This study sought to provide knowledge of the periodontal status of pregnant women in Trinidad along with their perceived oral health status, practices and knowledge. No previous data exists for this population.
Perceived oral health status
Over 62% of the pregnant women rated their oral health as good or very good and over one-third (37.7%) as fair or average. This is very similar to the findings of Keirse et al, 2010 but is lower than that reported in George et al, 2013 where 54.4% reported fair or average oral health status. This study also found higher levels of toothache reported (34.3%) and cavities (65.2%) than found in another study with 16.9% and 41.5% respectively ( George et al, 2013). It was gratifying to note that 68.9 % of participants felt that oral health is extremely important when compared to general health and this is higher than another study that reported 46.5% (George et al, 2013).
Oral health practices
It has been documented that pregnant women are hesitant to take up dental treatment (Al-Habashneh, 2005; Saddki et al, 2010) and the findings from this study show that over 90% did not attend the dentist and nearly 75% only when they had a problem. This is similar to other studies in Nepal where over 88% of participants had never visited a dentist and most often attended for toothache (55%) or caries (62%) (Erchik, 2019). In our study only 17.4% reported having been to a dentist in the last year and this is very low compared to other studies that reported 45.6% ( George et al, 2013) in Adelaide, Australia and some studies in the USA that have shown that less than half of women attend for dental treatment during pregnancy (Al-Habashneh, 2005; Mangskau et al, 1996; Lydon-Rochelle et al, 2004). In Adelaide Australia, it has been reported only 30-35% attend during pregnancy ( Keirse, 2010; Thomas, 2008). In the UK under the National Health Service dental treatment is free for pregnant women and up to one year post partum. Yet a study on immigrant mothers in North London found attendance rates of 32% (Hullah et al, 2008). Other studies done in rural communities in India ( Gupta, 2016) and Nigeria (Lasisi, 2018) also found very low attendance for dental treatment during pregnancy. No association was found with when the women last visited a dentist and brushing, flossing, use of mouthwash or BPE and this is most likely because so few women had dentists and the numbers were too low.
This low uptake of dental services could be due to cost which nearly 55% said in this study was a barrier to accessing care. This is agreement with other studies documenting cost as a significant barrier for accessing care (CDA, 2010; Thomas et al, 2008; BMC Child Birth; Keirse, 2010). Also almost half of the participants were also concerned about safety during dental treatment and that would prevent them from seeking care. This concern found in the Trinidad cohort has also been shown elsewhere in the USA (CDA, 2010) and Australia ( George et al, 2010; George, 2013). However, in this study most participants did have good oral health practices with over three-quarters (77.6%) reporting they brushed their teeth twice daily and the majority using fluoridated toothpaste (91.9%) and this is similar to other studies (George, 2013, Keirse, 2010; Thomas, 2008). Xylitol decreases the incidence of dental caries by increasing salivary flow and pH and reducing the number of cariogenic (Mutans Streptococci) and periodontopathic (Helicobacter pylori) bacteria, plaque levels, xerostomia, gingival inflammation, and erosion of teeth (Nordblad et al 1995; Nayak et al 2014).
Oral health knowledge
Pregnant women have good knowledge on flossing daily ( 97.5%) and attending routinely to the dentist to keep gums and teeth healthy (98.1%). However, there was very poor oral health knowledge in other areas and of concern was that 37.3% felt dental care should be avoided during pregnancy. This misconception has been reported in other studies around the world (Dinas et al, 2007; Mangskau et al, 1996; Saddki et al, 2010; Lydon-Rochelle et al, 2004). The majority (80.4%) also had the false impression that cavities could not be spread from the mother to the baby’s mouth and nearly three-quarters (72.3%) did not believe that a mother’s poor oral health could contribute to low birth weight (LBW) babies. These incorrect beliefs were high in this population compared to another study (George et al, 2013). It is clear that there is great scope for improving increased awareness of oral health during pregnancy in Trinidad.
Smoking in pregnancy is associated with increased risks of miscarriage, stillbirth, prematurity, low birth weight, perinatal morbidity and mortality, neonatal and sudden infant death, infant respiratory problems, poorer infant cognition and adverse infant behavioral outcomes (Cnattingius, 2004) and a significant reduction in birthweight has been associated with maternal smoking, as well as an increased risk of low birthweight and preterm birth (Andriani and Kuo, 2014). The odds ratio (OR) for the association between self-reported maternal smoking during pregnancy and asthma in logistic regression adjusted for confounders was 1.28 (Moradzadeh et al 2018). Yet 8.1% of the pregnant mothers in this study were smokers. The literature shows that internationally, large numbers of pregnant women smoke, with rates between 12% and 22% in high-income countries (Tong et al, 2013).
Periodontal status
Only 3.1% of pregnant mothers had periodontal health, while 37.2% demonstrated gingivitis. However nearly 60% of pregnant mothers had some form of periodontitis either mild (34.2%) or moderate to severe (25.2%). Erchick et al, 2019 also reported 40% prevalence of gingivitis in pregnant mothers but few women had signs of probing depths>3mm which is in contrast to the findings of this study. Other studies have found high prevalence of periodontal disease in pregnant women such as Gupta and Acharya, 2016 (95%), Miyazaki et al, 1991 (95%) and Jago et al, 1984 (84%) and more recently Gonzalez-Jaranay et al, 2017. Understanding oral health needs of pregnant women can guide oral health promotion and delivery of preventive care and potentially improve pregnancy outcomes.
Limitations of this study include the periodontal health status of this population of pregnant patients may not be as evenly distributed in the general population as it was in this convenience sample. Also there may have been bias in the self-reported oral health assessment and his study did not determine the number, if any, of patients with gestational diabetes.