A Community- Based Cross-Sectional Study
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Deghatipour et al. BMC Oral Health (2019) 19:117 https://doi.org/10.1186/s12903-019-0801-x RESEARCHARTICLE Open Access Oral health status in relation to socioeconomic and behavioral factors among pregnant women: a community- based cross-sectional study Marzie Deghatipour1 , Zahra Ghorbani2* , Shahla Ghanbari3, Shahnam Arshi4, Farnaz Ehdayivand5, Mahshid Namdari6 and Mina Pakkhesal7 Abstract Background: Oral health of women during pregnancy is an important issue. Not only it can compromise pregnancy outcomes, but also it may affect their newborn’s overall health. The aim of this study was to assess the oral health status and associated factors in pregnant women. Methods: A cross-sectional study was conducted amongst 407 pregnant women in the second and third trimester of pregnancy in Varamin, Iran. Oral health status was examined, and demographic, socioeconomic status and dental care behavior data were collected. Oral health indices included periodontal pocket, bleeding on probing (BOP) and decayed, missed, filled teeth (DMFT). Regression analysis of DMFT was used to study the association between demographic, dental care behaviors indicators and outcome variables using the count ratios (CR) and 95% confidence intervals (CI). Results: The mean (SD, Standard Deviation) age of participants was 27.35 (5.57). Daily brushing, flossing habit were observed in 64.1, and 20.6% of mothers, respectively. Mean (SD) of DMFT, D, M, F were 10.34(5.10), 6.94(4.40), 2.22 (2.68) and 1.19(2.23), respectively. Women older than 35 years had significantly more DMFT [CR = 1.35 (95% CI 1.13; 1.60)], less D [CR = 0.75 (95% CI 0.59; 0.94)], and more M [CR = 3.63 (95% CI 2.57; 5.14)] compared to women under 25 years after controlling for education and dental care behaviors. Women with academic education had significantly less decayed teeth [CR = 0.63 (95% CI 0.48; 0.84)], compared to women with under 12 years of education. Conclusions: Oral health status of pregnant women was not satisfactory, having an average of seven decayed teeth in their mouth. Keywords: Oral health, Pregnant women, Dental care behaviors Background is an important issue to general health of both the ex- Pregnancy is a natural process accompanied with con- pectant woman and her infant [3]. Evidence showed that siderable physiological and hormonal changes in insufficient of oral health care during pregnancy can women’s body, including oral cavity [1]. There are many have negative outcomes for both mothers and their new- common oral problems in pregnancy such as pregnancy borns [4]. gingivitis, benign gingival lesions, tooth mobility, tooth According to a systematic review, the relationship be- erosion, dental caries, and periodontitis [2]. Oral health tween pregnancy and gingivitis was confirmed. The characteristics of pregnancy-associated gingivitis are * Correspondence: [email protected] similar to common plaque-related gingivitis but with 2Community Oral Health Department, School of Dentistry, Shahid Beheshti more severity; the severity being correlated with blood University of Medical Sciences, Daneshjoo Blvd, Tehran, IR 19834, Iran steroid hormone levels [3]. Periodontal disease during Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Deghatipour et al. BMC Oral Health (2019) 19:117 Page 2 of 10 pregnancy has been criticized to be associated with ad- 16 years whose consent form was signed by her father as verse perinatal outcomes, including preeclampsia, pre- her legal guardian according the local rules. term delivery, low birth weight, increased fetal death and This community-based cross-sectional study was per- newborn’s care time in neonatal care unit [5–7] There- formed to provide the baseline data for a community fore, women should be given proper oral hygiene and oral health promoting intervention to be implemented oral health preventive services before, during and even in “Pishva”;“Pakdasht”, both regions located in Varamin, after child birth [8]. a southern part of Tehran Province in Iran. At the 2016 Mother’s oral health behavior during pregnancy, such census, Pishva’s population was 86,601 and Pakdasht was as dental visits, oral hygiene, and consumption of sweets 350,966 (https://www.amar.org.ir/english/Population- have a significant effect on their oral health during preg- and-Housing-Censuses). Pishva and Pakdasht are similar nancy and on their children’s oral health in the future [9, regions in terms of socioeconomic status. Data gathering 10]. Expectant women should be counseled to perform started in July 2016, and lasted for eight months. routine brushing and flossing, to avoid consuming exces- sive amounts of sugary snacks and drinks, and to consult Sample size and subject recruitment a dentist during pregnancy [11]. In this study in order to estimate the mean Decayed, Pregnant women may not be aware of the effects of Missed, Filled teeth (DMFT) in pregnant women, accord- their oral health on the fetus and their pregnancy out- ing to the previous study on decay-missing-filled (DMF) comes [12]. Plenty of studies have shown pregnant of Iranian pregnant women [21], the Standard Deviation women had negative attitude towards their oral health (SD), was found to be 3, considering 95% confidence with care and dental care utilization in pregnancy period [13, an error equal to 0.3 a sample of approximately 387 sub- 14]. Patients and dentists usually avoid dental treatment jects was needed to be participated in the study. during pregnancy because of absence of clinical guide- The target population was pregnant women in the sec- lines for dental management in pregnancy, lack of prac- ond/third trimester of pregnancy living in Varamin. tice standards, and anxiety about fetal safety during Women with known systemic disease, with high-risk dental procedures [15]. pregnancy, age under 15 years, and on long-term medi- Although oral health in pregnancy is an important cation were excluded. Recruitment was carried out in all issue in pregnancy health, few epidemiological studies the 17 health care centers in Pishva (7 health care cen- have reported clinical oral health indices in the popula- ters) and Pakdasht (10 health care centers), where more tion. A search in PubMed database with Mesh keywords than 70% of pregnant women residing in those regions of “pregnant women” and “oral health” in May 2019 re- usually receive their maternal care from these public sulted in finding 34 papers, from which only four con- health centers. All of the health care centers provided tained information regarding clinical oral health free maternal and child care for their target groups at examination [16–19]. This shortage of literature may be the same conditions. All 407 pregnant women in their because of neglected oral health as a part of needed ma- second/third trimester of pregnancy who received pre- ternal care and less dental visits in pregnancy. natal care from the health centers were recalled toparti- Oral health of Iranian adults (aged 35–44) has been cipate in the study. studied in a recent epidemiological study in 2012 [20]; however, it did not include pregnant women. Study design The aim of this study was to get baseline data about Two dentists were trained according to the World oral health status and dental care behaviors of pregnant Health Organization (WHO) oral health surveys basic women in Varamin, a partially deprived region in the methods (15), and were calibrated clinically using 10 pa- southern part of Tehran Province, Iran. tients in a two-day calibration workshop. The intra- and This information may be helpful to design and plan in- inter-examiner reliability of measuring dental caries and terventions regarding oral health promotion among this pocket depth were investigated for both examiners. The target population. mean inter-examiner agreement obtained in this activity was Kappa = 0.85. Dental and periodontal examinations were taken in in maternity care room of Pishva and Pak- Methods dasht health centers on an ordinary seat.. Teeth were This study was approved by the Committee of Ethics in dried by cotton rolls, and oral examination was per- Research Affairs of Dental School, Shahid Beheshti Uni- formed using battery-operated lights, mouth mirror, and versity of Medical sciences. After explanation of the community periodontal index probe according to the study objectives, an informed consent was obtained for recommendations of WHO [22]. the participation. Women filled the consent form, and For assessing periodontal status, BOP and periodontal signed it for participation. There was a participant under pocket were detected. Gingivae of all teeth present in Deghatipour et al. BMC Oral Health (2019) 19:117 Page 3 of 10 participants’ mouth examined by inserting the tip of the pregnancy. Education was added to Model 3 while oral WHO CPI probe between the gingiva and the tooth to health behaviors (brushing habit, flossing habit, dental assess absence or presence of bleeding response. All par- visit and sweet consumption) were added to Model 4. ticipant’s teeth present in the mouth were examined for absence or presence of gingival. Results bleeding and absence or presence of periodontal From the 532 registered women, 451 attended the exam- pockets; pocket depth is measured with the WHO CPI ination session. Also, 38 pregnant women (in Pishva) and periodontal probe.