|Year : 2014 | Volume
| Issue : 2 | Page : 58-62
Gynecologists' concerns about oral diseases – A step to interdisciplinary approach
Sapna Balachandra Reddy1, Savithra Prakash1, Nagesh Lakshminarayan2
1 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
2 Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
|Date of Web Publication||11-Sep-2015|
Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka
Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.
Background: Oral diseases can complicate pregnancy and labor, and in turn can affect the health of the baby. Such problems may be minimized if there is a well-coordinated interdisciplinary approach between dentists and gynecologists. Aim: The aim was to assess the knowledge, attitude, and the practice of gynecologists practicing in Davangere city toward the prevention of oral diseases. Materials and Methods: A cross-sectional survey was conducted among gynecologists in Davangere city. A predesigned and pilot tested structured questionnaire were distributed. The questionnaire consisted of questions pertaining to risk factors for dental caries, gingivitis and malocclusion, attitude about the routine dental visit, the role of gynecologists, and their interest to be a part of an interdisciplinary approach to prevent oral diseases. The participants were given sufficient time to answer the questionnaire. The descriptive statistics were generated using SPSS software. Results: Poor oral hygiene was recognized as the risk factor for dental caries by 85% of participants. A vast majority of 93.9% was willing to refer their patients to dentists. Only 68.7% were found to examine the oral cavity of their patients, and nearly, 50% of participants said that they will refer their patient to visit a dentist in the first trimester. Conclusion: Gynecologists seem to embrace a fair knowledge about oral diseases. Their attitudes toward the prevention of oral diseases were positive, whereas, their practice toward the prevention of oral diseases needs improvement.
Keywords: Gynecologists, interdisciplinary, oral problems
|How to cite this article:|
Reddy SB, Prakash S, Lakshminarayan N. Gynecologists' concerns about oral diseases – A step to interdisciplinary approach. Int J Oral Health Sci 2014;4:58-62
|How to cite this URL:|
Reddy SB, Prakash S, Lakshminarayan N. Gynecologists' concerns about oral diseases – A step to interdisciplinary approach. Int J Oral Health Sci [serial online] 2014 [cited 2020 Jul 12];4:58-62. Available from: http://www.ijohsjournal.org/text.asp?2014/4/2/58/165100
| Introduction|| |
Pregnancy is a unique time in woman's life and is characterized by complex physiological changes in the body, which bring noticeable variations in the oral cavity as well. It includes pregnancy gingivitis, benign gingival lesions, tooth mobility, dental erosion, dental caries, and periodontitis. Pregnant women are a group of the population who require special attention from the health care professionals regarding the oral health.
In view of female reproductive hormonal influences, pregnant women are more susceptible to periodontal disease. A few studies have verified that periodontal disease may be associated with adverse pregnancy outcomes such as premature birth and low birth weight infant., During pregnancy time when women may be more motivated to make health changes, maintaining good oral health is important apart from reducing the risk of adverse pregnancy outcomes. It also improves the general health of both, the mother and infant.
A study by Amin and Shetty  reported poor oral health status of pregnant women when compared with the counterparts of the same age. According to research, 76.10% pregnant women experienced some oral problems, whereas only 31% of them said visited a dentist. Utilization of dental services by pregnant women was found to be poor. Women tend to visit gynecologists more frequently than other medical professionals, hence, they play a crucial role in the health of women and more so for the pregnant women. Gynecologists can lend a helping hand to overcome the perceived barriers for an oral checkup such as long waiting hours, distance, and negative attitude of health professionals.
A few studies have assessed the knowledge, attitude, and practice of gynecologists about the prevention of oral diseases in pregnant women.,,, However, beliefs and cultural background changes the health-related attitudes and the practices of people. Thus, our aim was to assess the knowledge, attitude, and practice of gynecologists practicing in Davangere city toward prevention of oral diseases.
| Materials and Methods|| |
A descriptive cross-sectional survey was conducted among the practicing Gynecologists in Davangere. Clearance was obtained from the Institutional review board. Voluntary written the informed consent was obtained from all the participants.
A structured questionnaire containing eight questions was prepared. It included the provision for demographic details such as age, gender, specialization, and number of years in practice of the participants. The questions were aimed at eliciting information with respect to the knowledge of gynecologists about various risk factors for dental caries, gingivitis and malocclusion, attitude about routine dental visit, role of gynecologists, and their interest to be a part of interdisciplinary approach to prevent oral diseases. There were some questions to gather information on gynecologists' attitude toward preventing oral diseases and whether the gynecologists performed oral examination of their patients, do they recommend their patients to visit dentist and if so, in which trimester, were elicited to know their practices. The questionnaire so designed was scrutinized for its validity by conducting a pilot study.
Thirty participants were randomly selected from the pool of gynecologists practicing in Davangere city for conducting a pilot study. Subjects were briefed about the study purpose and assured confidentiality before they gave consent to take part in this study. Predesigned questionnaires were distributed and self-administered. Gynecologists were also asked to critique the instrument with respect to the clarity and relevance. They were invited to give suggestions. Their feedback was constructively utilized to modify the questionnaire. The internal consistency of the questionnaire was checked by subjecting the data to Cronbach's alpha test. The Cronbach's alpha was found to be 0.83 (83%) reflecting a high degree of reliability.
Administration of survey
All the active gynecologists who were in academics or practice and/or both within the geographical limits of Davangere city were included in the study. This included all the faculty, Postgraduate and diploma students in Gynecology Departments of two colleges, all the gynecologists in private practice and gynecologists working in government hospitals. It is a "whole sample." Permission to meet and conduct the study was obtained from the principals of both medical colleges. Questionnaires were distributed to all the participants. Data so collected were compiled and fed into Excel sheet to carry out further analysis in IBM SPSS, Portable version 19.
| Results|| |
One hundred and forty-seven gynecologists participated in the study. The majority (42.2%) of the participants were in the age group of 21–30 years. About 74% of the subjects were females. The majority (45.6%) of the participants were master degree holders. About 60% of the subjects had no practice experience outside academics. Other details of demographic data are in [Figure 1].
|Figure 1: Demographic details of study participants. Bottom up - age in years, gender, specialization, and the number of years of practice|
Click here to view
Knowledge about risk factors for the major oral diseases is presented in [Table 1]. A vast majority (85%) of the gynecologists rightly said that poor oral hygiene is a risk factor for dental caries, and 83.7% of the participants knew that frequent sugar intake is the causative factor.
|Table 1: Distribution of study subjects according to awareness of risk factors for the oral diseases|
Click here to view
A total of 93.9% said that routine dental visit is important (Q2). A majority (94.6%) of participants accepted that gynecologists have an important role to play in the prevention of oral diseases (Q3). About 93.9% of participants refer their patients to the dentist (Q4). About 90.5% of the subjects were interested in interdisciplinary approach (Q5). Most of the gynecologists (91.8%) were interested to have further information about the prevention of oral diseases (Q6). Almost 50% of the participants recommended their patients to visit a dentist during the first trimester of their pregnancy (Q7). Nearly, 69% of gynecologists said that they perform the oral examination of their patients (Q8) [Figure 2].
|Figure 2: Participants responses to attitude and practice to prevent oral diseases. Q2. Do you accept that routine dental visit is important in preventing oral diseases? Q3. Does gynecologist has an important role in the prevention of oral diseases? Q4. Do you refer your patients to the dentist? Q5. Are you interested in an interdisciplinary approach to prevent oral disease? Q6. Do you think you need further information about the prevention of oral diseases? Q7. In which trimester do you recommend your patient to visit the dentist? Q7.1 1st, Q7.2 2nd Q7.3 3rd, Q8. Do you perform an oral examination of your patient?|
Click here to view
| Discussion|| |
The rush of hormones during pregnancy causes a myriad of changes in mother's body. The oral changes include gingivitis, gingival hyperplasia, pyogenic granuloma, and salivary gland changes. Preeclampsia, fetal immune response  and preterm birth  are shown to be the adverse outcomes of oral conditions and pregnancy cohort study. Gynecologists are a part of the primary health care delivery system in India whereas dentists are not, but for an exception in few centers. Hence, gynecologists can fill the gap in the health care delivery system. The physiological changes due to pregnancy results in pregnancy gingivitis, benign oral gingival lesions, tooth mobility, tooth erosion, dental caries, and periodontitis in the oral cavity. The general health and labor are negatively impacted by poor oral health maintenance. Gynecologists are in a strategic position providing the oral health-related information and also referral service to pregnant women. This demands good knowledge, right attitude, and favorable practices toward oral health on their part. This will reduce the practice-level barriers like long standing hours.
The highest frequency of participants was females, young doctors - master degree holders (MD) and having an experience of 2 to 5 years gynecologists in our study. Similar findings were observed in the previous studies., Increased frequency of sugar intake and poor oral hygiene were the major causative factors for dental caries. In earlier studies, nearly, 80% of the gynecologists knew about it, whereas in our study slightly more (85%) participants were aware of the fact. Poor oral hygiene is the single most common cause of gingivitis as answered by 77.6% of participants. This result is in consensus with previous study  participants in that research opined that malocclusion occurred due to various factors such as the position of teeth, bottle feeding, and nonnutritive sucking habits. These risk factors were correctly recognized by slightly more than 50% of participants in the current study. In a previous study, more number of people said bottle feeding is the risk factor. The results showed that gynecologists' awareness about the risk factors for common oral diseases is good. It is encouraging, as awareness is the first stepping stone leading to healthy practices.
The routine dental visit is important according to 93.9% of participants to prevent the oral diseases. Slightly higher percentage (95.7%) was noticed in another study. On the contrary, only 35% participants advised dental checkup. More than 90% gynecologists recognize and understand their role in the prevention of oral diseases. An interesting and positive note from this study is that gynecologists show readiness to adopt an interdisciplinary approach to curtail the oral problems. A positive attitude (93.9%) was expressed by them in terms of willingness to refer their patients to dentists. In previous studies, this attitude ranged between 70% and 95.7%.,,, More than 65% participants said they examined the oral cavity of their patients, which is a positive move when compared to another study where only 38% of participants said that they perform an examination of the oral cavity. The second trimester is best suited for the dental treatment. This information was known to lesser than 50% of gynecologists when compared to 92.6% of the subjects who were aware of this fact in another study. Similar to another study  participants in this study also requested for further information on this topic. The oral health-related knowledge of gynecologists was not comprehensively assessed, which is one of the limitations of the study. This study focused only on the gynecologists practicing in an urban area. Thus, we recommend that future studies may include representation from both urban and rural areas. Further qualitative studies need to be conducted to get more insights into the attitudes of gynecologists in the prevention of oral diseases.
| Conclusion|| |
Overall, gynecologists' knowledge about oral diseases is good, their attitudes are right, but their practices toward prevention needs to be upgraded through an interdisciplinary approach. The application of knowledge in day-to-day practice seems to be lacking. Eagerness to know more has to be appreciated, and continuing medical education programs must be organized.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American College of Obstetricians and Gynecologists Women's Health Care Physicians, Committee on Health Care for Underserved Women. Committee Opinion No 569: Oral health care during pregnancy and through the lifespan. Obstet Gynecol 2013;122:417-22.
López NJ, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol 2005;76:2144-53.
Mannem S, Chava VK. The relationship between maternal periodontitis and preterm low birth weight: A case-control study. Contemp Clin Dent 2011;2:88-93.
Silk H, Douglass AB, Douglass JM, Silk L. Oral health during pregnancy. Am Fam Physician 2008;77:1139-44.
Amin R, Shetty P. Oral health status during pregnancy in mangalore. Nitte Univ J Health Sci 2014;4:114-7.
Sajjan P, Pattanshetti JI, Padmini C, Nagathan VM, Sajjanar M, Siddiqui T. Oral health related awareness and practices among pregnant women in Bagalkot District, Karnataka, India. J Int Oral Health 2015;7:1-5.
Shenoy R, Chacko V. Utilization of dental services due to dental pain by pregnant women in India: A qualitative analysis. J Interdiscip Dent 2013;3:18-20.
Bamanikar S, Kee LK. Knowledge, attitude and practice of oral and dental healthcare in pregnant women. Oman Med J 2013;28:288-91.
Baseer MA, Rahman G, Asa'ad F, Alamoudi F, Albluwi F. Knowledge, attitude and practices of gynecologists regarding the prevention of oral diseases in Riyadh city, Saudi Arabia. Oral Health Dent Manag 2014;13:97-102.
Shah HG, Ajithkrishnan C, Sodani V, Chaudhary NJ. Knowledge, attitude and practices among Gynecologists regarding Oral Health of expectant mothers of Vadodara City, Gujarat. Int J Health Sci (Qassim) 2013;7:136-40.
Bhalla A, Anuradha KP. Dental awareness and attitudes among gynaecologists/obstetricians in Kanpur city, Uttar Pradesh. Rev Prog 2013;1:1-8.
Reddy RS, Amara SL, Tatapudi R, Koppolu P, Nimma VL, Reddy RL. Awareness and attitude towards maintenance of oral health during pregnancy among patients and clinicians attending obstetrics and gynecology ward. J NTR Univ Health Sci 2013;2:102-8.
Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S. Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstet Gynecol 2003;101:227-31.
Ruma M, Boggess K, Moss K, Jared H, Murtha A, Beck J, et al.
Maternal periodontal disease, systemic inflammation, and risk for preeclampsia. Am J Obstet Gynecol 2008;198:389.e1-5.
Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, et al.
Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol 2006;107:29-36.
Lieff S, Boggess KA, Murtha AP, Jared H, Madianos PN, Moss K, et al.
The oral conditions and pregnancy study: Periodontal status of a cohort of pregnant women. J Periodontol 2004;75:116-26.
Alves RT, Ribeiro RA, Costa LR, Leles CR, Freire Mdo C, Paiva SM. Oral care during pregnancy: Attitudes of Brazilian public health professionals. Int J Environ Res Public Health 2012;9:3454-64.
Hashim R, Akbar M. Gynecologists' knowledge and attitudes regarding oral health and periodontal disease leading to adverse pregnancy outcomes. J Int Soc Prev Community Dent 2014;4:S166-72.
Patil S, Thakur R, Madhu K, Paul ST, Gadicherla P. Oral health coalition: Knowledge, attitude, practice behaviours among Gynaecologists and dental practitioners. J Int Oral Health 2013;5:8-15.
[Figure 1], [Figure 2]