From teen to parent: Oral health at the crossroads of youth and parenthood
Key Highlights
- Periodontal disease affects over 50% of pregnant women, especially during the second trimester, increasing risks for adverse pregnancy outcomes.
- Receiving nonsurgical periodontal therapy during pregnancy significantly reduces the risk of low birth weight and preterm birth compared to treatment after delivery.
- Oral health promotion and education improve clinical outcomes, decreasing periodontal disease prevalence among pregnant women.
- Low oral health literacy is linked to higher rates of dental decay, missing teeth, and poor oral health behaviors in young and pregnant women.
- Socioeconomic status and education levels are critical factors influencing oral health literacy and disease prevalence, highlighting the need for targeted interventions.
Editor's note: This article was written by five senior dental hygiene students, with oversight from their professor, Annie Walters, as part of their community oral health project for their capstone. They attend Northern Arizona University.
According to recent studies, there’s a growing need to improve the quality of oral health literacy for young parents and mothers. With current rates of periodontal disease associated with pregnancy, there’s the need to increase oral health literacy, access to care, and how to prevent disease. Periodontal disease affects birth rates, poor outcomes due to a lack of knowledge, increased inflammation, and bleeding.
Pregnancy and periodontal disease
A systematic review and meta-analysis evaluated 20 studies that all pointed to a high prevalence of periodontal disease in pregnancy, even though the diagnostic criteria for periodontal disease varied among the studies.1 Participants included those in different trimesters and any woman presenting with an illness requiring prophylactic antibiotics was excluded.
The participants were sampled randomly in 45% of the studies, while the rest were unclear. Fifteen of the studies identified changes in bleeding upon probing. It was reported that over half the participants experienced increased probing depths and clinical attachment loss (≥4 mm), with the highest prevalence occurring during the second trimester.1
Additionally, bleeding on probing ranged widely, with mean values between 49% and 86.2%.1 The relativity of this study emphasized the periodontal disease gateway to susceptibility to tooth loss, reduced quality of life, heart disease, diabetes mellitus, kidney disease, preterm birth, neonatal mortality, and long-term disability. The study identified the growing need for more research with an emphasis on subgroups of gestation, education levels, in different states, and other relevant factors.
The systemic link between periodontal disease and adverse pregnancy outcomes has been studied a length; however, a study from the Journal of Periodontology explored the correlation between periodontal therapy during pregnancy and its effects on adverse pregnancy outcomes. This study involved 200 pregnant women who were randomly assigned to the control group where the women received nonsurgical periodontal therapy (NSPT) after delivery, while the treatment group received the NSPT during the gestational period.
The mean age of both groups was 22-23 years old, and this was either their first or second birth. Both groups received the same treatment and assessments. Measurements included preterm and low birth weights. In low birth weight, there were 53.9% in the control group and 26.3% in the treatment group.2 This study demonstrated statistically significant results in that if a pregnant woman receives NSPT during the pregnancy, she will reduce her risk of adverse pregnancy outcomes versus receiving treatment after.2
Value of oral health promotion
Oral health promotion plays a major role in pregnant women's knowledge of oral care and oral health status. A 2022 study of 230 pregnant women compared oral health promotion between control and intervention groups. The objective was to compare the oral health of pregnant women who have oral health knowledge and those who do not.3
During this study, the control group received a typical questionnaire, while the intervention group received an oral health promotion questionnaire survey to compare the two. This study found that pregnant women receiving oral health promotion and education resulted in improved clinical outcomes and increased knowledge of oral health habits.3
After intervention, outcomes showed statistically significant improvements in those without periodontal disease to 14.4%.3 This study provided insight into the research question at hand by showing how pregnant women who are unaware of the importance of oral health care can be impacted by oral health education. Proper education and oral health promotion can help prevent oral disease progression in a pregnant patient.
There’s an apparent correlation between pregnant women and their oral health status. Data was collected in a cross-sectional study that included 150 pregnant women and 150 nonpregnant women by having them fill out a questionnaire and having an oral examination. After the study, the oral health status of the women who were pregnant was considerably poorer than those who were not.
The study showed higher bleeding on probing, as well as probe depths in those who were pregnant, demonstrating a significant difference.4 It’s important to promote and educate those having children so they fully understand their oral health and the risks that could arise.
Oral health literacy
Oral health literacy is essential for maintaining the dental and overall health of pregnant women. An observational cohort study involved women undergoing their first pregnancy to determine how oral health literacy and oral health knowledge are connected in first-time pregnant patients.5 A total of 132 women were interviewed in this study and given a survey that included baseline dental knowledge questions.5
A dental word recognition test was also administered during the interview to measure oral health literacy among these women.5 This report was the first on women who were first pregnant for the first tie, so there are no studies to compare. The results indicated a significant association between oral health literacy and oral health knowledge.5
Participants had low oral health literacy, which is concerning considering they’re at higher risk for disease development. This study demonstrated that oral health literacy and knowledge play a substantial role in periodontal disease in pregnant women.
Socioeconomic status and oral health
Oral health literacy, socioeconomic status, and education all play a role in oral health status. A cross-sectional study on oral health status determined a correlation between these factors and overall oral health. This was done on couples between 15 and 35 years old. Using an oral health literacy questionnaire, the researchers found that 64% of 828 participants had inadequate oral health literacy, 15% had marginal oral health literacy, and 21% had adequate oral health literacy.
Of the participants with adequate oral health knowledge, 81% had a high school diploma or higher.6 This factor indicates that teens who have not yet completed 12 years of education are at risk of having moderate or inadequate oral health literacy. Participants within the inadequate oral health literacy group were also determined to have increased prevalence of decay and missing teeth compared to the other two groups. This study highlights how oral health literacy and low education levels can have a significant influence on oral health parameters. Oral health literacy is a necessary and unmet need for the general population.
A systematic review was conducted on periodontal disease during pregnancy and pregnancy outcomes. This review assessed periodontal status, preterm birth, low birth weight, and preeclampsia. Collected studies included participants with and without periodontal disease and those with and without adverse pregnancy outcomes during pregnancy or postpartum.
Regarding low birth weight, the presence of periodontitis in maternal patients is modestly but significantly associated with continuous and categorical variables. Regarding preterm birth, there is mixed evidence of the association. The review determined that there is a strong association between periodontitis and preterm birth. However, case-control studies found that there is no statistically significant association between the two. Concerning preeclampsia, it was found by both meta-analyses and case-control studies that there is a positive association present.
Women who experienced preeclampsia showed a mean difference increase in probing depths of 0.96 mm.7 Factors that could influence results include what different researchers define as periodontal disease, how they define significance, and how they define association. Still, a connection exists between pregnancy outcomes and periodontitis. Periodontal disease could be prevented with improved oral hygiene and oral health literacy, which could in turn decrease the chance of these outcomes.
To conclude, it’s evident there’s an increase in oral health risks during pregnancy. After viewing various studies, the information suggests additional preventive measures are needed for the pregnant population to see a decline in periodontal disease. Preventive measures include wider knowledge of the risks of periodontal disease, the adverse pregnancy outcomes they are at risk for, and the importance of receiving nonsurgical periodontal therapy during pregnancy. Information will increase awareness as this vulnerable population lacks oral health literacy and knowledge.
References
1. Chen P, Hong F, Yu X. (2022). Prevalence of periodontal disease in pregnancy: A systematic review and meta-analysis. J Dent. 2022;125. doi:10.1016/j.jdent.2022.104253
2. Tarannum F, Faizuddin M. Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis. J Perio. 2007;78:2095-2103. doi:10.1902/jop.2007.060388
3. Hu W, Wang Y, Chen R, Pan T. Application of a systematic oral health promotion model for pregnant women: A randomized controlled study. Oral Health Prevent Dent. 2022;20:413-419. doi:10.3290/j.ohpd.b3555989
4. Geevarghese A, Baskaradoss JK, Sarma PS. Oral health-related quality of life and periodontal status of pregnant women. Matern Child Health J. 2017;(8):1634-1642. doi:10.1007/s10995-016-2255-y
5. Hom JM, Lee JY, Divaris K, Baker AD, Vann WF. Oral health literacy and knowledge among patients who are pregnant for the first time. JADA. 2012;143(9):972-980. doi:10.14219/jada.archive.2012.0322
6. Fazli M, Yazdani R, Mohebbi SZ, Shamshiri AR. Oral health literacy and socio-demographics as determinants of oral health status and preventive behavior measures in participants of a pre-marriage counseling program. Plos One. 2021;16(11):e0258810. doi:10.1371/journal.pone.0258810
7. Papapanou N. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes–systematic review. J Perio. 2023;84:181-194. doi:10.1902/jop.2013.134009
About the Author
Annie Walters, MS, RDH
Annie Walters, MSDH, RDH, has extensive experience as an oral health-care provider. She has spent time caring for individuals in Guatemala and Indian Health Service sites and is passionate about advancing access to care for individuals with specialized health care needs. She is a published author and is trained in Orofacial Myofunctional Therapy. Annie received her graduate degree from the University of New Mexico and currently serves as an assistant clinical professor at Northern Arizona University. Reach her at [email protected].