Objective: The objective of this study was to document oral health practices of pregnant women in two tertiary institutions in North-eastern Nigeria.Materials and Methods: This was a cross-sectional study of pregnant women seen at the antenatal clinics of the University of Maiduguri Teaching Hospital and Federal Medical Centre Yola from May 1, 2009 to July 1, 2009.Results: A total of 294 women were interviewed. They were aged 15-46 with a mean of 27.42 &#177; 5.97 years. The parity ranged from 1 to 9 with a mean of 2.23 &#177; 1.65. Twelve (4.1%) women gave a history of symptomatic oral lesion in index pregnancy. Forty-four (15%) had had previous encounter with a dentist, while the highest frequency of oral care was twice a day in 164 (55.8%) of respondents. The majority, 264 (89.9%), used toothbrush/toothpaste as a form of oral care while 2 (0.7%) used charcoal. Women of low parity tended to have better oral care than those of high parity (P = 0.002). Women who are employed had better oral care than housewives (x2 = 27.749, P = 0.001). There was no significant relationship between oral complaints and trimester of pregnancy (x2 = 4.271, P = 0.118).Conclusion: Oral healthcare among the respondents was encouraging but involvement of the dental surgeon in preventive oral care in pregnancy is rather dismal

Adesina, OA

Audu, BM

Bukar, M

Marupa, JY

English

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302 Nigerian Journal of Clinical Practice • Jul-Sep 2012 • Vol 15 • Issue 3Original ArticleAbstractObjective: The objective of this study was to document oral health practices of pregnant women in two tertiary institutions in North-eastern Nigeria.Materials and Methods: This was a cross-sectional study of pregnant women seen at the antenatal clinics of the University of Maiduguri Teaching Hospital and Federal Medical Centre Yola from May 1, 2009 to July 1, 2009.Results: A total of 294 women were interviewed. They were aged 15-46 with a mean of 27.42 ± 5.97 years. The parity ranged from 1 to 9 with a mean of 2.23 ± 1.65. Twelve (4.1%) women gave a history of symptomatic oral lesion in index pregnancy. Forty-four (15%) had had previous encounter with a dentist, while the highest frequency of oral care was twice a day in 164 (55.8%) of respondents. The majority, 264 (89.9%), used toothbrush/toothpaste as a form of oral care while 2 (0.7%) used charcoal. Women of low parity tended to have better oral care than those of high parity (P = 0.002). Women who are employed had better oral care than housewives (x2 = 27.749, P = 0.001). There was no significant relationship between oral complaints and trimester of pregnancy (x2 = 4.271, P = 0.118).Conclusion: Oral healthcare among the respondents was encouraging but involvement of the dental surgeon in preventive oral care in pregnancy is rather dismal.Key words: North-eastern Nigeria, oral health practice, pregnancyDate of Acceptance: 27-Aug-2011Address for correspondence: Dr. Mohammed Bukar, Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, PMB, 1414, Maiduguri, Borno State, Nigeria. E-mail: mbbukar07@yahoo.comIntroductionSeveral changes occur in the oral cavity during pregnancy with the greatest being in the gingiva.[1] Pregnancy, however, does not seem to predispose to tooth decay. [2] Bleeding gingiva is not uncommon in pregnancy as a result of increase systemic estrogen. These changes should return to normal after pregnancy or withdrawal of oral contraceptive pills. Bleeding and tenderness of the gingiva could also result from deficiency of vitamin C.[2] Periodontal disease is one of the most common infectious disorders in humans.[3] Previous studies have suggested a relationship between periodontal disease and adverse pregnancy outcomes like preterm birth, preeclampsia, and fetal growth restriction,[4,5] but the recent large prospective study has failed to demonstrate an association between periodontal disease and adverse pregnancy outcome.[6]The oral health needs of pregnant women in Northeastern Nigeria has not received the desired attention to the extent that even obstetricians hardly refer pregnant women to the dentist except if a complaint exist. This may be because there is poor appreciation of oral health needs of pregnancy. This review is an attempt to determine the oral health practices of pregnant women in northeastern Nigeria.Oral health practices among pregnant women in North Eastern NigeriaM Bukar, BM Audu, OA Adesina1, JY Marupa2Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital  Borno State, 1Department of Oral/Maxillofacial Surgery University of Maiduguri Teaching Hospital, 2Department of Obstetrics and Gynaecology Federal Medical Centre Yola, NigeriaAccess this article onlineQuick Response Code:Website: www.njcponline.comDOI: 10.4103/1119-3077.100625PMID: 22960965303Nigerian Journal of Clinical Practice • Jul-Sep 2012 • Vol 15 • Issue 3Bukar, et al.: Oral health in pregnancyMaterials and MethodsThis was a cross-sectional, questionnaire-based study of 294 women, aged 15--46 years seen at the antenatal clinic of two tertiary health institutions in Northeastern Nigeria (Federal Medical centre Yola and University of Maiduguri teaching hospital) from May 1, 2009 to July 1, 2009. Respondents were interviewed after verbal consent was obtained. No participant declined participation in the study. They were asked about their demographic characteristics, duration of pregnancy, previous contraceptive use, previous oral lesion and lesion in index pregnancy, previous visit to dentist, type of oral care, frequency of care, and material used for oral care among others. The research and ethical committee of the hospitals approved the study. The information obtained was analyzed using SPSS version 16 (SPSS, Inc, Chicago, IL, USA). The chi-square test was used to determine significance and a P-value <0.05 was considered significant.ResultsTwo hundred and ninety four respondents were interviewed during the period of study. The sociodemographic characteristics are shown in Table 1. They were aged 15-46 with a mean of 27.42 ± 5.97 years. The majority, 286 (97.3%), were married. The parity ranged from 1 to 9 with a mean of 2.23 ± 1.65. Most, 226 (76.9%), had at least secondary education with 50 (17.0%) being nonliterates. Housewives constituted the majority of the respondents, 142 (48.3%). Only 18 (6.1%) registered for antenatal care in the first trimester. Muslims made up 176 (59.9%) of those interviewed. Only 38 (12.9%) gave a history of previous contraceptive use.Table 2 reveals the oral health practices among the studied population. The majority, 264 (89.9%), used toothbrush/paste as a form of oral care while 2 (0.7%) used charcoal. Most women, 164 (55.8%), brush their teeth twice a day. Only 44 (15.0%) had visited the dentist in and out of pregnancy and only a few, 12 (4.1%), had symptomatic oral lesion in the index pregnancy, with excessive salivation been the most common.The relationship of variables of interest with oral care is depicted in Table 3. Women of low parity tended to have better oral care than those of high parity (c2 = 20.281, P = 0.002). Education had a positive influence on oral care (c2 = 45.940, P = 0.000). Employed women had better oral care than housewives (c2 = 27.749, P = 0.001). Those of Muslim faith had better oral care than their Christian counterparts (c2 = 15.662, P = 0.001). There was no significant relationship between oral complaints and the trimester of pregnancy (c2 = 4.271, P = 0.118) but a significant association was found between the frequency of oral care and trimester of pregnancy (c2 = 18.809, P = 0.016).DiscussionThe preponderance of women with some formal education 214 (82.9%), with 196 (76.9%) having had at least secondary education, compares favorably with a previous study on perception of oral health in South western Nigeria. [7] The high number of housewives, 48.3% in our study, is in sharp contrast to 44% professionals and civil servants found in Ibadan.[7] This difference in social class may affect oral health practice and health seeking behavior generally.Most of the women studied used toothbrush and paste as a form of oral care. This is similar to an earlier study.[8] The urban abode of the respondents might explain the high rate of use of toothbrush although some used a combination of toothbrush and chewing stick and a few used charcoals. The explanation given by Bassey et al.,[8] that the high use Table 1: Sociodemographic characteristics of respondents (n = 294)Characteristic Number Percentage Age (years)15-19 18 6.120-24 84 28.625-29 90 30.630-34 62 21.1³35 40 13.6Marital statusSingle 4 1.4Married 286 97.3Separated 2 0.7Divorced 2 0.7Parity1 138 46.92-4 120 40.8>5 36 12.2 Educational statusNon literate 50 17.1Primary 18 6.1Secondary 76 25.9Tertiary 150 51.0Occupation Housewife 142 48.3Business 30 10.2Civil servant 88 29.9Student 34 11.6Religion Christian 118 40.1Muslim 176 59.9Gestational age at bookingFirst trimester 18 6.1Second trimester 230 78.2Third trimester 46 15.6Previous contraceptive useNo 256 87.1Yes 38 12.9304 Nigerian Journal of Clinical Practice • Jul-Sep 2012 • Vol 15 • Issue 3Bukar, et al.: Oral health in pregnancyfew of the women presented in the first trimester when the incidence of excessive salivation is likely to be higher. At the time most of the women presented in the second and third trimesters of pregnancy, some would have forgotten such complaints and others would consider excessive salivation as normal.The high estrogen and progesterone levels during pregnancy induce hyperemia, edema, and bleeding of periodontal tissues making pregnant women susceptible to periodontal disease.[10,11] Previous studies have suggested a relationship between periodontal disease and adverse pregnancy Table 2: Oral health practices among the study group (n = 294)Variable Number PercentageNature of oral careToothbrush/paste 264 89.8Chewing stick 26 8.8Charcoal 2 0.7Toothbrush+chewing stick 2 0.7Frequency of daily oral care1 106 36.12 164 55.83 22 7.55 2 0.7Previous visit to the dentistNo 250 85.0Yes 44 15.0Presence of oral complaint in index pregnancyNo 282 95.9Yes 12 4.1Nature of oral complaintExcessive salivation 8 67Bleeding gingiva 3 25Toothache 1 8of toothbrush is a result of availability and cheapness and that no high level skill is required is not entirely satisfactory in that chewing stick is cheaper and at times free as people break branches of trees to make local chewing stick and their use requires no skill at all unlike use of toothbrush. Acceptance of modernity and attainment of western education might be contributing factors to high rate of use of toothbrush/paste. It would be interesting to look at oral health practice in rural areas where the sociodemographic characteristics are at variance with what obtains in urban cities. Contrary to a previous study[7] educational status had a positive influence on oral care in our study (c2 = 45.940, P = 0.000). Most respondents brush their teeth twice a day with 0.7% doing so five times a day due to distaste of the pregnancy. The increase in number of tooth brushing in pregnancy in this study is not because of awareness of oral healthcare but because of distaste associated with the pregnancy state.Most obstetricians in Nigeria hardly refer pregnant women for dental treatment due to lack of dental complaints by the women, but this could also be due to lack of awareness by doctors on the need for dental care during pregnancy. Similar observation has been made earlier.[7] The most common oral condition found in this study was excessive salivation, followed by bleeding gingiva. This is in consonance with a study by Koos and Moore[2] but in contrast with that of Bassey et al.[8] who found bleeding gingivas as the most common complaint. In contrast to previous studies,[9,10] oral complaints were not related to trimester of pregnancy in our study (c2 = 4.271, P = 0.118). This is because only a Table 3: Relationship between variables of interest and oral careVariable Nature of oral care TotalParity T C CH TC1 132 4 0 2 1382-4 104 14 2 0 120>5 28 8 0 0 36Total 264 26 2 2 294c2 = 20.281, P = 0.002Education T C CH TCNone 34 14 2 0 50Primary 16 2 0 0 18Secondary 68 8 0 0 76Tertiary 146 2 0 2 150Total 264 26 2 2 294c2 = 45.940, P = 0.000Occupation T C CH TCHousewife 120 20 2 0 142Business 28 2 0 0 30Civil servant 86 2 0 0 88Student 30 2 0 2 34Total 264 26 2 2 294c2 = 27.749, P = 0.001Religion T C CH TCChristian 116 2 0 0 118Muslim 148 24 2 2 176Total 264 26 2 2 294c2 = 15.662,  P = 0.001Oral complaint GA at booking1st 2nd 3rdNo 16 220 46 282Yes 2 10 0 12Total 18 230 46 294c2 = 4.271, P = 0.118Frequency of Daily care GA at booking1st 2nd 3rd1 4 86 16 1062 10 130 24 1643 4 14 4 225 0 0 2 2Total 18 230 46 294c2 = 18.808, P = 0.016T = Toothbrush/paste; C = Chewing stick; CH = Charcoal; TC = Combination of toothbrush with chewing stick; GA = Gestational age.305Nigerian Journal of Clinical Practice • Jul-Sep 2012 • Vol 15 • Issue 3Bukar, et al.: Oral health in pregnancyoutcomes like preterm birth, preeclampsia, and fetal growth restriction,[4,5] but the recent large prospective study has failed to demonstrate such an association.[6]For optimal oral health, dental professionals’ recommend preventive dental visits.[12] The most common measure of utilization of dental services is the number of visits to the dentist per person per year.[13] In our study only 15% visited the dentist in and out of pregnancy and all were for therapeutic purposes. The poor oral health seeking behavior of Nigerian pregnant women has been reported earlier by Arowojolu et al.[7] and Bassey et al.[8]In conclusion, oral healthcare among the respondents was encouraging but involvement of the dental surgeon in preventive oral care in pregnancy is rather dismal. However, the visit of pregnant women to the dentist during pregnancy could improve oral healthcare.References1. Leine MA. Effect of pregnancy and dental health. Acta Odontol Scand 2002; 60:257-64.2. Koos BJ, Moore PJ. Maternal physiology during pregnancy. In: DeCherney AH, Nathan L, editors. Current obstetrics andgynaecologic diagnosis and treatment. 9th ed. London: Lange books/McGraw-Hill; 2003. p. 154-62.3. Papapanou PN. Periodontal disease; Epidemiology. Ann Periodontol 1996;1:1- 36.4. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth. J Am Dent Assoc 2001;132:875-80.5. Mokeem SA, Molla GN, Al-Jewair TS. The prevalence and relationship between periodontal disease and pre-term low birth weight infants at King Khalid University Hospital in Riyadh, Saudi Arabia. J Contemp Dent Pract 2004;5:40-56.6. Srinivas SK, Sammel MD, Stamilio DM, Clothier B, Jeffcoat MK, Parry S, et al. Periodontal disease and adverse pregnancy outcomes: Is there an association? Am J Obstet Gynecol 2009;200:497.e1-8.7. Arowojolu MO, Aderinokun GA, Arowojulu AO. Perception of oral health needs by Nigerian pregnant women. Nig Med Pract 1999;37:70-3.8. Bassey GO, Anyanechi CE, Ekabua KJ, Ekabua JE. Oral health among antenatal care attendees in Calabar, Nigeria. J Obstet Gynaecol 2010;30:143-6.9. Garfield ML, Colley-Gilbert BJ, Melvitz DM, Romaguera R. Oral health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system. J Am Dent Assoc 2001;132:1009-16.10. Gajendra S, Kumar JV. Oral health and pregnancy: A review. N Y State Dent J 2004;70:40-4.11. Lyndon-Rochelle MT, Krakowack P, Hujoel P, Peters RM. Dental care and self-reported dental problems in relation to pregnancy. Am J Public Health 2004;94:765-71.12. Goodman HS, Macek MD, Wagner ML, Manz MC, Marrazzo ID. Self-reported awareness of unrestored dental caries. Survey of the Oral Health Status of Maryland Schoolchildren, 2000-2001. Pediatr Dent 2004;26:369-75.13. King T. Tooth brushing and utilization of dental services in Fiji (1998). Pac Health Dialog 2003;10:23-7.How to cite this article: Bukar M, Audu BM, Adesina OA, Marupa JY. Oral health practices among pregnant women in North Eastern Nigeria. Niger J Clin Pract 2012;15:302-5.Source of Support: Nil, Conflict of Interest: None declared.

Oral health practices among pregnant women in North Eastern Nigeria

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Oral health practices among pregnant women in North Eastern Nigeria

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