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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 1  |  Page : 44-47

Prevalence of dental caries and gingivitis among pregnant and nonpregnant women


Department of Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India

Date of Web Publication10-Sep-2018

Correspondence Address:
Dr. Rajul Ranka
Sharad Pawar Dental College and Hospital, Sawangi (m), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_5_18

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  Abstract 


Objective: The aim of this study was to find the occurrence of dental caries and gingivitis among pregnant women and to compare it with those in nonpregnant women. Materials and Methods: A total of 303 pregnant and 238 nonpregnant women were recruited from the Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha. Dental caries and gingivitis were defined clinically according to the World Health Organization (WHO) diagnostic criteria. Results: Over 63.3% of pregnant women had caries, and 71.9% had gingivitis. A significant difference came out between pregnant women and nonpregnant women with regard to dental caries (P = 0.0001) and gingivitis (P = 0.0007). The pregnant women were 2.2 times more likely to suffer from dental caries and 1.94 times more from gingivitis compared to nonpregnant women. Dental caries was significantly seen in pregnant women above 25 years of age, illiterate, and homemakers. Poor oral hygiene, poor dental care knowledge, and poor attitude were all important risk factors for dental caries and gingivitis. Conclusion: Proper dental healthcare programs should be conducted to improve the dental health and to increase the awareness of hygienic practices in pregnant women.

Keywords: Dental caries, gingivitis, oral hygiene, pregnant women


How to cite this article:
Patil S, Ranka R, Chaudhary M, Hande A, Sharma P. Prevalence of dental caries and gingivitis among pregnant and nonpregnant women. J Datta Meghe Inst Med Sci Univ 2018;13:44-7

How to cite this URL:
Patil S, Ranka R, Chaudhary M, Hande A, Sharma P. Prevalence of dental caries and gingivitis among pregnant and nonpregnant women. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2020 Sep 19];13:44-7. Available from: http://www.journaldmims.com/text.asp?2018/13/1/44/240901




  Introduction Top


Good oral health is important across a person's lifespan. Pregnancy is a particularly important time to promote oral health and healthy behavior including education about the prevention of dental caries and gingivitis.[1] Pregnancy affects nearly every aspect of a woman's life including her oral health. Hormonal changes in the body during pregnancy make them more susceptible to oral infections and gum diseases. These dental problems not only affect expectant mothers but also the developing baby. Oral cavity is subjected to reversible as well as irreversible changes due to fluctuations in levels of estrogen and progesterone during pregnancy, leading to dilatation and tortuosity of gingival microvasculature, circulatory stasis, and increase in oral vasculature permeability along with a decrease in host immunocompetence, thereby increasing susceptibility to oral infections.[2] Apart from the effects of hormonal changes, other factors such as HIV infection, lack of dental care, poor oral hygiene, smoking, low educational level, low employment status, increased age, and ethnicity contribute to a worsened periodontal condition during pregnancy.[3]

Dental caries is an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of the calcified tissues.[2] The reported risk factors that affect its occurrence include age, sex, socioeconomic status, race, geographical location, food habits, and oral hygiene practices.[4] It is believed that increased consumption of carbohydrates, increased acid in the mouth from vomiting, and reduced salivary production and/or increased acidity of saliva combine to raise the risk of dental caries in pregnant women.[5]

Published studies have shown that the prevalence rates of gingivitis during pregnancy range between 30% and 100%.[6] Reports from the Health Care Centers of Bangkok, Nakornsawan and Yala showed that the prevalence of gingivitis in pregnant women was 98.0%, 86.3% and 98.8%, respectively. The rates of those needing treatment for dental problems such as caries and gingivitis were 86.0%, 97.0%, and 94.8%, respectively.[7]

It has been estimated that the periodontal disease of the mother might cause more than 18% of all preterm births and low birth weight in infants.[8]

Despite efforts to improve the coverage of dental healthcare among pregnant women in Sawangi hospital, little data on the overall oral health of pregnant women in Sawangi and Vidarbha region are available. Therefore, the aims of this study were to identify common dental problems, especially caries and gingivitis in pregnant women, and to compare them with those in nonpregnant women in Sawangi. The results generated from this study could lead to improvements in dental care programs for pregnant women in Vidarbha region, Maharashtra.


  Materials and Methods Top


The study was carried out in the Department of Oral Pathology and Microbiology, Sharad pawar dental college, Sawangi (M), Wardha. The patients were recruited from Obstetrics and Gynecology, AVBR Hospital, Sawangi (M), Wardha. A total of 303 pregnant women in the second trimester attending antenatal outpatient department (OPD) and 238 women of reproductive age group (18—38 years) who were not pregnant were recruited from gynecology OPD. Written informed consent was obtained from all participants who agreed to take part in the study. Before a clinical examination, demographic information regarding age, education, occupation, socioeconomic status, and residence were obtained from the participants. Dental caries and gingivitis were defined according to the World Health Organization criteria; newly developed cavity (dental caries), and gingival bleeding on probing (gingivitis). The level of oral hygiene status, dental care knowledge, attitude, and behavior was noted.

Statistical analysis

Data were statistically analyzed. A logistical model was applied to calculate the odds ratio (OR) and 95% confidence interval of risk factors for dental caries and gingivitis. P < 0.05 was considered statistically significant.


  Results Top


The demographic characteristics of both pregnant and nonpregnant women are presented in [Table 1]. In the age group below 25 years, 64.6% were pregnant and 47% were nonpregnant which was statistically significant (P <.0001). Among education, 57.7% were illiterate among pregnant and 59.6% among nonpregnant which is not significant. Similarly, the data of literacy and occupation among pregnant and nonpregnant women were not significant.
Table 1: Demographic characteristics of women

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Dental disease by pregnancy status

As shown in [Table 2], pregnant women were more likely to have dental caries and gingivitis compared with nonpregnant women. Nearly 63.3% of pregnant women had dental caries, while in the nonpregnant group, the percentage of caries was around 44.5%. This difference came out to be statistically significant (P = 0.0001). Moreover, it was found that 71.9% of pregnant women had gingivitis in comparison to 60.5% among nonpregnant women. This difference was again statistically significant (0.0007).
Table 2: Dental diseases by pregnancy status

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Thus, significant differences were revealed between pregnant and nonpregnant women with regard to both dental caries and gingivitis.

Distribution of dental caries and gingivitis according to demographic characteristics

In [Table 3] occurrence of dental caries and gingivitis with different demographic characteristics of pregnant women are shown. Dental caries was more commonly seen in women who were below 25 years of age (51%), illiterate (53.1%), and homemakers (56.2%). Similar results were noted for gingivitis. Gingivitis was also seen more in women who were below 25 years of age (55.3%), illiterate (57.6%), and homemakers (54.1%).
Table 3: Distribution of dental caries and gingivitis according to demographic characteristics

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Predictors of dental caries and gingivitis among pregnant and nonpregnant women

Predictors of dental caries and gingivitis based on logistic regression analyses are shown in [Table 4]. It was found that pregnant women were 2.2 times more likely to suffer from dental caries (OR = 2.2, P = 0.0001) and approximately 2 times from gingivitis (OR = 1.94, P = 0.0006) than nonpregnant women. There was significant occurrence of dental caries in women who were more than 25 years of age (OR = 1.6, P = 0.03), who were illiterate (OR = 2.29, P = 0.002), and who were homemakers (OR = 1.42, P = 0.4). Gingivitis was significantly common in pregnant women above 25 years of age (OR = 2.48, P = 0.0038), who were illiterate (OR = 1.83, P = 0.0046), and who were homemakers (OR = 2.36, P = 0.01).
Table 4: Predictors of dental caries and gingivitis among sampled women

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Association between gingivitis and other factors among pregnant women

[Table 5] shows the relationship of dental caries with oral hygiene status, dental healthcare knowledge, and attitude among pregnant women. There was only mild difference in caries between the poor and good oral hygiene groups. Pregnant women with poor oral hygiene were 1.6 times (OR = 1.64; P = 0.09) more likely to have caries compared with those in the good oral hygiene group. There was no significant difference in caries between women either with good or poor knowledge (OR = 1.22; P = 0.87). In addition, there was only mild difference in caries between pregnant women with good and poor attitude. Pregnant women with poor attitude were 1.6 times (OR = 1.59; P = 0.14) more at risk of having dental caries.
Table 5: Associations of dental caries with oral hygiene status, dental care knowledge, and attitude among pregnant women

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Association between gingivitis and other factors among pregnant women

[Table 6] shows the relationship of gingivitis with oral hygiene status, dental healthcare knowledge, and attitude among pregnant women. The pregnant women with poor oral hygiene status were 1.5 times (OR = 1.49, P = 0.078) more likely to have gingivitis compared to those with good oral hygiene status. However, the occurrence of gingivitis in pregnant women with poor knowledge was significant (OR = 1.87, P = 0.005) compared to those with good knowledge. In addition, the occurrence of gingivitis was significantly more in patients with poor attitude (OR = 2.04, P = 0.01) than those with good attitude.
Table 6: Association of gingivitis with oral hygiene status, dental care knowledge, and attitude among pregnant women

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  Discussion Top


The physiologic changes during pregnancy may result in noticeable changes in oral cavity.[3],[9] All of these changes predispose women to gingivitis, benign oral gingival lesions, tooth mobility, tooth erosion, periodontitis, dental caries, and pregnancy gingivitis. The present study revealed that the rates of dental caries (63.3%) and gingivitis (71.9%) were significantly higher in pregnant than in nonpregnant women (dental caries 44.5% and gingivitis 60.5%). Kornman and Loesche reported that one-fourth of the women of reproductive age had dental caries.[10] These dental diseases can be due to an altered immune response or can be related to stress and anxiety during pregnancy, resulting in inadequate attention to oral hygiene and hence contributes to the deterioration in a woman's oral condition.[1] Furthermore, hormonal imbalances have been reported to be associated with changes in oral health during pregnancy since long. Pregnant women are at a higher risk of tooth decay for many different reasons. The possible causes of caries in pregnant females are changes in saliva and mouth flora, vomiting, neglected oral hygiene and nutritional changes, and inadequate attention to oral health.[2]

The alterations in progesterone and estrogen levels have been shown to affect the immune system and both the rate and pattern of collagen production in the gingiva. Both of these conditions reduce the body's ability to repair and maintain gingival tissues. Hence, women are more likely to develop gingivitis during pregnancy. Increase in the rate of both estrogen metabolism by the gingiva and in the synthesis of prostaglandins was found to contribute to the gingival changes observed during pregnancy.[2] Increased amount of progesterone and estrogen enhances exertion of gingivitis, and therefore, preventive procedures for oral hygiene are extremely important.[11]

In this study, we investigated the relationship of caries to risk factors. The results of our study revealed a higher occurrence of dental caries among these who were homemakers (56.2%) than working women (43.8%). A higher occurrence of dental caries was noted among those who were illiterate (53.1%) than those who had educated (46.9%). The high prevalence of dental caries in the low socioeconomic status is because of their poor oral hygiene practice, lack of awareness, improper food intake, and family status. Similar findings were seen for gingivitis, which was more common in homemakers (59.6%) and illiterate (57.8%) which is in agreement with the findings of other studies.[2] As access to dental care is directly related to income level; the poorest women are least likely to receive dental care and hence, the poor oral hygiene. Since mothers play a crucial role in demonstrating and passing on proper health habits to their children, pregnant women should be regarded as a prime target group for oral health education.[8] Preventive programs are necessary to save mother's teeth healthy and provide women with information about child's teeth care.[12]


  Conclusion Top


Dental caries and gingivitis were more prevalent among pregnant than nonpregnant women. The pregnant women with a poor oral hygiene status, inadequate knowledge of dental health care, and poor dental hygiene practice were at more risk of developing dental diseases such as dental caries, gingivitis, periodontitis, and other oral diseases. Therefore, women should be offered training in good oral hygiene habits and community awareness programs should be conducted to increase their awareness of the crucial importance of such habits and detailed knowledge about the diseases and their effects on health should be explained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Leous PA, Zborovsky EI. Social and economic potential of a preventive oral health programme in belarus within the framework of Cindi. Dental Status of Pregnant Thai Women. Copenhagen: WHO Regional Office for Europe; 1995. p. 1-21.  Back to cited text no. 1
    
2.
Mital P, Amit, Raisingani D. Dental caries and gingivitis in pregnant women. Sch J Appl Med Sci 2013;1:718-23.  Back to cited text no. 2
    
3.
Vogt M, Sallum AW, Cecatti JG, Morais SS. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Reprod Health 2012;9:3.  Back to cited text no. 3
    
4.
Saravanan S, Madivanan I, Subashini B, Felix JW. Prevalence pattern of dental caries in the primary dentition among school children. Indian J Dent Res 2005;16:140-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Cucó G, Fernández-Ballart J, Sala J, Viladrich C, Iranzo R, Vila J, et al. Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. Eur J Clin Nutr 2006;60:364-71.  Back to cited text no. 5
    
6.
Machuca G, Khoshfeiz O, Lacalle JR, Machuca C, Bullón P. The influence of general health and socio-cultural variables on the periodontal condition of pregnant women. J Periodontol 1999;70:779-85.  Back to cited text no. 6
    
7.
Silk H, Douglass AB, Douglass JM, Silk L. Oral health during pregnancy. Am Fam Physician 2008;77:1139-44.  Back to cited text no. 7
    
8.
Honkala S, Al-Ansari J. Self-reported oral health, oral hygiene habits, and dental attendance of pregnant women in Kuwait. J Clin Periodontol 2005;32:809-14.  Back to cited text no. 8
    
9.
Pirie M, Cooke I, Linden G, Irwin C. Dental manifestations of pregnancy. Obstetrician Gynaecol 2007;9:21-6.  Back to cited text no. 9
    
10.
Kornman KS, Loesche WJ. The subgingival microbial flora during pregnancy. J Periodontal Res 1980;15:111-22.  Back to cited text no. 10
    
11.
Vasiliauskiene I, Milciuviene S, Bendoraitiene E, Narbutaite J, Slabsinskiene E, Andruskeviciene V, et al. Dynamics of pregnant women's oral health status during preventive programme. Stomatologija 2007;9:129-36.  Back to cited text no. 11
    
12.
Vasiliauskiene I. Oral health status of pregnant women. Stomatologija Balt Dent Maxillofac J 2003;5:57-61.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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