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      Resident obstetricians’ awareness of the oral health component in management of nausea and vomiting in pregnancy

      research-article
      ,
      BMC Pregnancy and Childbirth
      BioMed Central
      Nausea, Vomiting, Oral health, Pregnancy

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          Abstract

          Background

          Nausea and vomiting are common in early pregnancy in 50-90% of pregnant women and resolves in all but 10% of these women. Many obstetricians encounter this problem and should be familiar with the probable outcomes, current treatment options and oral health component of its management. This study assessed the awareness of obstetrics residents of the oral health component of management of nausea and vomiting in pregnancy.

          Methods

          This study was carried out among resident doctors in Obstetrics and Gynaecology in Nigeria. A pre-tested, self-administered questionnaire was used for the data collection. The data collected were analyzed using the Statistical Package for Social Science (SPSS) version 17.0. Non parametric analysis in the form of chi square was carried out to test for statistical significance with P value <0.05 considered statistically significant.

          Results

          A total of 200 questionnaires were administered while 186 were filled and returned, giving a response rate of 93%, comprising 21.5% senior residents and 78.5% junior residents. Most of the respondents agreed that oral health is important in pregnancy. A majority (58%) also thought that oral health complaints in pregnancy were not normal. Fifty-seven percent of the respondents neither assessed teeth and gums of pregnant women for problems during ante-natal care nor educated them on care that would improve their oral health. Majority (95.7%) of the respondents assisted pregnant women with dealing with nausea and vomiting but were not aware of the oral health component of its management.

          Conclusion

          Oral health component in the management of nausea and vomiting in pregnancy has been largely neglected in obstetric care. It is pertinent that ante-natal health care providers receive adequate education on perinatal oral health care.

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          Most cited references37

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          Periodontal infection as a possible risk factor for preterm low birth weight.

          Peridontal diseases are gram-negative anaerobic infections that can occur in women of childbearing age (18 to 34 years). In the present investigation we sought to determine whether the prevalence of maternal periodontal infection could be associated with preterm low birth weight (PLBW), controlling for known risk factors and potential covariates. A case-control study of 124 pregnant or postpartum mothers was performed. PLBW cases were defined as a mother with a birth of less than 2,500 g and one or more of the following: gestational age < 37 weeks, preterm labor (PTL), or premature rupture of membranes (PROM). Controls were normal birth weight infants (NBW). Assessments included a broad range of known obstetric risk factors, such as tobacco use, drug use, alcohol consumption, level of prenatal care, parity, genitourinary infections, and nutrition. Each subject received a periodontal examination to determine clinical attachment level. PLBW cases and primiparous PLBW cases (n = 93) had significantly worse periodontal disease than the respective NBW controls. Multivariate logistic regression models, controlling for other risk factors and covariates, demonstrated that periodontal disease is a statistically significant risk factor for PLBW with adjusted odds ratios of 7.9 and 7.5 for all PLBW cases and primiparous PLBW cases, respectively. These data indicate that periodontal diseases represent a previously unrecognized and clinically significant risk factor for preterm low birth weight as a consequence of either PTL or preterm PROM.
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            Effect of pregnancy on periodontal and dental health.

            Clinical studies have shown that oral tissues can be affected by pregnancy. Pregnancy-related changes are most frequent and most marked in gingival tissue. Pregnancy does not cause gingivitis, but may aggravate pre-existing disease. The most marked changes are seen in gingival vasculature. Characteristic of pregnancy gingivitis is that the gingiva is dark red, swollen, smooth and bleeds easily. Women with pregnancy gingivitis may sometimes develop localized gingival enlargements. The gingival changes usually resolve within a few months of delivery if local irritants are eliminated. The inflammatory changes are usually restricted to the gingiva and probably do not cause permanent changes in periodontal tissues more often than those in the non-pregnant state. Although it is widely believed that pregnancy is harmful to the teeth, the effect of pregnancy on the initiation or progression of caries is not clear. Previous studies, however, indicate that the teeth do not soften, i.e. no significant withdrawal of calcium or other minerals occurs in the teeth. It is mainly the environment of the tooth that is affected. The number of certain salivary cariogenic microorganisms may increase in pregnancy, concurrently with a decrease in salivary pH and buffer effect. Changes in salivary composition in late pregnancy and during lactation may temporarily predispose to dental caries and erosion. Although their underlying mechanisms of action are not fully understood, pregnancy-related changes in the oral environment may have some untoward temporary or permanent effects on oral health. Most of these effects could be avoided by practising good oral hygiene.
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              Periodontal infection and preterm birth: results of a prospective study.

              Previous studies have suggested that chronic periodontal infection may be associated with preterm births. The authors conducted a prospective study to test for this association. A total of 1,313 pregnant women were recruited from the Perinatal Emphasis Research Center at the University of Alabama at Birmingham. Complete periodontal, medical and behavioral assessments were made between 21 and 24 weeks gestation. After delivery, medical records were consulted to determine each infant's gestational age at birth. From these data, the authors calculated relationships between periodontal disease and preterm birth, while adjusting for smoking, parity (the state or fact of having born offspring), race and maternal age. Results were expressed as odds ratios and 95 percent confidence intervals, or CIs. Patients with severe or generalized periodontal disease had adjusted odds ratios (95 percent CI) of 4.45 (2.16-9.18) for preterm delivery (that is, before 37 weeks gestational age). The adjusted odds ratio increased with increasing prematurity to 5.28 (2.05-13.60) before 35 weeks' gestational age and to 7.07 (1.70-27.4) before 32 weeks' gestational age. The authors' data show an association between the presence of periodontitis at 21 to 24 weeks' gestation and subsequent preterm birth. Further studies are needed to determine whether periodontitis is the cause. While this large prospective study has shown a significant association between preterm birth and periodontitis at 21 to 24 weeks' gestation, neither it nor other studies to date were designed to determine whether treatment of periodontitis will reduce the risk of preterm birth. Pending an answer to this important question, it remains appropriate to advise expectant mothers about the importance of good oral health.
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                Author and article information

                Contributors
                emien.enabulele@uniben.edu
                dentalaumon@yahoo.com
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                25 November 2014
                25 November 2014
                2014
                : 14
                : 1
                : 388
                Affiliations
                Department of Restorative Dentistry, University of Benin, Benin City, Edo State Nigeria
                Article
                388
                10.1186/s12884-014-0388-9
                4246477
                25421787
                3890f6a3-c676-4ebc-b675-dfac0d5e240d
                © Enabulele and Ibhawoh; licensee BioMed Central Ltd. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 May 2014
                : 6 November 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Obstetrics & Gynecology
                nausea,vomiting,oral health,pregnancy
                Obstetrics & Gynecology
                nausea, vomiting, oral health, pregnancy

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