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ORIGINAL RESEARCH Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 1  |  Page : 13-16
Periodontal disease as a risk factor in pre-term low birth weight - An assessment of gynecologists' knowledge: A pilot study


1 Department of Community Dentistry, Yenepoya Dental College, Deralakatte, Mangalore 575 018, India
2 Department of Periodontics, MCODS, Mangalore 575 003, India
3 Department of Community Dentistry, Coorg Institute of Dental Sciences, Virajpet, India

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Date of Submission24-Dec-2007
Date of Decision04-Jul-2008
Date of Acceptance25-Aug-2008
 

   Abstract 

Background: Pre-term low birth weight (PLBW) is a condition having tremendous financial impact on health care systems as well as the affected families. Studies suggest that 18.2% of all PLBW cases may be attributable to periodontal disease.
Objectives: To assess gynecologists' knowledge of periodontal disease as a risk factor in PLBW and their knowledge with regard to the oral manifestations of periodontal disease.
Materials and Methods: A questionnaire survey was conducted on gynecologists in the city of Mangalore. The respondents were divided into four groups - those practicing only in medical colleges, those having only a private practice, those practicing in both medical colleges and in private practice, and post-graduate students of gynecology in the medical colleges in the city.
Statistical Analysis Used: The Chi-square test for proportions was used to test the differences between the groups.
Results: Out of a total of 142 gynecologists, 93 participated in the survey. Group II respondents were omitted from the statistical analysis as the response rate was only 18.8%. Periodontal disease was considered to be a risk factor in PLBW by 52 (59.8%) respondents while 13 (14.9%) stated that it was not a risk factor at all. Sixty-seven (77%) respondents stated that bleeding/enlargement of the gingivae was a sign of periodontal infection.
Conclusions: Respondents' knowledge was high regarding the oral manifestations of periodontal disease but was low regarding periodontal disease as a risk factor in PLBW.

Keywords: Gynecologists, knowledge, periodontal disease, pre-term low birth weight

How to cite this article:
Shenoy RP, Nayak DG, Sequeira PS. Periodontal disease as a risk factor in pre-term low birth weight - An assessment of gynecologists' knowledge: A pilot study. Indian J Dent Res 2009;20:13-6

How to cite this URL:
Shenoy RP, Nayak DG, Sequeira PS. Periodontal disease as a risk factor in pre-term low birth weight - An assessment of gynecologists' knowledge: A pilot study. Indian J Dent Res [serial online] 2009 [cited 2019 Jun 24];20:13-6. Available from: http://www.ijdr.in/text.asp?2009/20/1/13/49049
Pre-term (<37 weeks gestation) low birth weight (<2500 grams) (PLBW) is a condition having tremendous financial impact on health care systems as well as the affected families. [1],[2],[3],[4] Globally, about 16% (more than 200 million) of the babies born were low birth weight (LBW) cases. [4] Disorders relating to short gestation and LBW are among the leading causes of death and disability in infants. [3],[4]

About 25% of PLBW cases occur without even a suspected risk factor. Estimates suggest that 18.2% of all PLBW cases may be attributable to periodontal disease. [3] Studies have shown that 1) periodontal disease is present before the pre-term low-weight birth (a necessary condition for causation) and 2) the patients with the most severe periodontal disease had the greatest risk for pre-term low-weight births even after adjusting for known risk factors. [1],[3],[4],[5],[6] Approximately 25% of pregnant women demonstrate increased periodontal pocketing and this increases the risk of pre-term birth (PTB) three to eight fold. [7],[8] Periodontal infections are preventable and treatable. Therefore, periodontitis can be viewed as a modifiable risk factor. [9]

Data obtained from Lady Goschen Hospital in Mangalore (predominantly serving the lower socioeconomic classes) showed that from January to December 2004, 6.7% of all births were PTB and 19.9% of all deliveries were LBW cases.

Integration of periodontal care into obstetric management may improve pregnancy outcomes as early intervention may reduce the microbial challenge to oral tissues already altered due to hormonal changes.

Therefore, this study was conducted with the objectives of assessing gynecologists' knowledge of periodontal health as a risk factor in PLBW and their knowledge with regard to the oral manifestations of periodontal disease.


   Materials and Methods Top


This study was conducted in Mangalore. With a population of approximately 600,000, it is a reputed center for education with five medical colleges and four dental colleges.

Subjects and Sampling: There are a total of 142 gynecologists in Mangalore. The respondents were divided into four groups based on the type of practice followed - those practicing only in medical colleges (Group I), those having only private practice (Group II), those practicing both in medical colleges and having private practices (Group III), and post-graduate students of gynecology in medical colleges (Group IV). This division into four categories was done to assess whether the type of practice followed by the gynecologists had any bearing on their knowledge levels.

The study was conducted from September to December 2005. The principal investigator approached the gynecologists individually and distributed the questionnaires by hand after obtaining their consent. The questionnaires were answered immediately in the presence of the investigator.

Questionnaire Design: The questionnaire was prepared by the principal investigator in consultation with the other authors. Reliability of the questionnaire was assessed using Cronbach's alpha internal consistency coefficient.

The questionnaire had ten items. Knowledge of periodontal disease as a risk factor in PLBW and awareness with regard to the oral manifestations of periodontal disease was assessed using nine questions. The tenth question was open-ended and asked for the respondents' comments on the study.

Statistical Analysis: The data collected was evaluated on the basis of the type of practice followed by the respondents. The Chi-square test for proportions was used to test the differences between the groups. A p-value of 0.05 was considered significant for all statistical analyses.

The Cronbach's alpha value for the first five questions was 0.91 and for questions 7, 8, and 9, it was 0.6228.


   Results Top


A total of 93 (65.5%) of the 142 gynecologists practicing in Mangalore completed the survey. The response rate was 22/27 (81.5%), 6/32 (18.8%), 23/28 (82.1%), and 42/55 (76.4%) for Groups I, II, III and IV, respectively. Those who did not participate in the study (especially those in Group II) cited lack of time, interest, or conflict with their busy practice schedule. As the response rate in Group II was only 18.8%, it was omitted from the statistical analysis.

Data obtained from the respondents of Groups I, III, and IV were subjected to statistical analysis. Comparisons between Groups I and III revealed the effect of private practice on the awareness of gynecologists regarding periodontal disease. Also, a comparison between all medical college staff (Groups I and III) and postgraduate students (Group IV) revealed whether there were differences in awareness about oral health between undergraduates and postgraduates.

The responses to the questions asked are given in [Table 1],[Table 2],[Table 3],[Table 4],[Table 5].

That "bleeding/enlargement of the gingivae is a sign of periodontal infection" was the belief of 63.6% respondents from Group I, 82.6% respondents from Group III, and 81.0% respondents from Group IV.

The differences between the groups were insignificant with the Chi-square values of the Group I vs. Group III analysis being 2.555 and the Groups I and III vs. Groups IV analysis being 4.98.

When questioned about their course of action if a patient asks their opinion about bleeding/enlargement of gingivae, 95.4% respondents from Group I, 86.9% respondents from Group III, and 92.9% respondents from Group IV stated that they would refer the patients for a dental opinion rather than advise medication themselves. The differences between the groups were insignificant with the Chi-square values of the Group I vs. Group III analysis being 5.83 and the Groups I and III vs. Group IV analysis being 0.089.

The referrals by the gynecologists would be to the following:

  • A total of 80.9% of Group I respondents stated they would refer patients to a general dental practitioner; 19.1% would refer their patients to a periodontist
  • A total of 35.0% of Group III respondents would refer their patients to a general practitioner; 65.0% would refer their patients to a periodontist
  • A total of 61.6% of Group IV respondents would refer their patients to a general practitioner; 38.3% would refer their patients to a periodontist
The Chi-square values of the Group I vs. Group III analysis was 8.91 (p = 0.0028, significant) and the Groups I and III vs. Groups IV analysis was 0.075 (P>0.05). It can be seen that awareness of a specialist practitioner (i.e., a periodontist) was highest among the Group III respondents.

In case patients with complaints of enlargement/bleeding from their gingivae insisted on a prescription for the same until a dental visit was possible, 46% of the respondents stated they would prescribe some medications out of whom 55% would prescribe antibiotics, analgesics, and anti-inflammatory drugs (in violation of the prevalent scientific view limiting the prescription of these drugs to only the rarest of cases); 15% would prescribe Vitamin C supplements (again, an unnecessary prescription), and 7.5% would prescribe mouth rinses and antiseptic gels.

The source for the above information (on periodontal disease as a risk factor for PLBW) was medical literature for 81.8% of Group I respondents. Among the Group III respondents, 4.3% obtained the information from a dentist, 73.9% obtained the information from medical literature while 8.7% stated that the information was obtained through knowledge and practice. Among Group IV respondents, 19.1% obtained the information from a dentist while 57.1% obtained the information from medical literature.

Medical literature was the predominant source of information on the topic for 67.8% of the gynecologists surveyed from Groups I, III, and IV.

The Chi-square values of the Group I vs. Group III analysis was 3.157 (P>0.05) and the Groups I and III vs. Group IV analysis was 9.933 (P = 0.0191, significant).

Assessment of Groups I, III, and IV for knowledge scores (by adding up the number of correct responses given by the respondents in each group) found that respondents in Group III had higher knowledge scores than those in Group IV, with the Group I respondents placing third.


   Discussion Top


To date, many studies have demonstrated the effects of maternal periodontal status on pre-term low-weight delivery. [1],[3],[4],[5],[6],[7],[8],[10] Although this information is easily available in medical literature, little information is available regarding the knowledge of gynecologists with regard to the above facts.

Among gynecologists practicing in Mangalore, this study showed that while knowledge regarding periodontal infection as a potential risk factor for systemic complications, importance of a regular dental check-ups, and the oral manifestations of periodontal disease was high, awareness regarding periodontal disease as a risk factor in PLBW was low.

The respondents in Group III showed high knowledge scores. This may be due to the fact that they remained in continuous contact with the recent advances and new facts coming to light on the topic. Continuing education programs may also have had some role to play in the difference in knowledge levels.

There are some limitations to this study. The sample size in Group II was very small when compared with the other groups. Therefore, the responses of those who participated in this study from Group II may not reflect the actual opinions of all the practitioners belonging to that group. Therefore, this group was omitted from the statistical analysis. Also, the total sample size was not large enough to detect significant differences for some of the outcomes between the four groups. Therefore, it may not be possible to extrapolate the results of this study to other settings in India or other parts of the world.


   Conclusions Top


The present study showed the following:

  • High knowledge levels among the respondents regarding the oral manifestations of periodontal disease
  • Low knowledge levels regarding periodontal disease as a risk factor in PLBW, with only 59.8% of the respondents considering it to be a risk factor
  • Comparisons between Groups I and III (revealing the effect of private practice on the awareness of gynecologists regarding periodontal disease) showed significant differences between them on whether a regular dental check-up is a must for pregnant women and awareness of a specialist practitioner (i.e., a periodontist)
  • Comparisons between all medical college staff (Groups I and III) and postgraduate students (Group IV) revealed that there were significant differences between them on the sources of information on periodontal disease as a risk factor for PLBW

   Acknowledgments Top


The authors wish to acknowledge Dr. K. Prashanth Shenoy, MDS, Professor, Yenepoya Dental College, Mangalore; Dr. Ashitha Uppoor, MDS Professor, MCODS, Mangalore; and Dr. S.R. Nayak, M.D. Professor, Kasturba Medical College, Mangalore for their valuable suggestions, guidance and help during the conduct of this study.

 
   References Top

1.Moreu G, Tιllez L, Gonzαlez-Jaranay M. Relationship between maternal periodontal disease and low-birth-weight pre-term infants. J Clin Periodontol 2005;32:622-7.  Back to cited text no. 1    
2.Offenbacher S, Jared HL, O'Reilly PG, Wells SR, Salvi GE, Lawrence HP, et al . Potential pathogenic mechanisms of periodontitis-associated pregnancy complications. Ann Periodontol 1998;3:233-50.  Back to cited text no. 2  [PUBMED]  
3.Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al . Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103-13.  Back to cited text no. 3  [PUBMED]  
4.Dasanayake AP. Poor periodontal health of the pregnant woman as a risk factor for low birth weight. Ann Periodontol 1998;3:206-12.  Back to cited text no. 4  [PUBMED]  
5.Offenbacher S, Lieff S, Boggess KA, Murtha AP, Madianos PN, Champagne CM, et al . Maternal periodontitis and prematurity. Part I : Obstetric outcome of prematurity and growth restriction. Ann Periodontol 2001;6:164-74.  Back to cited text no. 5    
6.Jeffcoat MK, Geurs NC, Reddy MS, Goldenberg RL, Hauth JC. Current evidence regarding periodontal disease as a risk factor in preterm birth. Ann Periodontol 2001;6:183-8.  Back to cited text no. 6  [PUBMED]  
7.Offenbacher S. Potential impact of maternal periodontitis on reproductive outcomes. In: Public health implications of periodontal infections in adults-conference proceedings. J Public Health Dent 2005;65:62-3.  Back to cited text no. 7    
8.Jeffcoat MK. Periodontal disease as a risk factor for preterm birth: epidemiology and a pilot intervention study. In: Public health implications of periodontal infections in adults-conference proceedings. J Public Health Dent 2005;65:63.  Back to cited text no. 8    
9.Reed S. Potential public health implications of associations between periodontitis and reproductive outcomes. In: Public health implications of periodontal infections in adults-conference proceedings. J Public Health Dent 2005;65:63-4.  Back to cited text no. 9    
10.Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC, et al . Periodontal infection and preterm birth. J Am Dent Assoc 2001;132:875-80.  Back to cited text no. 10    

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Correspondence Address:
Rekha P Shenoy
Department of Community Dentistry, Yenepoya Dental College, Deralakatte, Mangalore 575 018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.49049

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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