Original Article
Effectiveness of an integrated perinatal oral health
assessment and promotion program on the knowledge
in Indian pregnant women
Kalpana Bansal, Om P Kharbanda1, JB Sharma2, Mamta Sood3, Harsh Priya4, Alka Kriplani2
Departments of Pedodontics and Preventive Dentistry, 1Orthodontics and Dento‑Facial Deformities and 4Public Health Dentistry, Centre
for Dental Education and Research, All India Institute of Medical Sciences, Departments of 2Obstetrics and Gynecology and 3Psychiatry,
All India Institute of Medical Sciences, New Delhi, India
ABSTRACT
Background: Oral health during pregnancy plays
a crucial role in the overall health and well‑being
of pregnant women. Evidence shows that most
young children acquire cariogenic organisms from
their mothers. Poor maternal knowledge about
oral diseases combined with inappropriate feeding
can lead to severe caries among young children.
The aim of study was to assess the oral health
status of pregnant women and to evaluate the gain
in their knowledge after educational session in
an antenatal setting. Materials and Methods: It is a
pre‑ and post‑intervention study carried out on the
pregnant women (n = 198) attending an antenatal
clinic in a tertiary care hospital. A specially designed
semi‑structured 14‑point questionnaire was used to
assess the pre‑ and post‑knowledge and attitude to the
oral health. Each participant was educated for self and
infant oral care with the help of a specially prepared
colored printed booklet. Kruskal–Wallis test was used
to explore the associations between the age, education
and socioeconomic class and knowledge; Wilcoxon
signed‑rank test was used to compare pre‑ and
post‑knowledge score. Results: Median preoral
health knowledge–attitude score was found to be
4 (0–8) and was found to be associated with the level of
education (P = 0.014) and socioeconomic class (0.019).
There was a significant improvement in the median
postknowledge score to 7 (2–10) (P < 0.001) following
oral health educational session in all categories.
Conclusions: An integrated preventive oral health
checkup and educational program to pregnant
women can benefit the dental health of the women
and children. Prenatal care workers can be involved
to disseminate the oral health awareness to pregnant
women during antenatal visits.
KEYWORDS: Antenatal clinic, dental caries in
children, infant oral health, oral health knowledge, oral
health, pregnant women, prevention
© 2019 Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow
Address for correspondence:
Dr. Kalpana Bansal,
Department of Pedodontics and Preventive Dentistry, Centre for
Dental Education and Research, All India Institute of Medical
Sciences, New Delhi, India.
E‑mail: drkalpanabansal@gmail.com
Access this article online
Quick response code Website:
www.jisppd.com
DOI:
10.4103/JISPPD.JISPPD_201_19
PMID:
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Introduction
Oral healthcare during pregnancy has been recognized
as an important global public health issue. Research
continues to show an association between severe
periodontal disease and adverse outcomes in
pregnancy including preterm deliveries, low birth
weight babies, and preeclampsia.[1,2] Furthermore,
mothers with poor oral health and high levels of
cariogenic oral bacteria are at greater risk for infecting
their children with the bacteria and increasing their
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For reprints contact: reprints@medknow.com
How to cite this article: Bansal K, Kharbanda OP, Sharma JB,
Sood M, Priya H, Kriplani A. Effectiveness of an integrated
perinatal oral health assessment and promotion program on the
knowledge in Indian pregnant women. J Indian Soc Pedod Prev
Dent 2019;37:383-91.
383
Bansal, et al.: Oral health promotion program during pregnancy
children’s caries risk at an early age.[3] Apart from
getting infection from their mothers during early years,
it has been shown that inappropriate feeding practices
during early childhood (prolonged or repeated night
feeding), brushing attitude, and parental beliefs of
dental health in their children (importance of primary
teeth, breast/bottle feeding practices, weaning off
from feeding bottles during sleep) are also important
for development of early childhood caries (ECC).[4,5]
Earlier studies have shown that ECC can have an effect
upon the health of the child as well as the quality of life
of child and of the parents.[6,7]
Many women are unaware of the effects of poor
oral health behavior during and after pregnancy for
themselves as well as for their children.[8] Moreover,
they do not have adequate proper knowledge about
dental care in young children.[9,10] Although dental
care during pregnancy is safe,[11] many women do not
seek dental treatment during and after pregnancy,
thus deteriorating their oral health in the long term.[12]
Educating expectant mothers about their oral health
and the consequences of untreated caries and gingivitis
and its impact on their future newborns could be a
good beginning of prevention of dental diseases.[13] The
prevalence of ECC in India ranges from 54% to 68%,
thus calling for urgent need to implement cost‑effective
preventive and curative oral health programs for
children in our society.[4,14]
Studies from the west have suggested that the children
whose mothers participated in postnatal one‑time
intervention in the form of oral health counseling on 2nd
or 3rd day after delivery showed significantly low caries
experience as compared to children whose mothers
did not participate in the Oral Health Promotional
Program (OHPP).[15]
However, there are no studies available where in the
oral health education of pregnant women and their oral
health practices have been assessed in the antenatal
period, especially from the Indian subcontinent. The
present study was designed to assess oral health
status, oral hygiene practices, and self‑perception
about oral health among pregnant women and to
evaluate the effect of oral health education (with the
help of a printed educational booklet) on the oral
health knowledge and attitude (OHKA) of pregnant
women attending ante natal care.
Materials and Methods
The study was conducted from July 2016 to April 2017
at a maternity outpatient department in a tertiary care
hospital. Institutional Ethics Committee approval
was obtained (IEC‑242/May 06, 2016). The pregnant
women in first and second trimester who were
attending ante‑natal clinic (ANC) and those willing
to participate in the OHPP were included following
written informed consent.
384 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 |
Sample size
Oral health knowledge assessment questionnaire used
in the study was specially designed for this study
and has not been used previously; hence, we did not
have previous data available about its efficacy. Hence,
sample size calculation was done on the basis of the
prevalence of gingivitis during pregnancy. A sample
size of 185 individuals was estimated based on the
86% prevalence of gingivitis in pregnant women[16] and
considering 5% precision value at 95% confidence level.
Assessment of oral health status of expectant
mothers
Each participant underwent a detailed dental
assessment of oral health using mouth mirror and
illuminated light from a torch in the ANC while sitting
in an office chair. A single experienced public health
dentist examined and recorded the findings on Oral
Health Assessment Form (WHO, 2013)[17] which was
used in a selective manner. Various oral conditions like
dental caries; presence/absence of; gingival bleeding
in relation to any of the tooth in the mouth for the
periodontal status, dental erosions, dental trauma
and oral mucosal lesions were noted. In addition, the
presence of dental calculus stains and pericoronitis
was noted.
Oral health knowledge–attitude assessment
questionnaire
The survey instrument was an interviewer‑administered
14 items open‑ended semi‑structured questionnaire.
The questionnaire was designed by the investigators
based on a literature review about the oral health status,
the knowledge of the pregnant women and the poor
utilization of dental services by the pregnant women.
Questions 11–14 were adopted from the WHO Oral
Health Questionnaire for adults.[17] Face validity of the
questionnaire was checked by the experts in the field.
Their valued suggestions were incorporated. The ability
of the pregnant women to understand the questionnaire
was first assessed on 10 participants. Based on the
experience and feedback from a test sample, some
changes were incorporated in the terminologies.
A qualified pediatric dentist (KB) who was trained on the
items of the questionnaire translated and interviewed
the respondents to assess their knowledge.
The questionnaire comprised of two sections, the
first section contained participant’s demographic
variables such as age, monthly income, educational
and employment status, and clinical information like
stage of pregnancy and any medical comorbidity. The
socioeconomic status was assessed using updated
Kupuswamy scale.[18] The second section contained
three parts:
1. Part 1 (item 1–7) had knowledge questions which
determined the awareness regarding the cause of
gum disease, the effect of compromised oral health
on fetal health and pregnancy, and infant oral
health [Table 1]
 Bansal, et al.: Oral health promotion program during pregnancy

2. Part 2 had three questions (8–10) that were asked
to evaluate the attitude to dental problems and the
supervision of child’s brushing [Table 1]
3. Part 3 (11–14 items) assessed the oral health
practices, health‑seeking behavior, and
self‑perception for oral health [Table 2].
All the questions in part 1 and 2 were multiple
options with one correct response. The decision to
label the correct response was made on the basis
of the evidence‑based guidelines on oral health
during pregnancy and early childhood which was
predefined.[19] Each correct response of the respondent
was given a score of “1,” and all correct responses from
each participant were added to determine the prescore
of each participant. The pre‑ and post‑OHKA score
ranged from a minimum of 0 to maximum of 10 value.
Self‑perception about oral health was assessed with
the help of 14th question in the tool. Answer to each of

Table 1: Knowledge and attitude questions (item number 1‑10) and correct response
Question number Question Options Correct response
1 What is the cause of gum 1. Sugar/sweet foods Poor oral hygiene
disease? 2. Eating hard foods leading to deposits
3. Dental plaque
4. Poor oral hygiene leading to deposits
5. Do not know
2 Poor gums health during 1. Low birth weight in baby All of the above
pregnancy can lead to 2. Preterm child
3. Miscarriage
4. All of the above
5. Do not know
3 When should a child be 1. 6 months 12 months
weaned from the night feed? 2. 9 months
3. 12 months
4. 2 years
5. Do not know
4 When should you start 1. 6 months or when the teeth erupt 6 months or when the
brushing your child’s teeth? 2. 12 months teeth erupt
3. 2 years
4. 3 years
5. Do not know
6. Not much need as they will be the temporary teeth
5 When should the first dental 1. By 1st year after birth By 1st year after birth
visit of a child be made? 2. When a black spot is noted on teeth
3. When child has any pain in teeth
4. By 6 months after birth
5. Do not know
6 How should you clean your 1. Using a household cloth once a day Using moist clean cloth
child’s mouth before the 2. Baby brush twice a day
teeth are erupted? 3. Using moist clean cloth
4. Using toothpaste on finger after every feed
5. I do not know
7 How many times the gum 1. two times a day After every milk feed
pads of the predentate child 2. After every milk feed
be cleaned? 3. Three times a day
4. Once a day
5. Do not know
8 What is your opinion 1. Regular dental checkups All of the above
regarding how to maintain 2. Proper oral hygiene measures
good OH during pregnancy? 3. Nutritious diet rich in proteins and low in carbohydrates
4. All of the above
9 If dental pain/bleeding 1. Consultation with a dentist should be sought as early as Consultation with a
occurs during pregnancy, possible dentist should be sought
what is your opinion should 2. Only medication will be sufficient as early as possible
be done? 3. The appointment/consultation should be postponed till
the pregnancy is over
4. The visit to dentist might not relieve pain or aggravate the
pain; hence, home remedies should be tried
10 In your opinion, the teeth 1. 2‑3 6‑7
brushing of the child should 2. 3‑4
be supervised by an adult till 3. 4‑5
the age of (years) 4. 6‑7
OH=Oral health

Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 | 385
Bansal, et al.: Oral health promotion program during pregnancy

Table 2: Questionnaire items to assess the oral health practices, oral health‑seeking behavior, and
self‑perception toward oral health (item number 11‑14)
Question number Question Participant’s response
1 How do you take care of the oral hygiene 1. By brushing once in 2 days
2. By regularly brushing once a day
3. By brushing at least twice a day
4. By brushing twice a day and mouth wash once a day
2 How long is it since you last saw a dentist? 1. 6‑12 months
2. >1 year but <2 years
3. 2‑5 years
4. >5 years
5. Never
3 What was the reason of your last visit to the dentist? 1. Consultation/advice
2. Pain/trouble in teeth, gums or mouth
3. Treatment/follow‑up treatment
4. Routine checkup
5. Not applicable
4 Item for scoring self‑perception: Because of the state of your Often/sometimes/never score ‑ 2/1/0
teeth or mouth, how often have you experienced any of the
following problems during the past 12 months?
a. Difficulty in biting/chewing foods **
b. Difficulty with speech/trouble pronouncing words
c. Dry mouth
d. Felt embarrassed/tense due to appearance/problems of teeth
e. have avoided smiling because of teeth
f. Had sleep that is often interrupted
g. Have taken days off work
h. Difficulty doing usual activities
i. Felt less tolerant of spouse or people who are close to you
j. Have reduced participation in social activities
**Total score for self‑perception ranges from 0 to 20. If score is between 0 and 7, self‑perception about the OH is good; If between 8 and 13, then fair
self‑perception; If the score is between 14 and 20, then self‑perception is poor. OH=Oral health

these questions was in the form of never, sometimes
or often being scored as 0, 1, and 2. The scores were
summed up, and self‑perception was assessed as
GOOD self‑perception if the score was from 0 to 7,
FAIR if score is 8–13, and POOR self‑perception if
score was from 14 to 20.
Oral Health Promotional Program
After the knowledge assessment (pre‑scores), oral health
education was delivered to all the participants using a
specially printed colored booklet on oral health during
pregnancy and infant oral care instructions in the same
session to make the women aware of importance of
oral health during pregnancy. The educational booklet
was prepared using the information available from
evidence‑based guidelines.[19] It was first administered
to a sample of 10 pregnant mothers in ANC to test its
feasibility and practicability, and subsequently, some
changes were made. The booklet educated mothers
about common dental diseases such as gum problems,
dental caries and tooth erosions, healthy dental habits
during pregnancy, and infant oral care methods. Oral
health education of the mothers was conducted on
1:1 basis, and it took about 15–20 min’ session for each
mother.
feeding practices and about the importance of child’s
oral hygiene for the dental health.
During the posteducation follow‑up evaluation after
2–3 months in the ANC, the participants were assessed
regarding their knowledge and attitude about oral health
using the same questionnaire. Postscore was determined
by adding all correct responses. The pre‑ and post‑scores
were compared to determine the gain of knowledge of
mothers for self and infant dental care.
Statistical analysis
The data were compiled in excel sheet, and the
statistical analysis was carried out using STATA 12.0
(College Station, Texas, USA). Data were summarized
as number (%) and median (minimun–maximum)
The prevalence and 95% confidence interval were
calculated for various oral conditions. The change in
the post score from prescore was tested using Wilcoxon
signed‑rank test. The pre‑ and post‑knowledge and
attitude score was compared to various categories of
age, education, occupation, and socioeconomic class
using Kruskal–Wallis/rank sum test as appropriate.
P < 0.05 was considered as statistically significant.

Oral health educational pamphlets were given to Results

each pregnant mother following the interactions to
re‑enforce imparted education about weaning off Of 250 pregnant women in ANC who were
practice. They were made aware of correct infant invited to participate, 200 agreed to get enrolled

386 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 |
 Bansal, et al.: Oral health promotion program during pregnancy

in the study [Figure 1]. Follow‑up evaluation of Invited to participate

the oral health knowledge could be completed in n = 250
159 participants (response rate of 79.5%). Two women
Refused to participate
did not complete baseline assessment. Five women n = 50
were excluded due to abortion as they did not turn
up in ANC. Thirty‑four participants were lost to the Consented to
follow‑up (24 moved to other hospitals or cities, and participate = 200
Consented but did not come
three refused follow‑up and seven participants could for baseline data collection,
not be contacted). n=2

• Baseline data collection, n = 198

The mean age of the participants was • First questionnaire filling
28 ± 4.3 years (18–42 years). Majority were • Information about oral health during
pregancy and infant oral health
nonworking homemakers (67.2%) [Table 3], graduates
or postgraduates (64.6%), and belonged to middle
Loss to follow up n = 34
socioeconomic class (73%). • Shifted to other hospitals/
cities n = 24 Excluded as
• Refusal to fill up suffered abortion n = 5
Oral health status and oral health practices questionnaire n = 3
Dental caries was observed in 47.5% women (Decayed, • No contact could be made
Missing and Filled Teeth = 47.5%, untreated Decayed on telephone n = 7
Teeth = 43.4%) and gingival inflammation in 53.5%
Final analysis
mothers [Table 4]. Majority of the patients (62.6%) n = 159
reported brushing twice a day. One‑fifth (20.2%) of the
women reported visiting a dentist in last 1 year, 26% in Figure 1: Flow diagram of the study
last 5 years while 40% never visited a dentist. Dental
pain was the most common reason for the dental
visit (37.6%). Around 95% of participants had a good Table 3: Demographic and socioeconomic
perception of self‑health in the last 1 year. characteristics of the pregnant women (n=198)
Variable Summary measures
Pre‑ and post‑oral health knowledge and Age (years) 28±4.3 (18‑42)
Educational status
attitude
Below primary level 14 (7.1)
The median (range) OHKA score at baseline was
High school 56 (28.3)
4 (0–8), and after oral health education, it improved to
Graduate 67 (33.8)
7 (2–10) with a gain of 3 points which was statistically
Postgraduate/professional 6 1 (30.8)
significant (P < 0.001). The prescore was found to be
associated with the level of education (P = 0.014), and Occupation
socioeconomic class (P = 0.019), and no significant Working professional 15 (7.6)
association was found between the different categories Working nonprofessional 40 (20.2)
of age and occupation of the women [Table 5]. The Self‑employed/student 10 (5.0)
change in the post score from prescore was statistically Homemaker 133 (67.2)
significant in all the categories of age, education, Monthly income
occupation, and socioeconomic class. However, <15,000 52 (27.3)
even after the educational intervention, there was a 15,000‑30,000 69 (34.9)
statistically significant difference in the postknowledge 30,000‑50,000 39 (19.7)
scores among the pregnant women belonging to >50,000 38 (19.2)
different socioeconomic class (P = 0.031). Socioeconomic class
I (upper) 13 (6.6)
Pre‑ and post‑response to oral health II (upper middle) 74 (37.4)
III (lower middle) 71 (35.8)
knowledge and attitude questionnaire
IV (upper lower) 39 (19.7)
Pre‑ and post‑responses of the mothers to the various
V (lower) 1 (0.5)
items of the questionnaire have been shown in
Data presented as n (%) and mean±SD. SD=Standard deviation
Figure 2. After oral health education, the proportion
of correct responses by the participants in each
item of the questionnaire increased as compared to 65% of mothers did not know correctly about the time
preresponses. of beginning of brushing child’s teeth. Majority of
mothers (77%) did not consider that children should be
Before the oral health education, 72% of participants taken for the preventive 1st year dental visit and had a
did not know correctly when to wean the child from knowledge that a child should be brought to the dental
night time bottle/breastfeed. According to them, the clinic only in case of toothache or on the appearance of
children may be given night time feeding till 2–3 years; black spots/dental decay.

Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 | 387
Bansal, et al.: Oral health promotion program during pregnancy

Table 4: Oral health status, hygiene practices, and self‑perception of the pregnant women
Variable n Prevalence (95% CI)
OH status
DMFT 94 47.5 (40.3‑54.6)
Untreated DT 86 43.4 (36.4‑50.6)
Gingival bleeding 106 53.5 (46.3‑60.6)
Calculus deposits 32 16.2 (11.3‑22.0)
Dental stains 4 2.0 (0.5‑5.1)
Dental erosions 12 6.0 (3.1‑10.3)
Loss of attachment 6 3.0 (1.1‑6.4)
Pericoronitis 7 3.5 (1.4‑7.1)
Others 15 7.6 (4.3‑12.2)
Oral hygiene practices (n=198)
Brushing once in few days 6 (3.0)
Brushing once a day 53 (26.8)
Brushing twice a day 124 (62.6)
Brushing twice a day and mouth wash once a day 13 (6.6)
Regular OH measure and professional cleaning 2 (1.0)
When did they visit a dentist last time (n=198)?
6‑12 months back 40 (20.2)
1‑2 years back 19 (9.6)
2‑5 years 32 (16.2)
>5 years 27 (13.6)
Never 80 (40.4)
Reasons for their last dental visit (n=118)
Consultation 17 (8.6)
Pain/trouble in teeth, gums or mouth 74 (37.6)
Treatment/follow up treatment 22 (11.2)
Routine check‑up 5 (2.5)
Self‑perception about OH score (n=198)
Good (0‑7) 189 (95.0)
Fair (8‑13) 9 (5.0)
Poor (14‑20) 0 (0.0)
Data presented as n (%). CI=Confidence interval; DMFT=Decayed, Missing and Filled Teeth; DT=Decayed Teeth; OH=Oral health

from this, oral health beliefs and practices of mothers

100 toward oral health also influence the development of
90 ECC.
80
70
60 There are no studies available especially from Indian
50 subcontinent which have evaluated oral health
40
30 knowledge of pregnant women and educated these
20 mothers about their own oral health and oral health
10 practices for their new born children. In this study,
0
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 majority of participants were educated till high school
pre OHPP post OHPP levels or higher; only 7% of the mothers were illiterate
or had a very less formal education. Three‑fourth (73%)
Figure 2: Percentage of correct pre‑ and post‑responses to 14 item
Questionnaire. OHPP = Oral Health Promotional Program
of the sample is from the middle class socioeconomic
strata of the society. Majority of the participants in the
study were primigravida with few exceptions.
Discussion
There is a variation in the prevalence of dental
Oral health care during pregnancy is neglected health diseases in different populations depending on several
issue and is now being recognized as a major public demographic variables such as literacy levels, rural
health issue globally. Severe periodontal diseases have dwelling, socioeconomic status, and professional
been linked to adverse pregnancy outcomes, and it has status.[20,21] Cross‑sectional studies showed that
been recognized that mothers’ oral flora is transmitted the percentage of pregnant women with gingival
to the new born babies which can lead to ECC. Apart inflammation varies from 47% to 89% in different

388 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 |
 Bansal, et al.: Oral health promotion program during pregnancy

Table 5: Relationship of pre‑ and post‑oral health knowledge and attitude score among pregnant women
(n=159) with variables
Variables n Prescore Postscore Pb
Overall score 159 4 (0‑8) 7 (2‑10) <0.001
Age (years)
18‑30 116 4 (0‑8) 7 (2‑10) <0.001
31‑42 43 5 (1‑8) 8 (4‑10) <0.001
Pa 0.655 0.851
Educational status
Below primary level 11 4 (2‑7) 7 (4‑9) 0.005
High school 45 4 (0‑8) 7 (2‑10) <0.001
Graduate 53 5 (0‑8) 7 (5‑10) <0.001
Postgraduate/professional 50 5 (3‑8) 8 (4‑10) <0.001
Pa 0.014* 0.362
Occupation
Working professional 12 6 (4‑7) 8.5 (4‑10) 0.005
Working nonprofessional 31 5 (1‑8) 7.0 (4‑10) <0.001
Self‑employed/student 8 4.5 (3‑7) 7.5 (5‑9) 0.011
Homemaker 108 4 (0‑8) 7.0 (2‑10) <0.001
Pa 0.113 0.671
Socioeconomic class
Upper 10 6 (4‑7) 9 (5‑10) 0.008
Middle 120 5 (0‑8) 7 (2‑10) <0.001
Lower 29 4 (0‑7) 7 (4‑9) <0.001
Pa 0.019* 0.031*
Mother’s OH status
Dental caries
Yes 77 5 (0‑8) 7 (2‑10) <0.001
No 82 9 (0‑8) 7.5 (5‑10) <0.001
Pa 0.161 0.719
Gingivitis
Yes 85 4 (0‑8) 8 (2‑10) <0.001
No 74 5 (1‑8) 7 (4‑10) <0.001
Pa 0.363 0.398
Oral hygiene practices
Brushing once in few days 4 5 (2‑6) 7 (6‑8) 0.066
Brushing once a day 45 4 (0‑8) 8 (4‑10) <0.001
Brushing twice a day 98 5 (0‑8) 7 (2‑10) 0.0000
Regular home care combined with professional tooth cleaning 12 6 (2‑8) 8.5 (4‑10) 0.0041
Pa 0.196 0.802
Self‑perception about OH
Good 152 5 (0‑8) 7 (2‑10) <0.001
Fair 7 4 (2‑4) 7 (5‑10) 0.0176
Pa 0.05 0.259
a
Kruskal‑Wallis test; bWilcoxan signed‑rank test. Data presented as median (minimum‑maximum); *P<0.05, statistically significant. OH=Oral health

populations, and this variation in the disease rates is
due to different sociocultural characteristics, as well
as the differences in the definitions of periodontal
disease.[22] The prevalence of dental caries in the
pregnant women found in our study is consistent
with the results obtained from other studies which
reported 51.8% in urban (19) and 62.7% in the rural
populations.[23]
The data showed that only one‑fifth of the participating
women visited a dentist in the last 6–12 months and the
reason for the visit was the dental pain; majority (40%)
had never visited a dentist; reported to brush twice
a day (62.5%); and a majority (95%) perceived their
dental health in good condition. In a study from USA,
<50% of the pregnant women consulted a dentist
during pregnancy even though oral problem existed.[24]
In Australia, less than one‑third pregnant women saw
a dentist in the last 6 months. Women avoid dental
treatment during pregnancy unless an emergency
and are confused for accessing dental care during
pregnancy and early childhood,[25] thus reflecting a
poor attitude toward dental health during pregnancy.
Several reasons have been cited in the literature for

Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 | 389
Bansal, et al.: Oral health promotion program during pregnancy
the women not seeking dental care during pregnancy
such as poor domestic relationships, personal finances,
perception of dental experience, attitudes toward
dental providers, importance attributed to oral health,
and time constraints.[26]
On assessment of their preknowledge and attitude
for dental health, most of the mothers had inadequate
knowledge for infant oral hygiene and poor attitude
as is reflected by their low median scores (4),
with educational status and lower socioeconomic
class being significantly associated with poor
preknowledge. The study showed that oral health
education given to pregnant women during antenatal
checkup significantly improved the knowledge and
attitude scores (P < 0.001). Higher postknowledge and
attitude score could be observed in all the categories
of the participants as compared to the baseline; even
the mothers who were educated to primary level had a
significant gain of knowledge posteducation. This may
be attributed to the fact that each participant was given
oral health education on 1:1 basis using an information
booklet. It is the early childhood dental health behavior
adopted by new mothers that plays a crucial role in
the maintenance of good oral health of the child on the
long‑term basis.
The awareness was lacking regarding the time of
weaning from the feeding during sleep. In the absence
of regular oral hygiene measures, especially tooth
brushing for the children below 2–3 years, dental
plaque accumulation continues and promotes the
proliferation of pathogenic micro‑organisms on teeth.
In addition to that, inappropriate feeding practices
with the baby sleeping with bottle or breast milk in the
mouth further aggravates the oral environment, and
ECC sets in and progresses at a fast pace if timely oral
care is not rendered.
In another study about parental knowledge for the
oral health of preschool children, around 70% parents
responded that prolonged and frequent bottle feeds did
not affect dental health of the child, and approximately,
half of the parents did not brush their children’s teeth
under the age of 2 years. Most of the parents believe
that first dental visit should be made when permanent
teeth erupt.[27] In another study on Indian population,
the attitudes of parents toward child dental health
has been documented to be unfavorable, and dental
awareness and knowledge is poor.[28] In a study on
Brazilian mothers of newborn children, it was found that
that they have an inadequate knowledge concerning
dental caries in children.[29] Other researchers from all
over the world have concluded that mothers need to be
educated in several important areas related to feeding,
diet, and first dental checkup visit of their children.[30,31]
The main limitation of the study is its nonrandomized
design because it was considered unethical not to
provide education to one group of mothers after their
390 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 37 | Issue 4 | October-December 2019 |
assessment. Since this is a pilot project, the study
sample was small, a community‑based study with large
sample size is needed to prove the findings of this study
conclusively. A longer follow‑up and oral examination
of the children after teeth eruption would provide
definite evidence whether oral health education of
pregnant women will help in the reduction of ECC.
The strength of the study is that this is a first of its kind
of study conducted in Indian population to know the
awareness levels of the women toward oral health and
their attitude toward child dental health and the effect
of the oral health education on the knowledge gain of
women.
Conclusions
This study has shown that knowledge and attitude
of Indian pregnant women toward oral health care
during pregnancy and infant oral health is inadequate.
Oral health education during antenatal visits can
improve knowledge and practices for oral health
and infant dental care significantly in all categories
of the population irrespective of educational level,
occupation, and socioeconomic class. There is a need
to create awareness among new mothers about correct
oral hygiene methods and feeding practices for the
children as early as possible so that the dental health
of children is not jeopardized. Healthcare workers
should be trained to spread the education among the
pregnant women, new parents, and the elders in the
society about the importance of the dental health in
children, especially in the lower income strata and
rural areas of the country.
Acknowledgments
The authors acknowledge the help of Dr. Kalaivani M,
Scientist at the Department of Biostatistics, AIIMS.
New Delhi for the statistical design and the data
analysis for the research work.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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