Oral hygiene, prevalence of gingivitis, and associated risk factors among pregnant women in Sarlahi District, Nepal

Abstract

BackgroundThe oral health status of pregnant women in low-resource communities such as Nepal has not been well characterized. This sub-population is also of specific interest given associations between poor oral health and adverse pregnancy outcomes previously documented in other settings. We explored relationships between gingivitis and risk factors among pregnant women in rural Nepal.MethodsThe design was a community-based, cross-sectional study in a sub-area of Sarlahi District, Nepal. Pregnant women < 26 weeks gestation underwent clinical periodontal exams conducted by community-based oral health workers. Exams included a full mouth assessment measuring bleeding on probing (BOP), probing depth (PD) (six sites per tooth), and gingival recession, the distance from the cemento-enamel junction to the free gingival margin (two direct sites per tooth). Data on participant risk factors were collected through household surveys, including demographic characteristics, oral health behaviors, care seeking, and health attitudes. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors.ResultsWe enrolled 1452 participants, of which 40% (n = 582) had signs of clinical gingivitis and 60% (n = 870) clinical health. Average participant age was 23. Most participants (88%) had never received oral health care. Participants averaged 10% of sites with BOP with most (79%) having ≥1 site with BOP. Nine percent of participants had ≥1 site with PD ≥4 mm, although very few participants (0.7%) had sites with PD ≥5 mm. Few participants (13%) had any recession (≥1 mm). In the final adjusted model, odds of gingivitis increased by 3% for each year of age (aOR 1.03, 95% CI 1.00, 1.06) and were higher for women of short maternal stature (< 150 cm) (aOR 1.43, 95% CI: 1.14, 1.79) and among women reporting cost to be a barrier to seeking dental care (aOR 2.13, 95% CI: 1.09, 4.15).ConclusionsGingivitis was common and associated with age, maternal stature, self-reported high cost of dental care, and other risk factors among pregnant women in rural Nepal.Trial registrationClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).Electronic supplementary materialThe online version of this article (10.1186/s12903-018-0681-5) contains supplementary material, which is available to authorized users.

Prevalence of Gingivitis in Second Trimester of Pregnancy

“…29 This may be due to the fact that the sample in the study consisted mostly of young women. However, this result is in contrast to other studies 22,37 in which the authors have suggested that aging is a natural process which results in changes in host immunity which may cause the loss of periodontal support tissue. 29…”

“…The severity of gingivitis showed an association with the gravida of the female patient. The ndings in our study impersonates with another study done in Nepal 22 . Only a minority of pregnant women seek care for bleeding gums in the absence of pain.…”

“…33,34 In contrary to our study, in a previous research done in Nepal, the prevalence of gingivitis in pregnant women was found to be 40%. 22 The results may differ because of the di culty in comparisons of periodontal researches as variations exist in the index system, the population description, the sites examined and even the de nition of gingivitis. Such inter-study variabilities among different researches impedes an unequivocal conclusion about the parameter considered under observation.…”

“…21 In context of Nepal, the prevalence was found to be 40% in a study done in Sarlahi district, in which the examination had been performed by community-based oral health workers. 22 Nepal has been placed in the 15 percent of countries in the world where periodontal conditions of the population are amongst the worst. 23 Regular home care by the patient is very effective in controlling most in ammatory periodontal diseases.…”

Introductory Chapter: The Importance of Gingival Treatment and Prevention

“…Furthermore, the immune-inflammatory response toward periodontitis may initiate or exacerbate many systemic diseases including diabetes mellitus [15], osteoporosis, cancer [25], rheumatoid arthritis, and systemic lupus erythematosus [26]. In addition, pregnancy, which is the most delicate and important stage in a person's life, will be highly affected by any systemic disturbances or inflammation represented in the pregnant [27].…”