THIEME

Original Article 1

Knowledge of Pregnant Women about Pregnancy

Gingivitis and Children Oral Health
Rafi A Togo1  Balsam Al-Almai1  Fatimah Al-Hamdi1  Salha H. Huaylah1  Mashael Althobati1  Safeyah Alqarni1

1 Department of Pediatric Dentistry and Orthodontics King Khalid Address for correspondence Salha H. Huaylah, BDS,
University College of Dentistry Abha, Kingdom of Saudi Arabia Department of Pediatric Dentistry and Orthodontics King Khalid
University College of Dentistry Abha, Kingdom of Saudi Arabia
(e-mail: [email protected]).

 Eur J Dent

Abstract Objective  A cross-sectional questionnaire-based study was carried out among

251 pregnant women to assess their level of knowledge and perception regarding
pregnancy gingivitis and the oral health of new born children.
Materials and Methods  A self-administered validated questionnaire was distrib-
uted among pregnant women visiting the Child and Maternity Hospital, Ministry of
Health, Aseer, Saudi Arabia. The questionnaire included the questions related to their
knowledge/awareness about cause, treatment, preventive measures, and the adverse
effects of gingivitis on oral health of a woman.
Statistical Analysis  The data was entered into Microsoft excel sheet and put to sta-
tistical analysis using SPSS (version 17). Descriptive analysis and also chi-squared test
was used for comparison.
Results  Majority of pregnant women were found unaware about developing of preg-
nancy gingivitis as well as the cause, effects, treatment, and preventive measures for
the same. Most of the subjects agreed that it was essentially required to have oral
health education before their pregnancy term would start.
Conclusion  Most of the pregnant women said that they were unaware about preg-
Keywords nancy gingivitis, though few reported of being aware about it. It is inferred that
►►pregnancy the collaborative efforts between general dentists, pediatric dentists, public health
►►gingivitis ­dentists, and medical professionals are needed to raise awareness among pregnant
►►knowledge women regarding timely dental care to avoid the adverse pregnancy related outcomes
►►women due to gingivitis and periodontitis.

Introduction pregnancy. High levels of estrogen have been found to be

associated with occurrence of gingival hyperplasia, gingivitis,
Various physiological changes take place through the body pyogenic granulomas, dental caries, and alterations in sali-
of a pregnant woman that include both general and those vary flow.4 In the studies conducted previously, oral health
related to oral cavity.1 Due to hormonal fluctuations during of pregnant women, adverse pregnancy outcomes (such as
pregnancy, alterations occur in the levels of estrogen and preterm births, low birth weight), and oral health of infants
progesterone resulting in tortuous and dilated microvascu- have all been linked to each other.5
lature, more permeability of oral blood vessels, and lowering Pregnancy leads not only to the physiological changes in a
of host immunity, which eventually cause the host to become woman but it also has a menacing impact on her behavioral
more vulnerable to oral infections.2,3 Both reversible and irre- as well as dietary habits. With the increased need of energy,
versible changes take place in oral cavities of women during a pregnant woman has to modify the quantity and content of

DOI https://doi.org/ ©2019 Dental Investigation

10.1055/s-0039-1693236 Society
ISSN 1305-7456.
2 Pregnancy Gingivitis  Al-Almai et al.

diet that ultimately increases the carbohydrate quantum of An 11-item questionnaire, in both English and Arabic
food, resulting in more cariogenic food. al-Kanhal and Bani, languages, was used and the subjects were interviewed
in their study on pregnant women in Saudi Arabia, reported ­face-to-face so that any difficulty that might creep up in under-
that majority of women desired for more and more sweets, standing the questions could be explained to the ­subjects by
dates, milk, and salty and sour food, hence increasing their interviewer. Confidentiality of the responses and identity of
risk of dental caries and dental erosion.6 the patients were scrupulously maintained and assured so as
Oral health promotion and relevant oral health educa- to avoid nonresponse and social desirability bias.
tion, which would acquaint them regarding timely treatment The data was entered in Microsoft Excel sheet and put
and preventive measures for gaining optimal oral health, to statistical analysis using SPSS (version 17). Descriptive
are imperative to be imparted to women especially during ­analysis and chi-squared tests were used for comparison.
the child-bearing age. Women, during their pregnancy, face
a number of problems in utilizing the available oral health
Results
services due to which their oral health gets deteriorated.
They lack knowledge about the appropriate timing for get- In the present study, the age of pregnant women, who par-
ting their dental treatment done during or before pregnancy. ticipated, ranged between 27 and 39 years, with mean age
Some of them suffer from negative attitude toward seeking of 31.80 years (df=3.36). Majority (42.62%) of the pregnant
dental care that might be related to their past experience women had just heard about developing pregnancy gingivi-
and/or misconception about it. At times, even the dentists tis and they were not fully aware about it and 31.47% had
show reluctance to treat pregnant women that adds to the not even heard about it, whereas 25.89% were aware about it.
­negligence of pregnant women toward oral health.7 Majority of women (41.03%) did not get their dental checkup
Hence, a study was conducted in Aseer, Saudi Arabia done during pregnancy even after many of them (28.68%) had
among pregnant women to assess their knowledge and developed reddened and swollen gums. The cause of preg-
­perception toward pregnancy gingivitis and oral health of nancy gingivitis was not known to 32.66% of the pregnant
their children. women. As many as 35.05% respondents felt that daily tooth
brushing and flossing would prevent pregnancy gingivitis
(►Table 1). Yet as many as 28.68% pregnant women thought
Materials and Methods
that dentists would prefer medications as a treatment of
A cross-sectional questionnaire-based study was carried pregnancy gingivitis, while 19.92% did not know about it.
out among 18 to 40 years old pregnant women, who visited Around 27% of subjects considered tooth sensitivity to be the
the Child and Maternity Hospital, Aseer, Saudi Arabia. ­Prior main consequence of pregnancy gingivitis. When enquired
to conducting of study, ethical approval was obtained from whether pregnancy gingivitis could affect the oral health of
Scientific Research Committee, Aseer, Saudi Arabia. A total a new born, a majority of women (47.41%) were undecided
­convenient sample of 251 pregnant women was ­included about it, while 28.68% were unaware of any such effect on
in the study. All the pregnant women who were permanent the oral health of the new born. Most of the pregnant wom-
residents of Saudi Arabia, belonged to age group of 18 to 40 en (55.37%) were unaware about the adverse pregnancy
years and gave the consent of participation in the research, outcome, associated with pregnancy gingivitis (►Table  2).
were included in the study, while all those who suffered When the responses of pregnant women were compared,
from any systemic ailments such as diabetes and bleeding based on the level of education, a statistically significant dif-
­disorders were excluded from the study. ference was found between the responses of all the questions
A close-ended questionnaire was formulated and its reli- (p≤0.05). Respondents to the tune of 49% reported that they
ability was checked by conducting a pilot study on 20 preg- used moist towels for cleaning oral cavity of their children
nant women who were not a part of the final study sample. who were less than 18 months of age (►Fig. 1). Majority of
The questions were checked for ease in understanding and subjects believed positively to receive dental education com-
having clarity by repeating the study on the same respon- pulsorily at the start of their pregnancy term (►Fig. 2).
dents. Their responses were thereby checked for reliability
using Kappa statistics that yielded satisfactory results (0.81).
Discussion
The final questionnaire (Appendix I) included two sec-
tions: in the first section demographic data such as age and Inflammation of soft tissues surrounding the teeth, with-
educational qualification of the participants were recorded out loss of attachment, is known as gingivitis, while peri-
and in the second section questions related to awareness and odontitis involves damage of supporting tooth structures.
knowledge about oral health of women were enquired; as for The ­inflammation of gums that is exaggerated during the
instance those related to pregnancy gingivitis, its effect on period of pregnancy is known as pregnancy gingivitis giv-
oral health of women, its impact on their new born children, en rise due to changes in hormonal levels and in that of life
the preventive and treatment measures related to pregnancy style of a pregnant woman. In various previous studies, poor
gingivitis, and their frequency of visiting the dentist during oral health such as periodontitis in a pregnant woman has
pregnancy. Moreover, the questionnaire pertained to subject’s been associated with various adverse pregnancy outcomes
knowledge regarding the effect of poor oral health on preg- such as preterm births and low birth weights.8 Increase in
nancy outcomes such as preterm births and low birth weights. the hormonal levels of estrogen and progesterone can cause

European Journal of Dentistry

 Pregnancy Gingivitis  Al-Almai et al. 3

Table 1  Frequency distribution of responses according to education level of subjects

Q1) Being aware Total no. of Illiterate Primary High Higher Graduate Postgraduate
about developing respondents women school school secondary
pregnancy (%age) school
gingivitis during
pregnancy
Yes, I am fully aware 65 (25.89%) 1 (1.53%) 2 (3.07%) 3 (4.61%) 6 (9.2%) 8 (12.30%) 45 (69.23%)
No, I’m not aware 79 22 9 20 12 (15.18%) 14 (17.72%) 2 (2.53%)
(31.47%) (27.84%) (11.39%) (25.31%)
Not fully aware, but 107 22 17 26 21 (19.62%) 20 (18.69%) 1 (0.93%)
heard it (42.62%) (20.56%) (15.88%) (24.29%)
Chi-squared test = 149.54, df = 12, p-value = 0.0000.
Q2) Getting the Total no. of Illiterate Primary High Higher Graduate Postgraduate
dental checkup respondents women school school secondary
done during or (%age) school
before pregnancy
No, I didn’t 103 35 18 21 21 (20.38%) 6 (5.82%) 8 (7.76%)
(41.03%) (33.98%) (17.47%) (20.38%)
Yes, I did 62 (24.8%) 3 (4.83%) 4 (6.45%) 11 11 (17.74%) 22 (35.48%) 24 (38.70%)
(17.74%)
Yes I planned to but 49 (19.52) 6 2 (4.08%) 8 8 (16.32%) 8 (16.32%) 6 (12.24%)
did not go. (12.24%) (16.32%)
Yes, due to dental 37 (14.74%) 1 (2.70%) 4 9 9 (24.32%) 6 (16.21%) 10 (27.02%)
condition (10.81%) (24.32%)
Chi-squared test = 73.867, df = 15, p-value = 0.0000
Q3) Do you have Total no. of Illiterate Primary High Higher Graduate Postgraduate
any following respondents women school school secondary
signs of pregnancy (%age) school
gingivitis
Swollen & reddened 72 (28.68%) 14 6 (8.33%) 14 9 (12.5%) 12 (16.66%) 14 (19.44%)
gums (19.44%) (19.44%)
Bad breath 65 (25.89%) 12 8 11 8 (12.30%) 10 (15.38%) 10 (15.38%)
(18.46%) (12.30%) (16.92%)
Gum bleeding 69 (27.49%) 14 11 6 (8.69%) 7 (10.14%) 8 (11.59%) 12 (17.39%)
(20.28%) (15.94%)
Red spot over oral 10 (3.98) 4 (40%) 2 (20%) 5 (50%) 2 (20%) 0 (0%) 0 (0%)
lining
None 35 (13.94%) 1 (2.85%) 1 (2.85%) 3 (8.57%) 13 (37.14%) 12 (34.28%) 12 (34.28%)
Chi-squared test = 38.631, df = 20, p-value = 0.0071
Q4) What may Total no. of Illiterate Primary High Higher Graduate Postgraduate
be the cause of respondents women school school secondary
gingivitis during (%age) school
pregnancy
Hormonal changes 78 (31.07%) 2 (2.56%) 2 (2.56%) 14 12 (15.38%) 20 (25.64%) 22 (28.20%)
(17.94%)
Traumatic tooth 20 (7.96) 9 (45%) 2 (10%) 4 (20%) 2 (10%) 1 (5%) 2 (10%)
brushing
Poor oral hygiene 45 (17.92%) 2 (4.44%) 3 (6.66%) 9 (20%) 9 (20%) 14 (31.11%) 11 (24.44%)
Eating fried food 6 (2.39%) 2 1 2 2 (33.33%) 1 (16.66%) 3 (50%)
(33.33%) (16.66%) (33.33%)
Malnutrition 20 (7.96%) 8 (40%) 8 (40%) 2 (10%) 1 (5%) 0 (0%) 3 (15%)
Do not know 82 (32.66%) 22 12 18 13 (15.85%) 6 (7.31%) 7 (8.53%)
(26.82%) (14.63%) (21.95%)
Chi-squared test = 85.285, df = 25, p-value = 0.0000
continued

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4 Pregnancy Gingivitis  Al-Almai et al.

continued
Q5) Measures Total no. of Illiterate Primary High Higher Graduate Postgraduate
that you think can respondents women school schooling secondary
prevent Pregnancy (%age) school
gingivitis
Daily tooth brushing 88 (35.05%) 15 11 17 11 (12.5%) 14 (15.90%) 18 (20.45%)
and flossing (17.04%) (12.5%) (19.31%)
Balanced diet 55 (21.91%) 12 3 (5.45%) 11 (20%) 12 (21.81%) 9 (16.36%) 10 (18.18%)
(21.81%)
Dental checkup 58 (23.10%) 9 10 13 7 (12.06%) 9 (15.51%) 13 (22.41%)
before pregnancy (15.51%) (17.24%) (22.41%)
Monthly Scaling 10 (3.98%) 3 (30%) 0 (0%) 2 (20%) 2 (20%) 0 (0%) 3 (30%)
Dental checkup 32 (12.74%) 2 (6.25%) 1 (3.12%) 6 7 (21.87%) 10 (31.25%) 4 (12.5%)
during second (18.75%)
trimester
Do not know 8 (3.18%) 4 (50%) 3 (37.5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Chi-squared test = 39.0232, df = 25, p-value = 0.0367

Table 2  Frequency distribution of responses according to education level of subjects

Q6) What as per Total no. of Illiterate Primary High Higher Graduate Postgraduate
your knowledge, respondents school school secondary
is the treatment school
dentists provide for
pregnancy gingivitis
Surgical removal of 10 (3.98%) 5 (50%) 1 (10%) 2 (20%) 1 (10%) 1 (10%) 2 (20%)
swollen gum
No treatment 35 (13.94%) 8 (22.85%) 5 (14.28%) 9 (25.71%) 4 (11.42%) 1 (2.85%) 2 (5.71%)
needed
Professional scaling 60 (23.90%) 1 (1.66%) 1 (1.66%) 5 (8.33%) 15 (25%) 24 (40%) 28 (46.66%)
Extract the affected 24 (9.56%) 7 (29.16%) 7 (29.16%) 2 (8.33%) 1 (4.16%) 1 (4.16%) 0 (0%)
tooth
Medications 72 (28.68%) 8 (11.11%) 5 (6.94%) 17 15 (20.83%) 13 (18.05%) 15 (20.83%)
(23.61%)
Do not know 50 (19.92%) 16 (32%) 9 (18%) 14 (28%) 3 (6%) 2 (4%) 1 (2%)
Chi-squared test = 119.645, df = 25, p-value = 0.0000
Q7) What affect can Total no. of Illiterate Primary High Higher Graduate Postgraduate
pregnancy gingivitis respondents school school secondary
have on your oral school
health?
Overgrowth of gum 27 (10.75%) 2 (7.40%) 1 (3.70%) 3 (11.11%) 5 (18.51%) 6 (22.22%) 7 (25.92%)
tissue
No effect 22 (8.76%) 13 4 (18.18%) 3 (13.63%) 0 1 (4.54%) 1 (4.54%)
(59.09%)
Periodontal disease 34 (13.54%) 2 (5.88%) 3 (8.82%) 8 (23.52%) 6 (17.64%) 7 (20.58%) 8 (23.52%)
Tooth decay 40 (15.93%) 11 (27.5%) 7 (17.5%) 12 (30%) 7 (17.5%) 2 (5%) 1 (2.5%)
Tooth sensitivity 67 (26.69%) 4 (5.97%) 3 (4.47%) 11 13 14 21 (31.34%)
(16.41%) (19.40%) (20.89%)
Loose tooth 30 (11.95%) 1 (3.33%) 1 (3.33%) 4 (13.33%) 5 (16.66%) 11 (36.66%) 9 (30%)
Do not know 31 (12.35%) 12 9 (29.03%) 8 (25.80%) 3 (9.67%) 1 (3.22%) 1 (3.22%)
(38.70%)
Chi-squared test= 106.470, df = 30, p-value =0.000
continued

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 Pregnancy Gingivitis  Al-Almai et al. 5

continued
Q8). Will pregnancy Total no. of Illiterate Primary High Higher Graduate Postgraduate
gingivitis affect the respondents school school secondary
oral health of new school
born?
Yes, it will 60 (23.90%) 3 (5%) 2 (3.33%) 12 (20%) 11 (18.33%) 15 (25%) 24 (40%)
No, it won’t 72 (28.68%) 18 (25%) 12 16 4 (5.55%) 8 (11.11%) 8 (11.11%)
(16.66%) (22.22%)
Undecided 119 24 14 21 24 (20.16%) 19 (15.96%) 16 (13.44%)
(47.41%) (20.16%) (11.76%) (17.64%)
Chi-squared test = 39.4812, df = 10, p-value = 0.00002
Q9) What can Total no. of Illiterate Primary High Higher Graduate Postgraduate
be the adverse respondents school school secondary
pregnancy outcome school
of pregnancy
gingivitis?
Preterm birth 34 (13.54%) 1 (2.94%) 1 (2.94%) 2 (5.88%) 10 (29.41%) 10 (29.41%) 22 (64.70%)
No effect 55 (21.91) 15 8 (14.54%) 13 7 (12.72%) 7 (12.72%) 5 (9.09%)
(27.27%) (23.63%)
Malformation of 7 (2.78%) 1 (14.28%) 1 (14.28%) 1 (14.28%) 4 (57.14%) 4 (57.14%) 1 (14.28%)
bones
Cleft Lip/Cleft palate 16 (6.37%) 0 (0%) 1 (6.25%) 1 (6.25%) 4 (25%) 4 (25%) 7 (43.75%)
Do not Know 139 28 17 32 17 (12.23%) 17 (12.23%) 13 (9.39%)
(55.37%) (20.14%) (12.23%) (23.02%)
Chi-squared test = 75.038, df = 20, p-value = 0.0000

hyperaemia, edema, and bleeding in periodontal tissues; In the present study, when the participants were enquired
and these are the risk factors for bacterial infections.9 Hence, about getting their dental checkup done during their course
there arise a need to know the attitude of pregnant wom- of pregnancy, majority of them (41.03%) said they did not get
en toward their dental care so that oral health promotion their dental checkup done during or before pregnancy. This
strategies can be aimed at in the required direction for early finding is similar with the previous studies in which it was
diagnosis and treatment of pregnancy gingivitis and peri- reported that women decrease or stop visiting the dentists
odontitis, hence leading to prevention of its probable adverse for dental checkups during pregnancy.11,12
outcomes on new born babies. Thus, the present study was This finding is a pointer to misconceptions which the
conducted among the child-bearing age group of pregnant women are having regarding dental care especially during
women to assess their knowledge, attitude, and perception or before pregnancy. It is in contrast to the fact that dental
of pregnancy gingivitis. checkup should be undertaken by pregnant women before
When enquired about their awareness of developing their pregnancy so that the dentists are able to evaluate
gingivitis during pregnancy, majority (42.62%) of the preg- their oral health conditions and educate their patients about
nant women said that they had only heard about developing the expected changes in their oral tissues especially gingiva
pregnancy gingivitis and were not fully aware about it; oth- and also about the preventive measures to be adopted and
er 31.47% of the respondents had not even heard about it, practiced so as to avoid oral health-related problems. The
while 25.89% of them were aware about the same. Majority misconception of harm to the fetus due to dental checkup
of the women who were fully aware about pregnancy gingi- or dental-treatment leads to aversion of pregnant women to
vitis were graduates/postgraduates in sync with their edu- a dentist that ultimately endangers them as well as the oral
cational level, depicting a statistically significant difference health of child at later stages.13
between the responses of educated and uneducated respon- A good number of respondents (28.68%) agreed that they
dents. These findings indicate that education has a diverse had swollen and reddened gums; 27.49% of them com-
set of impact on the oral health awareness during pregnancy plained of having bleeding gums, yet other 25.89% said of
as is mentioned in previous study conducted by Sunita Bam- having bad breath, whereas only 13.9% felt that they had no
anikar and Liew KokKee wherein they found vivid difference signs of pregnancy gingivitis. These findings are in concord
in good oral health knowledge in educated pregnant women with previous studies, wherein they found the symptoms
in comparison of those having a little or no education; the like oral malador, bleeding gums, dental caries, dry mouth,
reason thereof might be their better social communication gingival redness persisting among pregnant women; and
with others and hence sharing of views and ideas leading also stress being one of the causal factors for such poor oral
to increase in their level of oral health-related knowledge.10 health.14,15

European Journal of Dentistry

6 Pregnancy Gingivitis  Al-Almai et al.

Fig. 1  Frequency distribution of respondents regarding cleaning of oral cavity of children less than 18 months old.

Fig. 2  Frequency distribution of respondents regarding their view about compulsorily having dental education at the start of pregnancy term.

In the present study, 32.66% of respondents did not know pregnant women; the level of education significantly deter-
about the cause of pregnancy gingivitis, while 31.07% of them mined the good oral hygiene among pregnant women.18
reported the hormonal changes to be the cause for the same In the present study, when the pregnant women were
and 17.92% considered poor oral hygiene as the cause for enquired about the measures they believed could prevent
pregnancy gingivitis. Hormonal changes during pregnancy pregnancy gingivitis, majority of them (35.05%) were aware
have been reported in various previously conducted ­studies of the fact that daily tooth brushing and flossing would be
as being the main cause of oral tissue changes inducing preg- able to prevent the same. Respondents to the tune of 12.74%
nancy gingivitis, periodontitis, and dental caries. During believed that getting dental checkup done during second
pregnancy, there is an increase in the metabolism of estrogen trimester would prevent pregnancy gingivitis; and as many
by gingiva and also prostaglandins that are ­synthesized, cause as 23.10% of the respondents believed that getting dental
alterations in gingival tissues.16 The immune system decreas- checkup done before pregnancy would be beneficial, while
es due to change in hormonal (­estrogen and ­progesterone) as 21.91% of them reported that balanced diet could prevent
levels, which has a bearing on the rate of collagen production; pregnancy gingivitis. According to the previous literature, all
and hence body becomes unable to repair the gingiva.17 Poor factors such as proper tooth brushing and flossing,10 regular
oral hygiene was reported, as the cause of pregnancy gingi- dental checkups before and during pregnancy, and a balanced
vitis, more by the educated pregnant women than by less/ diet have their due role in preventing pregnancy gingivitis. In
uneducated ones. This finding was analogous to the results previous studies, it is reported that scaling, polishing, and root
showed by previous studies, wherein the authors have men- planning should be done irrespective of the stage/trimester of
tioned that the health behavior and utilization of health ser- pregnancy so as to promote good oral health.19,20 It is found
vices are directly proportional to the level of education of that less food intake during pregnancy (especially during first

European Journal of Dentistry

 Pregnancy Gingivitis  Al-Almai et al. 7

trimester) was associated with gingival bleeding due to defi- 2. Pregnant women should be counseled well for undergo-
cient nutrients needed otherwise to protect the gingiva as ing thorough dental examination before and during preg-
well as the immune system from getting compromised.21 nancy that would prevent pregnancy gingivitis and its
In the present study, around 55.37% of the respondents outcomes.
were unaware about the adverse pregnancy outcome of 3. Preventive and education program should also include
pregnancy gingivitis and 21.91% believed that it had no such the topics regarding balanced, healthy diet needed for the
adverse effect, while 13.54% of them reported preterm births well-being of the expecting mothers as well as the devel-
as the adverse pregnancy outcome of pregnancy gingivitis. oping fetus.
Many previous studies have found the correlation between 4. It is recommended that pregnant women should undergo
periodontitis, preterm births, and low weight births. Also scaling/root planning at any stage of pregnancy without
maternal periodontitis has been associated with poor oral any fear.
health of child.22,23 Though the association of pregnancy gin- 5. It is recommended that the dentists should perform
givitis/periodontitis with adverse outcomes such as preterm surgical procedures such as extractions, restorations,
births is still under research, it is better to maintain good oral ­endodontic procedures in second or third trimester, after
health by pregnant women to avoid any associated compli- completion of fetal organogenesis. Moreover, dentists
cations as prevention has always been proven to be better should be aware of the proper seating posture for preg-
than cure. nant women on a dental chair.
In the present study, most of the pregnant women 6. All health care professionals (dental/medical) should
(49.40%) reported that using soft moist towel is the prop- work in collaboration with each other so that they prop-
er way of cleaning the oral cavity of children less than 18 erly opt for relevant referrals for patients especially preg-
months of age. It signifies that most of them were well versed nant women.
with the way of oral hygiene maintenance among infants,
Conflict of Interest
though not all of them were aware about the same. Hence,
Authors declare that there is no conflict of interest.
educative programs for women should include the methods
of oral hygiene measures and dental care of infants so as
to prevent the development and progression of early child- References
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 Pregnancy Gingivitis  Al-Almai et al. 9

Appendix I: Questionnaire
Q1 Are you aware that women can develop pregnancy gingivitis (swollen red gums) during pregnancy?

(a) Yes, I am fully aware

(b) No, I am not aware
(c) I am not fully aware, but heard about it.

Q2 Did you get a dental checkup done before or during the period of your pregnancy?

(a) No, I did not

(b) Yes, I did
(c) I planned to, but did not.
(d) Yes, due to dental condition

Q3 Do you have any of the following signs of pregnancy gingivitis?

(a) Swollen and reddened gums

(b) Bad breath
(c) Gum bleeding
(d) Red spot over oral lining
(e) None

Q4 What according to your knowledge may be the cause of gingivitis (red and swollen gums) during pregnancy?

(a) Hormonal changes

(b) Traumatic tooth brushing
(c) Poor oral hygiene
(d) Eating fried food
(e) Malnutrition
(f) Do not know

Q5 What measures according to your knowledge can prevent pregnancy gingivitis?

(a) Daily tooth brushing and flossing

(b) Balanced diet
(c) Dental checkup before pregnancy
(d) Scaling every month
(e) Dental checkup during second trimester
(f) Do not know

Q6 What according to your knowledge is the treatment, dentists provide for pregnancy gingivitis?

(a) Surgical removal of swollen gum

(b) No treatment needed
(c) Professional scaling
(d) Extract the affected tooth
(e) Medication
(f) Do not know

Q7 What effect can pregnancy gingivitis have on your oral health?

(a) Overgrowth of gum tissue

(b) No effect
(c) Periodontal disease
(d) Tooth decay
(e) Tooth sensitivity
(f) Tooth becoming loose
(g) Do not know

Q8 Will pregnancy gingivitis have effect on oral health of your new born?

(a) Yes, it will

(b) No, it will not
(c) Undecided

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10 Pregnancy Gingivitis  Al-Almai et al.

Q9 What effect can gingivitis possibly have on your pregnancy or the child to be born?

(a) Preterm birth

(b) No effect
(c) Malformation of bones
(d) Cleft lip and palate
(e) Do not know

Q10 What according to you is the proper way of cleaning the oral cavity of children less than 18 months of age?

(a) Tooth brush and paste

(b) Soft moist towel
(c) Electric tooth brush
(d) Mouthwash
(e) Saline

Q11 Do you suggest that pregnant women should have compulsory dental health education at the start of the pregnancy term?

(a) Yes
(b) No
(c) Undecided

European Journal of Dentistry