Coalition of attitude and practice behaviors among dental practitioners regarding pregnant patient's oral health and pregnant patient's perception toward oral health in and around Pondicherry.

BACKGROUND: This study aims to evaluate the knowledge, attitude, practice behaviors among general dental practitioners and assess the perception toward oral health by pregnant patients in and around Puducherry.
METHODOLOGY: A self-designed and structured questionnaire was used to obtain information from the dental practitioner and the pregnant patients.
RESULTS: The majority of the dental practitioners had a lack of knowledge, attitude, practice behaviors regarding pregnant patient's oral health and similarly majority of pregnant patient's perception toward oral health was poor.
CONCLUSIONS: Drowning and dilemmatic attitude and practice behavior of dentists to be streamlined to render right care to the pregnant women at the right time. Perplexing perception toward oral health care by pregnant women to be overcome to orient them to understand the impact of oral health on their general systemic health.

During the past few years, there has been increasing interest in the oral health of pregnant women due to the fact that they do not access oral health care, despite evidence that poor oral health can have an adverse impact on the health of themselves and their child. There are a few reasons behind this, and one of them is the reported association between maternal periodontal infection during pregnancy and obstetric complications including preeclampsia and premature birth. The physiological hormonal changes during pregnancy can manifest in the oral cavity as gingivitis, periodontitis, and benign lesions (pregnancy tumors). Apart from these hormonal changes, dietary factors play a role in developing tooth decay. Hence, a dentist must be qualified in terms of knowledge, possess the attitude, and implement practice behavior management while providing dental health care to pregnant women. It is equally imperative that pregnant women are sensitized to the facts regarding the impact of oral heath on their systemic health irrespective of their myths and fears related to dental treatment during the period of pregnancy. The purpose of this study was to evaluate the knowledge, attitude, practice behaviors and barriers regarding prenatal oral health care among general dental practitioners, and to assess the perception toward oral health by pregnant patients in and around Puducherry.

Methodology

With the help of yellow pages of Puducherry and Indian Dental Association, Puducherry branch approximately 150 general dentist were found to be practicing in Puducherry, and sample size was calculated with sample size calculator software by keeping confidence level as 95 and confidence interval as 5. With the help of monthly outpatient statistics in Department of Obstetrics and Gynecology of Mahatma Gandhi Medical College and Research Institute, approximately 800 pregnant women were recorded as new patients every month. Keeping confidence level as 95 and confidence interval as 5 the sample size was generated with the sample size generator software.

Subject validation

Two questionnaires were prepared. The first questionnaire was on the attitude and behavior among private practitioners in and around Puducherry regarding pregnant patient's oral Health, which was framed from the reference articles. The second questionnaire was on pregnant women perception toward their oral health, which was again framed from the reference articles.

Object validation

A pilot study was done on both general dental practitioners and pregnant women. The questionnaires were given to a number of 10 dentists and 10 pregnant women and reliability, and the validity of the questionnaires were assessed.

The attitude and behavior among private practitioners in and around Puducherry regarding pregnant patient's oral health were assessed with a pretested questionnaire. Another pretested questionnaire on perception toward their oral health was given to pregnant women reporting to Department of Obstetrics and Gynecology according to the inclusion criteria for the study. A quiet and calm environment was maintained that is comfortable for the patient. The patient's privacy was maintained and confidentiality ensured. Initial assessment of the dental practitioner and the pregnant women were done, and data were collected in a structured proforma. This was followed by the assessment of attitude and practice behaviors using the formatted questionnaire form comprising a comprehensive set of questions. The pregnant women were explained how to fill the questionnaire form. They were instructed to point to an answer on each question that describes the best how they felt. Data collected from the assessment form were well documented and statistically analyzed by frequency and percentage distribution, following which the results were calculated.

Results

1. Attitude and behavior among private practitioners

Only 17.6 % felt safe to perform dental care to pregnant women [Figure 1]

Figure 1

Questionnaire on the attitude and practise behaviours among private practitioners

Only 27.8 % have received any specific information on dental care to pregnant women [Figure 1]

63.9 % dentist only felt that emergency care be performed throughout pregnancy [Figure 1]

50 % of dentist only consider consulting patient's obstetrician a must [Figure 2]

Figure 2

Questionnaire on the attitude and practise behaviours among private practitioners

10.2 % consider dental imaging, a safe procedure throughout pregnancy [Figure 2]

30.6 % agree that delay in dental treatment would affect both the mother and child [Figure 2]

41.7 % of dentist only consider the legal risk associated with negative outcomes as a barrier for inappropriate oral health care of pregnant patients [Figure 3]

Figure 3

Questionnaire on the attitude and practise behaviours among private practitioners

16.7 % of dentist only have participated in continuing education courses on management of pregnant patients during your professional period [Figure 3].

2. Perception towards oral health by pregnant women

78.1% feel that oral health check up should be a routine component of monitoring pregnant women [Figure 4]

Figure 4

Questionnaire on the perception towards oral health by pregnant women.

Only 11.9 % agree that poor oral health could lead to premature birth [Figure 4]

91.2 % feel dental treatment during pregnancy is unsafe for the unborn baby [Figure 4]

Only 14.6 % feel dental treatment can be done during pregnancy [Figure 5]

Figure 5

Questionnaire on the perception towards oral health by pregnant women.

93.5 % feel routine dental check up will facilitate the pregnant women with an access to treatment at an early stage [Figure 5]

71.2 % feel dental treatment during pregnancy will transmit any infection to the fetus [Figure 5]

88.1 % feel getting dental treatment done during pregnancy is emotionally stressful [Figure 6]

Figure 6

Questionnaire on the perception towards oral health by pregnant women

84.2 % agree undergoing dental check up during pregnancy does not eliminate current or future risk of dental caries / problems [Figure 6]

91.9 % feel further research and education is required regarding the dental treatment on pregnant women [Figure 6].

Discussion

Pregnancy is a unique complex period with various physiologic changes that support the formation and maturation of a new life.[1] Oral cavity is the mirror of the human body as it reflects and influences systemic health.[2] Prenatal health is very much influenced by maternal oral health, and hence consistent and timely dental care is mandatory in a pregnant patient.[3] Poor oral health can affect the pregnant patient leading to complications such as gestational diabetes, preeclampsia.[4] Most predominant oral manifestation during pregnancy is the occurrence of pregnancy gingivitis and periodontitis due to the influence of increased levels of sex hormones such as estrogen and progesterone which are associated with increased permeability of oral vasculature thereby increasing the severity of inflammation in oral tissue to any stimuli. This is especially manifested as periodontitis.[56789] Notably, fungal infections like candidiasis are also more prevalent in pregnant patients.[10] It is pertinent to note that numerous studies have revealed the relationship between periodontitis and preterm delivery, low birth weight, and occasionally stillbirth.[11121314] Considering the impact of maternal oral health on the newborn, it is very essential that the pregnant patient be educated and motivated to consult dentists without any fear or myth regularly. In an attempt to sensitize this valuable platform, a questionnaire study was planned and conducted which has revealed that the majority of pregnant patient's perception toward oral health is poor.

It is an astonishing fact that there exists a dearth of attitude and practice behavior among dental practitioners toward pregnant patients’ oral health as part of this study. There is a very significant dilemma existing among dentists in performing dental treatment during pregnancy and very prominently with respect to the use of X-rays in diagnosis. It is an accepted fact that radiographs are indicated only when mandatorily required. However, well-collimated beams, lead aprons, and very minimal doses as low as 10 rads (100 mGy) cause less impact on the fetus.[1516171819] Ultimately, the realization and recognition of lack of attitude and practice behavior among general dental practitioners and poor perception of oral health by pregnant patients is a matter of concern for both health of the woman and the future children, which can be professionally protected and by raising awareness among both the dentists and patients for successful outcome.[20]

Conclusion

Every gestational woman should be encouraged to seek medical and dental care during pregnancy, as a failure in treating the developing problems affects the health of both the mother and the fetus. The dentist should attain a basic understanding of the underlying physiological changes of pregnancy, the influences, which are related to the use of medications during gestation and how these may interact with the delivery of dental care. The realization of this fact helps in the formulation of the treatment plan and the delivery of the necessary medical, nutritional, and dental care as well as it prepares the professionals for counseling their pregnant patients.

Questionnaire on the attitude and behavior among private practitioners in and around pondicherry regarding pregnant patient's oral health

Questionnaire on the perception towards oral health by pregnant women in and around pondicherry