|Year : 2019 | Volume
| Issue : 3 | Page : 83-87
Self-reported gingivitis among pregnant women and nonpregnant women in the City of Derna, Libya: Is there any difference? a cross-sectional survey
Ashraf Saad M. Elzer, Khalid Sassi, Marwa Elkremi, Torkay Ragab, Hajer Alwarfely
Department of Dental Technology, College of Medical Technology, Derna, Libya
|Date of Web Publication||15-Oct-2019|
Dr. Ashraf Saad M. Elzer
Department of Dental Technology, College of Medical Technology, Derna
Source of Support: None, Conflict of Interest: None
Background: Good oral hygiene maintain for pregnant women is the optimal goal of all health-care professionals. The purpose of this study is to assess and compare the prevalence of self-reported gingivitis among pregnant and nonpregnant women in the city of Derna, Libya. Materials and Methods: a cross-sectional survey design was used. A total of 363 women (182 [50.1%] pregnant and 182 [49.9%] nonpregnant women) who attended to public and private clinics of maternity health care in Derna city were randomly invited to have face-to-face interviews to evaluate their gingival and dental status. A questionnaire was used to explore the gingival status of the participants, including oral hygiene practice, gingival bleeding, socioeconomic status, and dental conditions. Collected data were analyzed using the SPSS software and applying appropriate statistical tests at P = 0.05. Results: The overall mean age of the participants is 27.60 ± 6.04 years (28.70 ± 6.09 and 26.50 ± 5.80 years in pregnant and nonpregnant women, respectively, P = 0.001). The prevalence of gingivitis (bleeding on using of tooth brushing) among all participated was 64.7% (68.1% and 61.3% for pregnant and nonpregnant women, respectively, P = 0.175). The pregnant women were more likely to report bleeding from their gum during brushing their teeth as compared to the nonpregnant women (odds ratio = 1.34, 95% confidence interval, 0.87–2.07). Conclusion: The prevalence of self-reported gingivitis in our study did not approach the statistically significant difference between pregnant and nonpregnant women. However, promoting oral health during pregnancy should be a routine practice to raise awareness about this common disease within pregnant women community.
Keywords: Gingival bleeding, Libya, pregnancy, self-report, tooth brushing
|How to cite this article:|
M. Elzer AS, Sassi K, Elkremi M, Ragab T, Alwarfely H. Self-reported gingivitis among pregnant women and nonpregnant women in the City of Derna, Libya: Is there any difference? a cross-sectional survey. Libyan J Med Sci 2019;3:83-7
|How to cite this URL:|
M. Elzer AS, Sassi K, Elkremi M, Ragab T, Alwarfely H. Self-reported gingivitis among pregnant women and nonpregnant women in the City of Derna, Libya: Is there any difference? a cross-sectional survey. Libyan J Med Sci [serial online] 2019 [cited 2020 Jan 19];3:83-7. Available from: http://www.ljmsonline.com/text.asp?2019/3/3/83/269228
| Introduction|| |
Good oral hygiene maintain for pregnant women is the optimal goal of all health-care professionals. Poor dental hygiene may have an undesirable effect on pregnant women and can lead to complications such as preterm birth (PTB), gestational diabetes mellitus, preeclampsia, and low-birth weight (LBW) of infants.,,, Recent studies had linked these pregnancies adverse outcomes to oral diseases., Pregnancy is a normal stressful condition that shows an increase in the level of estrogen and progesterone hormones that can cause gingival inflammation, especially in the 2nd and 3rd months of pregnancy. Previous studies have reported that the prevalence of gingivitis during pregnancy ranges between 30% and 100%.,,,,,,, Gingivitis is one of the most common oral diseases that affect the gum tissue, which covers the alveolar process and surrounds the cervical portion of the teeth. Gingivitis is plaque-induced inflammation of the gingiva, recognized by erythema and edema and bleeding on brushing or probing. Bleeding from the gum is the most common sign of gingivitis and can be assessed clinically by a gentle move of a periodontal probe on the gingival margin of the tooth (bleeding on probing [BOP]). And also bleeding on using the toothbrush has been significantly correlated to the BOP as a clinical finding of bleeding., Recent studies supported the fact that self-reported gingival bleeding is a useful method for assess the gingival health status among large populations or group of populations., Persist of gingivitis can lead to periodontitis, a more severe form of the disease which is a chronic inflammatory response to the tooth-associated microbial biofilm (plaque) that induces inflammation of adjacent tissues and causes local tissue destruction and loss of tooth attachment apparatus (ligament and bone). To the best of our knowledge, no published studies are assessing the epidemiology of self-reported gingivitis among pregnant and nonpregnant women in Libya. Therefore, this study aims to estimate the prevalence of self-reported gingivitis in pregnant women and to compare them with whose nonpregnant women in the city of Derna, Libya. The result of this study may help in the improvement of knowledge and attitude of pregnant women regarding oral health care.
| Materials and Methods|| |
A cross-sectional survey using face-to-face interviewer-administered questionnaire was conducted from March to May 2016.
Study area and population
The study population included all females (pregnant and nonpregnant women) who attended public and private maternity clinics aged from 16 and more. It locates in Derna city, Libya.
All participants were informed about the objective of this study, and informed consent was obtained from all the participants. The study was conducted in accordance with the Helsinki Declaration.
Sample size and sampling method
A total of 363 pregnant and nonpregnant women who were selected by the systematic random sampling method were invited to participate in the study.
Pregnant and nonpregnant women aged 16 and more were selected from all the maternity clinics in the city were included in the study.
The questionnaire was constructed from a literature review of self-reported studied in the English language form, and it followed the initiative of National Center of Disease Control to develop nonclinical methods for periodontal disease surveillance (National Oral Health Conference, 2006) to assess the prevalence of gingivitis among pregnant and nonpregnant women in the city of Derna, and it included sections for demographic characteristics, gingival status, oral hygiene status, and dental status. The questionnaire was pretested among the family members and friends before it used to clean up the flaws and to make sure that it valid for the purpose of the study. Data were gathering from face-to-face interviewer-administered questionnaire carried out by three well-trained dental hygienists using the Arabic language to translate the questions and to fill the constructed questionnaire.
Data analyses were conducted using the Statistical Packages for the Social Sciences version 22.0 (IBM, Ottawa, Canada). Data were summarized using frequency tables, mean, and standard deviation. The t-test for a continuous variable and Chi-square, Fisher's exact test, and logistic regression for category variables were used. The level of statistical significance was considered as P < 0.05.
| Results|| |
A total of 363 women (182 [51.1%] pregnant) and (181 [49.9%] nonpregnant) participated in this study and completed the face-to-face interview and answered all constructed questionnaires, given the participation rate of 91%. The mean age of the participants is 27.60 ± 6.04 years (28.70 ± 6.09 and 26.50 ± 5.80 years in pregnant and nonpregnant women, respectively, P = 0.001). The prevalence of gingivitis (bleeding on using of tooth brushing) among all participated was 64.7% (68.1% and 61.3% for pregnant and nonpregnant women, respectively, P = 0.175). The pregnant women were more likely to report bleeding from their gum during brushing their teeth as compared to the nonpregnant women (odds ratio [OR] = 1.34, 95% confidence interval [CI], 0.87–2.07).
The demographic features of the participants are shown in [Table 1]. There is a statistically significant difference in the age groups between pregnant and nonpregnant women (P = 0.002). No statistically significant difference has been found in education level and body mass index (P = 0.102 and P = 0.133, respectively). It was found that the majority of participants in both groups had a higher educational level (58.2% in the pregnant group and 68.2% for the nonpregnant group).
Self-reported gingival status by pregnancy status
As shown in [Table 2], both pregnant and nonpregnant women did not show a statistically significant difference regarding to the self-assessment questions of gingival status, except the question#5 (Do you suffer from stain in your teeth?) which showed that nonpregnant women are more likely to have stains than pregnant women (P = 0.001). Although the answered to the key question of this study “Did you suffer from gingival bleeding while you brushing your teeth?” did not show a statistically significant difference between both groups, there was a trend to increase reporting of gum bleeding during teeth brushing among pregnant compared to nonpregnant women (68.1% vs. 61.3%, OR 1.34, 95% CI 0.875–2.077, P = 0.175, respectively).
Self-reported of oral hygiene status by pregnancy status
As shown in [Table 3], both pregnant and nonpregnant women did not show a statistically significant difference regarding the self-assessment questions of oral hygiene status. However, most of the sample was used a toothbrush and paste on regular bases (95.1% for pregnant women and 97.2% for nonpregnant women) with brushing frequency of two times a day or more (68.7% for pregnant women and 71.3% for nonpregnant women). For dental floss and mouth wash used as oral hygiene aids, it showed that most of our sample was not used dental floss (89% for pregnant women and 86.7% for nonpregnant women) and were not used mouth wash (69.2% for pregnant women and 64.6% for nonpregnant women). It noted also that more than two-thirds of participants never visit the dental office at all to clean their teeth (65.4% for pregnant women and 69.6% for nonpregnant women).
Self-reported of dental status by pregnancy status
As shown in [Table 4], both pregnant and nonpregnant women did not show statistically significant differences regarding the self-reported questions of dental status. However, more than 70% of participants had reported a history of tooth extraction, and one-third of them reported more than three teeth had extracted. Tooth decay was a common reason for tooth extraction in both groups (90.2% for pregnant women and 87.5% for nonpregnant women). However, half of the participants reported the presence of tooth decay on their teeth.
| Discussion|| |
The overall prevalence of gingivitis (self-reported gingival bleeding during toothbrush) in the present study was 64.7%, with no statistical difference between pregnant (68.1%) and nonpregnant (61.3%) women. Gingivitis is a reversible condition that is diagnosed by the presence and extends of gingival inflammation frequently measured as BOP and without intervention would progress to periodontitis. Many researchers had identified a periodontal disease (gingivitis and periodontitis) during the pregnancy as one of the risk factors for PTB and LBW.,, The diagnosis of gingivitis is based on the presence of the following clinical signs: redness, edema, and BOP. Baser et al., in 2014, evaluating the gingival bleeding awareness by comparison of self-reports and clinical measurements on their participants groups, and they showed higher sensitivity (48%) and specificity rate (95%) within their groups. The validity of self-reported studies on gingivitis and periodontitis that made comparison with clinical measurements was reviewed by Blicher et al. in 2005 and they reported good validity with potentially higher validity could be obtained by several-reported questions and other predictors of periodontal disease. Khader et al., in 2014, was reported on their study that a self-reported periodontal disease scale is a valid instrument to be used for surveillance and monitoring periodontal disease in large populations. However, Vered and Sgan-Cohen, in 2003, did study to investigate the practical values of using questionnaires (self-perceived assessment) as compared to clinical examinations, and they showed a large discrepancy between self-assessment and professional assessment for both dental and periodontal health status. Moreover, Gilbert and Nuttall, in 1999, reported that self-reporting of periodontal health was not a successful tools for the diagnosis of gingivitis as many people who had some indications of the periodontal diseases appeared to be unaware of their condition. Our finding for the prevalence of gingivitis did not approach the statistically significant difference between both groups that is not in agreement with other studies  that showed the pregnant women more likely to report gingivitis compare to nonpregnant women since pregnancy itself may induce gingivitis because of increases in the level of sex steroid hormone. However, the majority of our sample despite used of toothbrush on regular bases, they reported poor oral hygiene status because of they did not use mouthwash and dental floss on regular bases. recent study reported the use of toothbrush alone did not serve the objective of maintaining good oral hygiene, especially in inaccessible areas like proximal embrasures, and they recommended using mouthwash antiseptic and dental floss as an adjunctive to mouth home care. There is a large thought between our participants that the pregnancy itself has a possible cause for dental decay and tooth loss due to extensive loss of calcium during the pregnancy period. However, both pregnant and nonpregnant women show no statistically differences regarding the history of tooth extraction, presence of tooth decay, presence of tooth filling, and dental caries as the main reason for tooth extraction. The reason why pregnant and nonpregnant women has no difference regarding gingival status questions is that both group in spite of their higher educational level they reported poor oral hygiene behavior.
| Conclusion|| |
Despite of that the prevalence of self-reported gingivitis in our study did not approach the statistically significant difference between pregnant and non-pregnant women. However, presence of gingival bleeding was highly reported between both groups. The motivation for dental care during pregnancy should be aware within the pregnant women community. We recommend doing further study with a large sample size using clinical examination measures to have a more accurate result.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Boggess KA, Berggren EK, Koskenoja V, Urlaub D, Lorenz C. Severe preeclampsia and maternal self-report of oral health, hygiene, and dental care. J Periodontol 2013;84:143-51.
Li Y, Caufield PW. The fidelity of initial acquisition of mutans streptococci by infants from their mothers. J Dent Res 1995;74:681-5.
Alwaeli HA, Al-Jundi SH. Periodontal disease awareness among pregnant women and its relationship with socio-demographic variables. Int J Dent Hyg 2005;3:74-82.
Mealey BL, Moritz AJ. Hormonal influences: Effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000 2003;32:59-81.
Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.
Lindhe J, Brånemark PI. The effects of sex hormones on vascularization of granulation tissue. J Periodontal Res 1968;3:6-11.
Cohen DW, Friedman L, Shapiro J, Kyle GC. A longitudinal investigation of the periodontal changes during pregnancy. J Periodontol 1969;40:563-70.
Kornman KS, Loesche WJ. The subgingival microbial flora during pregnancy. J Periodontal Res 1980;15:111-22.
Sooriyamoorthy M, Gower DB. Hormonal influences on gingival tissue: Relationship to periodontal disease. J Clin Periodontol 1989;16:201-8.
Lapp CA, Thomas ME, Lewis JB. Modulation by progesterone of interleukin-6 production by gingival fibroblasts. J Periodontol 1995;66:279-84.
Machuca G, Khoshfeiz O, Lacalle JR, Machuca C, Bullón P. The influence of general health and socio-cultural variables on the periodontal condition of pregnant women. J Periodontol 1999;70:779-85.
Kallio P, Ainamo J, Dusadeepan A. Self-assessment of gingival bleeding. Int Dent J 1990;40:231-6.
Kallio P, Nordblad A, Croucher R, Ainamo J. Self-reported gingivitis and bleeding gums among adolescents in Helsinki. Community Dent Oral Epidemiol 1994;22:277-82.
Kallio P. Self-assessed bleeding in monitoring gingival health among adolescents. Community Dent Oral Epidemiol 1996;24:128-32.
Kallio P, Murtomaa H. Determinants of self-assessed gingival health among adolescents. Acta Odontol Scand 1997;55:106-10.
Eke PI, Genco RJ. CDC periodontal disease surveillance project: Background, objectives, and progress report. J Periodontol 2007;78 Suppl 7S: 1366-71.
Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol 2007;78:1387-99.
Jeffcoat MK, Hauth JC, Geurs NC, Reddy MS, Cliver SP, Hodgkins PM, et al.
Periodontal disease and preterm birth: Results of a pilot intervention study. J Periodontol 2003;74:1214-8.
Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-80.
Khader YS, Ta'ani Q. Periodontal diseases and the risk of preterm birth and low birth weight: A meta-analysis. J Periodontol 2005;76:161-5.
Baser U, Germen M, Erdem Y, Issever H, Yalcin F. Evaluation of gingival bleeding awareness by comparison of self-reports and clinical measurements of freshman dental students. Eur J Dent 2014;8:360-5. [Full text]
Blicher B, Joshipura K, Eke P. Validation of self-reported periodontal disease: A systematic review. J Dent Res 2005;84:881-90.
Khader Y, Alhabashneh R, Alhersh F. The validity of a self-reported periodontal disease questionnaire among Jordanians. Dentistry 2014;4:201.
Vered Y, Sgan-Cohen HD. Self – Perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys. BMC Oral Health 2003;3:3.
Gilbert AD, Nuttall NM. Self-reporting of periodontal health status. Br Dent J 1999;186:241-4.
Rakchanok N, Amporn D, Yoshida Y, Harun-Or-Rashid M, Sakamoto J. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand. Nagoya J Med Sci 2010;72:43-50.
Mythri H, Ananda SR, Prashant GM, Subba Reddy VV, Chandu GN. The efficacy of antiseptic mouth rinses in comparison with dental floss in controlling interproximal gingivitis. J Int Soc Prev Community Dent 2011;1:31-5.
[Table 1], [Table 2], [Table 3], [Table 4]