This study was carried out in an urban setting at two maternal and child care hospitals in the State of Kerala, India. The selection of these two hospitals were based on the availability of a large number of accessible pregnant, post-partum and six-month post-partum women. These hospitals cater mostly to the low and middle income women and the cost of treatments are subsidized. This study presents the difference in the dental service utilization pattern among low and middle income women at three distinct phases of pregnancy - first trimester, post-partum and six-month post-partum. Post-partum women were least likely to seek routine dental care compared to pregnant or six-month post-partum women.
Pregnancy is associated with higher incidence of oral conditions like gingivitis and periodontitis . The probable reasons for an increase in the risk for dental diseases during pregnancy might be due to inadequate oral hygiene, medical co-morbidities, limited awareness about the importance of maintaining proper oral hygiene and failure to seek regular dental care [5, 6]. Also, maternal oral health is one of the greatest predictors of childhood oral health . Maternal behaviors, including attention to oral hygiene and dietary practice, may also influence this risk.
Pregnant women generally tend to postpone their dental visits until after delivery due to concern over their child’s health. In the US, less than 50% of pregnant women seek dental care during pregnancy [24, 25]. Similarly, other countries such as Australia (36%), Greece (27%) and UK (33%), have reported poor utilization of dental services by pregnant women . Poor utilization of dental services among pregnant women is well documented worldwide and is evident in India as well. In this study, more than half of the respondents reported having experienced some dental problem in the previous 6 months. However, only less than 15% of the post-partum women sought dental care during the same time period. About three-quarter of the six-month post-partum women and more than half of the pregnant women in the first trimester reported seeking dental care within the 6 months prior to the study. This indicates that most women in this study preferred to seek dental care either before the first trimester or postpone it until after delivery. Concern for child’s safety is a commonly cited barrier for pregnant women seeking dental care even though it is well established that dental treatment during pregnancy is extremely safe and will not result in adverse pregnancy outcomes . In addition, majority of the participants believe that poor oral health is normal during pregnancy.
Only a tenth of the participants recalled being advised on seeking regular dental care during pregnancy. Oral health is often ignored and not considered as a part of regular antenatal care and this finding is strongly supported by several other studies [17, 27]. Lack of awareness among pregnant women about the importance of maternal oral health is associated with poor utilization of dental services . Only over 5 % of the surveyed women in this study believed that dental diseases could lead to other diseases. Similar findings were reported by Boggess et al. .
Most pregnant women in this population undergo at least one antenatal care visit during pregnancy . Doctors and midwives could play a vital role in educating pregnant women and improving their awareness about oral health care during pregnancy. This could also address several misconceptions pregnant women may have, which in turn would influence their oral health practice and potentially improve the uptake of dental services.
Education was associated with dental attendance, with women who had completed secondary or higher education were more likely to seek routine dental care. Similar results were found in a systematic review of 25 studies . Educated women may have better knowledge and awareness about the importance of oral health and regular dental visits especially during pregnancy. Also, educated women might have better health literacy, therefore they might be able to navigate the healthcare system better . Similarly, more working women sought routine dental care as compared with unemployed women. Cost of dental services is a significant barrier especially among those belonging to the low socio-economic strata and those with minimal household incomes .
In the multivariate model, self-perceived oral health scores were associated with dental service utilization. It should be noted that the four self-reported global dimensions measure problems with mouth and teeth in general and were not restricted to the social and psychological consequences resulting from any particular dental pathology. Differences in the self-perceived oral health between the different groups of women reflect not only the variations in oral conditions but also variations in their attitudes towards oral health.
As described by Andersen , health services work towards improving the health status of the population, both as perceived by the population and as evaluated by health care professionals. The Andersen model acknowledges the role of several environmental and population characteristics in determining the need for oral health care, which could be perceived or normative. Though several studies have assessed the normative need of pregnant women, only few studies have explored the intricate relationship between perceived need and utilization of dental services. It is important to understand perceived need as it is closely related to the concept of self-efficacy. Self-efficacy assumes that people adopt self-care practices if they perceive that these practices make a difference . While several programs focus on educating and motivating pregnant women on the importance of good oral hygiene, the role of self-perceived oral health need is often overlooked. This study shows that self-perceived oral health is strongly associated with dental utilization. Therefore, raising the awareness towards oral health among pregnant women might lead to behavior changes that could improve dental utilization during pregnancy. Poor oral health during pregnancy can be detrimental to the mothers’ health and also to the well-being of the baby.
This study describes the plausible role of pregnancy status, educational level and self-perceived oral health in the utilization of dental services. Though the study was pragmatic and carried out in a non-research setting, it managed to get an acceptable response rate from the population studied. However, the results of this study should be interpreted with caution. Since this is a cross-sectional study, the direction of the causal relationship cannot be resolved. It is recognized that several pregnancy-related factors could lead women to perceive their oral health more negatively. It is also understood that dental service utilization is a complex interplay of several factors including availability, accessibility, social and cultural belief’s and finance. Further, additional assessments of pain, halitosis or esthetics were not performed in this study, which may influence the overall oral health perception. More robust longitudinal studies are required to explore the different variables contributing to dental service utilization.