International Journal of Current Research and Review (IJCRR)

Full Html

IJCRR - vol 09 issue 01, January

Pages: 09-12

Date of Publication: 07-Jan-2017

Print Article   Download XML  Download PDF


Author: Jaiganesh Ramamurthy1, Fathima Irfana2

Category: Healthcare

Abstract:Background: Periodontal diseases and systemic diseases are having association and various studies have been done to assess the scientific evidence. There are a lot of scientific data available to explain the association between periodontal diseases, adverse pregnancy outcomes such as preeclampsia and preterm low birth weight deliveries. It is also linked with stillbirth, miscarriage, intrauterine growth retardation. Pregnancy can influence gingival health and also the changes in the hormone level during pregnancy promote inflammation termed as Pregnant Gingivitis and it occurs without any changes in the plaque level.
Aim and Objective: To assess and compare the level of knowledge and attitude towards periodontal oral health among pregnant women.
Materials and Methods: Awareness of the relationship between oral health and pregnancy, demographics, oral health knowledge, oral hygiene, and dental visits during pregnancy and their willingness for treatment to be surveyed by self administered questionnaire from 100 pregnant females. The data was collected, summarized and statistically analyzed.
Results: Knowledge and awareness regarding periodontal disease, and its effect on the pregnancy and birth outcome is very limited. Knowledge and awareness about use of interdental aids, extra care during pregnancy and about premature labour and low birth babies are correlated with periodontal oral health.
Conclusion: Most pregnant women need more information about oral health, and prevention of gingival and periodontal diseases as they are more concern about general health and less aware and concern about dental health.

Keywords: Pregnancy, Periodontitis, Oral health

Full Text:


“Periodontal Disease” is a destructive inflammatory disorder of the hard and soft tissues surrounding teeth. Preterm birth, also known as premature birth, is the birth of a baby at less than 37 weeks gestational age(1).

The infected periodontium can represent an endocrine like source of potentially deleterious cytokines and lipid mediators which may increase the likelihood of adverse pregnancy outcomes. Pregnancy can influence gingival health. Changes in hormone levels during pregnancy promote an inflammation termed pregnancy gingivitis. This type of gingivitis may occur without changes in plaque levels.Furthermore, pregnancy increases the onset of new periodontal disease. If the pre-existing periodontal disease becomes active during the pregnancy, it may pose a significant concomitant infectious or inflammatory exposure and it can lead to preterm delivery of low birth weight babies(2).

Pregnancy is a unique period during a woman's life and is characterised by complex physiological changes, which may adversely affect oral health. Women’s life cycle changes presents unique challenges to the oral health care profession. Hormonal influences associated with the reproductive process alter periodontal and oral tissue responses to local factors creating diagnostic and therapeutic dilemmas. It is imperative, therefore, that clinician recognise, customise and vary periodontal therapy, according to an individual female and the stage of her life cycle(3-5).

Maintenance of oral health during pregnancy has been recognised as an important public health issue worldwide. A number of statements and guidelines have been published emphasising improved oral health care during pregnancy. Hormonal changes in pregnancy combined with neglected oral hygiene tend to increase the incidence of oral diseases like gingivitis(6-8).

The present study was conducted to assess knowledge and awareness regarding oral health among pregnant women in India. Relevant cross-sectional observational studies were included in the systematic review to assess the level of knowledge and awareness regarding oral health among pregnant women in Chennai. The results obtained would serve as baseline information for planning an oral health education program aimed at improving the oral health of pregnant women receiving care in the hospital. Specifically, it would identify areas of deficiency in the women’s knowledge and this would be helpful in formulating the content of the oral health messages(9-10).


A questionnaire based study was conducted by assessing the responses to selected basic questions about periodontal oral health in the Gynaecology department of shifa hospital, Chennai. The subjects were informed about the purpose of the study and ethical approval was obtained from the chief of the Hospital.

The demographic data and a questionnairewith 20 structured questions regarding the knowledge and awareness of periodontal oral health were given to all consenting pregnant women who attended the clinic during the study period.The first section contained questions on the respondent’s socio- demographic characteristics such as age, occupation, monthly income and educational status. The second section comprised of fifteen questions pertaining to awareness of relationship between oral health and pregnancy, oral health knowledge, oral hygiene, dental visits during pregnancy, advice about dental health requirements during pregnancy, history of bleeding gums and what, if any, actions were sought to treat perceived gingival problems and their willingness for treatment.







Monthly income:

Habits if any:

Gestational age:

Oral Hygiene Status:

  1. Do you brush your teeth? A. Yes B. No
  2. If no, then do you use any other oral hygiene method?_________
  3. Do you brush your teeth after every meal?                                                                                                         A. Yes           B. No
  4. Do you use interdental cleaning aids?                                                                                                               A. Yes       B. No
  5.  Do you think that extra care of oral hygiene is needed during pregnancy?                                                     A. Yes        B. No
  6.  Are you aware that dental disease and pregnancy are related ?                                                                    A. Yes     B. No
  7.  Do you know that Cavities (tooth decay) and gum disease are caused by infection in the mouth?               A. Yes              B. No
  8. Do you know about Premature labour and low birth babies ?                                                                         A. Yes          B. No
  9.  Premature labour means how many months early ?_________
  10. What will be the weight of low birth babies?________
  11. What do you think is the ideal weight of new born ?                                                                                        a) 2kg b) 2.5kg c) 3kg d) 4 -6kg
  12. Have you ever suffered from premature labor or low birth weight babies in the past?                                     A. Yes            B. No
  13. Are you aware that gum disease are related with premature labor and low birth weight babies?                       A. Yes           B. No
  14. Have you ever visited a dentist during or before your pregnancy?                                                                 A. Yes             B. No
  15. Do you know that Pregnancy makes your gums bleed, swell, become red?                                                   A. Yes              B. No
  16. Do your gums bleed during tooth brushing after conception?                                                                         A. Yes               B. No
  17. If you are found to have periodontal disease (gum disease) now during pregnancy ,will you undergo treatment for the same?                                                                                                                                  A. Yes                B. No
  18. If you are diagnosed with periodontal disease (gum disease) after delivery ,will you undergo treatment ?       A. Yes                 B. No
  19. Did your gynaecologist recommended oral check up before or during pregnancy?                                       A. Yes                   B. No




The data was collected and the results were tabulated .

The results obtained from the periodontal health awareness questionnaire were compiled and were tabulated and graphically represented.

Descriptivetabulations were done by age, education and occupation. For the purpose of analysis the level of education was categorised as low (primary education only), middle (secondary education) and tertiary (post secondary education). Thus the results were analyzed.


The commonest oral disease during pregnancy (i.e. Periodontal disease) is preventable by the institution of simple measures such as regular tooth-brushing and flossing.(10-12) However such positive behaviour would be influenced by the individual’s oral health knowledge and attitudes which in turn is influenced by the awareness of an individual. Thus, this study was designed to provide a view of periodontal awareness among pregnant females.


A majority of the pregnant women has good knowledge and information about general health. But they have limited knowledge and awareness regarding periodontal disease, and its effect on the pregnancy and adverse pregnancy outcomes. Most pregnant women need more information about oral health, and prevention of gingival and periodontal diseases. (13,14) Longitudinal studies are needed to assess the long-term effect of oral health education programs in maternity care centers on dental health knowledge and behavior of pregnant women. Long term studies are required to determine if there is a strong correlation between periodontal disease and premature labor. Also further studies are required to check whether periodontal therapy or prevention can reduce the risk of premature labor. Studies to assess the role of dental hygienists in designing and promoting information regarding periodontal health awareness and practices among pregnant women in maternity care centers.


The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Conflict of interest: Nil

Source of Funding: Nil


1. Boggess KA, Urlaub DM, Moos MK, Polinkovsky M, El-Khorazaty J, Lorenz C. Knowledge and beliefs regarding oral health among pregnant women. J Am Dent Assoc. 2011 Nov;142(11):1275-82.

 2. Loe H, Silness J. Periodontal Disease In Pregnancy. I. Prevalence And Severity. Acta Odontol Scand. 1963 Dec;21:533-51

 3. Jensen J, Lilijmack W, Bloomquist C. The effect of female sex hormones on subgingival plaque. J Periodontol1981;52(10): 599–602.

 4. Nuamah I, Annan BD. Periodontal status and oral hygiene practices of pregnant and non-pregnant women. East Afr Med J. 1998 Dec;75(12):712-4.

 5. Ferris GM. Alteration in female sex hormones: their effect on oral tissues and dental treatment. Compendium. 1993 ;14(12):1558-64.

 6. Zachariasen RD. The effect of elevated ovarian hormones on periodontal health: oral contraceptives and pregnancy. Women Health. 1993;20(2):21-30.

7. Sánchez AR, Kupp LI, Sheridan PJ, Sánchez DR. Maternal chronic infection as a risk factor in preterm low birth weight infants: the link with periodontal infection. J IntAcadPeriodontol 2004. Jul;6(3):89-

8. Al Mullahi A, Mendoza LF, Al Wahaibi MC. Audit on Patient’s Attendance Pattern, Reasons for Failed Appointments and Waiting Time at Oral Health Department. Oman Med J 2012. Jan;(1)(Suppl):75-100

9. Hajikazemi E, et al. The relationship between Knowledge, Attitude and Practice of Pregnant Women about Oral and Dental Care. European Journal of Scientific Research 2008;24(4):556-562

10. American Academy of Periodontology 2010; Baby steps to a healthy pregnancy and on time delivery.

11. Deasy MJ, Vogel RI. Female sex hormonal factors in periodontal disease. Ann Dent 1976;35(3):42-

12. Silk H, Douglass AB, Douglass JM, Silk L. Oral health during pregnancy. AmFam Physician 2008. Apr;77(8):1139-1.

13. Manjushavaradan, Jaiganesh Ramamurthy. Association of Periodontal Disease and Pre-term Low Birth Weight Infants.J Obstet.Gynaecol India 2015. May;65(3):167-171.

14. Misrathbanum A, Jaiganesh Ramamurthy. Periodontitis a risk factor for pre-eclampsia in pregnant women.Int J Pharm Bio Sci. Volume 5, Issue 2, 2014 ( April - June), Pages:736-739.