Oral health knowledge, behavior, and care seeking among pregnant and recently-delivered women in rural Nepal: a qualitative study

Abstract

BackgroundOral health behavior and attitudes of pregnant women in low-income countries are rarely examined, yet should be considered when designing preventative or therapeutic studies to reduce burden of oral diseases. We aimed to understand dental care-seeking behavior, as well as oral health knowledge and attitudes of oral health among pregnant women in rural Nepal.MethodsSemi-structured in-depth interviews (n = 16) and focus group discussions (3 groups, n = 23) were conducted among pregnant and recently-delivered women in Sarlahi, Nepal. Transcripts were translated from the local language to English then analyzed using a hybrid approach to thematic coding with Atlas.ti version 7.ResultsWomen felt confident describing the signs and symptoms of tooth decay and gum disease, but were not knowledgeable about where to receive care for tooth and/or gum pain and relied heavily on the knowledge of their community. Some women used a toothbrush and toothpaste at least once a day to clean their teeth, but many reported the traditional use of a branch of a local shrub or tree as their teeth cleaning instrument. Women suggested a willingness to consider using an oral rinse throughout pregnancy, perceiving that it might have a positive impact on infant health.ConclusionsFuture studies should focus on providing adequate and sustainable resources for pregnant women in Nepal and other low income settings to engage in good oral health behaviors (possibly supported through community-based workers), to maintain dental hygiene, and to access qualified dentists as a means of improving their oral health.Trial registrationClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

Prevalence of Gingivitis in Second Trimester of Pregnancy

“…Only a minority of pregnant women seek care for bleeding gums in the absence of pain. 26 They would rather brush their teeth with medicated toothpaste or wait for the problem to self-resolve thus carrying the disease in the next pregnancy. 26 Pregnant women with two or more previous births (multigravida) have signi cantly higher GI scores compared with those with one previous birth.…”

“…26 They would rather brush their teeth with medicated toothpaste or wait for the problem to self-resolve thus carrying the disease in the next pregnancy. 26 Pregnant women with two or more previous births (multigravida) have signi cantly higher GI scores compared with those with one previous birth. 5 Gravidity plays a role in periodontal pathosis but its effect becomes apparent only with the passage of time.…”

“…the level of oral health awareness, attitude and behavior is seen to improve with the level of education. 26 Lack of education is accountable for the belief that dental treatment during pregnancy might have a detrimental result on pregnancy outcome. 28 However, in our study, there was no association between gingival index and education level of the patient.…”

“…23 Regular home care by the patient is very effective in controlling most in ammatory periodontal diseases. 24 However, in low socio-economic countries like Nepal, even basic oral hygiene practice becomes di cult because affordability 25 and accessibility 26 of oral hygiene aids is an issue. More irking is the fact that pregnant women tend to look for other alternatives in case of any oral disease.…”

“…This includes pharmacy-prescribed allopathic medicine, self-application of clove oil and even jhar fuk, a traditional approach where a healer performs a spell to chase "worms" (germs) out of the teeth. 26 Attempts have been made to establish a relationship between gingivitis with age, gravida, parity, education and occupation. Increasing severity of gingivitis may be because of the untreated cumulative effect of the disease process over a period of time which is also applicable in terms of age, gravida and parity.…”