TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICES AMONG THE GYNECOLOGISTS REGARDING THE INFLUENCE OF PERINATAL MATERNAL ORAL HEALTH IN DETERMINING THE FUTURE DENTAL HEALTH OF THE CHILD

measures in the most effective and efficient way to nurture a caries free smile in a child ’ s future.


ISSN: 2320-5407
Int. J. Adv. Res. 8 (12), 929-936 930 measures in the most effective and efficient way to nurture a caries free smile in a child' s future.

…………………………………………………………………………………………………….... Introduction:-
The American Academy of Pediatric Dentistry (AAPD) recognizes that perinatal and infant oral health are the foundations upon which preventive education and dental care must be built to enhance the opportunity for a child to have a lifetime free from preventable oral disease 1 Dental caries remains as one of the most prevalent oral disease affecting the human population and despite the implementation of various preventive techniques and strategies, it continues to affect the health with social and economic adverse impacts. In a developing country like India, oral health care of children remains as one of the most challenging aspects and thus the prevalence of dental caries among children are at rise.2 Current data suggested that one out of two children in India is affected by dental caries and there is an increase in caries burden in deciduous dentition. Even after this widespread incidence, dental caries in children is still considered as the most commonly ignored chronic disease among children. 3 As per the FDI reports, untreated tooth decay in permanent and primary teeth ranks first and tenth respectively among the 291 commonest diseases and the unmet need for dental care was 3 times greater than for medical care. 4 In most of the conditions this dental ignorance/neglect occurs due to the lack of knowledge and awareness about the infectious nature of this dental pathology and its associated risk factors to the both dental and general health of children.
In a developing country like India, as the early care providers like the Gynecologists and Pediatricians are likely to interact with the early care givers of a child like the mothers than a Pedodontist, their role in supervising the dental health is inevitable and can be considered as the most effective and influential approach in primary prevention of dental diseases.
A Gynecologist evaluates the overall health of a pregnant mother and her developing child from its intrauterine period with utmost care. A proper perinatal oral health care guidance provided by Gynecologists during the time of pregnancy can help an expectant mother to improve or maintain good oral health status and thereby reduce the complications that can be associated with poor oral health in the mother5,6 and can indirectly dictate the future oral health and general health of her child. Gynecologists who are aware about the infectious nature of the oral microbes and the effect of discrete periods or windows of inoculation 7 should instruct the mother about the higher risk of developing dental caries in their children by the modification of maternal dental flora using proper perinatal preventive programs. So early intervention and counseling during the perinatal period from can effectively lay down the foundation to ensure good oral health for the mother and thereby for the infant.8 A good Perinatal oral health guidance by Gynecologists incorporating the familial and maternal influence of the dental disease and the nature of acquisition of oral bacteria in a child's mouth can reduce the chances of caries susceptibilities in the children.
The early interventions and management of oral conditions can definitely improve a child's oral health, general health along with well-being, and school readiness.9 Delayed diagnosis of dental disease can result in exacerbated problems which lead to more extensive and costly care.10 So the knowledge, attitude and practice of the Gynecologists plays an equally important role as Pedodontists in the prevention of the early oral diseases.
Hence, the present study was conducted to know the knowledge, attitude and Practice of gynecologists in Central Kerala, South India, towards oral health care of children.

Materials and Methods:-
A cross sectional questionnaire survey was conducted among gynecologists of Central Kerala, South India. The sample comprised of 200 gynecologists including private practitioners and doctors from government hospitals. Both sexes were adequately represented and their ages ranged from 30 to 75 years. After obtaining prior permission from the concerned specialty organization authorities, the doctors were asked to answer a questionnaire designed to their particular specialty. All answers were treated with utmost confidentiality. The questionnaire pertained to both maternal and infant/child oral health care and included questions on prenatal counseling, feeding practices, dietary habits, oral hygiene practices and importance of primary dentition. Data Collected was subjected to Statistical Analysis SPSS Version 22.

Results:-
Among the 200 Gynecologists participated in this study a response rate of 100% was obtained.
Among the participants 68(28 %) of the participants had experience below 10 years and 76(38%) had an experience within a range of 10-20years and 56(34%) had experience above 20 years. A total of 21 questions were included in the questionnaire.

Knowledge of Gynecologists:
82% of the gynecologists recognized Pediatric dentistry as a separate specialty. A less response was obtained for the knowledge regarding the influence of periodontitis in causing preterm delivery (40%) and regarding the vertical transmission of microbes (38%). Only 46% answered correctly about the influence of birth condition on the dental development. 56 % had knowledge regarding the influence of nutrition, infection medication on dental development. Only 44% of the gynecologist have knowledge regarding the common oral disease. Gynecologists had no knowledge about the first dental visit and its importance.

Attitude of Gynecologists:
A majority of the gynecologists responded positively for the questionnaire related to the maternal oral health as a factor, which influence child oral health 81% and 78% considered pregnancy as a critical period in determining oral health care. 52% of the participants also considered perinatal oral health care as a mean to reduce future chance of ECC.

Practice of Gynecologists:
Even though gynecologists are aware about the pregnancy counseling related to the maintance oral hygiene during pregnancy, only 36% of the participants practically advocated dental health checkups during pregnancy period. Only 42% of the gynecologists recommended cleaning gums pads of infants before the eruption of teeth.

Discussion:-
The AAPD recognizes that infant oral health is the foundation upon which preventive education and dental care must be made to enhance the opportunity for a lifetime free from preventable oral disease.The allied health professionals and community organizations must be involved as partners to achieve this goal.
Dental awareness of qualified medical practitioners may be inadequate with regard to knowledge about dental diseases, oral hygiene practice and speciality treatment rendered by the pediatric dentist. There are very few studies reported in literature on the oral health awareness of medical practitioners particularly, gynecologists. It is unclear to what degree these specialists are knowledgeable about oral health and the extent to which they may already be participating in prevention and assessment. Also, little is known about the incidence of dental problems in their practice.
Hence this study was undertaken to know the knowledge, attitude and practice of gynecologists towards oral healt h care of children, with the help of a specially designed questionnaire. The advantages of a questionnaire study are that, it allows information to be collected and analyzed easily. It also allows the concerned specialist to express freely their perception on oral health care.
In our study it was observed that most gynecologists are aware of pediatric dentistry as a specialty, but only a small number of gynecologists refer pregnant mothers to a pediatric dentist.
Maternal periodontitis and its influence on the child birth was one of the most studied perinatal oral health related topic in the literature and was documented as early as from mid-1990s by the works of Offenbacher who defined the condition as a sevenfold increased risk factor for a mother to deliver a pre-term, low birth weight baby.5 In this study the knowledge of the Gynecologists about the influence of maternal periodontitis as a factor which can contribute for birth difficulties was not known by majority of the participants and only 40% of the Gynecologists considered the maternal periodontal diseases as an influencing factor that can cause preterm delivery of child and this result was in accordance with the studies of Subramaniam P.11 Disturbances of dentofacial structures that seen after the birth can be the reflection of the maternal general and oral health complications during the prenatal or postnatal period. The factors like preterm birth, low birth weight and the mode of delivery were the birth factors which can adversely influence the future dental development of the child.12 Perinatal health factors including maternal general health, nutritional deficiency, consumption of antibiotics, trauma, maternal infections during the course of pregnancy can cause a direct damage to the ameloblast which can lead to enamel defects in children and can add risk to the future dental health of the child. 12 In the current study only 56% of the Gynecologists knew about the influence of all these factors on the child dentition and was accordance with the previous study.13 As the jaw of a child at the time of birth contain all the tooth germs of the primary teeth and permanent first molars and incisors in its developing stages, any disturbances during this perinatal period can leave their mark in those dental tissues depending on the stage of formation of the hard tissue. Enamel defects especially enamel hypoplasia and hypo-mineralization which was characterized with a defect in the matrix formation and mineralization phase respectively can disturbs the dental morphology and may predispose the conditions for plaque accumulation and caries progression and in severe cases may even cause space loss and malocclusion.12 But 50.9% of the Gynecologists who participated in the study believed that tooth germs will be absent in a neonates jaw which also suggests their lack of knowledge about the dental development and its significance at the time of birth.
From this study it appears that gynecologists do not understand how the oral health of the mother affects the oral health of the child. Although this relationship is specifically observed with regard to maternal and infant caries levels, very few gynecologists were aware of it. Almost 50% of the gynecologists were of the opinion that the mother's oral health affects only the position of the child's teeth.
Gynecologist are unaware about knowledge regarding the mode of transmission of oral bacteria, so that they cannot effectively anticipate the pregnant mother about the condition and to reduce the risk of developing ECC in their children. In the present study the concept of the transmission of oral bacteria were understood by only 27% of the participants and 38% of the participants even suggested that such acquisitions won't occur.
On evaluating the attitude of gynecologist about the importance of perinatal oral health, 78% of the Gynecologists responded that they consider pregnancy as a critical period for determining the child's future dental health and 81% of the Gynecologists responded that they considered poor oral hygiene of mother as a determining factor for the future general and oral health issues of the child. 52% of the Gynecologists who participated in the current study also considered that a proper perinatal oral health care guidance can effectively reduce the chances of development of the most prevalent dental disease, ECC in the Pediatric group. Similar response was also reported in previous studies.11 ,13 Dental caries during infancy being a preventable condition, encouragement for a professional caries risk assessment as early as from the 6th month of age, promotion of proper infant oral hygiene measure and education of the mother about the chances of horizontal and vertical mode of transmission of oral bacteria's can effectively reduce the future risk of developing ECC. 14 But in the present study only 46% of gynecologists understood the influence of the familial high caries rates, poor oral hygiene and bottle feeding as the predisposing factors for developing ECC.
The main aim of perinatal oral health care, with regard to dental caries transmission, was to decrease the load of cariogenic bacteria in an expectant mother's mouth so that the MS colonization of the infant can be delayed as long as possible. A good perinatal oral health guidance provided by the Gynecologists can effectively fulfill the situation.
In the present study the response of the Gynecologists in incorporating oral health related topics during the prepregnancy counseling was found to be satisfactory and 68% of the Gynecologists reported that they included oral health related topics during pre-pregnancy counseling. But the actual implementation of this approach by advocating a routine professional dental checkup during pregnancy period was found to be followed only by 36% of the Gynecologists .
According to AAPD recommendations oral hygiene measures should be implemented no later than the time of eruption of the first primary teeth but the cleaning of the gum pads can be started as early as within the first week of birth using wet gauze or cloth. 15 In the present study it was noted that only 42% of the Gynecologists advocated proper infant oral hygiene measure and which pointed to their less involvement in the infant oral health care.
So on evaluating the overall response of the Gynecologists, a good attitude towards the Pediatric oral health care was present among the participants but their knowledge and practical approaches were found to be limited.
There are certain limitations to this study. As, with any questionnaire survey, there is the potential for responder bias. Although the response rate was 100%, the respondents had different opinions regarding oral health in their practice. Moreover this survey was kept as short as possible, limiting the use of open-ended questions that could have enabled us to obtain further details regarding their awareness of child oral health. Further studies with more questions structured to elicit in depth information need to be undertaken.