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Brief Research Article
Awareness of the Association between Periodontal Disease and Pre-term Births among General Dentists, General Medical Practitioners and Gynecologists *Fouzia Tarannum1, Sanchita Prasad2, Muzammil2, Lalith Vivekananda1, Jayanthi D3, Mohamed Faizuddin4 1
Reader, 2Post Graduate Student, 3Professor, 4Professor and Head of the Department, Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
Summary In the recent decades, periodontal disease has been identified as a risk factor for pre-term deliveries. Hence, it is important to evaluate the awareness of health-care providers of the association between periodontal diseases and pre-term birth. A self-administered questionnaire was distributed to random samples representing general medical practitioners (GMPs), general dental practitioners (GDPs) and Gynecologists for this study. A knowledge score was calculated for correct answers to 11 survey questions related to oral health effects during pregnancy and compared among the three groups. In this study, 133 physicians, 135 dentists and 100 Gynecologists completed the questionnaire. More GDPs (67.4%) than GMPs (56.4%) and Gynecologists (63%) reported there was an association between periodontal disease and pre-term low birth weight. Efforts to increase this awareness may prove valuable in improving preventive care during pregnancy.
Key words: General dental practitioners, General medical practitioners, Gynecologists, Periodontal disease, Pre-term low birth weight
Pre-term low birth weight (PLBW) infants have a tremendous impact on the health care system thus there is a continuous search of risk factors for PLBW deliveries that are amenable to prevention.1 The risk factors include age, height, weight, socio-economic status, ethnicity, smoking, alcohol, nutritional status, stress, parity, birth interval, previous complications, pre and antenatal care, maternal hypertension, infections and cervical incompetence.2 *Corresponding Author: Dr. Fouzia Tarannum, 79/13, 5th Cross, Pillanna Garden, 1st Stage, Bengaluru-560 084, Karnataka, India. E-mail:
[email protected]
Access this article online Website: www.ijph.in DOI: 10.4103/0019-557X.114992 PMID: ***
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Periodontal disease is a chronic inflammatory disease of bacterial origin and hence been associated with an increased risk for pre-term birth.3 American Academy of Periodontology has recommended that pregnant women or women planning pregnancy undergo periodontal examination and receive appropriate treatment if indicated because of the likelihood of its positive effects on pregnancy outcomes.4 Therefore, given the safety of providing periodontal care to the mother during pregnancy and the likelihood of its positive effects on pregnancy outcomes, it may be reasonable to expect prudent practice of health-care providers to recommend periodontal examination and/or care to pregnant females until conclusive evidence of lack of benefit is established. Gynecologists are the first health workers to contact the pregnant patients and their awareness about the association between periodontal disease and pregnancy outcomes is vital for prevention of pre-term deliveries. In the light of the above mentioned facts, the present survey was designed to examine the awareness of the association between periodontal diseases and premature low birth
Indian Journal of Public Health, Volume 57, Issue 2, April-June, 2013
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weight infants among general medical practitioners (GMPs), general dental practitioners (GDPs) and Gynecologists. The study protocol was approved by the Ethical Review Committee of M. R. Ambedkar Dental College and Hospital prior to commencement of the project. The list of practicing GMPs, Gynecologists and GDPs in Bangalore North Taluk (urban district) was selected from the Karnataka medical products and services directory, Yellow pages and Bangalore dental directory. There were 350 GMPs, 378 GDPs and 196 Gynecologists enlisted. Practitioners available between 01/01/2011 and 15/02/2011 were surveyed. A total of 240 GMPs, 250 GDPs and 155 Gynecologists were approached and asked to participate in the study. Subjects were requested to complete an anonymous, self-administered, structured one page Questionnaire. The questionnaire used in this survey was a close ended questionnaire with responses presented as yes/no/don’t know choices. The questionnaire was pre-tested for acceptability, validity and reliability. The validity was examined by evaluating whether the questions in the questionnaire are a correct and comprehensive reflection of the concept the questionnaire which is intended to measure. Reliability was tested by asking the pilot sample to complete the questionnaire on two separate occasions 2 weeks apart. The two sets of responses were then compared statistically using Spearman’s Rank Correlation Coefficient. The acceptability of the questionnaire was evaluated by asking the subjects how they found answering the questionnaire and how long it took them to complete the questionnaire. The final questionnaire was then prepared with a cover letter stating the title and purpose of the survey. The first part of the questionnaire recorded demographic information (age, sex and specialty) followed by questions as shown in Table 1. Results on continuous measurements are presented on Mean±SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5% level of significance. 67% (240 out of 350) of GMPs, 66% (250 out of 378) of GDPs and 79% (155 out of 196) of Gynecologists in Bangalore north zone could be included in the survey. 185 GMPs (response rate = 77%), 197 GDPs (response rate = 79%) and 117 Gynecologists (response rate = 75%) agreed to participate in the study and filled the questionnaire.
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The reason for less response rate was time constraint. Only 133 GMPs, 135 GDPs and 100 Gynecologists had completed the questionnaire. Incomplete questionnaires were excluded. The mean ages of participating GMPs, GDPs and Gynecologists were 32.14 ± 9.4, 31.20 ± 4.6 and 38.70 ± 9.7 years respectively. All participants agreed that good oral hygiene is necessary for good systemic health and that there is an association between oral disease and systemic disease. Table 1 shows the percentage of responses of the health-care providers for all the questions. The statistical analysis was conducted using statistical software SPSS 11. Statistical significance for the difference in the percentage was calculated using Chi-square test. GDPs was significantly more aware than GMPs and Gynecologists that pregnant females were more susceptible to tooth mobility, gingival bleeding and gingival growths. More number of GDPs reported that there was an association between periodontal diseases and adverse pregnancy outcomes. The number who agreed for the effect of periodontal disease on pre-eclampsia is less than the number who agreed on the effect on PLBW. Overall the Gynecologists were more aware than the GMPs. A score of numerical value one was given for every positive response. Total knowledge score (TKS) was calculated as the sum of all positive responses and the significance of the difference in mean scores among different groups was calculated using ANOVA. Table 2 shows the means of TKS of all the three groups. TKS was the highest for GDPs followed by Gynecologists and GMPs. Tukey’s Honestly Significant Difference analysis indicated that the significant difference in ANOVA is because of the highest TKS in GDPs. Only 67.4%, 56.4% and 63% of surveyed GMPs, GDPs and Gynecologists respectively, reported awareness of the association between periodontal diseases and PLBW. This low level of awareness is somewhat surprising given the level of emerging evidence supporting this association. To our knowledge, this is the first study reporting dentist awareness of this issue. For GMPs, this figure is lower than that reported from a survey of obstetricians from North Carolina where 84% considered periodontal disease to be a significant risk factor for adverse pregnancy events.5 50% Physicians in Northern Jordan reported a possible association between “oral health and pregnancy outcomes.”6 The difference in results is likely due to the
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Tarannum, et al.: Periodontal Disease and Pre-term Birth
Table 1: Awareness of different health-care groups about the relation of periodontal disease with pregnancy (n=368) Questions
Response
GMPs (n=133) (%)
GDPs (n=135) (%)
Gynecologists (n=100) (%)
P value
81 (60.90) 43 (32.33) 09 (06.76) 86 (64.66) 32 (24.06) 15 (11.27) 38 (28.57)
104 (77.03) 29 (21.48) 02 (01.48) 131 (97) 02 (1.48) 02 (1.48) 94 (69.63)
84 (84) 14 (14) 2 (2) 81 (81) 9 (9) 10 (10) 46 (46)
