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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2024 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the 

original author and source are credited  

 

 

Psychology of pregnant females regarding perinatal oral health 
Mehlawat Jiksha 1*, Shrivastav Arpit 2 

1 Post graduation student, Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana 

2 Post graduation student, Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana 

Article Info: 
_____________________________________________ 
Article History: 

Received   27 December 2023     
Reviewed  18 January 2024 
Accepted   31 January 2024 
Published 15 March 2024 

_____________________________________________ 
Cite this article as:  

Mehlawat J, Shrivastav A, Psychology of pregnant 
females regarding perinatal oral health, Asian 
Journal of Dental and Health Sciences. 2024; 
4(1):16-20 

DOI: http://dx.doi.org/10.22270/ajdhs.v4i1.61  

_____________________________________________ 

*Address for Correspondence:   

Dr. Mehlawat Jiksha, Post Graduation student, 
Department of Public Health Dentistry, Sudha 
Rustagi College of Dental Sciences and research, 
Faridabad, Haryana  

Abstract 
_________________________________________________________________________________________________________________ 

Aim: To evaluate the attitude, behaviour, experience and knowledge of pregnant females regarding 
perinatal oral health in rural population of Faridabad. 

Methodology: Data was collected through personal interview. Eleven questions related to 
knowledge, attitude, experience and behaviour were asked. Data was analysed using IBM SPSS 
version 21. 

Results: About one- fourth of the study population experienced adverse effects on oral health during 
pregnancy and their knowledge was also found to be poor with respect to perinatal oral health 
maintenance. They also reported ill behaviours to manage morning sickness. Despite this, their 
attitude towards maintenance of perinatal oral health was found to be positive. 

Conclusion: The dental status of the child is a direct reflection of maternal oral condition in 
pregnancy. Thus, there is a need for educational oral health interventions in pregnant women to 
improve their own and children oral health status. 

Keywords: Perinatal, Oral health, Pregnancy, Rural population   

 

INTRODUCTION 

Diseases related to oral cavity are a noteworthy burden on 
public health in India. Oral health is an integral part of general 
health as recognized by WHO. The outcomes of the poor oral 
health are seen on the individual, community as well as on the 
system for health care, which acts as a notable risk factor for 
various other systemic problems.1 In developing countries like 
India, there is a wide distinction in oral health level between 
urban and rural community, with expanding inequality in 
access to quality care, specifically in the rural areas.2 

According to the definition of public health 1920, every 
individual must realize the birthright of health and longevity 
and should have the access to the health care services.3 To 
assist oral and dental health for longevity, efficient and 
appropriate care is mandatory. In women, oral and dental care 
is highly essential all through the phases of life, especially 
during pregnancy, breastfeeding and menopausal periods.4 
Pregnant women are susceptible to a wide range of oral health 
conditions that could be harmful to their own health and the 
future of their baby. Pregnant women undergo adaptive 
remaking in body structure due to hormonal balance changes 
during pregnancy because of the higher levels of estrogen and 
progesterone. Such endocrine actions also effects the oral 
cavity, which may show short-term or abiding changes as well 
as modifications that are considered morbid.5  

According to American Academy of Pediatric Dentistry 
(AAPD), perinatal and infant oral health plays a vital role for 
children to possess a livelihood free from oral diseases. 

Perinatal period is around the time of birth, which begins with 
completion of 20th to 28th week of gestation and ends one to 
four weeks after birth. It holds a crucial role for the health and 
well-being of pregnant women and their newborn children.6 
Inspite of this fact, pregnant women do not seek dental care 
during the pregnancy and those who confront such services 
show unwillingness to dentists for providing care. The 
expectant mothers primarily in the rural population are not 
aware of the inference of poor oral health for their pregnancy 
and their unborn child.7,8,9 

The women in pregnancy having restricted or no resources for 
health care generally present with consequential issues 
regarding oral health in perinatal period. They may also 
indicate narrow valuing the significance of preventive oral 
health practices during the gestation and postnatal period. It is 
of main concern among the low-income community with 
higher incidence rate of gingivitis, periodontitis and dental 
caries.10 The perceptions that poor oral health in pregnancy is 
normal may drive the failure to obtain oral health care.11 The 
lack of dental and oral health knowledge by pregnant patients 
is a serious barrier to perinatal care.10,11 Hence the present 
study was conducted to evaluate the attitude, behavior, 
experience and knowledge of pregnant females regarding 
perinatal oral health in rural population of Faridabad. 

METHODOLOGY:  

An anonymous 11-question survey was conducted among 60 
pregnant women visiting an outpatient obstetric clinic at the 
public health centre among the rural population of Faridabad 

                     Open Access                                                                                                                                                                                                       Research Article                                                                           

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Mehlawat et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):16-20 

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during a 15day time period from 25th November to 10th 
December in 2019. Sample size estimation was done by using 
G Power software (version 3.0). A minimum total sample 
size of 60 was found to be sufficient for an alpha of 0.05, 
power of 80%, 0.6 as effect size.  The survey addressed 
questions regarding patient’s knowledge, attitude, experience 
and behavior. The patients were also inquired about their 
knowledge concerning to linked unfavorable pregnancy 
outcomes and were commended oral health care behaviors in 
pregnancy. The questions were in multiple choice, bivariate, 
and choose all patterns. The data were analysed using IBM 

Statistical Package for the Social Science version 21. 
Descriptive statistics were tabulated and reported as 
percentages. 

RESULTS: 

The present study composed of 60 pregnant females who 
visited the public health centre for consulting obstetrician, 
were of 23.06 ± 3.2 years. Among the females, 83.3% were 
unemployed and 36.7% were having either their first or 
second pregnancy. None among the pregnant females had any 
insurance coverage (Figure 1). 

 

 

FIGURE 1: Descriptives of study population 

 

In our society, there are many misconceptions regarding the 
effect of pregnancy on oral health. Approximately one-third of 
the patients didn’t recognize any commonly described 
physiologic oral cavity changes related to pregnancy. Only 

about 25% reported that they experienced bleeding gums 
during the period of pregnancy (Figure 2). Patients perceived 
tooth decay, tooth loss, swollen gums and tooth ache were 
normal events associated with pregnancy. 

 

 

FIGURE 2: Experiences of the study population 

83.3

36.7

0
0

10

20

30

40

50

60

70

80

90

Occupation status (unemployed) No of pregnancy (1st and 2nd) Coverage to insurance

20
1.7

25

8.3 8.3

69.3

0

10

20

30

40

50

60

70

80

Tooth decay Tooth loss Bleeding

gums

Swollen

gums

Tooth ache Morning

sickness



Mehlawat et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):16-20 

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The maintenance of the oral hygiene is crucial and it becomes 
a necessity during pregnancy. In this regard, 75% of the 
pregnant females showed no importance of changing 
toothbrush every 3-4 months. In concern to their behavior, 
88.3% pregnant females were reported of not visiting to 
dentist in past 6 months, whereas 60% females showed 
positive response towards the importance of dental evaluation 
every 6 months (Figure 3). The pregnant females were asked 

about managing morning sickness during pregnancy to 
measure the potential risk behaviors. Among them, 69.3 % 
reported morning sickness. About 38.3% responded managing 
by rinsing with baking soda, 18.3% were brushing their teeth 
and 31% responded they did not know. This former behavior 
is recognized as potentially harmful to teeth by the dental 
community (Table 1). 

 

 

 

FIGURE 3: Attitude and Behavior of study population 

 

TABLE 1: Risky behavior: morning sickness management 

Behavior in response to Percentage (%) 

Brush teeth immediately  18.3 

Drink water 11.7 

Rinse with baking soda in water 38.3 

Don’t know 31.7 

 

In interest of the perception of pregnant females towards the 
safe oral health intervention, most of them identified teeth 
cleaning is a safe and an admissible intervention in pregnancy, 
40% identified antibiotics and pain medications as safe; and 
very few acknowledged teeth X-ray, filling cavities, fluoride 
treatment, and local anesthesia as safe interventions in 
pregnancy (Table 2). 

The pregnant patients showed poor knowledge regarding the 
risks associated with periodontal disease in pregnancy such as 
worsening gum disease, tooth loss, caries, miscarriage, 
preterm birth and growth restriction (Table 3). Pregnant 
females were inquired to gauge their knowledge related to the 
undertakings that vigour the risk of transmission of bacteria 
causing caries among children postpartum. Majority, 76.7% 
responded that the risk of getting caries was not there until 
the teeth erupts in the oral cavity, whereas few acknowledged 
that sharing spoon can be considered as risky. (Figure 4) 

TABLE 2: Knowledge towards the safe oral health 
intervention 

Intervention  Safe during 

pregnancy (%) 

Not safe during 

pregnancy (%) 

Teeth cleaning 55 45 

Teeth X-ray 45 55 

Filling cavities 25 75 

Fluoride treatment 15 85 

Local anesthesia 15 85 

Antibiotics  38.3 61.7 

Pain medications 40 60 

 

TABLE 3: Knowledge about periodontal disease and its 
outcomes 

 Yes (%) No (%) 

Worsening gum disease 23.3 76.7 

Tooth loss 25 75 

Caries 25 75 

Miscarriage  25 75 

Preterm birth 25 75 

Growth restriction 25 75 

 

60

75 76.7

0

10

20

30

40

50

60

70

80

90

Imortance of dental

evaluation every 6 months

(yes)

Importance of changing

toothbrush every 3-4

months (no)

Current dental issues (no)



Mehlawat et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):16-20 

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FIGURE 4: Postpartum risk of vertical transmission of S. Mutans 

 

DISCUSSION:  

During pregnancy, every female undergoes complex physical 
and physiological changes which have a crucial impact on 
body organs, especially the oral cavity.12 Perinatal period is an 
opportunate time during which the women can be motivated 
and educated, so as to perform dental treatment on expectant 
mothers which can provide them as well as their children a 
safe future. Pregnancy care visits to obstetricians provide 
teachable moment to educate expectant mothers regarding the 
diet including nutritious food of adequate quality and in 
quantity which controls food cravings helping in preventing 
the caries process. It also educates that dental treatment 
including comprehensive oral examination, dental 
prophylaxis, dental radiographs with proper shielding and 
local anesthetic, is safe in all trimesters and optimal in the 
second trimester. Hence, a combination of personal and 
professional care is very important in improving the oral 
health.  

According to the WHO, the provisions for oral health-care 
services are few in rural parts of India, where the majority of 
the Indian population resides. This is further complicated by 
the great variation that occurs across this population in social 
parameters such as income and education.1 Apart from the 
health care services, health insurance is one of the traditional 
barrier which restricts the approach to such services. In our 
study also none of the patients had any insurance coverage 
neither for the medical nor for the dental care. This is 
probably due to the lack of knowledge and dearth of health 
care providers who could educate the expectant mothers 
regarding it.13 

In the present study periodontal disease was experienced by 
almost 1/4th of the study population. Whereas, literature 
suggest the prevalence of periodontal disease as 40%. Sixty 
percent of the subjects were aware about the importance of 
dental evaluation every 6 months and similarly results were 
reported by Ganesh et al and Thomas et al.14,15 It was found 
that patients had poor knowledge about perinatal oral health 
similar to the study conducted by Thomas et al among the 
expectant mothers to evaluate the knowledge and attitude of 
expectant mothers about infant oral health and their oral 
hygiene practices in Mangalore city.  

The study conducted by Ganesh et al (2011) among 208 
antenatal women attending Government Maternity Hospital 

found that 86.1% of the women were not aware of oral health 
problems during pregnancy and majority of them were not 
aware of oral health problems during pregnancy. Similarly in 
our study, Patients perceived tooth decay, tooth loss, swollen 
gums and tooth ache were normal events associated with 
pregnancy. Naumah I and Annan BD (1998) did a study on the 
periodontal status and oral hygiene practices of pregnant and 
non-pregnant women attending the outpatient clinic of the 
department of Obstetrics and Gynaecology of Korle-Bu 
Teaching Hospital where they reported the prevalence of 
gingival bleeding was 89% among pregnant women, in 
contrast with only 25% in our study.16 

Pregnant patients need to be educated specially in the rural 
areas regarding the changes during pregnancy which are to be 
considered normal physiologic changes and the events that 
should be identified as pathologic. In addition, patients 
perception regarding the procedures such as teeth X-ray, 
filling cavities, fluoride treatment, and local anesthesia is 
required to be altered as they are the safe interventions to be 
carried out during pregnancy with appropriate 
precautions.13The pregnant females should be particularly 
specified to evade the risky behavior carried out to manage 
the morning sickness by either brushing or rinsing with 
baking soda immediately after vomiting. 

Oral hygiene of the mother, especially in pregnancy directly 
influences on infant’s oral health. Poor understanding and 
knowledge of good oral health practices, poor dietary habits 
and practice saliva-sharing activities in combination increases 
the likelihood of transmitting caries causing bacteria from 
mother to infants.17 High Mutans Streptococci levels and 
carious lesions are recognized as risk factors in the 
transmission of Mutans Streptococci (MS) from mother to 
child. S. mutans load reduction in the mothers oral cavity 
diminishes the vertical transmission to the infant which 
reduces the probability of caries among infants, as evidence 
based research suggested.13,18 

LIMITATION: 

The current study bears some limitations. Firstly, the 
convenience sampling selection procedure of participants and 
sample size do not necessarily represent the entire target 
population. Secondly, small sample size is a limitation.  

 

23.3

76.7

0

10

20

30

40

50

60

70

80

90

Kissing on

mouth

Cleaning

pacifiers with

your mouth

Sharing spoon Giving baby

formula

None of these

until baby gets

teeth



Mehlawat et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):16-20 

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CONCLUSION: 

Perinatal oral health is a very important health concern 
phenomenon. In this period, oral health negligence has a great 
effect on both mother and child’s physical and oral health. 
Generally, dental care is not given preference by women 
during the pregnancy, and those who seek dental care usually 
defy the wish to get any treatment provided. A widespread 
cognizance is needed about oral health problems, to evade 
difficulties caused by delinquency and dearth of personal-care, 
with the support of healthy lifestyles, by acquiring appropriate 
habits to eat and practicing good oral hygiene and by paying 
regular visits to the dentist.  

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