*Angelika Kobylińska1, Nicole Sochacki-Wójcicka2, Dariusz Gozdowski3, Dorota Bomba-Opoń2, Mirosław Wielgoś2, Dorota Olczak-Kowalczyk1
Dental care in pregnancy in Poland. A postnatal questionnaire study
Opieka stomatologiczna w czasie ciąży w Polsce. Postnatalne badanie ankietowe
1Department of Pediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
21st Chair and Department of Obstetrics and Gynecology, Medical University of Warsaw
Head of Chair and Department: Professor Mirosław Wielgoś, MD, PhD
3Department of Experimental Design and Bioinformatics, Faculty of Agriculture and Biology, Warsaw University of Life Sciences
Head of Department: Krzysztof Pawłowski, PhD
Streszczenie
Wstęp. Ciąża jest okresem zwiększonego ryzyka występowania chorób w obrębie jamy ustnej, mających wpływ na przebieg ciąży i zdrowie dziecka. Kobiety ciężarne powinny dbać o zachowanie zdrowia uzębienia i przyzębia poprzez intensyfikację działań profilaktycznych i leczniczych.
Cel pracy. Ocena powodów zgłoszenia się kobiet w ciąży do dentysty i rodzaju udzielanych im świadczeń stomatologicznych z uwzględnieniem wpływu czynników socjodemograficznych, w tym miejsca zamieszkania, oraz rodzaju placówki medycznej.
Materiał i metody. Przeprowadzono elektroniczne badanie ankietowe kobiet do 5 lat po porodzie (zgoda Komisji Bioetycznej WUM). Pytania dotyczyły danych socjodemograficznych, przebiegu ciąży i porodu, wizyt w gabinecie stomatologicznym w czasie ciąży, rodzaju wykonywanych procedur oraz placówek, w których je wykonywano. Do analizy statystycznej zastosowano test chi-kwadrat, współczynnik korelacji rang Spearmana. Przyjęto poziom istotności p ≤ 0,05.
Wyniki. Analizowano 3439 ankiety kobiet w wieku 13,1-45,4 roku, wypełnione od 2 tygodni do 5 lat po porodzie, w tym 40,9% mieszkanek dużych miast, 74,8% z wykształceniem ponadmaturalnym, 41% w dobrej sytuacji ekonomicznej. Wizytę w gabinecie stomatologicznym w czasie ciąży, częściej prywatnym, odbyło 62,3% kobiet. Najczęściej przyczyną wizyty była potrzeba lecznicza. Zgłaszalność i powody wizyty zależały od: wieku, statusu ekonomicznego, aktywności zawodowej, miejsca zamieszkania, poziomu wykształcenia, opieki stomatologiczna przed ciążą i zaleceń ginekologa. Świadczeń stomatologicznych udzielono 63% kobietom, które zgłosiły się do dentysty. Najczęściej leczono próchnicę zębów (53,7%), wykonywano skaling (13,6%) i leczenie endodontyczne (9,5%), najrzadziej zdjęcia radiologiczne (2,5%). Z wyjątkiem ekstrakcji i leczenia endodontycznego wszystkie procedury wykonywano częściej w gabinetach prywatnych niż posiadających umowę z NFZ.
Wnioski. Zgłaszalność ciężarnych do dentysty, modyfikowana czynnikami socjodemograficznymi, jest związana z potrzebami leczenia stomatologicznego i skierowaniem od ginekologa. Zbyt rzadkie wykonywanie procedur profilaktycznych i unikanie diagnostyki radiologicznej w czasie ciąży wskazują na konieczność rozpowszechnienia wiedzy dotyczącej zasad opieki stomatologicznej w czasie ciąży wśród przyszłych matek i lekarzy dentystów.
Summary
Introduction. Pregnancy is a period of increased risk of oral diseases that affect both the course of pregnancy and child’s health. Pregnant women should pay particular attention to dental and periodontal health by implementing intensified preventive and therapeutic activities.
Aim. An evaluation of the reasons for dental visits and the types of dental services among pregnant women, with reference to the impact of the socio-demographic factors such as place of residence and the type of medical facility.
Material and methods. An electronic survey was conducted among women up to 5 years postpartum (consent of the bioethical committee of Medical University of Warsaw). Socio-demographic data as well as information on the course of pregnancy, dental appointments during pregnancy, the type of dental procedures and the type of attended healthcare facilities were collected. The chi-square test and Spearman’s rank correlation coefficient were used for statistical analysis. A p ≤ 0.05 was accepted as statistically significant.
Results. A total of 3,439 questionnaires completed 2 weeks to 5 years after delivery by women aged between 13.1 – 45.4 years, including 40.9% of urban residents, 74.8% of women with higher education, and 41% of women in good economic situation, were analysed. A total of 62.3% of respondents reported attending dental appointments (usually private) during pregnancy. The need for treatment was the most common reason for the visit. The attendance and the reasons for dental visits depended on the age, economic status, professional activity, place of residence, level of education, dental care before pregnancy and gynaecologist’s recommendations. A total of 63% of women who reported to the dentist received dental care. The most common procedures included dental caries treatment (53.7%), dental scaling (13.6%) and endodontic treatment (9.5%). Dental radiography was less common (2.5%). Except for tooth extraction and endodontic treatment, all procedures were usually performed in private practices rather than those having a contract with the Polish National Health Fund.
Conclusions. Dental attendance among pregnant women, which is modified by socio-demographic factors, is associated with the need for dental treatment and a referral from a gynecologist. The limited use of preventive procedures and avoiding diagnostic radiology during pregnancy indicate the need to educate both future mothers and dentists on dental care in pregnancy.
Introduction
Changes occurring in the woman’s body during pregnancy, especially those having effects on the endocrine and immune system, salivary quantity and quality, as well as gastrointestinal disorders, may have negative effects on the quality of life, the overall health status of the woman, the course of pregnancy and child’s health. A relationship was demonstrated between periodontitis in a pregnant woman and low birth weight and premature delivery as well as between high cariogenic bacterial count and primary dental caries in the child (1-5). Dental care in pregnancy should be enhanced and comprehensive (the concept of a whole mouth therapy), i.e. it should include intensive prevention of oral diseases, treatment of dental caries and its complications, periodontal diseases and oral mucosa (6-9).
In Poland, pregnant and puerperal women are entitled to a greater range of therapeutic and preventive procedures reimbursed by the National Health Fund, which allows for regular check-up visits at 3-month intervals, necessary preventive and therapeutic procedures, as well as individual health education. The Ordinance of the Minister of Health of 23 September 2010 (which was replaced with the ordinance of 20 September 2012) additionally introduced standards for the management in pregnancy and puerperium, which emphasise the need for dental care and the importance of maintaining oral health during pregnancy. These include healthy lifestyle promotion, including oral health (until 10 weeks pregnant), oral health monitoring (at pregnancy weeks 11-14, 21-26, and 33-37) as a part of prevention provided by a doctor or midwife as well as dental check-up visits, including oral health assessment, determination of preventive and therapeutic needs and setting a treatment plan by the 10th week of pregnancy. Promotional and educational activities targeting oral health are also implemented, among other things, during parentcraft classes, by regional authorities, scientific associations and the Ministry of Health.
Aim
The aim of the study was to assess the reasons for dental appointments and the types of dental services among pregnant women, considering socio-demographic factors, such as the place of residence and the type of medical facility.
Material and methods
This was an anonymous, electronic survey including women whose pregnancy was terminated within 5 years before the date of completing the questionnaire. The study was conducted in April and May 2017. The questionnaire included questions regarding age at pregnancy termination and at questionnaire completion, the place of residence (large/small urban or rural region), level of education, family financial situation, professional activity, the course of pregnancy and delivery (comorbidities, date and type of delivery), child’s birth weight, the use of dental care in pregnancy, reasons for dental appointments, as well as preventive and therapeutic procedures performed. Incorrect or incomplete questionnaires were excluded from the analysis. The questionnaire regarding the period of pregnancy was approved by the Bioethics Committee of the Medical University of Warsaw (approval no. KB/93/2015 dated May 5, 2015).
The obtained data were analysed statistically with the chi-square test and a correlation analysis using the Spearman rank correlation coefficient. Statistica 12 (Statsoft) was used in the analysis and a p ≤ 0.05 was accepted as statistically significant.
Results
A total of 3,439 of 3,455 completed questionnaires were included in the analysis. The socio-demographic characteristics of respondents are shown in table 1. The questionnaires were completed 2 weeks to 5 years after termination of pregnancy (on average after 1.78 ± 1.44 years). Maternal age ranged between 13 and 43 years (mean age 26.79 ± 4.06 years) at delivery and between 13.1 and 45.4 years (mean age 28.84 ± 4.04 years) at the time of questionnaire completion. A total of 2,524 (73.4%) women were primiparas. General disorders were experienced during pregnancy by 1,019 (29.6%) respondents. The most commonly reported anomalies included the risk of premature delivery (16.1%), thyroid disease (18.17%), hypertension (8.5%) and diabetes (7.7%). Preeclampsia (2.0%) and gestational cholestasis (1.7%) were less common. Full-term delivery was reported by 92.9% of women, with the dominance of vaginal delivery (61.8%). Emergency and elective caesarean section was performed in 22.1 and 16.1% of respondents, respectively. A total of 170 (4.9%) children had birth weight below 2500 g (mean birth weight 3,389 ± 532 g).
Tab. 1. Socio-demographic characteristics of respondents
| Total number of respondents | 3439 (100%) |
| Age at delivery (years) | ≤ 20 | 200 (5.8%) |
| 21-25 | 1104 (32.1%) |
| 26-30 | 1551 (45.1%) |
| > 30 | 584 (17%) |
| Age at questionnaire completion (years) | ≤ 20 | 62 (1.8%) |
| 21-25 | 620 (18,0%) |
| 26-30 | 1633 (47.5%) |
| > 30 | 1124 (32.7%) |
| Place of residence | rural area | 911 (26.5%) |
| small town | 1122 (32.6%) |
| large city | 1406 (40.9%) |
| Education | primary/middle/basic vocational | 117 (3.4%) |
| secondary | 750 (21.8%) |
| incomplete higher/higher | 2574 (74.8%) |
| Professional activity during pregnancy | 2750 (80.0%) |
| Financial situation | bad | 316 (9.2%) |
| average | 1713 (49.8%) |
| good or very good | 1410 (41%) |
| The use of dental care before pregnancy | when needed | 1625 (47.3%) |
| once a year | 1139 (33.1%) |
| more than once a year | 607 (17.7%) |
A total of 2,142 (62.3%) respondents used dental care during pregnancy, with lower attendance among women from rural (58.6%) and smaller urban (60.6%) vs. larger urban (66.0%) areas. In addition to the place of residence (r = 0.047), the use of dental care was also associated with the financial situation (Spearman’s rank correlation coefficient [r] = 0.076), level of education (r = 0.090), professional activity during pregnancy (r = 0.068), referral from a gynaecologist (r = 0.287), as well as the use of dental care before pregnancy (r = 0.249). Factors associated with the general maternal health condition, pregnancy and delivery had no effects on dental attendance.
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