INTRODUCTION:
Oral
health or hygiene is an important part of the general health, as well as in
pregnancy, due to the fact that the oral cavity is a ‘window’ through which
external microorganisms interact with the host.1 Researchers have
shown that a myriad of systemic diseases can manifest their effect on the oral
health of the individual.2 In addition, it has been shown that there
is a relationship between periodontal diseases and systemic conditions such as
cardiovascular diseases and diabetes, and preterm low birth weight.1,3
Based on the fact that in pregnancy there are
different dynamics of the physiology, due to hormonal changes, and periodontal
diseases are common with prevalence ranging from 30% to 100%.4,5 Due
to these hormonal changes in pregnancy these periodontal diseases, which are as
a result of inflammatory changes, are associated with destruction of the
supporting structures resulting in bone and attachment loss.6 Periodontal
diseases are known to be associated with adverse outcomes in pregnancy such as
preeclampsia, preterm labour and low birth weight.7-12 These
diseases are major causes of maternal morbidity and mortality, and by
maintaining good oral health and hygiene the adverse outcomes may be prevented.8
Obstetricians and midwives, the main specialists
caring for pregnant women, need to encourage them to maintain personal oral hygiene and to visit
the dentist regularly.2-4
Awareness of periodontal diseases has
increased in recent times but is still not up to the expected.3-4
Periodic visits to the dentist can help diagnose many oral diseases such as caries,
periodontitis and malocclusion which when detected early can be treated resulting
in better prognosis.9
In a study by Penmetsa et al., 260 pregnant
women were evaluated on the awareness of dental health in pregnancy; the respondents
were divided into 2 groups, A and B.1 Group A, with 130 respondents
had regular visits with the dentist and Group B, with 130 respondents also
never saw a dentist. Among the study participants only 3.96% of Group
A and 1.93% of Group B were aware of the association between periodontal disease
and adverse pregnancy outcome.1 When respondents were asked
regarding the advice from a gynaecologist for a dental check-up, only 7.97% and
4.92% in the respective groups responded positively.1
In a study by Boggess et al., on 599
individuals, the result showed that pregnant women have little knowledge on
oral health association with pregnancy, which varied according to maternal race
or ethnicity.4 In another study, by Gupta et al., the level of
awareness was 60% irrespective of education and age.5 A research
work by Nagi et al., showed similar results, wherein 75% of the individuals had
no knowledge regarding periodontal complications.12
Aim:
To
determine the level of awareness of oral health care amongst antenatal clinic
attendees at a private setting in Port Harcourt, Rivers State.
METHOD:
This
was a cross-sectional study involving antenatal clinic attendees conducted in a
private hospital over a period of one year. Informed consent was obtained from
subjects. The data obtained was analyzed using SPSS version 25.
Study
Location:
First
Rivers Hospital, Port Harcourt, Nigeria. Obstetrics and Gynaecology Department
is one of the key departments in the hospital with consultants in charge.
Sample
Size Determination
In
evaluating oral health awareness in pregnancy a previous study showed that 60%
of pregnant women were aware of oral health and its importance in pregnancy in
a study by Gupta et al.
Therefore, the sample size from simple proportion with 5% accuracy and 95%
level of confidence will be calculated as below.
The
required sample size was calculated from this formula:
Where:
n
= desired sample size.
z
= the standard normal deviate, usually set at 1.96, which corresponds to 95%
confidence level.
P=
the proportion (prevalence) from previous study 60%
q
= 1.0 –p
d
= degree of accuracy desired, usually set at 50% (0.05) or 2% (0.02).
Therefore, 
=
230.49
Approximately
= 240
RESULTS:
Two
hundred and forty questionnaires were analyzed for the study under review. The
mean age was 30 ± 2 years. The modal parity was 2. The mean gestational age was
20 weeks. Seventy-two (30%) of the attendees were aware of dental health care
in pregnancy; of which 48 (20%) had tertiary education while 19 (7.9%) and 5
(2.1%) of the respondents had secondary and primary levels of education
respectively.
Table
1: Summary of Results
|
Number of respondents
|
240
|
|
Mean age
|
30
± 2 years
|
|
Modal parity
|
2
|
|
Have
awareness of oral health
|
72
(30%)
|
Table
2: Education status of participants having awareness about oral health
|
Educational level
|
Number (n)
|
Percentage (%}
|
|
Primary
|
5
|
2.1
|
|
Secondary
|
19
|
7.9
|
|
Tertiary
|
48
|
20
|
|
|
72
|
30
|
Inclusion
criteria:
All
the pregnant women that consented to the study for the period under review.
Exclusion
criteria:
Pregnant
women who did not consent to the study.
DISCUSSION:
This study shows that the awareness of oral health amongst the 240 antenatal
clinic attendees that participated was 30%, this was less than half. The
awareness was highest among pregnant women with tertiary level of education (Tables
1 and 2), and was higher than that obtained by Boggess et al., on 599
individuals, which showed that pregnant women have little knowledge on oral
health association with pregnancy which varied according to maternal race or
ethnicity.4 Similarly, in a study by Gupta et al., low level of awareness (60%) was reported irrespective of
education and age.5 Nagi et al. in their study on pregnant women
reported that 75% of participants had no knowledge regarding periodontal
complications.⁶
Inference was made
of low awareness by gynaecologists on the relationship between pregnancy and
periodontal disease.1 Periodontal diseases are known to be
associated with adverse effects in pregnancy such as preeclampsia, preterm
labour and low birth weight.1-4 These diseases in pregnancy are
major causes of maternal morbidity and mortality.1,2 By maintaining
good oral health and hygiene the adverse outcomes may be prevented.3-4
In a study by Penmetsa et al. 260 pregnant women were evaluated on the
awareness of dental health in pregnancy, the study participants were divided
into two groups, A and B.¹ Group A with 130 respondents had visited a dentist,
and Group B with 130 respondents also never saw a dentist in their lifetime. Among
the study participants, only 3.96% of Group A and 1.93% of Group B were aware
of the association between periodontal disease and adverse pregnancy outcome.1,7-14
CONCLUSION:
Oral health is an
important aspect of general health and taken cognizance of during antenatal care.
However, from this study, the awareness of oral health amongst pregnant women
was relatively poor, far below 50%.
There is the need to incorporate oral health care (hygiene/education) in
routine antenatal talks. Furthermore, increased awareness by pregnant women
regarding oral health, more importantly periodontal diseases, is likely to lead
to seeking early evaluation by a dentist following referral by the attending obstetrician
and gynaecologist, or midwife.
Maintaining good oral health is a stepping stone in preventing pregnancy
complications associated with poor oral health such as pre-eclampsia,
prematurity and low birth weight.
Oral health education inclusion in the antenatal clinic talks will
invariably lead to improvements in health seeking behaviour of pregnant women
with regard to oral diseases, and expectedly, lead to better perinatal and maternal
outcomes. It also helps in the prevention of the transmission of cariogenic pathogens
from the mothers to the children in later life.
Conflict of interest:
Authors have declared that there was no
conflict of interest.
Acknowledgement:
Mother, Baby and Adolescent Care Global
Foundation.
Ethics:
Guidelines in line with Helsinki’s declaration
(revised 13th edition).
REFERENCES:
1.
Penmetsa
GS, Meghana K, Bhavana P, Venkalakshmi M et al. Awareness, Attitude and
Knowledge Regarding Oral Health among Pregnant women. A comparative study.
Niger Med J 2018;59(6):70-73.
2.
Kane
SF. The effects of oral health on systemic health. Gen Den 2017;65:30-4.
3.
Ramamurthy
J, Fathima I. Assessment of knowledge and awareness about periodontal oral
health among pregnant women – A questionnaire study. Int J Curr Res Rev 2017;9:
9-17.
4.
Boggess
KA, Urlaub DM, Moos MK, Polinkovsky M et al. Knowledge and beliefs regarding
oral health among pregnant women. J Am Dent Assoc 2011;142: 1275-82.
5.
Gupta
S, Jain A, Mohan S, Bhaski N, Walia PK. Comparative evaluation of oral health
knowledge practice and attitude of pregnant women and their awareness regarding
adverse outcome. J Clin Diagn Res. 2015;9:ZC26-32.
6.
Nagi
R, Sahu S, Nagaraju R. Oral health, nutritional knowledge and practice among
pregnant women and their awareness relating to adverse pregnancy outcomes. J
Indian Acad Oral Med Radiol 2016;28:396-402.
7.
Rogers
SN. Dental attendance in a sample of pregnant women in Birmingham, UK.
Community Dent Health 1991;8:361-8.
8.
Ayamolowo
LB, Esan AO, Ibitoye OS et al, Oral health behavior of pregnant women in
Nigeria: a scoping review. BMC Oral Health 2024; 24:971.
9.
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(3):601-11.
10.
Azadbakht
K, Baharvand P, Artemes P, Niazi M, Mahmoudvand H. Prevalence and risk factors
of oral cavity parasites in pregnant women in Western Iran. Parasite Epidemiol
Control 2022; 19:e00275.
11.
Adesina
KT, Ernest MA, Tobin AO, Isiaka-Lawal SA, et al. Oral health status of pregnant
women in Ilorin, Nigeria. J Obstet gynaecol. 2018;38(8): 1093-8.
12.
Umoh
AO, Savage KO, Ojehanon PI. Association between maternal Gingivitis, Low Birth
Weight and Preterm Delivery. JMBR. 2013: 12(1):65-75.
13.
Uwambaye
P, Munyanshongore C, Rulisa S, Shian H et al. Assessing the Association between
Periodontitis and premature birth: a case–contol study. BMC Pregnancy
Childbirth 2021;p:21.
14.
Adeniyi
A, Donnelly L, Jansesen P, Jevitt C, von Bergman H et al. A qualitative study
of Health Care Providers’ views on integrating oral health into prenatal care.
JDR Clin Trans Res. 2021;6(4): 409-19.
