Journal of Pharmacy And Bioallied Sciences
Journal of Pharmacy And Bioallied Sciences Login  | Users Online: 560  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 
    Home | About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions | Online submission

 Table of Contents  
Year : 2019  |  Volume : 11  |  Issue : 6  |  Page : 194-197  

Effect of dental health education on the knowledge and attitude among expectant mothers: A questionnaire study

Department of Pedodontics and Preventive Dentistry, VMSDC, VMRFDU, Salem, Tamil Nadu, India

Date of Web Publication28-May-2019

Correspondence Address:
Dr. Nandhini B Selvarajan
Flat No. B3, Golden Palace Appartment, Thiyagabhramam Street, Suramangalam, Salem 636005, Tamil Nadu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JPBS.JPBS_293_18

Rights and Permissions

Background: Although dental caries levels have declined and stabilized the world over, the problem of early childhood caries has remained persistent in many areas of the world affecting certain segments of society, especially the socially deprived, who remain at high risk to this disease. Parents have an essential role in mediating between their children and environment for which prenatal period is the best time for health interventions. This mediation is done through preventive services they provide to their children such as dietary habits supervision, oral hygiene performance, and other practices that can be enhanced by prenatal dental health education. Purpose: The purpose of the study was to evaluate, by means of a questionnaire, the expectant mother’s knowledge and attitude toward dental health and to test the effectiveness of the health education tool. Materials and Methods: The baseline questionnaire consisted of 27 questions, which was distributed to 138 participants. Subsequently, provision for dental health education was made in batches of 20. After 3 weeks, 10 questions were randomly selected from the first questionnaire for reassessment session. Paired t test was used for statistical analysis. Results: The mean overall knowledge improved from 67.4% to 97.32% and attitude improved from 75.83% to 99.22%. Conclusion: Knowledge and attitude of mothers was found to increase on provision of dental health education, which were retained even after a period of 3 weeks.

Keywords: Anticipatory guidance, dental health education, expectant mothers

How to cite this article:
Selvarajan NB, Krishnan R, Kumar S. Effect of dental health education on the knowledge and attitude among expectant mothers: A questionnaire study. J Pharm Bioall Sci 2019;11, Suppl S2:194-7

How to cite this URL:
Selvarajan NB, Krishnan R, Kumar S. Effect of dental health education on the knowledge and attitude among expectant mothers: A questionnaire study. J Pharm Bioall Sci [serial online] 2019 [cited 2021 May 12];11, Suppl S2:194-7. Available from:

   Introduction Top

Oral health forms a predominant part of overall health. Good oral health contributes to overall physical, mental, and social well-being of infants. Prevention of oral diseases among infants should begin early to ensure a successful oral health. Research shows that parents play a vital role for maintaining a good oral hygiene among their infants and toddlers. Expectant mothers are more prone to periodontal diseases and dental caries.

The level of education and socioeconomic status is significantly associated with oral health attitude and practice. A cross-sectional study conducted by Chaitra et al.[1] revealed that the knowledge of pregnant women of rural group about association of oral health and adverse pregnancy outcome was poor. Dental health education in pregnancy can lead to improved oral health and hence improved pregnancy outcomes. Insufficient knowledge in maintaining a good oral health and nutritional status can lead to complications such as preterm and low birth weight deliveries.[2] It can even adversely affect the infant oral health by increasing risks of developmental dental defects and caries. Oral diseases may affect the health of an expectant mother and the unborn child.

The purpose of oral health education program is to improve access to knowledge regarding anticipatory guidance to mothers during pregnancy. Because mothers play an important role in establishing positive attitudes, knowledge, and awareness to their children, an attempt was made to assess the knowledge and attitude toward oral health among expectant mothers.

   Aim of theStudy Top

The aims of this study were to assess the knowledge and attitude toward oral health among expectant women, and to evaluate the level of awareness after providing dental health education.

[TAG:2]Methods and Subjects[/TAG:2]

A cross-sectional survey was conducted at government primary health centers after obtaining the ethical approval from the institutional ethical committee. Written informed consent was obtained individually from all the participants who were willing to participate in the questionnaire survey. The subjects were asked to fill their personnel data regarding age, standard of education, order of pregnancy, and socioeconomic status of the individuals. The expectant mothers selected were between the age of 22 and 35 years, from low socioeconomic status, and were categorized based on their level of education as primary, middle school, high school, and higher secondary. A total of 197 subjects were selected for this study, of which 138 agreed to participate.

Data collection

The baseline questionnaire consisted of 27 questions based on a five-point Likert scale ranging from strongly agree to strongly disagree. The questionnaire was prechecked for construct validity and content validity with the coauthors of the study. All contents in the questionnaire were initially prepared in English followed by translation into the local language.

The baseline data were obtained based on questions pertaining to knowledge on nutrition and oral health, diet and dental caries, facts on oral health, dental visit, and preventive strategies. The other contents included their attitude toward oral hygiene and dental visit. The time allotted for the questionnaire survey was 20min for each participant. After answering all the questions in the written format, provision for dental health education using audiovisual aids was carried out in batches of 20 and the time allotted for each session was 15min. This presentation was an interactive one where the subjects were allowed to ask questions and any clarifications regarding the dental health education were cleared.

The same subjects were reassessed after 3 weeks. For this 10 questions were randomly picked from the first questionnaire. A total of 15 subjects withdrew from the study after which the total participants present were 123. While filling the reassessment questionnaire, women were not permitted to clarify any doubts and they were given 7min for reassessment.

Statistical analysis

Students paired t test was used for statistical analysis with a P value set at 0.005.

   Results Top

Results of paired t test showed most of them had a good baseline knowledge toward nutrition and dental health, which even improved on provision of dental health education [Table 1]. The baseline data showed that knowledge on nutrition and dental health was 72.76%, which increased to 96.59% on provision of dental health education. The knowledge on facts of oral health improved from 69.43% to 98.86%. Participants showed an improved knowledge on diet and dental caries from 62.70% to 96.69%. The overall knowledge on teething, eruption, and malocclusion increased from 65.15% to 97.89%. The results of knowledge on preventive strategies improved from 66.96% to 96.56% and showed highly significant statistical values.
Table 1: Overall improvement in the knowledge of expectant mothers pre- and post-dental health education results after a waiting period of 3 weeks

Click here to view

The baseline data on attitude obtained from their first dental visit were 73.72%, which drastically improved to 99.19%. The attitude level on oral hygiene improved from 94.78% to 99.24%. The results were found to be highly significant. The mean overall knowledge improved from 67.4% to 97.32% and attitude improved from 75.83% to 99.22%.

   Discussion Top

Tooth decay remains a substantial problem in many children. It is made even worse by the existing barriers that prevent them from obtaining proper dental care. Infancy and toddlerhood are considered as critical times in terms of risk of early childhood caries, dental injuries, and so on. Researches show that mothers play an important role in the decision-making processes regarding health care for their children.[3] A cross-sectional study conducted by Nagi et al.[4] reported that knowledge and practices of pregnant women should be improved for better pregnancy outcomes.

Identifying the indispensable role of mothers about health care for their children becomes mandatory to assess the knowledge and attitudes regarding infant oral health and educating them as they are the primary caregivers.[5]

A study by Reddy et al.[6] showed that the women were not conscious of oral cavity conditions that occur during pregnancy and the need for meticulous management of oral hygiene and treatment by a dentist.

The intention of pediatric dentists is to focus and promote on early positive aspects on oral health care. In this study a five-point Likert scale was chosen since it does not require the participant to provide a concrete yes or no answer. Moreover it allows the participants to show their level of agreement (from strongly disagree to strongly agree) with the given statement (items) on a metric scale. Here all the statements in combination revealed the specific dimension of the attitude toward the issue, hence necessarily interlinked with each other.[7]

The results of the study showed a significant increase in both the knowledge and attitude among the expectant mothers. The knowledge was imparted with regard to weaning and effects of cariogenic diet and its role on dental caries. In a questionnaire study reported by Mani et al.,[8] only 3% of the caretakers practiced the right time to start giving semisolid food for a child at the nursery and most of them (64.7%) started feeding semisolid food for a child at the nursery at the age of 1 year, thus increasing the risk factors of caries.

The knowledge on preventive strategies was very low before giving them oral health care awareness, which improved significantly with the post-questionnaire tests. The most effective level was observed with facts on oral health, which showed a significant improvement.

The attitude regarding dental visit, in the first questionnaire, was that most of the mothers felt it is not essential to visit a dentist biannually. With provision of the importance of dental visit, the posttest results showed positive outcome. These women often fail to realize that their behavior and attitude toward oral health during pregnancy can have an effect on their child’s oral health. Many of these women were not aware of the fact that tooth development takes place between sixth and eighth week in utero.

Baseline data obtained showed that the subjects in this study did not have any knowledge on the importance of deciduous teeth and its oral hygiene, the possible sequelae of caries with intake of carbohydrate diet, and when it is important to start weaning. This study investigated this issue and it was encouraging to see that these women showed positive attitude toward retaining the knowledge of prenatal dental health education imparted to them even after 3 weeks.

Most pregnancy follow-up appointments are performed on a monthly basis. Therefore, it is important to assess if this knowledge could be retained between follow-up appointments during pregnancy as an effective measure for education and reinforcement.

Cardenas LM et al.[9] demonstrated an average of 34.67% improvement in knowledge with provision of prenatal dental health education among expectant mothers. The American Academy of Pediatric Dentistry (AAPD) recently introduced guidelines on perinatal oral health care. These guidelines suggest anticipatory guideline education to the mother about prevention of dental caries through diet, oral hygiene, fluoride and delay of colonization, and professional oral health care. In the present study, knowledge was imparted on the factors recommended by the AAPD, which worked out well on these expectant mothers.[10]

Grael AMF et al. Adriana et al.[11] conducted a study to evaluate the degree of knowledge about oral health in a group of 60 pregnant women before and after providing access to an educational manual. The study concluded that there was an increase in knowledge in the expectant mothers after providing access to prenatal dental health education.

Paradis et al.[12] reported that a 15-min educational DVD of newborn about anticipatory guidance had a positive impact on parent’s knowledge about routine child care.

Prenatal education is the key to dental care of the infant, because mothers serve as models for their children and a good oral health of the infant relies on the knowledge of the parent towards oral health.[13] The results from this study showed an above average knowledge among mothers about infant oral health, and a higher number of mothers showed comparatively better knowledge and attitude with provision of dental health education. Studies of same design need to be conducted on larger samples and on different sectors of population and groups so as to evaluate the knowledge and attitude with a long-term follow-up up to their delivery, even during their nursing period.

   Conclusions Top

Based on the results of this study, the following conclusions were arrived at:

  1. Knowledge and attitude of mothers were found to increase on provision of dental health education.

  2. Educating pregnant women on oral health can be beneficial and pregnant women were capable of retaining most of the information for at least 3 weeks.

  3. Information on oral health should be included in education provided to pregnant women, especially for those of underserved backgrounds (who are at increased risk) through federal and/or state-based programs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Chaitra TR, Wagh S, Sultan S, Chaudhary S, Manuja N, Sinha AA. Knowledge, attitude and practice of oral health and adverse pregnancy outcomes among rural and urban pregnant women of Moradabad, Uttar Pradesh, India. J Interdiscip Dentistry 2018;8:5-12.  Back to cited text no. 1
  [Full text]  
Marchi KS, Fisher-Owens SA, Weintraub JA, Yu Z, Braveman PA. Most pregnant women in California do not receive dental care: Findings from a population-based study. Public Health Rep 2010;125:831-42.  Back to cited text no. 2
Gross GJ, Howard M. Mothers’ decision-making processes regarding health care for their children. Public Health Nurs 2001;18:157-68.  Back to cited text no. 3
Nagi R, Sahu S, Nagaraju R. Oral health, nutritional knowledge, and practices among pregnant women and their awareness relating to adverse pregnancy outcomes. J Indian Acad Oral Med Radiol 2016;28:396-402.  Back to cited text no. 4
  [Full text]  
Dogra S, Arora R, Bhayya DP, Thakur D. Knowledge and attitude of lactating mothers towards infant oral health care in Udaipur IOSR. J Dental Med Sci 2014;13:57-60.  Back to cited text no. 5
Reddy RS, Amara SL, Tatapudi R, Koppolu P, Nimma VL, Reddy RL. Awareness and attitude towards maintenance of oral health during pregnancy among patients and clinicians attending obstetrics and gynecology ward. J Dr NTR Univ Health Sci 2013;2:102-8.  Back to cited text no. 6
Joshi A, Kale S, Chandel S, Pal DK. Likert scale: Explored and explained. Br J Appl Sci Technol 2015;7:396-403.  Back to cited text no. 7
Mani SA, Aziz AA, John J, Ismail NM. Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: A preliminary study. J Indian Soc Pedod Prev Dent 2010;28:78-83.  Back to cited text no. 8
[PUBMED]  [Full text]  
Cardenas LM, Ross DD. Effects of an oral health education program for pregnant women. J Tenn Dent Assoc 2010;90:23-6.  Back to cited text no. 9
American Academy of Pediatric Dentistry (AAPD) guideline on Perinatal Oral Health Care. Perdiatr Dent 2009;31:90-9.  Back to cited text no. 10
Grael AMF, de Carvalho SH. Knowledge of pregnant before and after of the application of an educational manual in oral health. RGO: Rev Gaúcha Odontol 2013;61:563-9.  Back to cited text no. 11
Paradis HA, Conn KM, Gewirtz JR, Halterman JS. Innovative delivery of newborn anticipatory guidance: A randomized, controlled trial incorporating media-based learning into primary care. Acad Pediatr 2011;11:27-33.  Back to cited text no. 12
Bhat PK, Aruna CN, Badiyani BK, Alle R. Knowledge and attitude on infant oral health among graduating medical students in Bangalore City, India. JIMSA 2014;27:13-14.  Back to cited text no. 13


  [Table 1]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Aim of theStudy
   Methods andSubjects
    Article Tables

 Article Access Statistics
    PDF Downloaded68    
    Comments [Add]    

Recommend this journal