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© Borgis - New Medicine 3/2019, s. 105-112 | DOI: 10.25121/NewMed.2019.23.3.105
Angelika Kobylińska1, Grażyna Marczuk-Kolada2, Marcin Studnicki3, *Dorota Olczak-Kowalczyk1
Dental care in pregnancy – the state of knowledge among Polish dentists and gynaecologists, and factors affecting knowledge about dental management in pregnancy
Opieka stomatologiczna w ciąży ? stan wiedzy polskich dentystów i ginekologów oraz czynniki wpływające na wiedzę na temat postępowania stomatologicznego w ciąży
1Department of Paediatric Dentistry, Medical University of Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Department of Paediatric Dentistry, Medical University of Białystok, Poland
Head of Department: Grażyna Marczuk-Kolada, MD, PhD
3Department of Experimental Design and Bioinformatics, Warsaw University of Life Sciences, Poland
Head of Department: Professor Wiesław Mądry, PhD
Streszczenie
Wstęp. Stan zdrowia ogólnego, przebieg i czas trwania ciąży są ważnymi czynnikami wpływającymi na termin porodu i dobrostan dziecka, w tym jego masę urodzeniową i zdrowie jamy ustnej. Zgłaszalność kobiet w ciąży do lekarza dentysty nie jest jednak wystarczająca. Przyczynami ograniczonego korzystania z opieki stomatologicznej w czasie ciąży może być niewystarczająca wiedza lekarzy dentystów i ginekologów-położników.
Cel pracy. Celem pracy była ocena wiedzy lekarzy dentystów i ginekologów-położników w Polsce w zakresie problemów zdrowia jamy i opieki stomatologicznej u kobiet w ciąży oraz jej uwarunkowań socjoekonomicznych.
Materiał i metody. Anonimowy elektroniczny kwestionariusz skierowany do lekarzy dentystów i ginekologów-położników zawierał pytania dotyczące charakterystyki demograficznej respondentów oraz 29 pytań jednokrotnego wyboru dotyczących zagadnień stomatologicznych w ciąży podzielonych na 4 grupy tematyczne (grupa I ? związek między chorobami przyzębia ciężarnej a przebiegiem ciąży i stanem zdrowia dziecka, grupa II ? postępowanie stomatologiczne oraz zmiany fizjologiczne dotyczące zdrowia jamy ustnej w ciąży, grupa III ? bezpieczeństwo zabiegów stomatologicznych w ciąży, grupa IV ? udzielanie porad prozdrowotnych). Dane poddano analizie statystycznej.
Wyniki. Ankietę wypełniło 485 dentystów i 185 ginekologów-położników (łącznie 670 lekarzy). Dentyści częściej byli świadomi zależności między chorobami jamy ustnej ciężarnej a masą urodzeniową dziecka oraz ryzykiem chorób przyzębia i próchnicy u dziecka w przyszłości. Rzadziej udzielali natomiast prawidłowych odpowiedzi dotyczących bezpieczeństwa wykonywania diagnostyki radiologicznej w ciąży. Lekarze ginekolodzy częściej mieli natomiast wątpliwości dotyczące wykonywania niektórych procedur stomatologicznych, w tym aplikacji lakieru fluorkowego i skalingu. Średnia liczba prawidłowych odpowiedzi na wszystkie pytania ogółem w grupie dentystów była wyższa niż w grupie ginekologów. Wśród dentystów stwierdzono korelację z wiekiem i dłuższym okresem praktykowania, wśród ginekologów zaś z wiekiem i typem praktyki.
Wnioski. Niezadowalający stan wiedzy o postępowaniu stomatologicznym i jego bezpieczeństwie w ciąży wśród dentystów i ginekologów w Polsce wskazuje na konieczność prowadzenia działań edukacyjnych personelu stomatologicznego i pełniącego opiekę okołoporodową. Stan wiedzy w obu grupach zawodowych jest związany z wiekiem lekarzy, w grupie dentystów dodatkowo z okresem praktykowania, a ginekologów-położników z typem praktyki.
Summary
Introduction. The overall health condition, as well as the course and duration of pregnancy are important determinants of the term of delivery and child’s well-being, including birth weight and oral health. Unfortunately, dental attendance of pregnant women is insufficient. This may result from the poor oral health knowledge of dentists and obstetrician-gynaecologists.
Aim. The aim of the study was to assess the knowledge of Polish dentists and obstetrician-gynaecologists on oral health and dental care in pregnant women, as well as its socio-economic determinants.
Material and methods. An anonymous questionnaire for dentists and obstetrician-gynaecologists, which included questions on the demographic characteristics of respondents, as well as 29 single-choice questions on dental issues in pregnancy, which we classified into 4 thematic categories (I ? relationship between maternal periodontal diseases and the course of pregnancy/child’s health; II ? dental management and oral physiological changes in pregnancy; III ? the safety of dental procedures in pregnancy; IV ? providing health advice) was carried out. The data were analysed statistically.
Results. A total of 485 dentists and 185 obstetrician-gynaecologists (670 doctors in total) completed the questionnaire. Dentists were more likely to know the relationship between oral conditions in pregnancy and birth weight, the future risk of periodontal diseases and caries in the child. However, they were less likely to provide correct answers to questions on the safety of diagnostic radiology in pregnancy. On the other hand, obstetrician-gynaecologists were more likely to have doubts about performing some dental procedures, including fluoride varnish application and scaling. The mean number of correct answers to all questions was higher in the group of dentists vs. gynaecologists. Correlations with age and a longer period of practice were found in the group of dentists, while correlations with age and the type of practice were observed among gynaecologists.
Conclusions. The poor level of knowledge of Polish dentists and gynaecologists on dental treatment and its safety in pregnant women indicates the need for education of dental and obstetric practitioners. The level of knowledge in both these professional groups is associated with age and, additionally, with the length of practice in the case of dentists, and the type of practice in the case of obstetrician-gynaecologists.



Introduction
The overall health condition, as well as the course and duration of pregnancy are important determinants of the term of delivery and child’s well-being, including birth weight and oral health. Local inflammation associated with e.g. periodontal diseases, which is a reservoir for gram-negative anaerobic bacteria, may have systemic consequences for a pregnant woman and the developing foetus, such as an increased risk of preterm delivery, intrauterine growth restriction, pre-eclampsia or gestational diabetes, due to the increased vascular permeability and production of pro-inflammatory cytokines.
The relationship between maternal oral health and the course of pregnancy, the term of delivery, and even the oral health in the child is now beyond doubt. In accordance with the Regulation of the Minister of Health of 16 August 2018 regarding the organisational standard of perinatal care, a woman should report to the dentist before 10th gestational week. The aim of such a visit is to assess oral heath, specify preventive and therapeutic needs, as well as plan further management and implement necessary procedures.
Dental attendance among pregnant women is insufficient. Studies in Poland showed that despite the common conviction of women about the safety of dental treatment during pregnancy, only 62.3% of pregnant women reported for dental appointment (1). The reasons for the limited use of dental care during pregnancy include poor awareness of the importance of maintaining oral health among women and, at the same time, insufficient involvement of non-dental personnel providing perinatal care in providing oral health education and requesting feedback on dental visit, as in accordance with the regulation. The available data indicate that only 17.6% of pregnant women are referred by their obstetrician-gynaecologists to a dental office. At the same time, a relationship was found between receiving a referral and visiting a dentist. A total of 87.3% of women who received referral reported for a dental visit. In the group without referral, only 56.9% of women had an appointment (2). It was also shown that dental attendance increases when the referring physician requests a written feedback on the state of oral health. At the same time it was found that one in three women who reported for a dental visit were offered no dental services, including preventive management. The scope of dental services provided for pregnant women was also limited. Diagnostic radiology was performed in only 2.5% of women despite the fact that 4 times more frequent endodontic treatment was carried out requiring radiographic diagnostics (1). The reasons for the limited use of dental care during pregnancy may include poor knowledge of dentists and obstetrician-gynaecologists on the relationships between oral health and the general health in a pregnant woman, the impact of oral pathologies on the course of pregnancy and foetal health, as well as on the principles of dental management, its safety in particular.
Aim
The aim of the study was to assess the knowledge of Polish dentists and obstetrician-gynaecologists on oral health and dental care in pregnant women, as well as its socio-economic determinants.
Material and methods
Dentists and obstetrician-gynaecologists were invited to participate in an electronic survey. To this end, links were distributed in social networks, forums and professional portals, medical conferences and by mail. The online questionnaire was active from June to December 2018. The participation in the study was voluntary and anonymous.
The questionnaire included questions on the demographic characteristics of respondents (sex; age; type, place and duration of practice; specialisation; mean number of pregnant patients per month), as well as 29 single-choice questions on dental issues in pregnancy classified into 4 categories (I ? relationship between maternal periodontal diseases and the course of pregnancy/child’s health; II ? dental management and physiological changes affecting oral health in pregnancy; III ? the safety of dental procedures in pregnancy; IV ? providing health advice). The questionnaire was evaluated by 10 dentists and 5 gynaecologists, and modified in accordance with their comments.
Statistical analysis was performed using Statistica 12 (Statsoft), the chi square (χ2) independence test, the t-test, one-way analysis of variance, and Spearman’s rank correlation coefficient. The level of significance was set at p < 0.05.
The study was approved by the Bioethics Committee of the Medical University of Warsaw (AKBE 228/2018 dated 10 December 2018).
Results
A total of 485 dentists and 185 obstetrician-gynaecologists (670 doctors in total) participated in the survey. Table 1 presents the characteristics of the study group.
Tab. 1. Characteristics of the study group
 Dentists N = 485 (100%)Gynaecologists N = 185 (100%)Total N = 670 (100%)
Sexfemale406 (83.7%)112 (60.5%)518 (77.3%)
male79 (16.3%)73 (39.5%)152 (22.7%)
X-squared = 39.681 p-value < 0.0001*
Age< 30 years154 (31.8%)19 (10.3%)173 (25.8%)
30-40 years191 (39.4%)52 (28.1%)243 (36.3%)
> 40 years140 (28.9%)114 (61.6%)254 (37.9%)
X-squared = 66.528 p-value < 0.0001*
Practice locationcity > 100 thousand inhabitants273 (56.3%)109 (58.9%)382 (57%)
town165 (34%)62 (33.5%)227 (33.9%)
country26 (5.4%)3 (1.6%)29 (4.3%)
mixed21 (4.3%)11 (5.9%)32 (4.8%)
X-squared = 5.2308 p-value = 0.1557
Type of practiceagreement with the National Health Fund22 (4.5%)58 (31.4%)80 (11.9%)
private292 (60.2%)38 (20.5%)330 (49.3%)
mixed system171 (35.3%)89 (48.1%)260 (38.8%)
X-squared = 66.528 p-value < 0.0001*
Length of practice< 5 years154 (31.8%)41 (22.2%)195 (29.1%)
5-10 years127 (26.2%)29 (15.7%)156 (23.3%)
11-20 years103 (21.2%)13 (7%)116 (17.3%)
> 20 years101 (20.8%)102 (55.1%)203 (30.3%)
X-squared = 78.236 p-value < 0.0001*
Mean number of pregnant patients/month 4.53 (± 23.35)37.43 (± 39.02)13.62 (± 32.09)
t = -10.755p-value < 0.0001*
*statistical significance p < 0.05

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Piśmiennictwo
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otrzymano: 2019-09-03
zaakceptowano do druku: 2019-09-24

Adres do korespondencji:
*Dorota Olczak-Kowalczyk
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-091 Warszawa
tel.: +48 (22) 116 64 24
do-k@o2.pl

New Medicine 3/2019
Strona internetowa czasopisma New Medicine