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 Table of Contents  
Year : 2013  |  Volume : 57  |  Issue : 2  |  Page : 92-95  

Awareness of the association between periodontal disease and pre-term births among general dentists, general medical practitioners and gynecologists

1 Reader, Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
2 Post Graduate Student, Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
3 Professor, Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
4 Professor and Head of the Department, Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India

Date of Web Publication15-Jul-2013

Correspondence Address:
Fouzia Tarannum
79/13, 5th Cross, Pillanna Garden, 1st Stage, Bengaluru-560 084, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-557X.114992

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In the recent decades, periodontal disease has been identified as a risk factor for pre-term deliveries. Hence, it is important to evaluate the awareness of health-care providers of the association between periodontal diseases and pre-term birth. A self-administered questionnaire was distributed to random samples representing general medical practitioners (GMPs), general dental practitioners (GDPs) and Gynecologists for this study. A knowledge score was calculated for correct answers to 11 survey questions related to oral health effects during pregnancy and compared among the three groups. In this study, 133 physicians, 135 dentists and 100 Gynecologists completed the questionnaire. More GDPs (67.4%) than GMPs (56.4%) and Gynecologists (63%) reported there was an association between periodontal disease and pre-term low birth weight. Efforts to increase this awareness may prove valuable in improving preventive care during pregnancy.

Keywords: General dental practitioners, General medical practitioners, Gynecologists, Periodontal disease, Pre-term low birth weight

How to cite this article:
Tarannum F, Prasad S, Muzammil, Vivekananda L, Jayanthi D, Faizuddin M. Awareness of the association between periodontal disease and pre-term births among general dentists, general medical practitioners and gynecologists. Indian J Public Health 2013;57:92-5

How to cite this URL:
Tarannum F, Prasad S, Muzammil, Vivekananda L, Jayanthi D, Faizuddin M. Awareness of the association between periodontal disease and pre-term births among general dentists, general medical practitioners and gynecologists. Indian J Public Health [serial online] 2013 [cited 2023 Mar 21];57:92-5. Available from:

Pre-term low birth weight (PLBW) infants have a tremendous impact on the health care system thus there is a continuous search of risk factors for PLBW deliveries that are amenable to prevention. [1] The risk factors include age, height, weight, socio-economic status, ethnicity, smoking, alcohol, nutritional status, stress, parity, birth interval, previous complications, pre and antenatal care, maternal hypertension, infections and cervical incompetence. [2]

Periodontal disease is a chronic inflammatory disease of bacterial origin and hence been associated with an increased risk for pre-term birth. [3] American Academy of Periodontology has recommended that pregnant women or women planning pregnancy undergo periodontal examination and receive appropriate treatment if indicated because of the likelihood of its positive effects on pregnancy outcomes. [4] Therefore, given the safety of providing periodontal care to the mother during pregnancy and the likelihood of its positive effects on pregnancy outcomes, it may be reasonable to expect prudent practice of health-care providers to recommend periodontal examination and/or care to pregnant females until conclusive evidence of lack of benefit is established.

Gynecologists are the first health workers to contact the pregnant patients and their awareness about the association between periodontal disease and pregnancy outcomes is vital for prevention of pre-term deliveries. In the light of the above mentioned facts, the present survey was designed to examine the awareness of the association between periodontal diseases and premature low birth weight infants among general medical practitioners (GMPs), general dental practitioners (GDPs) and Gynecologists.

The study protocol was approved by the Ethical Review Committee of M. R. Ambedkar Dental College and Hospital prior to commencement of the project. The list of practicing GMPs, Gynecologists and GDPs in Bangalore North Taluk (urban district) was selected from the Karnataka medical products and services directory, Yellow pages and Bangalore dental directory. There were 350 GMPs, 378 GDPs and 196 Gynecologists enlisted. Practitioners available between 01/01/2011 and 15/02/2011 were surveyed. A total of 240 GMPs, 250 GDPs and 155 Gynecologists were approached and asked to participate in the study. Subjects were requested to complete an anonymous, self-administered, structured one page Questionnaire. The questionnaire used in this survey was a close ended questionnaire with responses presented as yes/no/don't know choices.

The questionnaire was pre-tested for acceptability, validity and reliability. The validity was examined by evaluating whether the questions in the questionnaire are a correct and comprehensive reflection of the concept the questionnaire which is intended to measure. Reliability was tested by asking the pilot sample to complete the questionnaire on two separate occasions 2 weeks apart. The two sets of responses were then compared statistically using Spearman's Rank Correlation Coefficient. The acceptability of the questionnaire was evaluated by asking the subjects how they found answering the questionnaire and how long it took them to complete the questionnaire.

The final questionnaire was then prepared with a cover letter stating the title and purpose of the survey. The first part of the questionnaire recorded demographic information (age, sex and specialty) followed by questions as shown in [Table 1]. Results on continuous measurements are presented on Mean±SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5% level of significance.

67% (240 out of 350) of GMPs, 66% (250 out of 378) of GDPs and 79% (155 out of 196) of Gynecologists in Bangalore north zone could be included in the survey. 185 GMPs (response rate = 77%), 197 GDPs (response rate = 79%) and 117 Gynecologists (response rate = 75%) agreed to participate in the study and filled the questionnaire. The reason for less response rate was time constraint. Only 133 GMPs, 135 GDPs and 100 Gynecologists had completed the questionnaire. Incomplete questionnaires were excluded. The mean ages of participating GMPs, GDPs and Gynecologists were 32.14 ± 9.4, 31.20 ± 4.6 and 38.70 ± 9.7 years respectively. All participants agreed that good oral hygiene is necessary for good systemic health and that there is an association between oral disease and systemic disease.
Table 1: Awareness of different health-care groups about the relation of periodontal disease with pregnancy (n=368)

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[Table 1] shows the percentage of responses of the health-care providers for all the questions. The statistical analysis was conducted using statistical software SPSS 11. Statistical significance for the difference in the percentage was calculated using Chi-square test. GDPs was significantly more aware than GMPs and Gynecologists that pregnant females were more susceptible to tooth mobility, gingival bleeding and gingival growths. More number of GDPs reported that there was an association between periodontal diseases and adverse pregnancy outcomes. The number who agreed for the effect of periodontal disease on pre-eclampsia is less than the number who agreed on the effect on PLBW. Overall the Gynecologists were more aware than the GMPs.

A score of numerical value one was given for every positive response. Total knowledge score (TKS) was calculated as the sum of all positive responses and the significance of the difference in mean scores among different groups was calculated using ANOVA. [Table 2] shows the means of TKS of all the three groups. TKS was the highest for GDPs followed by Gynecologists and GMPs. Tukey's Honestly Significant Difference analysis indicated that the significant difference in ANOVA is because of the highest TKS in GDPs.
Table 2: Mean of knowledge score different health-care groups

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Only 67.4%, 56.4% and 63% of surveyed GMPs, GDPs and Gynecologists respectively, reported awareness of the association between periodontal diseases and PLBW. This low level of awareness is somewhat surprising given the level of emerging evidence supporting this association. To our knowledge, this is the first study reporting dentist awareness of this issue. For GMPs, this figure is lower than that reported from a survey of obstetricians from North Carolina where 84% considered periodontal disease to be a significant risk factor for adverse pregnancy events. [5] 50% Physicians in Northern Jordan reported a possible association between "oral health and pregnancy outcomes." [6] The difference in results is likely due to the manner in which the question was asked. In our study, the question was on the specific association between periodontal disease and PLBW infants while in the other two studies, the question asked was more general.

GDPs were significantly more likely to report an association than GMPs and Gynecologists, which might indicate that the incorporation of this topic in the curriculum is practiced in dental, but not medical schools. This is not surprising since the majority of active research in this field is pursued by periodontists. The level of awareness of Gynecologists and GMPs is critical because of its possible impact on the ability to inform and refer pregnant females for appropriate care. This level of awareness of GMPs and of Gynecologists is also alarming for its subsequent impacts on patient awareness of this issue.

Hormonal changes in pregnancy have been associated with increased susceptibilities to gingivitis and gingival bleeding and pregnancy tumors." [7] We hypothesized that awareness of the association between periodontal diseases and PLBW infants would be related to general awareness of these oral health effects seen during the pregnancy. Expectedly, GDPs were significantly more aware than GMPs and Gynecologists that pregnant females were more susceptible to gingivitis, gingival bleeding and pyogenic granuloma formation. While 93% of dentists recommended a pregnant female should have an evaluation/prophylaxis visit during pregnancy, only 61% of physicians did. This issue is a cause for concern due to the resultant negative influence on preventive efforts.

A meta-analysis of randomized controlled clinical trials has suggested that periodontal treatment significantly reduces the risk for PLBW deliveries. [8] The results of this survey indicate that both Gynecologists and GMPs were less aware or unsupportive of this association compared with the dental health care providers. More alarmingly, only small percentages of sampled GMPs and Gynecologists recognized the common gingival problems of pregnancy. These results may indicate a strong need for interdisciplinary communication and coordination to assure the provision of adequate health-care to pregnant females.

Whether the reported numbers in this study reflect awareness or attitude is not easily discernable. Participant answers to the question might indicate a lack of awareness of the association or it might reflect their disagreement with the association despite being aware of the evidence. This difficulty in distinction is inherent with survey-type studies. We have therefore attempted to phrase the question to reflect awareness, i.e. "is there an association between periodontal diseases and PLBW infants" rather than attitude, i.e. "do you believe there is an association between periodontal diseases and PLBW infants," and our results may therefore be considered more likely to reflect awareness.

Global applicability of these findings from practitioners in one city is limited given the relative lack of similar data from health-care providers in other regions and countries. The high public health impact of assuring adequate healthcare provider awareness and dissemination of this information to patients may warrant further large sampled comparative studies.

Good levels of awareness of the association between periodontal disease and PLBW were reported in GDPs, Gynecologists and GMPs surveyed in this study. Efforts to increase this awareness may prove valuable in improving preventive care during pregnancy. Seminars and interactive workshops can be organized for the medical practitioners by dental researchers to create awareness on this topic. Publishing articles or reports related to these in medical journals may also prove useful.

   References Top

1.Denise M. The epidemiology of preterm birth. Clin Obstet Gynaecol 1998;31:521-30.  Back to cited text no. 1
2.Abramowitz M, Kass EH. Pathogenesis and prognosis of prematurity. N Eng J Med 1966;275:878-88, 938-43, 1001-7, 1057.  Back to cited text no. 2
3.Radnai M, Gorzó I, Urbán E, Eller J, Novák T, Pál A. Possible association between mother's periodontal status and preterm delivery. J Clin Periodontol 2006;33:791-6.  Back to cited text no. 3
4.Task Force on Periodontal Treatment of Pregnant Women, American Academy of Periodontology. American Academy of Periodontology statement regarding periodontal management of the pregnant patient. J Periodontol 2004;75:495.  Back to cited text no. 4
5.Wilder R, Robinson C, Jared HL, Lieff S, Boggess K. Obstetricians' knowledge and practice behaviors concerning periodontal health and preterm delivery and low birth weight. J Dent Hyg 2007;81:81.  Back to cited text no. 5
6.Al-Habashneh R, Aljundi SH, Alwaeli HA. Survey of medical doctors' attitudes and knowledge of the association between oral health and pregnancy outcomes. Int J Dent Hyg 2008;6:214-20.  Back to cited text no. 6
7.Amar S, Chung KM. Influence of hormonal variation on the periodontium in women. Periodontol 2000 1994;6:79-87.  Back to cited text no. 7
8.Polyzos NP, Polyzos IP, Mauri D, Tzioras S, Tsappi M, Cortinovis I, et al. Effect of periodontal disease treatment during pregnancy on preterm birth incidence: A metaanalysis of randomized trials. Am J Obstet Gynecol 2009;200:225-32. Available from: Available from: [Last accessed on 2012 Oct 01].  Back to cited text no. 8


  [Table 1], [Table 2]

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