|Year : 2013 | Volume
| Issue : 3 | Page : 111-115
Nigerian dentists and oral health-care of pregnant women: Knowledge, attitude and belief
Agnes O Umoh, Clement Chinedu Azodo
Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||22-Nov-2013|
Clement Chinedu Azodo
Department of Periodontics, Prof. Ejide Dental Complex, Room 21, 2nd Floor, University of Benin Teaching Hospital, P.M.B. 1111 Ugbowo, Benin City, Edo State
Background: Pregnant women seek preventive, interventional and rehabilitative oral health-care for their oral health and protection of their fetus and babies after delivery. The objective of the study was to determine the Nigerian Dentist's knowledge, attitude and belief pertaining to the oral health-care of pregnant women. Materials and Methods: This cross-sectional of Nigerian dentist was conducted between June and December, 2011 using Huebner et al., modified dentist's attitude to the pregnant women questionnaire Results: The overall response rate of 92.5% (149/160). Receipt of continuing medical education (CME) was reported among the participants on periodontal disease of pregnant patients (22.1%), oral hygiene of pregnant patients (20.1%), early childhood caries (35.6%) and general dental problem (51.0%). The majority (92.6%) agreed that Dentists have the skill to counsel pregnant patients, But only 73.8% of them provided oral hygiene instruction frequently to pregnant patients and even fewer (6.0%) were involved in educational advice on oral health for young women. Many of the participants agreed that counseling pregnant patients about periodontal disease and its effect on the developing baby is of utmost importance. Participants also dominantly agreed that dental treatment should be part of prenatal care and 97.3% of them opined that physician recommendation will increase the likelihood of pregnant seeking dental care. More than half (56.4%) of the participants reported that Dentists should be concerned about being sued if something goes wrong with the pregnancy. The recommended ways to improve oral health-care of pregnant women among the participants were through CME (92.6%), provision of educational materials on oral health-care of pregnant women (93.3%) and information on ways to counsel pregnant women (98.0%). Conclusion: Data from this study revealed high preparedness, positive attitude and favorable disposition in dental care provision for pregnant women among the studied Nigerian Dentists.
Keywords: Dentists, oral health-care, pregnancy
|How to cite this article:|
Umoh AO, Azodo CC. Nigerian dentists and oral health-care of pregnant women: Knowledge, attitude and belief. Sahel Med J 2013;16:111-5
| Introduction|| |
It has been established that pregnancy is associated with the development of some oral lesions and worsening of existing ones with adverse effects on pregnancy and pregnancy outcome.  The transmission of maternal cariogenic organism to offspring with resultant causation of dental caries in the offspring, even after child birth, has also been well-documented.  This means that pregnant women will be seeking preventive, interventional and rehabilitative oral health-care for restoration of their oral health as well as protection of their fetuses and babies after delivery. The heightened risk for dental conditions among pregnant women is related to the intraoral changes associated with hormonal changes during pregnancy as well as delays in the treatment for their oral disease.  It is therefore imperative that enhanced screening and referral services in preconception and pregnant populations be given considerable attention. 
The recommendation of preconception dental consultation among pregnant women is gaining ground due to the documented adverse effects of periodontal disease on pregnancy outcome.  Preventive oral health information delivery during pregnancy is important because pregnant women are usually favorably disposed towards any action that will be beneficial to their fetus. However, emergency interventional care, with delayed definitive care after parturition, is still commonly practiced in developing countries. This is probably because of the need to reduce stress and insult to the fetus.  The development of a proper oral health-care package for pregnant women by Dentists, in collaboration with stakeholders in maternal health-care, is necessary in developing countries. This will be facilitated by understanding the oral health giver's perspective on oral health-care of pregnant women with a view to improve gap in knowledge, correct negative attitude and optimize preventive and interventional approaches. The objective of the study was to determine the knowledge, attitude and belief pertaining to the oral health-care of pregnant women among Dentists in Nigeria.
| Materials and Methods|| |
This questionnaire-based cross-sectional study of 160 Dentists conveniently selected from major cities (Benin City, Lagos, Ibadan, Ile Ife Port Harcourt and Enugu) in the southern part of Nigeria was conducted between June and December, 2011. The participants recruited were all categories Dentists working in University of Benin Teaching Hospital, Lagos University Teaching Hospital, University College Hospital, Obafemi Awolowo University Teaching Hospital, University of Port Harcourt Teaching Hospital and University of Nigeria Teaching Hospital. Demographic characteristics of the participants showed that more than half (51.0%) of the participants were older than 30 years, 67.8% were males, 53.0% were unmarried and 14.8% of the participants received their dental degree more than 10 years ago. About one-third (33.6%) of the participants were house officers, 65 (43.6%) were resident doctors, 22 (14.8%) were general dental practitioners while 12 (8.1%) were consultants. The questionnaire used for data collection was a modified Huebner et al.  General dentist attitude to the pregnant woman questionnaire used in previous studies among Oregon Dentists in United States of America. It elicited information on demography, receipt of continuing medical education (CME) and the content of the CME, attitude, disposition and willingness to render oral health-care to pregnant women. The information on mode and timing of oral health-care, drugs, radiographs among pregnant women were also obtained from the participants with the questionnaire. The data analysis in the form of descriptive, non-parametric and logistic regression was carried out using the statistical package for the social sciences (SPSS) version 17.0 (SPSS, Inc., Chicago, IL, USA). Statistical significance was set at P < 0.05.
| Results|| |
Out of the 160 questionnaires administered, 149 of them were returned filled and considered useable for the study, giving a response rate of 92.5%. Receipt of CME was reported among the participants on following topics: periodontal disease of pregnant patients-33 (22.1%), oral hygiene of pregnant patients-30 (20.1%), early childhood caries-53 (35.6%) and general dental problem-76 (51.0%). About three-quarters (73.8%) of the participants provide oral hygiene instruction regularly to pregnant patients, but fewer (6.0%) reported involvement in educational advice on oral health for young women [Table 1].
The majority (97.3%) of the participants agreed that dental treatment should be part of prenatal care and that pregnant patients will more likely seek dental care if their physicians recommended it. Many (92.6%) agreed that Dentists have the skill to counsel pregnant patients and about three-quarters of the participants disagreed with the statement that physicians are more able to counsel pregnant patients about oral health than Dentists.
A total of 133 (89.3%) of the participants disagreed with the statement that there is little that can be done to affect pregnant patient's oral hygiene and the majority 146 (98.0%) also agreed that counseling pregnant patients about periodontal disease and prematurity is important for their health and attested that it is worthy of their time to counsel pregnant patients about how periodontal disease can affect the baby 133 (89.3%).
Less than half (41.6%) of the participants reported that the link between periodontal disease and preterm birth is still unclear to them for them to warn their patients about it. More than half (56.4%) of the participants reported that Dentists should be concerned about being sued if something goes wrong with the pregnancy. The majority of participants agreed that dentist need information on oral health-care of pregnant women in the form of CME (92.6%) and educational materials (93.3%) [Table 2].
|Table 2: Nigerian dentists' attitudes and beliefs toward behavioral counseling and treatment for pregnant women*|
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A total of 50.3% of the participants reported that routine scaling and polishing can be regularly performed among pregnant women while 10.7% and 29.5% of the participants reported that single tooth and full mouth radiograph, respectively should never be taken by pregnant women. Endodontic therapy, resin based composite restoration and nitric oxide sedation were also considered inappropriate by 8.1%, 1.3% and 32.2% of the participants, respectively. Participants 98 (65.8%) favored the 2 nd trimester for routine dental care. A total of 53 (35.6%) and 48 (32.2%) of the participant favored 1 st and 3 rd trimesters, respectively. Emergency care was recommended almost equally in all trimesters; 1 st trimester-80 (53.7%), 2 nd trimester-98 (65.8%), 3 rd trimester-71 (47.7%) [Table 3].
|Table 3: Nigerian dentists' knowledge of appropriate use and timing of procedures for pregnant patients*|
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There was an increase in antibiotics, analgesics and narcotics prescription from 1 st trimester through 2 nd trimester to 3 rd trimester. The dominant analgesics and antibiotics prescribed for the pregnant women were paracetamol and penicillins [Table 4].
|Table 4: Nigerian dentists' report of prescription of pharmaceutical for pregnant patients|
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| Discussion|| |
The increasing reports of adverse effect of periodontal diseases on pregnancy outcome, the transmissibility of maternal cariogenic bacteria to babies and the amelioration occasioned by adequate antenatal dental treatments, have necessitated a concerted effort into the incorporation of dental care into the overall antenatal care.  The receipt of continuing dental education by the substantial proportion of participants on pregnancy and early childhood related problems, their expression of interest in continuing dental education program about pregnant patients and their agreement that dental treatment should be part of prenatal care indicate high-level of preparedness and positive disposition to proper oral health-care delivery to pregnant women.
Dentist's perceived barriers have the strongest direct effect on their current practice and is invariably the most important factor deterring Dentists from providing care to pregnant patients.  Recognizing the benefit of counseling pregnant patients about the periodontal disease and prematurity and reporting that Dentists have the skill to counsel pregnant patients to indicate positive attitude for the oral health-care delivery to pregnant women. This contrasted with a report where Dentists did not provide prenatal counseling because they did not consider it a priority in the dental office and due to non-reimbursement.  However, in a study among public health professionals in Brazil, Dentists were shown to significantly have more favorable attitude toward oral health-care of pregnant women. 
Pregnancy is not a reason to defer routine dental care and necessary treatment for oral health problems because safety and effectiveness of providing oral health-care during pregnancy have been confirmed.  In this study, routine dental health-care delivery among pregnant women was mainly rendered in the 2 nd trimester while emergency dental health-care delivery among pregnant women was rendered almost equally in all the trimesters. Organogenesis is expected to have been completed in the 2 nd trimester of pregnancy and this makes this period an ideal time for pregnant women to undergo dental procedures. Although, it has been reported that dental treatment of pregnant women can be carried out with precaution at any time,  teratogenicity in the 1 st trimester and difficulty in the positioning of the gravid patient on the dental chair in the 3 rd trimester, may be a source of concern and this may be the likely explanation for the response of the participants in this study. There was an increase in antibiotics, analgesics and narcotics prescription from 1 st trimester through 2 nd trimester to 3 rd trimester. The lesser tendency of adverse effect of drug with the ageing of pregnancy may be the explanation.  The dominant analgesics and antibiotics prescribed in this study to the pregnant women were paracetamol and penicillins. The safety of these drugs at any trimester signifies that pregnant dental patients are at negligible risk of teratogenic effect from drug prescription in dental practice.
Few misconceptions existed in relation to offering pregnant women full mouth radiological investigation and endodontic treatment, subjecting them to nitric oxide sedation and prescription of drug in the 1 st trimester of pregnancy. These misconceptions may impede effective oral health-care delivery among pregnant women and the acknowledgment of about half of the participants in this study that Dentists should be concerned about being sued if something goes wrong with pregnancy may compound it. It has been stated that appropriate management of routine and dental emergencies can be denied by the practitioner because of misconceptions about pregnancy and fetal tolerance.  However, reports of need for educational materials on pregnant patients among the majority of the participants in this study indicate that the correction of these misconceptions and their obvious implications should be carried out through CME and provision of educational materials.
| Conclusion|| |
Data from this study revealed high preparedness, positive attitude and favorable disposition in the dental care provision for pregnant women among the studied Nigerian Dentists. The few misconceptions noticed will be corrected through CME and provision of education materials on oral health of pregnant women.
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[Table 1], [Table 2], [Table 3], [Table 4]