

Frequency and factors associated with the utilization (curative and preventive) of oral health care services among pregnant women in Kinshasa, Democratic Republic of Congo

BACKGROUND

The Democratic Republic of Congo (DRC) has one of the highest maternal and neonatal mortality rates in Africa. There is a growing body of evidence about the relationship between poor oral health and adverse pregnancy outcomes. However, there is a lack of information about oral health status during pregnancy in the DRC. This study aimed to identify the factors related to the utilization of oral health care services among pregnant women.

METHODS

A hospital-based cross-sectional study was conducted in four health facilities representing each administrative district of the city of Kinshasa, between March and May, 2021. The study population comprised pregnant women aged at least 18 or over attending antenatal care (ANC), selected using a simple random sampling technique. Data were collected using a structured questionnaire. Multivariable logistic regression was employed to identify factors associated with the outcome variable using the adjusted odds ratio (AOR) with its 95% confidence interval (95% CI) and p value  <  0.05.

RESULTS

A total of 5% of the 500 pregnant women who participated in the study were identified as users of oral healthcare services. 15% of pregnant women were aware of the necessity of oral health care during pregnancy, while 58% indicated that dental visits for routine and/or treatment purposes were not a priority during pregnancy. Factors associated with its utilization were knowledge of the need for oral health care during pregnancy (AOR:3.62, 95% CI: 1.42-9.26), knowledge of the importance of routine visits or dental treatment for oral diseases during pregnancy (AOR: 4.94, 95% CI: 1.70-16.73), and having experience oral health problem during the current pregnancy (AOR: 3.13, 95% CI: 1.22-8.21).

CONCLUSION

The utilization of oral health care services during pregnancy is very low. Appropriate public health initiatives are urgently needed to facilitate collaboration between health professionals to integrate oral and dental consultations, oral health counseling, and check-ups as an essential component of routine ANC.

Oral Health Knowledge, Attitudes, Practices, and Literacy of Pregnant Women: A Scoping Review

PURPOSE

Pregnancy is a state particularly sensitive to oral pathologies (periodontal and decay). The oral health status of pregnant women can have an impact on the outcome of the pregnancy and the oral health of the child to come. As in the general population, the oral health of pregnant women is socially determined and dependent on psychosocial factors, including factors related to health behaviours. Research into the determinants of oral health in pregnant women will allow a better understanding of the mechanisms of action specific to this period of perinatality.

MATERIALS AND METHODS

The methodology of a scoping review was selected with the objective of investigating the contribution of knowledge, attitudes, practices (KAP) and oral health literacy on pregnant women's oral health.

RESULTS

Of the 67 articles selected, 52 studied the 'knowledge' component, 27 the 'attitude' (including the perception and beliefs concerning health), and 54 the 'practice' component, while 6 articles examined literacy. The KAP components were studied in relation to socioeconomic determinants, oral health status, healthcare utilisation and oral health literacy. The level of oral health literacy of pregnant women is strongly related to their living environment and socioprofessional level which influences their attitudes and practices. Woman's oral health practices before pregnancy can be a predictor of her practices during pregnancy.

CONCLUSION

The complex nature of the attitude component (locus of control, sense of self-efficacy, perceived importance) is little discussed. The heterogeneity and exhaustiveness of topics related to KAP raises the question of how to more accurately assess KAP in pregnant women in a valid, reproducible, and transferable manner and the need to build a structured oral health consensus body of work. This review is a first step towards identifying the psychosocial factors that are essential for developing a model of educational intervention in oral health that combines the process of behavioural change and decision making while taking into account the concept of empowerment, and with the aim of reducing social inequalities in health.

Periodontal Diseases and Pregnancy: Knowledge and Clinical Practice Habits of French Midwives

PURPOSE

Several studies have demonstrated the role of periodontal disease as risk factor of adverse pregnancy outcomes, including preterm birth, low birthweight and pre-eclampsia. As such, midwives can play an essential role in prevention and early screening as the preferred intermediary of pregnant women. The purpose of this study was to assess the knowledge, training and daily practice habits of midwives to determine if they fulfill their role in oral health prevention.

MATERIALS AND METHODS

A questionnaire was sent by e-mail to practicing midwives and fifth-year midwifery students in the Brittany region of France. Data were collected online and descriptive data analyses were conducted.

RESULTS

A total of 192 practicing midwives and 13 students participated in the survey. The results showed that the majority of midwives were not familiar with the correlation between periodontal disease and adverse pregnancy outcomes and did not implement screening and prevention to a sufficient extent.

CONCLUSION

The explanation for this lack of knowledge seems to come from the initial training, since the topic of oral health is almost never discussed during midwives' studies. Most agreed they needed more training on periodontal disease and adverse pregnancy outcomes. Improving and integrating oral health education into the midwife academic curriculum can enhance midwives' engagement in oral health.

Oral Health and Knowledge among Postpartum Women

Oral health behavior and risks during pregnancy and after birth affect the oral health of babies and toddlers. We examined the oral and gingival health and caries prevalence of 150 postpartum women shortly after giving birth and assessed their knowledge of oral hygiene using a questionnaire. We also compared the oral health knowledge of nulliparous and multiparous women. Although most participants (98.0%) understood the importance of maintaining oral hygiene in children, their overall knowledge of oral health was medium-low, regardless of the number of previous pregnancies. Only 4.6% of women received oral health advice from their obstetrician during their pregnancy. Most participants had a high gingival index score, which correlated with dental pain during pregnancy. In contrast, the number of decayed, missing and filled teeth was significantly lower in first-time mothers. There was a statistically significant positive correlation between women who regularly visit their dentist and those who regularly take their children to the dentist. Expecting mothers should be educated about their own oral health and that of their developing fetus and children. Raising awareness among obstetricians with regards to this topic may be an effective way to achieve this.

Oral Hygiene Practices and Awareness of Pregnant Women about the Effects of Periodontal Disease on Pregnancy Outcomes

Objectives

Adverse pregnancy outcomes, such as preterm low birth weight (PTLBW), is a severe public health issue that needs to be dealt with by educating the general female population, dental practitioners, and gynecologist. One of the major contributing factors is periodontal disease, which accounts for about 18.2% of all PTLBW cases worldwide, and prevention of the same could reduce the occurrence of PTLBW babies. This study aimed to assess the oral hygiene practices and awareness of pregnant women about the effect of periodontal disease on pregnancy outcomes.

Methods

A descriptive cross-sectional study was conducted where 400 pregnant women after consent were requested to complete an anonymous, self-administered, structured questionnaire with twenty-one close-ended questions.

Results

Only 5% of participants in this study reported that gum diseases during pregnancy lead to preterm labor or low birth weight babies. About 70.7% of pregnant women mentioned that they did not use any interdental cleaning aids, and 54.5% did not use mouthwashes.

Conclusion

Tooth brushing practices among pregnant women were good; however, there was an overall lack in the use of adjunctive aids. The study highlighted a deficiency in the awareness of pregnant women regarding the association between periodontal disease and adverse pregnancy outcomes.

Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring

Periodontal disease (PD) is one of the most common oral conditions affecting both youths and adults. There are some research works suggesting a high incidence of PD in pregnant women. As an inflammatory disease of bacterial origin, PD may result in the activation of the pathways affecting the course and the pregnancy outcome. The authors, based on the literature review, try to answer the PICO question: Does maternal periodontitis (exposure) influence the incidence of complications rates in pregnancy and the development of systemic diseases in childhood and adult offspring (outcome) in the humans of any race (population) compared to the offspring of mothers with healthy periodontium (comparison)? The authors try to describe the molecular pathways and mechanisms of these interdependencies. There is some evidence that maternal periodontitis may affect the pregnancy course and outcome, resulting in preeclampsia, preterm delivery, vulvovaginitis and low birth weight. It can be suggested that maternal periodontitis may affect offspring epigenome and result in some health consequences in their adult life.

A Survey on Oral Health Knowledge, Attitudes and Practices of Pregnant Women Attending Four General Health Hospitals in Switzerland

PURPOSE

To evaluate the knowledge and practices of Swiss women regarding oral health during pregnancy.

MATERIALS AND METHODS

Self-reported questionnaires were attributed to 385 women from 4 public hospitals in the French speaking part of Switzerland from February 2015 to June 2016.The questionnaire consisted of 32 questions including demographic characteristics, oral health habits and awareness of oral changes during pregnancy.

RESULTS

The majority of women (64%) were in the 3rd trimester of pregnancy and had a university education (41%). Oral health was considered very important for half of the women (52%) and moderately important for 38% of them. 71% of the women did not notice any change concerning their oral health conditions. Of the remaining 29%, gingival bleeding was the main symptom reported, followed by gingival redness and oedema. Pain and sensitivity were also reported by a few participants. Most of the pregnant women attended dental appointments during their pregnancy, but not on a regular basis, mainly because of lack of time. Almost half of the population had an adequate oral hygiene routine and adapted their eating habits to a much healthier pattern during pregnancy. A large proportion of the participants (71%) was aware that pregnancy renders teeth and gums more vulnerable and that oral health is related to adverse pregnancy outcomes. However, this information was rarely imparted to them by health professionals.

CONCLUSION

Although pregnant women in the French speaking part of Switzerland seem to be moderately informed about the importance of oral health during pregnancy, health-care professionals do not seem to participate actively. Health professionals need to more actively inform pregnant patients about the importance of preventive oral health measures and oral health care during pregnancy.