Periodontal status, tooth loss and self-reported periodontal problems effects on oral impacts on daily performances, OIDP, in pregnant women in Uganda: A cross-sectional study

  • Health and Quality of Life Outcomes, Volume 7, Year 2009

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Study Justification:
This study aimed to investigate the prevalence of oral impacts on daily performances (OIDP) during pregnancy in Uganda. The study aimed to assess the relationship between periodontal status, tooth loss, and self-reported periodontal problems with oral impacts. The justification for this study is to improve maternal health and well-being by addressing oral health as an important part of antenatal care.
Highlights:
– The study found that a substantial proportion of pregnant women in Uganda experienced oral impacts on daily performances.
– The impacts were most significant in terms of functional concerns, such as eating and speaking.
– The study identified a relationship between tooth loss, periodontal problems, and oral impacts.
– The prevalence of oral impacts was higher in rural areas compared to urban areas.
Recommendations:
– Antenatal care programs in Uganda should address pregnant women’s oral health.
– Access to regular dental care facilities should be improved in societies with limited access.
– Strategies should be developed to prevent tooth loss and manage periodontal problems during pregnancy.
Key Role Players:
– Oral health professionals: Dentists and dental hygienists who can provide dental care and education to pregnant women.
– Community leaders: They can play a role in recruiting pregnant women for oral health interventions.
– Policy makers: They can develop policies and allocate resources to improve oral health services for pregnant women.
Cost Items for Planning Recommendations:
– Training and capacity building for oral health professionals.
– Development and implementation of oral health education programs.
– Provision of dental equipment and supplies.
– Monitoring and evaluation of oral health interventions.
– Integration of oral health services into existing antenatal care programs.
Please note that the cost items provided are general and may vary depending on the specific context and resources available in Uganda.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is cross-sectional, which limits the ability to establish causality. However, the study includes a large sample size and uses validated measures. To improve the evidence, future research could include a longitudinal design to establish causal relationships and consider controlling for potential confounding variables.

Background: An important aim of antenatal care is to improve maternal health- and well being of which oral health is an important part. This study aimed to estimate the prevalence of oral impacts on daily performances (OIDP) during pregnancy, using a locally adapted OIDP inventory, and to document how periodontal status, tooth-loss and reported periodontal problems are related to oral impacts. Methods: Pregnant women at about 7 months gestational age who were members of a community based multi-center cluster randomized community trial: PROMISE EBF: Safety and Efficacy of Exclusive Breast feeding in the Era of HIV in Sub-Saharan Africa, were recruited in the district of Mbale, Eastern Uganda between January 2006 and June 2008. A total of 877 women (participation rate 877/886, 98%, mean age 25.6, sd 6.4) completed an interview and 713 (participation rate 713/886, 80.6%, mean age 25.5 sd 6.6) were examined clinically with respect to tooth-loss and according to the Community Periodontal Index, CPI. Results: Seven of the original 8 OIDP items were translated into the local language. Cronbach’s alpha was 0.85 and 0.80 in urban and rural areas, respectively. The prevalence of oral impacts was 25% in the urban and 30% in the rural area. Corresponding estimates for CPI>0 were 63% and 68%. Adjusted ORs for having any oral impact were 1.1 (95% CI 0.7-1.7), 1.9 (95% CI 1.2-3.1), 1.7 (1.1-2.7) and 2.0 (0.9-4.4) if having respectively, CPI>0, at least one tooth lost, tooth loss in molars and tooth loss in molar-and anterior regions. The Adjusted ORs for any oral impact if reporting periodontal problems ranged from 2.7(95% CI 1.8-4.2) (bad breath) through 8.6(95% CI 5.6-12.9) (chewing problem) to 22.3 (95% CI 13.3-35.9) (toothache). Conclusion: A substantial proportion of pregnant women experienced oral impacts. The OIDP impacts were most and least substantial regarding functional- and social concerns, respectively. The OIDP varied systematically with tooth loss in the molar region, reported chewing-and periodontal problems. Pregnant women’s oral health should be addressed through antenatal care programs in societies with limited access to regular dental care facilities. © 2009 Wandera et al; licensee BioMed Central Ltd.

Participating women of the present study were members of a multicentre randomized community trial and birth cohort study (“Safety and efficacy of exclusive breast feeding (EBF) promotion in an African setting with high prevalence of HIV”- PROMISE EBF) conducted in Uganda and three other sub Saharan African countries – Burkina Faso, Zambia and South Africa. A district was selected as the intervention site with the randomization unit being 1-2 villages of on average 1000 inhabitants (35 infants per year given a birth rate of 3.5%). Pregnant women resident in twenty four villages selected for randomization in urban and rural areas of Mbale district, Eastern Uganda, were recruited consecutively by local community leaders into the Promise EBF study between January 2006 and June 2008. Urban villages were sited within Mbale municipality while rural villages were sited in Bunghoko sub-county. A total of 886 pregnant women were eligible to participate in interviews and oral clinical examination. This number satisfied a sample size of 800 pregnant women calculated for the oral sub-study, assuming a prevalence of tooth loss (i.e. at least one tooth lost) of 50%, a precision of 0.05 and a design effect of 2. As this study included several outcomes, the size of the sample was calculated separately for each of them and the largest sample size required was adopted. The procedures of recruitment and participation in the Promise EBF study are detailed in another publication [24]. Ethical Clearance was obtained from the Ethical board, Faculty of Medicine, Makerere University. Written consent was obtained from all participants in the study and verbal consent was obtained prior to each examination and interview. Structured interviews were designed with EpiHandy software to be used on handheld computers [25]. Interviews were conducted in face to face settings with participants at household level. The interview schedules were developed in English and translated into the local language of Lumasaaba. Oral health professionals reviewed the interview schedule for semantic, experiential and conceptual equivalence and sensitivity to culture and selection of appropriate words were considered. The interview schedules were piloted before administration. The conceptual model adapted from the model of Wilson and Cleary [26] linking indicators of oral diseases to their symptomatic-, functional- and disability consequences was applied to identify factors to consider as determinants of OHRQoL and to structure the multivariate analyses. The interviews covered questions on mother’s health status, socio-demographic characteristics and perceived oral health status. Self-reported periodontal problems were assessed by asking respondents about their experience with bleeding gums, color change in gums, swollen gums, tooth decay, bad breath, bad taste toothache and pain in gums. Responses were categorized as no = 0 and yes = 1. Self-reported chewing problems were assessed by asking women whether or not they anticipated difficulties eating seven Ugandan food items (green banana, millet bread/maize meal, rice, cassava, meat, vegetables and fish) (responses were 0 = no, 1 = yes) The food items were identified through discussions with residents of the area prior to designing the interview. The seven food items were added into a chewing problem index (range 0-7) and dichotomized into 0 = no difficulties with chewing food items and 1 = difficulty with chewing at least one food item. Oral disadvantage or the psychosocial consequences of oral disease and tissue damage were measured broadly using seven of the original eight item OIDP inventory (i.e. During the previous 6 months – how often have problems with your teeth and mouth caused you any difficulty with; eating, speaking, cleaning teeth, smiling, sleeping, work performance and social contact). The OIDP item considering emotional stability was removed due to problems with translation into the local language and possible misinterpretation by the study group. Each frequency item was scored 0-3, where (0) never, (1) less than once a month, (2) once or twice a month up to once or twice a week, (3) 3-4 times a week or more often. Finally, the extent of oral impacts, OIDP-extent, (range 0-7) was calculated as a simple count score (OIDP SC); i.e. summing dichotomized frequency items in terms of (1) affected (including the original categories 1,2,3) and (0) not affected (including the original category 0). Socio-demographics were assessed in terms of place of residence, age, educational level, last dental visit, parity and months of pregnancy. Family wealth was assessed as an indicator of socio-economic status in accordance with a standard approach in equity analyses [27]. Household durable assets indicative of family wealth (e.g. bicycle, television, car, motor cycle) assessed as (1) available/in working condition, (2) not available/nor in working condition were analyzed with principle component analysis, PCA. The first component resulting from the analysis was used to divide households into four approximate quartiles of wealth status ranging from 1st quartile (least poor) to 4th quartile (most poor). The socio-demographic variables controlled for in the analyses, their coding and the number of subjects (%) according to categories in urban and rural residence are shown in Table ​Table11. Socio-demographic indicators among pregnant women in urban and rural areas of Mbale district. (n = 877) *The total number of the various categories do not add to 877 due to missing values A trained and calibrated dentist (MW) carried out all clinical oral examinations under field conditions based on the World Health Organization (WHO) criteria [28], recording the data on a prepared record sheet. All fully erupted permanent teeth were scored, excluding third molars. Oral examinations were performed at house hold level with subjects seated, examiner using a headlamp as source of illumination, mouth mirror and a periodontal probe. Neither radiographic examination nor drying of teeth was performed. Periodontal status was assessed using a specially designed lightweight CPITN probe with a 0,5 mm ball tip with periodontal pockets were measured from the edge of the free gingiva to the bottom of the pocket. Using the epidemiological part of the CPITN, the Community Periodontal Index (CPI) [28,29] with 10 index teeth (17,16,11,26,27,47,46,31,36,37) and 6 sextants (17-14, 13-23, 24-27, 38-34, 33-43, 44-47) per individual, four indicators of periodontal status were applied. Only index teeth were examined and the criteria used were; healthy periodontal status (code 0), bleeding on probing observed (code 1), calculus detected during probing (code 2), pocket 4-5 mm (code 3) and pocket >5 mm (code 4). Each index tooth was scored on 2 sites (buccal and lingual) and each sextant was scored according to its highest CPI score. If no index tooth was present in a sextant, all the remaining teeth in that sextant were examined and the highest score is recorded as the score for that sextant. In accordance with the hierarchical assumption of the CPI index, teeth with score 3 were assumed positive with respect to bleeding and calculus whereas teeth with score 2 were assumed positive with respect to bleeding [30]. Prevalence of bleeding-, calculus and pocket sextants was assessed as the percentage of subjects affected, or percentage of subjects having at least one affected sextant. Prevalence of healthy sextants was assessed as the number of subjects having 6 healthy sextants. Severity of periodontal condition was assessed by the mean number of sextants having CPI code 0,1,2,3 and 4. Total CPI was also presented as the percentage distribution of dentate subjects according to highest score in the mouth. For analyses this total CPI score was dichotomized into CPI = 0 and CPI>0. Tooth-loss was recorded for all teeth except the third molars and in terms of loss of any tooth (1 = yes, 0 = no), at least 1 tooth lost in both anterior & premolar regions (1 = yes, 0 = no), at least one tooth lost in molar region only (1 = yes, 0 = no) and at least 1 tooth lost in both in anterior & molar regions (1 = yes, 0 = no). Duplicate clinical examinations were carried out on 50 mothers considered to be representative of the study participants after a period of one month. Analysis performed on the duplicate examination recordings gave Kappa values of 0.91 for missing teeth. With respect to indicators of periodontal condition, kappa values ranged from 0.48 (CPI index tooth 11) to 0.85 (CPI index tooth 31). These figures indicate moderate to good intra examiner reliability according to WHO [28]. Data was analyzed using SPSS version 15.0 (Chicago, IL, USA). Cross tabulation, chi square statistics and Univariate ANOVA were used to assess bivariate relationships. Logistic regression analyses were conducted with OIDP and chewing problems using the logit model and 95% Confidence intervals (CI) given for the odds ratios.

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Based on the provided description, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide pregnant women with information and resources related to oral health during pregnancy. These apps can include features such as educational content, appointment reminders, and access to virtual consultations with oral health professionals.

2. Telemedicine: Implement telemedicine services that allow pregnant women in remote or underserved areas to receive oral health consultations and advice from dental professionals through video calls or phone consultations. This can help overcome barriers to accessing dental care in areas with limited dental facilities.

3. Community-based Oral Health Programs: Establish community-based oral health programs that provide oral health education, screenings, and preventive services specifically targeted at pregnant women. These programs can be implemented in collaboration with local healthcare providers and community leaders to ensure widespread access and participation.

4. Integration of Oral Health into Antenatal Care: Integrate oral health assessments and interventions into routine antenatal care visits. This can involve training healthcare providers to conduct basic oral health screenings and provide preventive interventions such as fluoride treatments or dental cleanings during pregnancy.

5. Public Awareness Campaigns: Launch public awareness campaigns to educate pregnant women and their families about the importance of oral health during pregnancy. These campaigns can use various media channels, such as radio, television, and social media, to disseminate information and promote positive oral health behaviors.

6. Partnerships with Dental Schools and NGOs: Collaborate with dental schools and non-governmental organizations (NGOs) to provide free or low-cost oral health services to pregnant women. Dental students and volunteers can be trained to provide basic dental care under the supervision of licensed dentists, increasing access to care for underserved populations.

7. Health Financing Mechanisms: Explore innovative health financing mechanisms, such as microinsurance or community-based health financing schemes, to make oral health services more affordable and accessible for pregnant women. This can help overcome financial barriers that prevent women from seeking necessary dental care during pregnancy.

8. Training and Capacity Building: Provide training and capacity building programs for healthcare providers, including midwives, nurses, and community health workers, to improve their knowledge and skills in oral health promotion and preventive care for pregnant women. This can enhance the overall quality of antenatal care and ensure that oral health is adequately addressed.

These innovations can help improve access to maternal oral health care and contribute to better overall maternal health outcomes.
AI Innovations Description
The study mentioned in the description aims to improve access to maternal health by addressing oral health during pregnancy. The researchers conducted a cross-sectional study in Uganda to estimate the prevalence of oral impacts on daily performances (OIDP) during pregnancy and to examine the relationship between periodontal status, tooth loss, and reported periodontal problems with oral impacts.

The study recruited pregnant women at about 7 months gestational age who were participating in a community-based multi-center cluster randomized trial called PROMISE EBF. A total of 877 women completed an interview and 713 were examined clinically. The women were asked about their oral health status, including self-reported periodontal problems such as bleeding gums, tooth decay, bad breath, and toothache. The researchers also assessed periodontal status using the Community Periodontal Index (CPI) and recorded tooth loss.

The findings of the study showed that a substantial proportion of pregnant women experienced oral impacts on their daily performances. The most common impacts were related to functional concerns, such as eating and chewing difficulties. The prevalence of oral impacts was higher in the rural area compared to the urban area. The study also found that periodontal status, tooth loss, and reported periodontal problems were associated with oral impacts. For example, women with periodontal problems were more likely to experience oral impacts compared to those without periodontal problems.

Based on these findings, the study recommends that pregnant women’s oral health should be addressed through antenatal care programs, especially in societies with limited access to regular dental care facilities. This would involve integrating oral health assessments and interventions into routine antenatal care visits. By improving access to oral health services during pregnancy, maternal health and well-being can be enhanced.
AI Innovations Methodology
The study mentioned focuses on the oral health of pregnant women in Uganda and its impact on their daily lives. To improve access to maternal health, including oral health, the following innovations and recommendations can be considered:

1. Integration of oral health into antenatal care: Antenatal care programs should include oral health screenings and education to raise awareness about the importance of oral health during pregnancy. This can be done by training healthcare providers to assess and address oral health issues during routine antenatal visits.

2. Mobile dental clinics: To overcome the limited access to regular dental care facilities, mobile dental clinics can be set up to provide oral health services to pregnant women in remote areas. These clinics can travel to different communities, offering preventive and curative dental treatments.

3. Community health workers: Training community health workers to provide basic oral health education and screenings can help reach pregnant women who may not have access to formal healthcare services. These workers can provide information on oral hygiene practices, identify oral health problems, and refer women to appropriate dental services.

4. Oral health education campaigns: Conducting targeted oral health education campaigns can help raise awareness about the importance of maintaining good oral health during pregnancy. These campaigns can use various mediums such as radio, television, and community gatherings to reach a wide audience.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be developed as follows:

1. Define indicators: Identify specific indicators that can measure the impact of the recommendations on improving access to maternal health. For example, indicators can include the percentage of pregnant women receiving oral health screenings, the percentage of women reporting improved oral health knowledge, and the percentage of women accessing dental services during pregnancy.

2. Data collection: Collect baseline data on the identified indicators before implementing the recommendations. This can be done through surveys, interviews, and medical records review. The data should include information on the target population, their oral health status, and their access to dental services.

3. Implementation of recommendations: Implement the recommended innovations, such as integrating oral health into antenatal care, setting up mobile dental clinics, training community health workers, and conducting oral health education campaigns.

4. Post-implementation data collection: After implementing the recommendations, collect data on the same indicators to assess the impact of the interventions. This can be done through follow-up surveys, interviews, and monitoring of dental service utilization.

5. Data analysis: Analyze the collected data to determine the changes in the identified indicators. Compare the post-implementation data with the baseline data to assess the impact of the recommendations on improving access to maternal health.

6. Evaluation and adjustment: Evaluate the results of the analysis and identify areas that need improvement. Based on the findings, make necessary adjustments to the recommendations and interventions to further enhance access to maternal health.

By following this methodology, the impact of the recommendations on improving access to maternal health, specifically oral health, can be simulated and assessed. This will help in identifying effective strategies and interventions to address the oral health needs of pregnant women and improve their overall maternal health outcomes.


Statistics:
Citations: 35
Identifiers:
DOI: 10.1186/1477-7525-7-89
Research Areas:
Community Interventions, Disability, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Burkina Faso, Multi-Countries, South Africa, Uganda, Zambia
Study Design:
Cohort Study, Cross Sectional Study, randomised-control-trial
Study Approach:
Quantitative
Participants Gender:
Female
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