|ORIGINAL RESEARCH REPORT
|Year : 2017 | Volume
| Issue : 3 | Page : 119-125
Oral health in pregnancy: Self-reported impact of exposure to oral health information
Clement C Azodo1, Vivian O Omuemu2
1 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
2 Department of Community Health, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||17-Aug-2017|
Clement C Azodo
Room 21, 2nd Floor, Prof. AO Ejide Dental Complex, University of Benin Teaching Hospital, PMB - 1111 Ugbowo, Benin City - 300001, Edo State
Source of Support: None, Conflict of Interest: None
Introduction: There is dearth of information on the impact of oral health information on knowledge and belief of oral health among pregnant women. The objective of the study was to determine the impact of oral health information on oral health knowledge and belief among Nigerian pregnant women. Materials and Methods: This cross-sectional survey was conducted among pregnant women attending the antenatal clinic (ANC) of a large university teaching hospital in Benin City, Nigeria, using interviewer-administered questionnaire as data collection tool. Descriptive and regression statistics were performed on data collected using SPSS version 17.0. P <0.05 was considered statistically significant. Results: A total of 410 pregnant women with a mean age of 29.6 ± 5.3 years participated in this study. Of the participants, 94 (22.9%) exhibited adequate overall oral health knowledge. The significant determinants of oral health knowledge were ever received oral health information and receipt of oral health advice in pregnancy. About two-thirds (61.5%) of the participants held erroneous oral health believes. The erroneous oral health belief was significantly higher among the unmarried, multiparous, nonchristians, illiterate, and nonprofessional indigenous participants. Educational attainment emerged as the only significant predictor of good oral health belief. Conclusion: Data from this study revealed that exposure to oral health information exerted a significant positive impact on oral health knowledge but not on belief of the studied pregnant women. Exploration of the quality and mode of receipt of oral health information among pregnant women is recommended.
Keywords: Attitude information, knowledge, oral health, pregnant women
|How to cite this article:|
Azodo CC, Omuemu VO. Oral health in pregnancy: Self-reported impact of exposure to oral health information. J Clin Sci 2017;14:119-25
| Introduction|| |
Oral health is recognized as a critical component of overall health, longevity, and well-being. This was collaborated in World Health Organization (WHO) dedicating the 1994 World Health Day to Oral Health with a focus on the promotion and further development of oral health and oral health care. The two supreme governing bodies of WHO, the World Health Assembly (WHA) and the Executive Board, also made oral health the subject of discussion and agreed on an action plan for oral health for the first time in 25 years.
Oral diseases are among the most prevalent and preventable chronic health conditions in the world, impacting negatively on the oral, general, and reproductive health of women, their quality of life, and the oral health of their children., These oral diseases which are on the increase in developing countries  are known to be common in pregnant women due to changes in hormones, immunity, oral microflora and diet, poor oral health awareness, erroneous beliefs, and poor oral health practices. Pregnancy is known to affect oral tissues with the most frequent and greatest changes occurring in the gingival tissue due to the hormonal (estrogen and progesterone) fluctuations' levels in combination with oral flora change and decreased immune response. These hormonal changes in addition to inadequate daily mouth care also increases the susceptibility to dental caries and periodontal diseases in pregnancy. However, preventive measures such as oral health education, dietary control, professional oral prophylaxis, correct tooth brushing, and interproximal cleaning have been shown to improve and facilitate the maintenance of oral health. The improvement of oral health and the prevention of oral diseases among pregnant women is necessity because it reduces the transmission of cariogenic bacteria from mothers to children, thereby delaying the onset of childhood caries. Despite the fact that pregnant woman are particularly amenable to disease prevention and that health promotion interventions can enhance their health and that of their fetus, they rarely receive guidance about proper preventive dental and oral health care. Honkala and Al-Ansari  reported that most pregnant do not receive instructions concerning oral health care during their pregnancy.
Few studies on oral health knowledge and attitude have been conducted among pregnant women in developing countries, despite the fact that oral health knowledge is considered an essential prerequisite for health-related behavior that may result in better oral health., The majority of the previous studies on oral health of pregnant women were mainly concerned about their oral health status and treatment needs which were either perceived or normatively determined. A few others assessed the knowledge, attitude, and practices of pregnant women toward child oral health. The studies on oral health knowledge, attitude, and practices of pregnant women in Nigeria assessed neither source of oral health information nor the effect of oral health information on oral health knowledge and belief., The source of oral health information in comparison to other health information is relatively understudied with attendant paucity of information. There also exists gap in knowledge on the impact of oral information on oral health knowledge and belief. The increasing information on the effects of oral diseases on pregnancy and pregnancy outcome  also makes improvement of oral health of pregnant women, a vital research area and the concern of everybody in the community-both oral health and nonoral health professionals. The objective of the study was to determine the impact of oral health information on oral health knowledge and attitude among Nigerian pregnant women.
| Materials and Methods|| |
The protocol for this study was reviewed and approval granted by the Ethics and Research Committee of University of Benin Teaching Hospital, Benin City, Nigeria. Written informed consent was obtained from the participants. Participation was voluntary, and no incentive was offered.
Study design/study setting
This was a cross-sectional study among pregnant women attending antenatal clinic (ANC) of University of Benin Teaching Hospital, Benin City, Nigeria. University of Benin Teaching Hospital is a large university teaching hospital in Benin City. It is the most preferred hospital for pregnant women seeking antenatal services in Benin City and environs because it offers effective maternal and child health-care services at reasonable prices.
Using the Cochran  statistical formula (N = Z2Pq/d2), the minimum sample size for the study was 384 where Z = 95% confidence interval, P (the prevalence of pregnant women with good knowledge) was set at 50%, q was equal to 1 − P, and d is minimum acceptable degree of error which is set at 5%.
Pregnant women that registered and are attending ANC irrespective of the trimester of their pregnancy constituted the study population. A systematic random sampling technique was used in selecting every third registered pregnant woman until the minimum sample size was achieved. The selected pregnant women were tracked and contacted during their routine antenatal appointment day. However, pregnant women previously diagnosed as being diabetic or HIV-positive were excluded from the study because these disease conditions are associated with increased occurrence of oral diseases. Pregnant women who did not consent were also excluded.
Data collection tool
An 18-item interviewer-administered questionnaire was the data collection tool. The questionnaire was developed by the researchers and validated by experts in oral health epidemiology. The questionnaire was subsequently pretested among twenty pregnant women attending a secondary health facility in Benin City. The average completion time for the questionnaire obtained during the pretest was 10 min. One of the researchers, a dentist of 8 years working experience, administered the questionnaires.
The questionnaire elicited information on demographic characteristics, exposure and sources of oral health information, and receipt of oral health advice during pregnancy. The first seven questions assessed the demographic characteristics (age, marital status, parity, religion, ethnicity, educational attainment, and occupation). The oral health knowledge was assessed using the responses to six questions which elicited the information on the knowledge of effect of pregnancy on oral tissues, etiology and transmissibility of dental caries, oral health link with general health, effect of periodontal disease on pregnancy outcome, effect of tetracycline on developing teeth of fetus, and ingestion of calcium and vitamins in the current pregnancy. The assessment was done on initial response to each question and subsequently collated together to ascertain the overall oral health knowledge. The response to question on the effect of pregnancy on oral tissues was scored as follows: no knowledge – 0; partial knowledge – 1; and full knowledge – 2. The correct response to other questions on knowledge was scored 1, while incorrect or no response was scored 0. The minimum and maximum score for knowledge was 0 and 7, respectively. The score 0–3 was considered inadequate oral health knowledge while score 4–7 was considered adequate oral health knowledge. The mean values obtained from the pilot study was rounded up to the nearest whole number and considered to be the lower limits of adequate knowledge. This adopted cutoff method has been similarly used in a previous oral health study in Nigeria. The belief on tooth loss during pregnancy and the effect of maternal nutrition on fetal tooth development were the two questions that assessed oral health belief. The response to the question on belief was rated in Likert scale as strongly agree, agree, undecided, disagree, and strongly disagree. The scoring on the belief that maternal nutrition affect fetal tooth development was strongly agree = 5, agree = 4, undecided = 3, disagree = 2, strongly disagree = 1, and no response = 0. The response to question on belief on tooth loss during pregnancy was reversed score as no response = 0, strongly agree = 1, agree = 2, undecided = 3, disagree = 4, and strongly disagree = 5. The reverse score was based on the fact that agreement with the assessed belief is an erroneous belief. The minimum score was 0 and maximum score was 10. The cutoff for the positive belief was the score of 5. Those with score of below 5 were considered to have erroneous oral health belief while those with scores of 5 and above were considered to have correct oral health belief.
Descriptive statistics (simple frequency and percentages) and test of significance (Chi-square statistics), binary logistic regression, were performed on data collected using Statistical Package of the Social Sciences version 17.0 (Chicago, IL, USA). In the binary logistic regression, oral health knowledge and beliefs were independently considered as dependent variable while demographic characteristics, ever received oral health information, and receipt of oral health advice in pregnancy were considered as independent variable. P <0.05 was considered statistically significant.
| Results|| |
A total of 410 pregnant women with a mean age 29.6 ± 5.3 years participated in the study. The majority (63.4%) were younger than 30 years, unmarried (97.6%), multiparous (57.1%), Christians (95.6%), and indigenous population (63.9%). Most had no tertiary education (53.4%) and were nonprofessionals (57.8%). The predominant perceived risk factors of dental caries reported by the participants were sugar (46.8%) and worms (28.8%). A total of 9.3% of the participants reported that pregnancy affects the teeth and the gum (full knowledge), gum only (6.8%) (partial knowledge), and teeth only (3.4%) (partial knowledge). About one-fifth (19.5%) of the participants exhibited correct knowledge of the transmissibility of dental caries and 28.3% of the participants rightly reported that maternal oral disease affects fetal growth. Three-quarters (75.6%) of the participants recognized that oral health is an important component of general health and 38.5% of the participants correctly reported that maternal tetracycline ingestion affects fetal tooth development. Three-quarters (75.2%) of the participants had taken calcium, milk, and vitamins during this pregnancy. Less than one-third of the participants (26.1%) reported receiving oral health advice during pregnancy [Table 1]. The main sources of information among the participants were doctors (22.9%), television (14.1%), and dentists (14.1%). About one-fifth (19.5%) of the participants reported nonexposure to oral health information [Table 2]. A total of 27.8% and 15.1% of the participants strongly agreed and agreed that maternal nutrition affect their fetal teeth development, respectively. Three-quarters (75.1%) of the participants disagreed overall [disagreed 176 (42.9%) and strongly disagreed 123 (32.2%)] that pregnant women usually lose their teeth with pregnancy [Table 3].
|Table 1: Oral health knowledge and receipt of advice on oral health care among the participants|
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Of the participants, 22.9% exhibited adequate overall oral health knowledge. This adequate knowledge was higher among the nonindigenous participants (P = 0.048), those that have ever received oral health information (P < 0.001) and those that acknowledged the receipt of oral health advice in pregnancy (P = 0.002). About two-thirds (61.5%) of the participants held erroneous oral health belief. This was significantly higher among the unmarried, multiparous, nonchristians, indigenous participants, nontertiary educational attainment, and nonprofessionals [Table 4]. The determinant of oral health knowledge was ever received oral health information and the receipt of oral health advice in pregnancy while the determinant of oral health belief was educational attainment [Table 5].
|Table 4: Overall oral health knowledge and belief among the participants|
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|Table 5: Determinants of the overall oral health knowledge and belief among the participants|
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| Discussion|| |
Dental caries is acquired chronic infective disease process caused by the acidic by-products of bacteria inhabiting organized dental plaque and if left undisturbed demineralize the enamel surfaces of the teeth. The etiology of dental caries is multifactorial which includes increased consumption of refined carbohydrates, particularly sucrose, relatively poor oral health-care standards and susceptible tooth. In this study, a little less than half (46.8%) of the participants correctly identified sugar as a risk factor. Historically, worm with blackhead was wrongly advocated to be the cause of dental caries in the early twentieth century. This wrong knowledge has persisted among the public and this may have been the reason why 28.8% of the respondents in this study still upheld such knowledge. This lack of adequate knowledge about oral diseases and their prevention is similar to the findings among pregnant women studied in a tertiary hospital in Nigeria.
Pregnancy is an opportune time to educate women on health; therefore, educating pregnant women about periodontal disease and dental caries prevention is critical for the achievement of optimal oral health for the mothers and their children. However, only 26.3% of the respondents received advice on how to care for their babies teeth in this study. This is similar to the findings of a study among pregnant women in Kuwait where most of the women did not receive instructions concerning oral health care during their pregnancy. Despite the fact that pregnant women are particularly amenable to disease prevention and health promotion interventions which could enhance their health and that of their fetus, it means that this opportunity is not being harnessed in the ANC where this study was conducted. The lack of oral health information given by health professionals may also be due to the lack of training and guidelines in this area. Adoption of international guideline on the provision of oral health education by prenatal care providers to bring about changes in health-care delivery and improve the overall standard of care is necessary in Nigeria.Streptococcus mutans, the bacteria primarily responsible for initiation of dental caries, is usually passed from saliva of mothers or caregivers to their children when they kiss or share food with them., High titers of mutans streptococci exist in the saliva of women who have experienced extensive tooth decay increasing their chances of transmitting it to their infants. In this study, only 19.5% of the respondents were aware of the transmissibility of dental caries from mothers to their children. Nulliparous women revealed higher knowledge, but a study conducted among pregnant and nursing mothers in Japan revealed that nursing mothers had better knowledge than the pregnant women, suggesting that health education during pregnancy will be effective in promoting dental health knowledge.
In this study, only 9.3% of the respondents knew that pregnancy affects teeth and gums which was <80.6% of the mothers in Saudi Arabia who reported that pregnancy has effect on teeth and gums. In Southern Finland, a survey of pregnant women living at the Lohja municipal health center area revealed that 47% of them were of the opinion that pregnancy is detrimental to dental health. The physiological state of pregnancy exerts adverse effects on almost all the systems of the body and contributes to oral pathologies by affecting the teeth and gum both directly and indirectly. The most prominent of these oral problems are gingival changes. These may have led 28 (6.8%) of the participants to report that pregnancy affects gums only. Health of women is particularly important as it serves as indicator of health of the family especially children. The importance of oral health in pregnancy has been documented a long time ago, but recent links between maternal periodontal disease and pregnancy outcome have enhanced and accentuated its importance. Maternal periodontal diseases have been documented to be associated with adverse pregnancy outcomes such as preterm babies, low birth weight babies, and gestational diabetes. The optimal period for introducing preventive measures in pregnant women, which will help in providing conditions for the proper development of fetal teeth as well as preventing tooth decay in pregnant women, is the first trimester of pregnancy. In this study, 28.3% of them knew that maternal oral disease affects fetal growth and development which is lower than values reported in previous studies among postnatal American mother (43.0%), Saudi Arabian mothers (69.7%), and Greek pregnant women (72.2%).
Tetracycline is a common antibiotic used in self-medication for diarrhea among Nigerians. Ingestion of tetracycline during pregnancy causes hypoplasia of deciduous teeth because it can cross the placenta gets incorporated into the teeth during calcification which starts 3–4 months in utero. In this survey, 38.5% of the respondents knew that tetracycline affects fetal tooth development. Three-quarters (75.6%) of the respondents recognized that oral health is an important component of general health. In recent years, health professionals have become increasingly aware that the soft and hard tissues of the mouth and their function contribute significantly to women's general health and quality of life.
The most common source of oral health information was doctors followed by dentists and television. Similarly, a study among Nigerian undergraduates revealed doctors as their predominant sources of oral health information. This differed with findings from Kuwaiti  and Chinese mothers  who were mostly informed about oral health through television/radio. The low oral health manpower, inequitable distribution of oral care centers, and fear of dentist may account for the reason why oral health information were more from the doctors rather than from dentists. This is substantiated by the high consultation of doctors for oral health problems in Nigeria. A reasonable number of the participants had tertiary level of education which may responsible for 13.7% of them having their oral health information from books and schools they attended.
Factors such as tetracycline use, pregnancy toxemia, prolonged or difficult delivery, uncontrolled diabetes, and a number of viral infections can contribute to enamel hypoplasia in an infant. An adequate diet during gestation is important for optimal dental development of the fetus. In this study, 42.9% of the respondents agreed and strongly agreed that that diet and nutrition affect their fetal teeth development. Teaching related to oral health during pregnancy should include the importance of proper nutrition to ensure maternal and fetal oral health, including taking prenatal vitamins and eating foods high in protein, calcium, phosphorus, and Vitamins A, C, and D which is consistent with the international guidelines on oral health-care provision by prenatal providers., Development of deciduous teeth begins between the 3rd and 6th month of pregnancy therefore getting the right and receive sufficient amounts of nutrients, including Vitamins A, C and D, protein, calcium, folic acid, and phosphorous will help to ensure healthy development of the dentition. In this study, 75.2% of the participants reported taking calcium, milk, and vitamins during this pregnancy.
Adequate overall oral health knowledge exhibited by 22.9% of the participants in this study was comparable to the 27.2% reported in a previous study in another geographical location in Nigeria. This adequate knowledge was significantly higher among the nonindigenous participants, those who have ever received oral health information and those who acknowledged the receipt of oral health advice in pregnancy. However, the determinant of oral health knowledge was ever received oral health information and the receipt of oral heal advice in pregnancy. The implication is that exposure to oral health from any source and the receipt of oral health advice in pregnancy will facilitate oral health awareness and improvement. Report of improved oral health knowledge and attitude of pregnant women following educational programs exists in the literature.,,
Receipt of advice on oral hygiene among pregnant women from dentist has been reported to increase their likelihood of having high oral hygiene in pregnancy by 146% when compared with their counterparts who had not been advised before. It is therefore necessary to carry out, a proper oral health prevention, and adequately inform and motivate pregnant women, so that we could have satisfied mothers and caries free children in the future as great interest exists for all preventive oral health measures and dental procedures during pregnancy. About two-thirds (61.5%) of the participants held erroneous oral health belief. This was significantly higher among the unmarried, multiparous, nonchristians, Edo, nontertiary educational attainment, and nonprofessionals. Erroneous oral health belief has also been reported among Saudi Arabian mothers. The only determinant of oral health belief was educational attainment. It confirmed that improvement of educational attainment is necessary to correct erroneous harmful oral health beliefs. Boggess et al. also found that oral health beliefs varied according to maternal education.
| Conclusion|| |
Overall, the oral health knowledge of pregnant women was inadequate. The major sources of oral health information were doctors, dentists, and television. Exposure to oral health information exerted a significant positive impact on oral health knowledge but not on belief of the studied pregnant women. Exploration of the quality and mode of receipt of oral health information among pregnant women is recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]