Adherence to and acceptability of three alcohol‐free, antiseptic oral rinses: A community‐based pilot randomized controlled trial among pregnant women in rural Nepal

Abstract

Objectives Antiseptic oral rinses have been evaluated as interventions to reduce the risk of adverse pregnancy outcomes associated with periodontal disease in pregnant women. Oral rinse use is not common in Nepal or other countries in South Asia, where the prevalence of adverse pregnancy outcomes is high. Understanding whether pregnant women in rural communities in this region would incorporate rinse use into their daily teeth cleaning routine is an important prerequisite to future research on this topic in South Asia. Methods We conducted a community‐based pilot randomized controlled trial of three alcohol‐free, antiseptic oral rinses among pregnant women <22 weeks pregnant in rural Nepal with the aim of assessing rinse acceptability, adherence, and effect on clinical periodontal measures. At baseline, participants underwent a clinical periodontal examination, and then were classified as healthy or having at least mild gingivitis (≥1 site with probing depth (PD) 3 mm and bleeding on probing (BOP) or ≥4 mm (PD)). Participants were stratified by periodontal status and randomized within each exposure category to chlorhexidine (CHX) (0.12%), cetylpyridinium chloride (CPC) (0.05%), salt and water (NaCl), or control (no rinse). Rinse participants were followed weekly for 12 weeks, and all participants underwent a second periodontal examination and answered a questionnaire. Results Pregnant women in the rural Terai region of Nepal showed high adherence to (mean weekly rinse use: 185 mL (standard deviation: 66 mL)) a recommended 210 mL and acceptability of all three rinses. Participants reported greater frequency of tooth brushing with toothpaste and improvements in other recommended oral hygiene behaviours. CHX significantly reduced rates of gingivitis (defined as a participant with BOP ≥ 10% of sites) and the extent of BOP (gingivitis at the end of follow‐up for CHX vs control: RR 0.37, 95% CI: 0.16, 0.84). CPC and NaCl rinse groups had rates of gingivitis and extent of BOP similar to the control group (gingivitis at the end of follow‐up for CPC: RR 0.81, 95% CI: 0.47, 1.38; NaCl: RR 0.92, 95% CI: 0.55, 1.56). Conclusions Adherence to and acceptability of three alcohol‐free, antiseptic oral rinses were high among pregnant women in rural Nepal. Among participants with mild gingivitis at baseline, CHX rinse was most effective at reducing signs of disease compared to the control group. Oral rinse should be considered as a supplement to current oral self‐care routines for pregnant women in settings where rinse use is uncommon and access to oral health services is limited.

Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review

“…Pregnancy is the best time to bring about positive behavioural change in women [ 88 ]. A study by Erchick et al [ 89 ] concluded that pregnant women were more likely to adopt their oral hygiene intervention as it has a direct impact on the health of the fetus and newborn. Although no studies have examined the association between the level of oral health knowledge and the source of such knowledge during pregnancy, some studies reported that culture, elder family members and peers from participants’ networks, including friends, are the origins of such beliefs [ 12 , 22 , 23 ].…”

A nomogram prediction of periodontitis in Chinese pregnant women with different sociodemographic and oral behavior characteristics: A community-based study

“…In the present study, gestational age was associated with the risk of periodontitis in pregnant women in the multivariable analysis, independent of age (OR = 1.28, 95% CI: 1.17-1.39, p < 0.001). The percentage of pregnant women with periodontitis varies signi cantly in the literature from 0.6-47.0% and is dependent not only on the sociodemographic and environmental factors but also on the stage of pregnancy [17][18][19][20].…”

“…Bacterial plaque control and periodontal treatments can reportedly contribute to decreased periodontal in ammation and improved quality of life during pregnancy [28], and reduce the prevalence of APOs in women with periodontitis [29]. Moreover, early intervention in healthy and high-risk pregnant women can play a key role in the preservation of adequate periodontal health throughout the pregnancy [30]. Upon studying the oral health awareness and oral behavior of pregnant women, we found that the daily tooth brushing frequency before pregnancy and past frequency of periodontal treatment were associated with periodontitis during pregnancy.…”

Oral and general health conditions involved in periodontal status during pregnancy: a prospective cohort study

“…According to scientific literature, bacteria plaque control during pregnancy and more complex periodontal treatments such as scaling and root planning, can contribute to decreased gingival inflammation [ 14 ], improved quality of life during pregnancy [ 15 ], and reduce the prevalence of adverse pregnancy outcomes in women with PD [ 16 ]. Also, early interventions in healthy and high-risk pregnant women can play a key role in the preservation of adequate periodontal health throughout pregnancy [ 17 ]. For these reasons, identifying groups of women at high risk of developing gingival and periodontal conditions during pregnancy (women with obesity and/or diabetes mellitus or women with periodontal diseases before pregnancy), is necessary to improve the efficiency of these dental interventions and directing the attention of the caregivers and health professionals responsible for these patients towards the implementation of early preventive measures.…”