Skip to main content
Top
Published in: BMC Oral Health 1/2020

Open Access 01-12-2020 | Gingival Diseases | Research article

Effectiveness of a family-centered behavioral and educational counselling approach to improve periodontal health of pregnant women: a randomized controlled trial

Authors: Pei Liu, Weiye Wen, Ka Fung Yu, Xiaoli Gao, Edward Chin Man Lo, May Chun Mei Wong

Published in: BMC Oral Health | Issue 1/2020

Login to get access

Abstract

Background

Poor oral hygiene and high hormone levels during pregnancy can lead to a deterioration in periodontal health. This study assessed the effectiveness of a family-centered behavioral and educational counselling program on improving the periodontal health of women during pregnancy and postpartum.

Methods

A randomized controlled trial was conducted among pregnant women (10th-22nd gestational week) and their husbands. Participating families were randomized into test and control groups. Intervention in the test group included explanation of oral health education (OHE) pamphlets, oral hygiene instruction, individualized feedback, and proposed solutions to overcome barriers in self-care. Reinforcements were implemented in the 3rd trimester of pregnancy and six months postpartum. In the control group, only OHE pamphlets were distributed. The assessed outcomes were bleeding on probing (BOP), periodontal pocket (Poc), loss of clinical attachment (LoA), and Visible Plaque Index (VPI). The data collection was carried out at baseline (T0), in the 32nd gestational week (T1), and 12 months postpartum (T2).

Results

Altogether 589 pregnant women were recruited, and 369 attended all three visits (test:188; control:181). In the test group, the mean VPI score at T0 was 0.19, which decreased to 0.14 at T1 and 0.15 at T2. In the control group, the mean VPI decreased from 0.19 at T0 to 0.16 at T1, but increased to 0.22 at T2. A main effect of time and intervention and an interaction between time and intervention were detected (all p < 0.05), indicating that the intervention effect differed between T1 and T2. The test group showed a significantly greater decrease over time than the control group did. Similarly, the mean BOP% decreased more significantly over time in the test group (T0:57%, T1:46%, T2:35%) than in the control group (T0:58%, T1:52%, T2:46%). For Poc and LoA, there were improvements in both study groups at 12 months postpartum, compared with during pregnancy (p < 0.001).

Conclusions

Providing family-centered, behavioral, and educational counselling to pregnant women at an early stage of pregnancy and with reinforcements can improve their oral hygiene and reduce gingival inflammation. The effect can be sustained over an extended period and is greater than that of distributing oral health leaflets alone.
Literature
1.
go back to reference Kornman KS, Loesche WJ. The subgingival microbial flora during pregnancy. J Periodontal Res. 1980;15(2):111–22.CrossRef Kornman KS, Loesche WJ. The subgingival microbial flora during pregnancy. J Periodontal Res. 1980;15(2):111–22.CrossRef
2.
go back to reference Mariotti A. Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med. 1994;5(1):27–53.CrossRef Mariotti A. Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med. 1994;5(1):27–53.CrossRef
3.
go back to reference Gürsoy M, Pajukanta R, Sorsa T, et al. Clinical changes in periodontium during pregnancy and post-partum. J Clin Periodontol. 2008;35(7):576–83.CrossRef Gürsoy M, Pajukanta R, Sorsa T, et al. Clinical changes in periodontium during pregnancy and post-partum. J Clin Periodontol. 2008;35(7):576–83.CrossRef
4.
go back to reference Nuamah I, Annan RT. Periodontal status and oral hygiene practices of pregnant and non-pregnant women. Eas Afri Med J. 1998;75(12):712–4. Nuamah I, Annan RT. Periodontal status and oral hygiene practices of pregnant and non-pregnant women. Eas Afri Med J. 1998;75(12):712–4.
5.
go back to reference Mealey BL, Moritz AJ. Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontology 2000. 2003;32(1):59–81.CrossRef Mealey BL, Moritz AJ. Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontology 2000. 2003;32(1):59–81.CrossRef
6.
go back to reference Rakchanok N, Amporn D, Yoshida Y, et al. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand Nagoya. J Med Sci. 2010;72(1):43–50. Rakchanok N, Amporn D, Yoshida Y, et al. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand Nagoya. J Med Sci. 2010;72(1):43–50.
8.
go back to reference Lieff S, Boggess KA, Murtha AP, et al. The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women. J Periodontol. 2004;75(1):116–26.CrossRef Lieff S, Boggess KA, Murtha AP, et al. The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women. J Periodontol. 2004;75(1):116–26.CrossRef
9.
go back to reference Figuero E, Carrillo-de-Albornoz A, Herrera D, et al. Gingival changes during pregnancy: I. influence of hormonal variations on clinical and immunological parameters. J Clin Periodontol. 2010;37(3):220–9.CrossRef Figuero E, Carrillo-de-Albornoz A, Herrera D, et al. Gingival changes during pregnancy: I. influence of hormonal variations on clinical and immunological parameters. J Clin Periodontol. 2010;37(3):220–9.CrossRef
10.
go back to reference Xie Y, Xiong X, Elkind-Hirsch KE, et al. Change of periodontal disease status during and after pregnancy. J Periodontol. 2013;84(6):725–31.CrossRef Xie Y, Xiong X, Elkind-Hirsch KE, et al. Change of periodontal disease status during and after pregnancy. J Periodontol. 2013;84(6):725–31.CrossRef
11.
go back to reference Morelli EL, Broadbent JM, Leichter JW, et al. Pregnancy, parity and periodontal disease. Aust Dent J. 2018;63:270–8.CrossRef Morelli EL, Broadbent JM, Leichter JW, et al. Pregnancy, parity and periodontal disease. Aust Dent J. 2018;63:270–8.CrossRef
12.
go back to reference Vamos CA, Thompson EL, Avendano M, et al. Oral health promotion interventions during pregnancy: a systematic review. Community Dent Oral Epidemiol. 2015;43(5):385–96.CrossRef Vamos CA, Thompson EL, Avendano M, et al. Oral health promotion interventions during pregnancy: a systematic review. Community Dent Oral Epidemiol. 2015;43(5):385–96.CrossRef
13.
go back to reference Cardenas LM, Ross DD. Effects of an oral health education program for pregnant women. J Tenn Dent Assoc. 2010;90:23–7.PubMed Cardenas LM, Ross DD. Effects of an oral health education program for pregnant women. J Tenn Dent Assoc. 2010;90:23–7.PubMed
14.
go back to reference Cibulka NJ, Forney S, Goodwin K, Lazaroff P, Sarabia R. Improving oral health in low-income pregnant women with a nurse practitioner-directed oral care program. J Am Acad Nurse Pract. 2011;23(5):249–57.CrossRef Cibulka NJ, Forney S, Goodwin K, Lazaroff P, Sarabia R. Improving oral health in low-income pregnant women with a nurse practitioner-directed oral care program. J Am Acad Nurse Pract. 2011;23(5):249–57.CrossRef
15.
go back to reference Bahri N, Tohidinik HR, Bahri N, Iliati HR, Moshki M, Darabi F. Educational intervention to improve oral health beliefs and behaviors during pregnancy: a randomized-controlled trial. J Egypt Public Health Assoc. 2015;90(2):41–5.CrossRef Bahri N, Tohidinik HR, Bahri N, Iliati HR, Moshki M, Darabi F. Educational intervention to improve oral health beliefs and behaviors during pregnancy: a randomized-controlled trial. J Egypt Public Health Assoc. 2015;90(2):41–5.CrossRef
16.
go back to reference Shahnazi H, Hosseintalaei M, Esteki Ghashghaei F, Charkazi A, Yahyavi Y, Sharifirad G. Effect of educational intervention on perceived susceptibility self-efficacy and DMFT of pregnant women. Iran Red Crescent Med J. 2016;18(5):e24960.CrossRef Shahnazi H, Hosseintalaei M, Esteki Ghashghaei F, Charkazi A, Yahyavi Y, Sharifirad G. Effect of educational intervention on perceived susceptibility self-efficacy and DMFT of pregnant women. Iran Red Crescent Med J. 2016;18(5):e24960.CrossRef
17.
go back to reference Lin DL, Harrison R, Aleksejuniene J. Can a prenatal dental public health program make a difference? J Can Dent Assoc. 2011;77:b32.PubMed Lin DL, Harrison R, Aleksejuniene J. Can a prenatal dental public health program make a difference? J Can Dent Assoc. 2011;77:b32.PubMed
18.
go back to reference Geisinger ML, Geurs NC, Bain JL, et al. Oral health education and therapy reduces gingivitis during pregnancy. J Clin Periodontol. 2014;41(2):141–8.CrossRef Geisinger ML, Geurs NC, Bain JL, et al. Oral health education and therapy reduces gingivitis during pregnancy. J Clin Periodontol. 2014;41(2):141–8.CrossRef
19.
go back to reference Al Khamis S, Asimakopoulou K, Newton T, et al. The effect of dental health education on pregnant women’s adherence with toothbrushing and flossing - a randomized control trial. Community Dent Oral Epidemiol. 2017;45(5):469–77.CrossRef Al Khamis S, Asimakopoulou K, Newton T, et al. The effect of dental health education on pregnant women’s adherence with toothbrushing and flossing - a randomized control trial. Community Dent Oral Epidemiol. 2017;45(5):469–77.CrossRef
20.
go back to reference Castilho AR, Mialhe FL, Barbosa TD, et al. Influence of family environment on children’s oral health: a systematic review. J Pediatr. 2013;89(2):116–23.CrossRef Castilho AR, Mialhe FL, Barbosa TD, et al. Influence of family environment on children’s oral health: a systematic review. J Pediatr. 2013;89(2):116–23.CrossRef
21.
go back to reference Zhang Y, Wong MCM, Lo ECM. Pathways of oral health knowledge, attitudes, practices, and status in married couples. Community Dent Oral Epidemiol. 2016;4:400–7.CrossRef Zhang Y, Wong MCM, Lo ECM. Pathways of oral health knowledge, attitudes, practices, and status in married couples. Community Dent Oral Epidemiol. 2016;4:400–7.CrossRef
22.
go back to reference Zhang Y, Wong MCM, Lo ECM. Structural equation model for parental influence on children’s oral health practice and status. BMC Oral Health. 2020;20:56.CrossRef Zhang Y, Wong MCM, Lo ECM. Structural equation model for parental influence on children’s oral health practice and status. BMC Oral Health. 2020;20:56.CrossRef
23.
go back to reference Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229–35.PubMed Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229–35.PubMed
24.
go back to reference World Health Organization. Oral health surveys: basic methods, 4th ed. World Health Organization 1997. World Health Organization. Oral health surveys: basic methods, 4th ed. World Health Organization 1997.
25.
go back to reference Bartholomew LK, Parcel GS, Kok G. Intervention mapping: a process for developing theory and evidence-based health education programs. Health Educ Behav. 1998;25(5):545–63.CrossRef Bartholomew LK, Parcel GS, Kok G. Intervention mapping: a process for developing theory and evidence-based health education programs. Health Educ Behav. 1998;25(5):545–63.CrossRef
26.
go back to reference Elder JP, Ayala GX, Harris S. Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med. 1999;17(4):275–84.CrossRef Elder JP, Ayala GX, Harris S. Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med. 1999;17(4):275–84.CrossRef
27.
go back to reference Renz A, Ide M, Newton T, et al. Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev. 2007;18(2):CD005097. Renz A, Ide M, Newton T, et al. Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev. 2007;18(2):CD005097.
28.
go back to reference Clarkson JE, Young L, Ramsay CR, et al. How to influence patient oral hygiene behavior effectively. J Dent Res. 2009;88(10):933–7.CrossRef Clarkson JE, Young L, Ramsay CR, et al. How to influence patient oral hygiene behavior effectively. J Dent Res. 2009;88(10):933–7.CrossRef
29.
go back to reference Szwajcer EM, Hiddink GJ, Maas L, et al. Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: evidence for the life course perspective. Fam Pract. 2008;(Suppl 1):99–104. Szwajcer EM, Hiddink GJ, Maas L, et al. Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: evidence for the life course perspective. Fam Pract. 2008;(Suppl 1):99–104.
30.
go back to reference Tayebi T, Zahrani ST, Mohammadpour R. Relationship between adequacy of prenatal care utilization index and pregnancy outcomes. Iran J Nurs Midwifery Res. 2013;18(5):360–6.PubMedPubMedCentral Tayebi T, Zahrani ST, Mohammadpour R. Relationship between adequacy of prenatal care utilization index and pregnancy outcomes. Iran J Nurs Midwifery Res. 2013;18(5):360–6.PubMedPubMedCentral
31.
go back to reference Tokhi M, Comrie-Thomson L, Davis J, et al. Involving men to improve maternal and newborn health: a systematic review of the effectiveness of interventions. PLoS One. 2018;13(1):e0191620.CrossRef Tokhi M, Comrie-Thomson L, Davis J, et al. Involving men to improve maternal and newborn health: a systematic review of the effectiveness of interventions. PLoS One. 2018;13(1):e0191620.CrossRef
32.
go back to reference Baelum V, Fejerskov O, Manji F, et al. Influence of CPITN partial recordings on estimates of prevalence and severity of various periodontal conditions in adults. Community Dent Oral Epidemiol. 1993;21:354–9.CrossRef Baelum V, Fejerskov O, Manji F, et al. Influence of CPITN partial recordings on estimates of prevalence and severity of various periodontal conditions in adults. Community Dent Oral Epidemiol. 1993;21:354–9.CrossRef
33.
go back to reference Eke PI, Thornton-Evans GO, Wei L, et al. Accuracy of NHANES periodontal examination protocols. J Dent Res. 2010;89:1208–13.CrossRef Eke PI, Thornton-Evans GO, Wei L, et al. Accuracy of NHANES periodontal examination protocols. J Dent Res. 2010;89:1208–13.CrossRef
34.
go back to reference Kingman A, Susin C, Albandar JM. Effect of partial recording protocols on severity estimates of periodontal disease. J Clin Periodontol. 2008;35:659–67.CrossRef Kingman A, Susin C, Albandar JM. Effect of partial recording protocols on severity estimates of periodontal disease. J Clin Periodontol. 2008;35:659–67.CrossRef
35.
go back to reference Department of Health. Oral Health Survey 2011. Hong Kong: department of health, Government of the Hong Kong SAR 2013. Department of Health. Oral Health Survey 2011. Hong Kong: department of health, Government of the Hong Kong SAR 2013.
Metadata
Title
Effectiveness of a family-centered behavioral and educational counselling approach to improve periodontal health of pregnant women: a randomized controlled trial
Authors
Pei Liu
Weiye Wen
Ka Fung Yu
Xiaoli Gao
Edward Chin Man Lo
May Chun Mei Wong
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-020-01265-6

Other articles of this Issue 1/2020

BMC Oral Health 1/2020 Go to the issue