Evaluation of Gynecologists' Awareness About Oral Health Condition During Pregnancy in Chennai City.

BACKGROUND/
OBJECTIVES: A cross-sectional study was conducted to evaluate the knowledge and practiced behaviors of gynecologists regarding oral health during pregnancy and association of periodontal disease with adverse pregnancy outcomes.
MATERIALS AND METHODS: This study was conducted among 200 gynecologists. A self-structured, close-ended questionnaire containing 22 questions was prepared. The principal investigator approached the gynecologists personally and distributed the questionnaire after obtaining their informed consent.
RESULTS: Of the 200 gynecologists approached, 200 filled the questionnaire, yielding a response rate of 100%. The majority (87%) acknowledged a connection between oral health and pregnancy and 63% agreed that periodontal disease can affect the outcome of pregnancy. However, only 60% gynecologists advise major/minor surgery during pregnancy, and many of them (74%) said that second trimester is the safe period for dental treatment. Almost three-quarters of the participants (79%) regarded dental radiograph and more than half (74%) considered administration of local anesthesia to be unsafe during pregnancy.
CONCLUSION: This study demonstrated that gynecologists have a relatively certain level of knowledge regarding oral health status during pregnancy and the relationship of periodontal disease to pregnancy outcomes. However, there clearly exist misconceptions regarding the provision of dental treatment during pregnancy. To provide better oral health care, more knowledge needs to be made available to the pregnant women and medical community, mainly to the gynecologists who are primary health-care providers for pregnant women, and misconception regarding the types of dental treatments during pregnancy should be clarified.

INTRODUCTION

Pregnancy involves complex physical and hormonal changes that have a significant effect on almost every organ system, including the oral cavity. Oral problems associated with pregnancy primarily include gingivitis and periodontal infection.[1] Oral health during pregnancy has long been a focus of interest. It involves multiple substantial and hormonal changes that have a momentous impact at the time of pregnancy.[2] Pregnant women with periodontitis may be at a higher risk of preterm birth/low birth weight (PLBW).[3] Studies showed 18.2% of all PLBW cases may be attributable to the periodontal disease.[4] Although the mechanisms by which periodontal diseases may cause preterm birth and/or low birth weight have not been elucidated, one proposed mechanism relates to the seeding of urinary tract infections with bacteria from periodontal disease in the mother.[567]

Gynecologists are the primary health-care providers who are in constant contact with the pregnant women and are often involved in the assessment and treatment of women all over their lives.[89] Understanding the level of their knowledge on the association of periodontal disease with the pregnancy outcomes can improve pregnancy outcomes and prevent preterm deliveries.[10] Hence, the aim of this study was to evaluate the knowledge, awareness, and practiced behaviors of gynecologists regarding oral health care during pregnancy and association of periodontal disease with adverse pregnancy outcomes in Chennai city.

MATERIALS AND METHODS

The present cross-sectional study was conducted among randomly selected gynecologists in Chennai city. In this study, 200 gynecologists participated and returned completely filled questionnaires. All the data were collected from gynecologists who are practicing in both the government and private hospitals/clinics in Chennai. A self-structured, closed-ended questionnaire containing 22 questions was prepared. The principal investigator approached the gynecologists personally and distributed the questionnaire after obtaining their informed consent. Their confidentiality was assured. The questions were answered immediately in 5 minutes and handed over to the investigator. Questions are summarized in Table 1.

Table 1

Questionnaire

S. no.	Questions	Reply
1.	Do you agree pregnancy increases the likelihood of gingival inflammation?	Yes/No
2.	Have your patients reported with bleeding gums, small swelling, and tooth mobility during pregnancy?	Yes/No
3.	Do you advise pregnant women to delay dental visit after pregnancy?	Yes/No
4.	Do you believe it is safe to use the regular local anesthetic solution containing vasoconstrictor for pregnant patients?	Yes/No
5.	Do you agree dental radiograph to be safe during pregnancy?	Yes/No
6.	Do you believe that gingival periodontal inflammation can affect the outcome of pregnancy?	Yes/No
7.	Do you think periodontal disease can lead to preterm birth/low birth weight?	Yes/No
8.	Advising patient to visit dentist during pregnancy?	Yes/No
9.	Do you know about oral manifestations caused by hormonal changes, which are specifically related to pregnancy?	Yes/No
10.	Have you ever given any advice to a patient regarding any changes in oral cavity during pregnancy?	Yes/No
11.	Have you ever advised pregnant women to maintain good oral hygiene and get routine dental check-up done?	Yes/No
12.	Do you feel examination of oral cavity should be integral part of maternal health?	Yes/No
13.	Do you check oral cavity of expectant mothers?	Yes/No
14.	Do you advise major/minor surgery during pregnancy?	Yes/No
15.	Do you think updating yourself with latest technology related to dentistry will benefit you?	Yes/No
16.	Do you think attending conference on oral health is useful?	Yes/No
17.	Do you advise patient to quit tobacco/alcohol?	Yes/No
18.	Can gum disease in the mother affect the birth weight of child?	Yes/No
19.	Do you think that patient’s attitude toward dental care is related to dental health?	Yes/No
20.	Do you advise your patient to use fluoridated tooth paste?	Yes/No
21.	Do you think dental reference is important for your patient?	Yes/No
22.	Which trimester you think that is safe for dental treatment?
	I.First	Yes/No
	II.Second	Yes/No
	III.Third	Yes/No

Statistical analysis

All returned questionnaires were coded and analyzed. Results were expressed as the number and percentage of respondents for each question and this descriptive statistics was analyzed using SPSS statistical package.

Of the 200 eligible gynecologists, all agreed to participate in this study and returned completely filled questionnaires, yielding a response rate of 100%; the results obtained are summarized in Table 2.

Table 2

Results

S. no.	Question asked	Total (200)		Total (100%)
		Yes	No	Yes	No
1.	Do you agree pregnancy increases the likelihood of gingival inflammation?	128	72	64	36
2.	Have your patients reported with bleeding gums, small swelling, and tooth mobility during pregnancy?	144	56	72	28
3.	Do you advise pregnant women to delay dental visit after pregnancy?	20	180	10	90
4	Do you believe it is safe to use the regular local anesthetic solution containing vasoconstrictor for pregnant patients	54	146	27	73
5.	Do you agree dental radiograph to be safe during pregnancy?	44	156	22	78
6.	Do you believe that gingival periodontal inflammation can affect the outcome of pregnancy?	126	74	63	37
7.	Do you think periodontal disease can lead to preterm birth/low birth weight?	134	66	67	33
8.	Advising patient to visit dentist during pregnancy?	134	66	67	33
9.	Do you know about oral manifestations caused by hormonal changes, which are specifically related to pregnancy?	104	96	52	48
10.	Have you ever given any advice to a patient regarding any changes in oral cavity during pregnancy?	138	62	69	31
11.	Have you ever advised pregnant women to maintain good oral hygiene and get routine dental check-up done?	146	54	73	27
12.	Do you feel examination of oral cavity should be integral part of maternal health?	182	18	91	9
13.	Do you check oral cavity of expectant mothers?	126	74	63	37
14.	Do you advise major/minor surgery during pregnancy?	60	140	30	70
15.	Do you think updating yourself with latest technology related to dentistry will benefit you?	176	24	88	12
16.	Do you think attending conference on oral health is useful?	180	20	90	10
17.	Do you advise patient to quit tobacco/alcohol?	106	94	53	47
18.	Can gum disease in the mother affect the birth weight of child?	126	74	63	37
19.	Do you think that patient’s attitude toward dental care is related to dental health?	192	8	96	4
20.	Do you advise your patient to use fluoridated tooth paste?	98	102	49	51
21.	Do you think dental reference is important for your patient?	148	52	74	26
22.	Which trimester you think that is safe for dental treatment?
	I.First	48	152	24	76
	II.Second	148	52	74	26
	III.Third	4	196	2	98

Table 2 and Figures 1-3 display response of the gynecologists to the questions. More than 64% of the participants agreed that pregnancy increases the likelihood of gingival inflammation. Similarly, a high percentage (87%) of the gynecologists acknowledged a positive association between oral health and pregnancy. In addition, 67% believed that gingival/periodontal inflammation can affect the outcome of pregnancy and 63% agreed that periodontal disease can lead to preterm labor and low birth weight.

Figure 1

Gynecologists’ awareness about relationship between periodontal disease and pregnancy

Figure 3

Safest trimester of dental treatment—opinion by gynecologists

Gynecologists’ attitude and opinion regarding dental treatments during pregnancy

This study also shows that 74% of the gynecologists considered second trimester to be the safest time for dental procedures, 67% of them advised their patients to visit dentist during pregnancy, 21% considered intra and extra oral radiographs to be safe, and 74% considered administration of local anesthesia containing vasoconstrictor to be unsafe during pregnancy.

DISCUSSION

To our knowledge, this is the first published study conducted in Chennai to assess the level of knowledge of the gynecologists in relation to the association of periodontal disease with pregnancy outcomes. Although the overall knowledge level of the gynecologists was satisfactory in this study, there still exist minor misconceptions among gynecologists regarding provision of dental treatments during pregnancy. In response to the question whether it is safe to take intra/extraoral radiographs for a pregnant patient, most of the gynecologists (79%) answered “No.” Dental radiographs play an important role in diagnosis and treatment of many dental conditions.[1112] Many studies have reported that it is safe to take necessary intra/extraoral dental radiographs of pregnant women, and that they do not pose any risk to developing fetus.

Another frequent misconception in relation to dental treatment of pregnant women is avoiding the use of local anesthetic agents containing vasoconstrictors. The majority (74%) did not believe that local anesthesia containing vasoconstrictor is safe for pregnant women.[1013] Research[14] has shown that the use of regular dental anesthetics containing vasoconstrictors during pregnancy is safe. Certain limitations exist in this study. However, this study might provide baseline information for continuing education programs in future that are provided to gynecologists working in Chennai.

CONCLUSION

Maternal health-care professionals play a vital role in promoting good oral health by connecting pregnant women to the source of dental care. Gynecologists in this study displayed certain level of knowledge, but some misconceptions exist among them regarding the types of dental treatment performed during pregnancy. So to provide better oral health care, more awareness and knowledge needs to be made available to the pregnant women and medical community, mainly to the gynecologists who are primary health-care providers for pregnant women and misconception regarding the types of dental treatments during pregnancy should be clarified and can thereby reduce the incidence of maternal and neonatal complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.