Periodontal problems are seen in approximately 40% of pregnant women and maternal oral disease is also considered to increase risk of early childhood caries. Consequently the importance of oral health promotion during pregnancy as been recognised by a number of agencies and inter-professional guidelines have been endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association and other organisations. The aim of this review was to examine the range, scope and impact of existing oral health promotion interventions during pregnancy.

Methods

Searches were conducted in the CINAHL, Web of Science, PsychInfo, PubMed, and Cochrane Central databases. English language quasi-experimental, experimental, or pretest/post-test design health promotion interventions including at least 5 pregnant women with outcomes including oral health knowledge, attitudes, and/or behaviours were considered.

Results

• 7 studies (2 RCTs; 2 quasi experiments and 3 pretest/post-test designs) were included.
• 5 were conducted in the USA; 1 Canada and 1 Lithuania.
• Intervention methods varied across studies, and included individual and group prenatal visits, instructions on oral hygiene, lectures, audiovisual presentations, and dental supplies.
• Outcomes measured included knowledge, beliefs, attitudes, self-efficacy and oral hygiene, and health-seeking behaviours.
• 5 studies measured knowledge as an outcome and it was considered the main determinant of behavior change.
• Few studies specifically addressed prenatal oral health guidelines.
• All but one study showed significant improvement in one of these outcomes post-intervention.

Conclusions

The authors concluded: –

Few oral health interventions targeting pregnant women were found, and even fewer actually addressed oral-related symptoms, hygiene behaviors, and potential oral–systemic implications specific to pregnant women. This review demonstrates that there is a significant lag in evidence-based oral health promotion interventions despite the clear evidence of the importance oral–systemic health. Subsequently, more theory- and evidence-based interventions addressing the prenatal oral health guidelines using rigorous designs are needed to improve oral–systemic health for both women and their offspring across the lifecourse.

Comments

This review only identified a small number of studies despite a wide-ranging database search. The authors also noted the in many of the studies there was only a vague description of the interventions. They also note that only in one of the studies was the intervention based on a recognised health behaviour theory.

Also of interest is a 2012 review by George et al, which looked at the knowledge, attitudes, and behavior of dental, and prenatal care practitioners about oral health care during pregnancy. They identified

…the existence of significant practitioner barriers as well that further exacerbate the problem. Dentists and prenatal care practitioners have no clear consensus on perinatal oral health, which has resulted in the limited focus on oral health and delays in dental treatment during prenatal care.

Links

Vamos CA, Thompson EL, Avendano M, Daley EM, Quinonez RB, Boggess K. Oral health promotion interventions during pregnancy: a systematic review. Community Dent Oral Epidemiol. 2015 May 8. doi: 10.1111/cdoe.12167. [Epub ahead of print] PubMed PMID: 25959402.

George A, Shamim S, Johnson M, Dahlen H, Ajwani S, Bhole S, Yeo AE. How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth. 2012 Sep;39(3):238-47. doi: 10.1111/j.1523-536X.2012.00553.x. Epub 2012 Jun 27. Review. PubMed PMID: 23281906.