Oral Status Of Pregnant Women - A Hospital Based Study

Keywords

Oral Status; Pregnancy; Gingival Bleeding; Dental Caries; Halitosis.

Introduction

From the perspective of oral health, pregnancy is considered a unique, sensitive and crucial period. This is due to the physical, hormonal and emotional changes that take place during this period [1]. Proper dental care during pregnancy is very important, since pregnancy causes various hormonal changes in the body that can actually increase the risk of developing gum diseases causing pregnant women to be more susceptible to gingival inflammation [2]. During pregnancy women are said to be vulnerable to certain oral diseases such as dental caries and periodontal diseases. Due to inadequate maintenance of oral health during this period there are implications for oral health in the woman's subsequent life [3, 4]. Furthermore, during the first trimester, regular self-oral hygiene care, such as tooth brushing and flossing is important. It is nearly impossible in some women especially in the premolar and molar area because of pregnancy related nausea and vomiting symptoms [3]. This situation may impact the quality of the mother’s life [4]. Although the changes in clinical parameters for gingival inflammation like bleeding on probing, was said to be reversible at the end of pregnancy or after delivery [5-7]. A previous study has shown that periodontal treatment during pregnancy improves quality of life [4].

Hormonal changes during pregnancy along with gastric acid secretion causes recurrent morning sickness, leading to erosion of dental enamel [5]. Furthermore progesterone decreases plasma bicarbonate levels contributing to reduced pH [8]. This along with increased sugar consumption due to cravings, increases the risk of candida colonisation [6] and dental caries [7, 9-11] which left untreated leads to tooth mobility [12]. Changes in oral hygiene practices and dietary habits can increase the risk of tooth decay during pregnancy [13]. This is supported by a study conducted in Iraq that showed a significant difference in decayed teeth among pregnant women and non pregnant women [14]. It has also been suggested that children born to mothers who have high caries levels are more likely to develop early caries [15, 16].

Hormonal variations during pregnancy, estrogen and progesterone could exacerbate the inflammatory response in dental plaque, resulting in severe forms of gingivitis [17-20]. Due to increased production of oestrogen and progesterone during pregnancy, there is an increased development of gingivitis and periodontitis. This is attributed to increased vascular permeability and tissue oedema [17, 21]. Studies show the association between periodontal disease with gestational diabetes mellitus, which contributes to maternal and infant morbidity as well as the risk of the mother developing type 2 diabetes mellitus subsequently [22, 23]. Moreover, maternal periodontal disease may increase the risk of adverse pregnancy outcomes such as pre-eclampsia, pre-term births, retarded fetal growth and low birth weight [24, 25]. The above relationships could be explained by the poor awareness of the importance of oral hygiene and inaccessibility to dental clinics [26, 27]. Periodontitis, gingivitis and poor oral health are common causes of halitosis, which occurs due to volatile sulfur compounds by oral bacteria [28, 29].

Previously our team had conducted numerous clinical trials [30- 36] systematic reviews [37-42] and survey [43] over the past five years. Maintaining oral health during pregnancy may be achieved by early screening and referring pregnant mothers to oral treatment to complete overall well-being of the mother and fetus.This survey aims to assess the oral status of pregnant women who visited Saveetha Dental College.

Materials and Methods

Our study population consisted of 50 pregnant patients who visited Saveetha Dental College in the past one year. A questionnaire with oral health related questions was developed. Ethical clearance was obtained from the institutional ethics board - SDC/ SIHEC/2020/DIASDATA/0619-0320

The data was retrieved from 86,000 patients’ records among which 60 pregnant patients were selected. Phone calls were made to the patient and the patient was asked about their oral health. This study involved 3 reviewers. Data included the study were from the time period of June 2019 to March 2020. Certain measurements were taken in order to minimize bias, such as simple random sampling, collecting more data sources and including the data from the institute.

The data was then entered in Microsoft Excel and was analysed using SPSS IBM software version 20.0. Descriptive statistics were calculated to explore the demographic data. A cross tabulation analysis was conducted to examine the categorical variables. Chisquare test was used to identify the presence of significance between the variables.

Questionnaire

1. Are you experiencing bleeding gums during pregnancy?
2. Are you experiencing mobility of your teeth?
3. Do you have any dental caries?
4. Do you experience bad breath during pregnancy?
5. Do you experience teeth sensitivity during pregnancy?

Results and Discussion

The following results were obtained from our study. 68.3% of the participants reported they experienced bleeding gums during pregnancy and 31.7% of the participants reported they did not experience bleeding gums during pregnancy (Figure 1). Mobility was experienced by 35% of the participants and was not experienced by 65% of the participants (Figure 2). 61.7% of participants reported they experienced dental caries during pregnancy and 38.3% of participants reported they did not experience dental caries during pregnancy (Figure 3). Halitosis was experienced by 70% of the participants and was not experienced by 30% of the participants (Figure 4). 33.3% of the participants reported they experienced sensitivity during pregnancy and 66.7% of participants reported they did not experience sensitivity during pregnancy (Figure 5).

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Figure 1:

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Figure 1. This bar chart shows the answer for the question - Are you experiencing bleeding gums during pregnancy? X axis shows the answers with (Yes) or (No) options and the Y axis shows the percentage of patients who responded they experienced bleeding gums (Yes) or they did not experience bleeding gums (No). 68.3% experienced bleeding gums during pregnancy while 31.7% did not experience bleeding gums during pregnancy. Most pregnant women experienced bleeding gums during pregnancy.

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Figure 2. This bar chart shows the answer for the question - Are you experiencing mobility of your teeth? X axis shows the answers with (Yes) or (No) options and the Y axis shows the percentage of pregnant patients who responded they experienced mobility (Yes) and they did not experience mobility (No). 35.0% experienced mobility during pregnancy while 65.0% did not experience mobility during pregnancy. Most pregnant women did not experience mobility during pregnancy.

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Figure 3. This bar chart shows the answer for the question - Do you have any cavities or dental caries? X axis shows the answers with (Yes) or (No) options and the Y axis shows the percentage of pregnant patients who responded they experienced dental caries (Yes) and they did not experience dental caries (No). 61.7% experienced dental caries during pregnancy while 38.3% did not experience dental caries during pregnancy. Most pregnant women experienced dental caries during pregnancy.

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Figure 4. This bar chart shows the answer for the question - Do you experience halitosis during pregnancy? X axis shows the answers with (Yes) or (No) options and the Y axis shows the percentage of pregnant patients who responded they experienced halitosis (Yes) and they did not experience halitosi (No). 70.0% experienced halitosis during pregnancy while 30.0% did not experience halitosis during pregnancy. Most pregnant women experienced halitosis during pregnancy.

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Figure 5. This bar chart shows the answer for the question - Do you experience teeth sensitivity during pregnancy? X axis shows the answers with (Yes) or (No) options and the Y axis shows the percentage of pregnant patients who responded they experienced sensitivity (Yes) and they did not experience sensitivity (No). 33.3% experienced teeth sensitivity during pregnancy while 66.6% did not experience teeth sensitivity during pregnancy. Most pregnant women did not experience sensitivity during pregnancy.

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When comparing the diet status and the oral status of the patients, following results were obtained in or study. Non vegetarians have a higher prevalence of bleeding gums than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value = 3.389a , df = 1, p value = 0.066 (>0.05)] (Figure 6). Non vegetarians have a higher prevalence of mobility than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value = 0.959a , df = 1, p value = 0.327 (>0.05)] (Figure 7). Non vegetarians have a higher prevalence of dental caries than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value: 1.641a, df = 1, p value = 0.200 (>0.05)] (Figure 8). Non vegetarians have a higher prevalence of halitosis than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value = 1.964a , df = 1, p value = 0.161 (>0.05)] (Figure 9). Non vegetarians have a higher prevalence of sensitivity than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value: 0.043a , df = 1, p value = 0.836 (>0.05)] (Figure 10).

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Figure 6. This Bar chart represents the association between diet and bleeding gums. [X-axis represents the vegetarian diet and the non vegetarian diet. Y-axis represents the number of pregnant patients who responded they experienced bleeding gums (Yes) and did not experience bleeding gums (No). Non vegetarians have a higher prevalence of bleeding gums than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value = 3.389a df = 1, p value = 0.066 (>0.05)].

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Figure 7. This bar chart represents the association between diet and mobility. [X-axis represents the vegetarian and the non vegetarian diet. Y-axis represents the number of pregnant patients who responded they experienced mobility (Yes) and they did not experience mobility (No). Non vegetarians have a higher prevalence of mobility than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value = 0.959a df = 1, p value = 0.327 (>0.05)].

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Figure 8. This Bar chart represents the association between diet and dental caries. [X-axis represents the vegetarian and the non vegetarian diet. Y-axis represents the number of pregnant patients who responded they experienced dental caries (Yes) and did not experience dental caries (No). Non vegetarians have a higher prevalence of dental caries than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value: 1.641a df = 1, p value = 0.200 (>0.05)].

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Figure 9. This bar chart represents the association between diet and halitosis. X-axis represents the vegetarian and the non vegetarian diet. Y-axis represents the number of pregnant patients who responded they experienced halitosis (Yes) and they did not experience halitosis (No). Non vegetarians have a higher prevalence of halitosis than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value = 1.964a, df = 1, p value = 0.161 (>0.05)].

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Figure 10. This bar chart represents the association between diet and sensitivity. [X-axis represents the vegetarian and the non vegetarian diet. Y-axis represents the number of pregnant patients who responded they experienced sensitivity (Yes) and did not experience sensitivity (No). Non vegetarians have a higher prevalence of sensitivity than vegetarians. However it is statistically not significant. [Pearson’s Chi Square value: 0.043a, df = 1, p value = 0.836 (>0.05)].

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From the results of our study we can see that 68.3% of women experienced bleeding gums during pregnancy. Nata Fonseca Silva et al [44], states that gingivitis can be considered the main oral disease affecting women in the gestational period, due to an increase in the concentration of female sex hormones. According to our study 35% of pregnant women experienced mobility during pregnancy. This result is in line with A.George et al [45], where mobility was present in few patients in his study. This could because the periodontal status of each patient differs, which could eventually lead the difference in mobility.

61.7% of our patients experienced dental caries which is similar to the studies by George et al [45], Africa et al [46], Kamate et al [47]. The mean DMFT score was 7.18 in [46] which was higher than the score of 4.08 reported in a rural hospital in India. Increased caries activity may be seen due to increased candida levels in the oral cavity. In [45] 41.5% reported cavities as a dental problem.

Bad breath (halitosis) was reported by 70% of patients as their major concern. This result is similar to the study conducted by Naorungroj et al [48] in which 61% of pregnant women reported bad breath experience. This could be due to poor oral hygiene status, higher plaque deposits along with increased nausea and vomiting during pregnancy. 33.3% of pregnant women experienced sensitivity during pregnancy. A review by VT Hemalatha et al [49] stated that sensitivity was not seen in most patients during pregnancy. Tooth erosion can result from nausea and vomiting of pregnancy [50], because of the hydrochloric acid content of regurgitated gastric juice [51]. There is possibility for the buffering capacity of saliva to change during pregnancy leading to a more acidic environment [52]. Effects of tooth erosion such as tooth sensitivity may last beyond the duration of pregnancy [53]. All pregnant women do not experience vomiting and this could be one of the reasons for lower prevalence of sensitivity.

Limitations of the study include smaller sample size, education level of the patient and other pregnancy complications. Hence for future scope a larger sample size could be used with better knowledge and treatment modalities along with providing adequate education on oral health care of pregnant women.

Conclusion

Within the limits of the present study oral status of pregnant women was assessed. Most patients experienced gingival bleeding, dental caries and halitosis while few patients experienced mobility and sensitivity. No association was found between the diet of pregnant women and their oral status.

Acknowledgement

Thanks to Saveetha Dental college for allowing me to review the case sheets.

Authors Contribution

First author (Fathima Bareera Rezvi) performed the analysis, and interpretation and wrote the manuscript. Second author (Dr. Revathi Duraisamy) contributed to conception, data design, analysis, interpretation and critically revised the manuscript. Third author(Dr.Manjari Chaudhary) participated in the study and revised the manuscript. All the three authors have discussed the results and contributed to the final manuscript.

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