Indian Journal of Dental Sciences

: 2021  |  Volume : 13  |  Issue : 3  |  Page : 169--174

Oral hygiene awareness among pregnant women in Chennai: A cross-sectional study

Gayathri Somasheker, S Pudhumai Lakshmi, Nandhini Vishwanath, Sumathi H Rao, Geetha Thirugnanasambandam 
 Department of Periodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
Gayathri Somasheker
Department of Periodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu


Background: The association between preganancy and poor oral health and its effects on preterm low birth infants are well documented in scientific literature. A pilot study was conducted with 160 pregnant women in the year 2016 showed that oral hygiene awareness among pregnant women was least among those who did not complete basic school education. This was the motive to conduct the present survey. Aims and Objectives: The Aim of this survey is to determine the knowledge and awareness on oral hygiene practices and to evaluate the role of education status on awareness of poor oral health and pregnancy outcomes among 500 pregnant women in Chennai city, Tamil Nadu, using self-tested questionnaire. Materials and Methods: A Descriptive cross sectional study was conducted among 500 pregnant women attending maternity clinics in Chennai using Self administered questionnaire. Results: Among 500 participants majority of them 72% of school educated never visited dentist. Only 6.2% of Undergraduate women was referred by gynecologist for dental check up during pregnancy. 31.3% of school educated felt that first trimester was safe to undergo dental treatment with p=0.000. Conclusion: This survey showed that level of education played a significant role in awareness about oral hygiene among pregnant women.

How to cite this article:
Somasheker G, Lakshmi S P, Vishwanath N, Rao SH, Thirugnanasambandam G. Oral hygiene awareness among pregnant women in Chennai: A cross-sectional study.Indian J Dent Sci 2021;13:169-174

How to cite this URL:
Somasheker G, Lakshmi S P, Vishwanath N, Rao SH, Thirugnanasambandam G. Oral hygiene awareness among pregnant women in Chennai: A cross-sectional study. Indian J Dent Sci [serial online] 2021 [cited 2022 Jul 2 ];13:169-174
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Periodontitis is the inflammatory disease of the periodontium affecting 30% of women among the childbearing age.[1],[2] Periodontal disease is a chronic inflammatory disease in response to bacterial plaque and microbial complex. Maintaining good oral hygiene is a key component of general well-being in women's life, which is important during the preconception period. There are various physical, physiological changes that take place during pregnancy. Hormonal changes during maternal life, like estrogen and progesterone, can cause inflammation, bleeding gums, pregnancy tumor, increased sensitivity, and risk of bacterial infection.[3],[4] The prevalence of gingivitis in pregnancy was shown to be 30%–100%.[5],[6],[7],[8] The changes in hormone levels have found to affect periodontal disease progress and healing. These irregularities can lead to increased gingival vascularization and decreased immunity. Increased level of Prevotella species during pregnancy utilizes the steroid hormones for their growth, which indirectly tend to increase gingival inflammation.[9],[10],[11] Maternal periodontitis has proven risk of preterm low birth weight infants in the scientific literature.[12],[13],[14],[15],[16],[17],[18] Pregnant women should be aware of the changes that could be expected during maternal life so that importance of maintaining oral hygiene during pregnancy is known and the adverse outcomes of poor oral health could be avoided. A pilot study was conducted with 160 pregnant women in 2016 among women visiting the gynecologist department in Sathyabama Dental College and Hospital, Chennai. The results of this study showed that oral hygiene awareness among pregnant women was least among those subjects who did not complete basic school education. This was the motive to conduct the present survey with a sample size of 500 pregnant women in Chennai.[19] This study was carried out to assess the awareness among pregnant women about oral hygiene and if the level of education level could play a role in acquiring knowledge of adverse outcomes of poor oral health.

 Materials and Methods

This was a descriptive cross-sectional study conducted among 500 pregnant women attending maternity clinics in Chennai, Tamil Nadu. The study was approved by institutional ethics and research committee. Pregnant women who gave informed consent were recruited for the study. A self-administered questionnaire was formed in English and Tamil language. The questionnaire was validated using the Cronbach alpha test using SPSS Package Software (Statistical Package for the Social Sciences package v.21 software (SPSS Inc., Chicago, IL, USA). Pilot study was conducted with 160 pregnant participants. The questionnaire consisted of open- and closed-ended responses. A trained investigator was recruited to help the participants to complete the questionnaire. The questionnaire consisted of 16 questions divided into four sections. The first section included sociodemographic data such as age, education status, trimester, occupation, and address. The second section consists of details related to oral hygiene practises and awareness of gingival diseases such as frequency of brushing, adjuvant oral hygiene aids, bleeding gums, and the trimester they considered safe for dental therapy was noted. Third section consisted of awareness about factors that could affect the fetus like self-medication, dental radiation exposure, and influence of smoking. A fourth section included a question to know if their gynecologist referred them to dental check-up during prenatal period.

Sample selection

Five hundred pregnant women in the age group of 18–40 years made up the study population. The subjects were categorized as Group A-school educated (Educated up to 12th Standard), Group B-under graduate (completed graduation), and Group C-(completed master degree), [Graph 1]. The subjects were randomly selected and then categorized based on their education status into the above three categories.[INLINE:1]

Inclusion criteria

Pregnant women in the age group of 18–40 yearsSystemically healthy.

Exclusion criteria

Medically compromisedOn antibiotic therapy for the past 6 monthsIlliterate.


Chi-square is used to find statistical significance between education status and oral hygiene awareness. The P value less than the standard value 0.050 was considered as statistically significant. Descriptive analysis is made to find the percentage for each category.

The first section of questionnaire consists of sociodemographic data. The mean age of the subjects was 27.16 years. The age ranged from 18 years to 40 years. The subjects were categorized based on the education status as Group A with 150 participants who were school educated (educated up to 12th standard), Group B with 225-under graduate (completed graduation), and Group C with 125 participants-(completed Master degree). Majority of subjects (45%) belonged to Group B, [Graph 1].

Awareness on oral hygiene practices

It was found that brushing after every meal and use of adjunctive oral hygiene aids like use mouth rinse and interdental aids was mainly practiced among Group B (n = 225). 30.7% used mouth rinses and 3.6% used interdental aids. In Group C (n = 125), 39.2% used mouth rinses and 6.4% used interdental aids. In Group A (n = 150), 11.5% used mouth rinses and 2.7% used interdental aids. The usage of adjunctive aids for maintaining oral hygiene was which was statistically significant with P = 0.005 and 0.012, respectively, among Group B and Group C, [Graph 2], [Graph 2]A and [Table 1].[INLINE:2]{Table 1}

Awareness of gingival diseases

Bleeding gums during pregnancy were not noticed by 62.7% of Group A, 70.2% of Group B and 60.8% of Group C with a P = 0.013, which was significant. About 69.8% of Group B and 75.2% of Group C felt that dental treatment is necessary for bleeding gums compared to 38.7% of Group A. 59.1% of Group B and 64.8% Group C and 46% of Group A were aware that gingival diseases could cause adverse effect on pregnancy with P = 0.003 and 0.004 which was statistically significant [Graph 3], [Graph 3]A, and [Table 1].[INLINE:3]

Awareness on factors that affect fetus

About 20.7% of Group A, 8% of Group B, and 10.4% of Group C respondents had taken medications without prescriptions with a P = 0.006. 93.6% of Group C and 83.1% of Group B were aware that taking medications without prescriptions could have adverse effects on the fetus compared to 78% of Group A with P = 0.002, which was significant. Seventy-two percent of Group A had not visited a dentist since their pregnancy, 40% of Group B and 40.8% of Group C visited the dentist every 6 months with a P = 0.049 and 0.032, respectively, which was statistically significant. Forty-six percent of Group A, 15.6% of Group B, and 9.6% of Group C was not aware that frequent exposure to radiation could affect the infants with P = 0.000, which was highly significant [Graph 4] and [Table 1].[INLINE:4]

Safer trimester for undergoing dental treatment

Majority of Group A respondents 31.3%, 29.3% of Group B, and 20.8% of Group C responded that first trimester would be safe for the dental procedure with P = 0.000. About 57.3% of Group B and 76.3% Group C compared to 45.3% of Group A felt that second trimester would be safer to undergo dental treatment with P = 0.000, which was statistically significant. About 23.3% of Group A, 13.3% of Group B, and 5.6% of Group C responded for third trimester to be safe for dental treatment with P = 0.000, which was highly significant [Table 1].

Premature delivery and smoking practice

Twelve percent of Group A had a history of premature delivery compared to 3.1% of Group B and 4% of Group C with P = 0.001, which is statistically significant. Two percent of Group A and 2.4% of Group C had a history of the smoking habit. The habit of smoking was not significant among all the three groups of respondents. Majority of the respondents 88% of Group A, 87.1% in Group B, and 91.2% of Group C were aware that smoking and drinking alcohol could have adverse effects on their infants with a P = 0.054, which was significant [Table 1].

Gynecologist's referral for dental check up

Among all the 500 respondents, only 8% of Group A, 6.2% of Group B, and 6.4% of Group C was advised by their gynecologist to visit the dentist during the pregnancy checkup. Ninety-two percent of Group A, 93.8% of Group B, and 93.6% of Group C were not referred to dental check-up during their pregnancy with P = 0.782 [Graph 3], [Graph 5] and [Table 1].[INLINE:5]


In our survey, it was found that education status played an important role in the attitude toward awareness about oral hygiene practices among Group B and Group C respondents. The awareness about bleeding gums, dental therapy and the effect of periodontal diseases on preterm low birth weight infants was known among majority of Group B and Group C compared to Group A respondents. The gingival and periodontal disease during pregnancy is due to an increase in the level of progesterone and estrogens are well documented in literature. There are variations in the levels of hormones in each trimester, thereby making the pregnant women more prone to develop periodontal disease. A similar study suggested the need for educational intervention and preventive health programs during pregnancy.[20] Another study concluded that high literacy levels were co related to awareness and knowledge on health parameters.[21] Majority of the respondents in our survey belonged to 2nd trimester (40%) and third trimester (32%) belonged to Group B. In regard to knowledge and awareness of oral hygiene practices, all practised brushing of teeth as a daily routine, but adjuvant of oral hygiene aids like mouth rinse, interdental aids were mostly used among Group B and Group C. This could be correlated to the role of educational intervention in awareness. In the section about knowledge on the factors that could affect the fetus, like radiation exposure, self-medication, regular dental visits, influence of smoking and its effect on pregnancy, it was reported that most Group A respondents took medications without prescriptions. About 72% of Group A never visited dentist where 40% of Group B and 40.2% of Group C visited the dentist every 6 months. Self-medication is a downturn problem and 10% of birth defects are mainly due to exposure of drugs taken without prescription.[22] Out of several factors that influence the use of self-medication like age, income, people perception of disease, education level is also one of the factors. Majority of Group B and Group C was aware that it was safer to undergo dental treatment in second trimester. Majority of the respondents knew that environmental factors like smoking and alcohol could cause adverse effects on pregnancy outcomes. Smoking is a modifiable risk factor with can cause morbidity and mortality. Studies conducted on smoking and its effects on pregnant women found a need for educational intervention.[22],[23],[24] The percentage of pregnant women referred to dental check up was very low. About 6.2% of Group B, 6.4% of Group C and 8% of Group A pregnant women were referred to dental check up by their gynecologists. The percentage of subjects referred to dental check up by gynecologist in our survey is less compared to studies conducted by Penmetsa et al. and Patil et al. 7.97% and 25% of the respondents were sent for dental referral, respectively. Pregnant women spend most of the prenatal period under the care of their gynecologists.[25],[26] The most reliable health practitioner during the prenatal and postnatal periods would be the gynecologist. During maternal life, there is fear among women of the risk to the fetus if dental therapy is done. These misconceptions could be cleared only with the advice of medical health practitioners, in whom the pregnant women would have an inbuilt trust.[27]


In our survey, the respondents included were from Chennai city, and hence, the results of the study cannot be generalized for a wide population. There was unequal distribution of participants in the three categories, which has given variations in the results. The barriers to undergo dental treatment during pregnancy could not be covered within the scope of this survey.


This survey is a small insight to current existing awareness on oral hygiene measures followed by pregnant women. It is very evident within the limits of our survey that education level has an important stand in the awareness gained among the three groups of respondents. Oral hygiene and practices were highly prevalent among the educated Groups B and C compared to Group A. There is a need for medical health practitioners and the gynecologists to educate and recommend their patients about oral hygiene and risk of preterm low birth weight infants associated with poor oral hygiene. A need to mandate specific guidelines to include routine dental check up for expected mothers.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Patil S, Ranka R, Chaudhary M, Hande A, Sharma P. Prevalence of dental caries and gingivitis among pregnant and nonpregnant women. J Datta Meghe Inst Med Sci Univ 2018;13:44-7.
2Machuca 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;70:779-5.
3Togoo RA, Al-Almai B, Al-Hamdi F, Huaylah SH, Althobati M, Alqarni S. Knowledge of pregnant women about pregnancy gingivitis and children oral health. Eur J Dent 2019;13:261-70.
4Tarsitano BF, Rollings RE. The pregnant dental patient: Evaluation and management. Gen Dent 1993;41:226-34.
5Deasy MJ, Vogel RI. Female sex hormonal factors in periodontal disease. Ann Dent 1976;35:42-6.
6Bamanikar S, Kee LK. Knowledge, attitude and practice of oral and dental healthcare in pregnant women. Oman Med J 2013;28:288-91.
7Onigbinde O, Sorunke M, Braimoh M, Adeniyi A. Periodontal status and some variables among pregnant women in a Nigeria tertiary institution. Ann Med Health Sci Res 2014;4:852-7.
8Tandon S, D'Silva I. Periodontal physiology during pregnancy. Indian J Physiol Pharmacol 2003;47:367-72.
9Hashim R, Akbar M. Gynecologist's knowledge and attitudes regarding oral health and periodontal disease leading to adverse pregnancy outcomes. J Int Soc Prevent Communit Dent 2014;4:166-72.
10Apoorva SM, Suchetha A. Effect of sex hormones on the periodontium. Indian J Dent Sci 2010;2:36-40.
11Alchalabi HA, Al Habashneh R, Jabali OA, Khader YS. Association between periodontal disease and adverse pregnancy outcomes in a cohort of pregnant women in Jordan. Clin Exp Obstet Gynecol 2013;40:399-402.
12Baskaradoss JK, Geevarghese A, Al Dosari AA. Causes of adverse pregnancy outcomes and the role of maternal periodontal status – A review of the literature. Open Dent J 2012;6:79-84.
13Marin C, Segura-Egea JJ, Matinez-Sahuquillo A, Bullón P. Correaltion between infant birth weight and mother's periodontal status. J Clin Periodontol 2005;32:299-04.
14Han YW. Oral health and adverse pregnancy outcomes – What's next? J Dent Res 2011;90:289-93.
15Saddki N, Bachok N, Hussain NH, Zainudin SL, Sosroseno W. The association between maternal periodontitis and low birth weight infants among Malay women. Community Dent Oral Epidemiol 2008;36:296-304.
16Reddy BV, Tanneeru S, Chava VK. The effect of phase-I periodontal therapy on pregnancy outcome in chronic periodontitis patients. J Obstet Gynaecol 2014;34:29-32.
17Singh S, Kumar A, Kumar N, Verma S, Soni N, Ahuja R. Periodontal disease and adverse pregnancy outcome-a study. Pak Oral Dent J 2011;31:163-5.
18Offenbacher 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.
19Samuel GS, Raj DA, Manimegalai AG, Sujatha A, Rajkumari S. Assessment of oral health awareness among pregnant women in Chennai-a cross-sectional survey. World J Pharmacol Res 2016;5:929-6.
20Gupta S, Jain A, Mohan S, Bhaskar N, Walia PK. Comparative evaluation of oral health knowledge, practices and attitude of preganant and non–preganant women and their awareness regarding adverse pregnancy outcomes. J Clin Diagn Res 2015;9:26-2.
21Rasheed P, Al-Sowielem LS. Health education needs for pregnancy: A study among women attending primary health centers. J Family Community Med 2003;10:31-8.
22Ebrahimi H, Atashsokhan G, Amanpour F, Hamidzadeh A. Self-medication and its risk factors among women before and during pregnancy. Pan Afr Med J 2017;27:183.
23Al-Shaikh GK, Alzeidan RA, Mandil AM, Fayed AA, Marwa B, Wahabi HA. Awareness of an obstetric population about environmental tobacco smoking. J Family Community Med 2014;21:17-22.
24Bertani AL, Garcia T, Tanni SE, Godoy I. Preventing smoking during pregnancy: the importance of maternal knowledge of the health hazards and of the treatment options available. J Bras Pneumol 2015;41:175-81.
25Penmetsa GS, Meghana K, Bhavana P, Venkatalakshmi M, Bypalli V, Lakshmi B. Awareness, attitude and knowledge regarding oral health among pregnant women: A comparative study. Niger Med J 2018;59:70-3.
26Patil SN, Kalburgi NB, Koregol AC, Warad SB, Patil S, Ugale MS. Female sex hormones and periodontal health-awareness among gynecologists – A questionnaire survey. Saudi Dent J 2012;24:99-104.
27Paneer S, Muthusamy N, Manickavel RP, Venkatakrishnan CJ, Rathnavelu P, Jayaram M. Evaluation of gynecologist's awareness about oral health condition during pregnancy in Chennai city. J Pharm Bioallied Sci 2019;11:331-4.