Research on Oral Health and pregnancy – Cheap Homework Help

Description

The research needs are based on the documents that I am attaching and need to be HIGHLIGHT and see it to me back. Second, in pregnancy, many dental diseases can appear such as periodontal disease, gum bleeding, etc. As well depression after pregnancy very important. If you have access to Wilkins Dental Hygiene will be great or any other dental hygiene book but as well needs I need the highlight and send me those back, please. APA 7.

Pregnancy with the articles that I will provide.

Using the information in the research session in the library find 1-2 evidence-based peer reviewed articles that relate to your topic.  This will require at least researching three or five articles to choose the best ones.  The student will search for one article that meets the following criteria:

1. English language
2. Dental journal
3. 3. It must be a review article/evidence based
4. It cannot be one of the following
   • an editorial
   • letter to the editor
   • case study or history

5. The medical/disabling condition must be such that it has an impact

on the dental hygiene process of care.

6. Publication dates within 10 years is recommended.

You may use Wilkins or another text book for an additional reference if needed.

A typewritten minimum 5-6page paper and double-spaced paper based on the journal article including the highlighted article and your submission is uploaded.

                         The assignment will include the following outline: See Rubric for complete grading criteria.

1. Information technology: Research and obtain electronically, print, and read each article carefully; highlight with a highlighter the important information.
2. Introduction: Etiology of the disorder and what was the “interesting factor.”
3. Trends and Barriers: Evaluate state, statistics of the disorder, regional or national trends and/or any legislation for the potential impact on provision of dental care.
4. Disorder, disease or condition: Identify, physical, mental, medical, social, and dental needs of people with this special need.
   1. Role of Hygienist: dental implications, treatment plan need(s), interdisciplinary care consideration, legal and ethical considerations, oral hygiene considerations
   2. Conclusion and reflection: summarizing what you have learned from this assignment
   3. Information literacy: APA citation format, references, cite and reference throughout

     the paper.

8. Professional preparation: college level writing, plagiarism, submitted copy of the

highlighted article.  Self-check for plagiarism, your paper will be checked

Literature Research Assignment Rubric

:  Hard Copy:      YES      NO       Highlighted Article:   YES    NO

COMMENTS:

ORAL HEALTH MUMBAI JULY 2020 29
Information
Oral Health
Some useful tips that
you will find useful
• Tell your dentist (and doctor) if you are pregnant. Routine
dental care can be done any time during pregnancy.
Any urgent procedure can be done, as well. However,
all elective dental procedures should be postponed
until after the delivery. Before you have your dental
appointment, check with your obstetrician, i.e., the doctor
who specializes in pregnancy, childbirth, and a woman’s
reproductive system.
• To see if she has any special precautions/instructions for
you.
• Tell your dentist the names and dosages of all drugs you
are taking – includingmedications and prenatal vitamins
prescribed by your doctor – as well as any specific
medical advice your doctor has given you. Your dentist
may need to alter your dental treatment plan based on
this information.
• Dental x-ray should be avoided during as they cause
harmful effect to the foetus until and unless there is an
emergency. Your dentist will use extreme caution to
safeguard you and your baby, such as shielding your
abdomen and thyroid. Advances in technology have made
X-rays much safer today than in past decades.
• Don’t skip your dental checkup appointment simply
because you are pregnant. Now more than any other
time, regular periodontal (gum) exams are very important,
because pregnancy causes hormonal changes that put
you at increased risk for periodontal disease and for tender
gums that bleed easily – a condition called pregnancy
gingivitis. Pay particular attention to any changes in your
gums during pregnancy. If tenderness, bleeding or gum
swelling occurs at any time during your pregnancy, talk
with your dentist or periodontist as soon as possible.
• Follow good oral hygiene practices to prevent and/or
reduce oral health problems.
ORAL HEALTH
DURING PREGNANCY:
IS IT NECESSARY OR NOT??
Dr. Kirti Goel
30 ORAL HEALTH MUMBAI JULY 2020
Information
Oral Health
MORNING SICKNESS:
If morning sickness is keeping you from brushing your teeth
change to a bland-tasting toothpaste during pregnancy. Ask
your dentist or hygienist to recommend brands.
Rinse your mouth out with water or a mouth rinse if you
suffer from morning sickness and have bouts of frequent
vomiting.
EATING RIGHT DURING PREGNANCY:
Avoid sugary snacks. Sweet cravings are common
during pregnancy. However, keep in mind that the
more frequently you snack, the greater the chance of
developing toothdecay.
Eat a healthy, balanced diet. Your baby’s first teeth
begin to develop about three months into pregnancy.
Healthy diets containing dairy products, cheese, and
yogurt are a good source of these essential minerals
and are good for baby’s developing teeth, gums, and
bones.
Dental Examination
Health care providers should encourage all women to schedule
a dental examination if it has been more than 6 months since their
last examination or if they have any oral health problems. Patients
often need reassurance that prevention, diagnosis, and treatment of
oral conditions, including dental X-rays (with shielding of the abdomen and
thyroid) and local anesthesia (lidocaine with or without epinephrine), are safe
during pregnancy. Conditions that require immediate treatment, such as extractions, root canals, and restoration
(amalgam or composite) of untreated caries, may be managed at any time during pregnancy. Delaying treatment
may result in more complex problems. Counseling should include reinforcement of routine oral health maintenance,
such as limiting sugary foods and drinks, brushing twice a day with fluoridated toothpaste, flossing once daily, and
dental visits twice a year. Dental providers often recommend the use of chlorhexidine and fluoridated mouth rinses,
and xylitol-containing chewing gum to decrease oral bacteria. No adverse effects have been reported with these
products during pregnancy but they have not been studied extensively. For patients with vomiting secondary to
morning sickness, hyperemesis gravidarum, or gastric reflux during late pregnancy, the use of antacids or rinsing
with a baking soda solution (i.e., 1 teaspoon of baking soda dissolved in 1 cup of water) may help neutralize the
associated acid.
References
1.https://dx.doi.org/10.4274/jtgga.galenos.2018.2018.0139
2.https://www.dentalassociates.com/dental-topics/dental-care-during-pregnancy
3.https://www.webmd.com/oral-health/dental-care-pregnancy
Copyright of Oral Health (0974-3960) is the property of Indian Dental Association and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder’s express written permission. However, users may print, download, or email
articles for individual use.

Fakheran et al. BMC Oral Health (2020) 20:294
https://doi.org/10.1186/s12903-020-01290-5
RESEARCH ARTICLE
The impact of pregnancy on women’s oral
health‑related quality of life: a qualitative
investigation
Omid Fakheran1, Mahmoud Keyvanara2, Zahra Saied‑Moallemi3 and Abbasali Khademi4*
Abstract
Background: Complex psychological and physiological changes occur in women’s body during pregnancy. These
changes affect both oral health status and oral health-related quality of life (OHRQoL). In almost all of the previous
cross-sectional design studies on pregnant women, generic OHRQoL instruments have been used to measure
OHRQoL. While such instruments may be reliable, they may not be appropriate to evaluate the OHRQoL in special
populations like pregnant women. The purpose of this study was to investigate the self-perceived factors affecting
the OHRQoL among pregnant women.
Methods: In this qualitative descriptive study, twenty- seven pregnant women were recruited from four healthcare
centers located in Isfahan city, Iran. The interpretative phenomenological analysis was used to collect and analyze the
data. Four criteria of credibility, dependability, transferability, and confirmability were implemented through established
procedures to confirm the study rigor.
Results: Three major themes and six sub-themes capturing the impacts of pregnancy on women’s OHRQoL were
identified. They covered all areas of life, including daily life, psychological well-being, social life, physical impact,
and also barriers to utilization of dental care services. Some new domains such as “dentists’ refusal to treat pregnant
women”, “negative feelings about pregnancy” and “concerns about fetal health” were found as important factors which
could influence the OHRQoL during pregnancy.
Conclusion: The findings help to better understand the oral health issues impacting women during pregnancy and
to achieve person-centered care and improved oral health outcomes in pregnant women. The conceptual framework
created based on the results of this study may help health care workers and policy makers for improving the health of
pregnant women.
Keywords: Pregnancy, Oral health, Health related quality of life, Qualitative research
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Introduction
Oral health-related quality of life (OHRQoL) describes a
person’s perception of how oral health influences an individual’s
quality of life and overall well-being. Locker et al.
defined OHRQoL as “the impact of oral disorders on
aspects of everyday life that are important to patients and
persons, with those impacts being of sufficient magnitude,
whether in terms of severity, frequency or duration,
to affect an individual’s perception of their life overall”
[1]. There are several oral diseases and systemic conditions
which may cause functional limitations, psychological
discomfort, or social disability and may consequently
affect the OHRQoL of the individuals [2–5].
Open Access
*Correspondence: muikhademi@gmail.com
4 Dental Research Center, Department of Endodontics, Dental Research
Institute, Faculty of Dentistry, Isfahan University of Medical Sciences,
Isfahan, Iran
Full list of author information is available at the end of the article
Fakheran et al. BMC Oral Health (2020) 20:294 Page 2 of 11
Pregnancy is a unique period of life during a woman’s
life. During pregnancy many complex physiologic
changes occur in the women’s body, which can adversely
affect oral health [6]. Many studies have reported that
oral health care needs of pregnant women are completely
different from the general population [7–9]. Periodontal
disease, Xerostomia, halitosis, and tooth mobility are
the most common problems related to oral health during
pregnancy [10, 11]. In this regard, some studies have
reported that the increasing levels of oral disease have
a negative impact on the OHRQoL and perceptions of
well-being among pregnant women [12–15]. In a study
conducted among 150 pregnant women and 150 nonpregnant
women in India, the authors found that the
OHRQoL was significantly poorer in pregnant women
than in non-pregnant women [13]. These investigators
reported that the impact of pregnancy on the OHRQoL
was significant in terms of causing psychological discomfort,
functional limitation, psychological disability, physical
pain, and handicap [13].
In this regard, multiple studies measuring OHRQoL
in pregnant and postpartum populations use generic
instruments [16]. Generic OHRQoL questionnaires such
as oral Health Impact profile (OHIP) and Oral Impacts
on Daily Performances (OIDP) are broad measurement
scales that measure the OHRQoL in the general population
[17, 18].
A recent systematic review reported that the most
affected domains of OHRQoL in the general population
were different from the most affected domains in pregnant
women [16]. Based on this study, the most affected
domains of OHRQoL in pregnant women were related to
the mental and psychological discomfort [16]; however,
the most affected domain in the general population was
physical health [2]. Moreover, the psychosocial domains
were less affected in the general population [2]. Based
on these discrepancies in the results of OHRQoL measurement
in the general population vs. pregnant women,
generic scales for measurement of OHRQoL may not
reflect the actual perception of pregnant women regarding
their oral health status and related problems. Previously,
it has been documented that condition-specific
instruments for assessing OHRQoL may be advantageous
over generic measures in various diseases and conditions
[19–22]. Specific measures have been developed for specific
conditions (e.g., malocclusion) to tap the symptoms
and impacts associated with those conditions, which may
increase their sensitivity compared with that of generic
instruments [19, 23]. Furthermore, another advantage
of condition-specific instruments over generic tools is
that generic instruments generally have higher “floor
effects” (i.e. no impact) since many of the symptoms
tapped may not be prevalent or relevant among pregnant
women [23]. On the other hand, the generic OHRQoL
instruments may not sufficiently reflect some important
domains such as oral health-related psychosocial issues
in pregnant women [16]. In this regard, it seems to be
beneficial to develop a specific OHRQoL measure for
pregnant women.
Guyatt et al. described the steps that should be followed
during the development of a condition-specific
HRQoL measure [24]. This method has also been used
successfully for the development of a condition-specific
OHRQoL instrument [19]. The first step in this regard is
identifying the issues that are important to the individuals
suffering from a specific disease or condition [24].
The best scientific approach for collecting the opinions
of individuals about their experiences is qualitative
research [25, 26]. All the available data in the literature
about measuring the OHRQoL during pregnancy are
quantitative in nature. Therefore, we believe further
research is required to explore, describe, and clarify
the pregnant women’s OHRQoL from a qualitative perspective.
A qualitative approach allows us to better
understand those aspects of oral health disturbances in
pregnant women which may have been ignored by quantitative
research [27].
In this study, qualitative research methods were used
to characterize and describe the women’s experiences
about OHRQoL during pregnancy. The aim of this study
was exploring and classifying the self-perceived factors
behind pregnant women’s OHRQoL, The findings of this
study may improve the knowledge of dental health care
professionals regarding the issues which may influence
the OHRQoL of women during pregnancy. Moreover,
these findings may encourage the researchers for conducting
more longitudinal studies in the way of needassessment
for developing a pregnancy specific OHRQoL
measure.
Methods
The project was initiated by the first author (OF) as a part
of his Ph.D. dissertation, supervised by the other three
authors (MK, ZS, and AK). The study group was set up
with a researcher in public health dentistry, a professor
in social medicine, a professor expert in clinical dentistry,
and a researcher expert in the OHRQoL issues.
This study group was deliberately fitted in the conceptual
framework defined by the World Health Organization
[28].
During the first series of meetings, we specified the
conditions of feasibility of our project, defined our target
population, and started to draw up a preliminary list
of the aspects of the OHRQoL during pregnancy. We
also conducted a systematic review project to collect
Fakheran et al. BMC Oral Health (2020) 20:294 Page 3 of 11
all available data regarding the OHRQoL in pregnant
women [16].
Researcher’s subjectivity
This investigation is based on the qualitative approach
and the investigators perceive the importance of transparency
and reflexivity regarding the researcher’s subjectivity
[29]. The first author is a clinician-scientist with
6 years of clinical experience. He has prior experience in
the field of oral health issues of pregnant women. The
second author (MK) is a professor in medical sociology
with 20 years of experience in qualitative studies. The
third author (ZS) is an associate professor in the department
of community dentistry and is expert in the field of
oral health-related quality of life. The fourth author (AK)
is a professor of clinical endodontics with 30 years of
research experience. The second author (MK) was considered
a critical auditor and reviewed the trustworthiness
of the qualitative data in the final stages of the study.
All authors share an interest in patient-centered perspectives
and health-related qualitative research.
Design
In this qualitative descriptive study, the interpretative
phenomenological analysis (IPA) approach was used
to collect and analyze the data. The study protocol was
approved by the Ethics Committee of Isfahan University
of Medical Sciences (ID: 396,722). The purpose and
protocol of the study was explained to each participant,
and written consent was obtained from the participant
before each interview. All the participants were informed
that interviews would be audio-recorded. All pregnant
women were assured of the confidentiality of the data
and the anonymity of the participants. They were also
aware that they had the right to leave the session at any
time during the study.
Entrée/setting
This study was conducted in four healthcare centers
located in Isfahan city, Iran. To establish rapport and
build trust with the pregnant women, the main investigator
[OF] assisted the local dentist in the health care
center with routine oral health examinations prior to initiating
data collection. The interviews were conducted
in a quiet meeting room in the healthcare centers on the
scheduled day of pregnant women’s dental examinations.
Sample
Pregnant women of any gestational age attending
the healthcare centers, located in Isfahan, Iran, were
recruited if they had no history of pregnancy -related
complications or chronic health conditions. The eligible
women were referred by midwives in the healthcare
centers to the research team members. All participants
were female, pregnant, 18–45 years old, and able to read
and speak Farsi. Purposive sampling method was applied
and continued until data saturation. During the recruitment
of pregnant women, maximum variations regarding
socio-economic aspects, number of pregnancies,
and women’s gestational age were considered. The participants
completed a demographic and background form
prior to the interviews. Data saturation was achieved
through twenty-seven interviews, which is in line with
other authors reporting data saturation after thirty interviews
to develop a specific OHRQoL measure [19]. The
mean age of the participants was 27.7 years (SD = 1.23).
Descriptive statistics reflecting the participants’ demographic
characteristics are given in Table 1.
Procedure
The interviews were performed in a quiet room and
lasted about 30–40 min. Data were collected using semistructured,
audio-recorded, face-to-face interviews. An
interview guide was developed with two open ended
requests, “Please, tell me about your oral and dental
health condition during your pregnancy” and, “please
tell me about the impacts of your oral health condition
on your life”. To get a deeper understanding and to clarify
some parts of the interview, follow-up questions such as
“Can you tell me more about that?” or “Can you clarify
that?” were asked. Close to the end of the interview, the
participant was asked: “How would you describe the
overall condition of your teeth or gums?” A poor-toexcellent
response scale was used for assessing self-rated
oral health condition of participants. The interviewer’s
field notes and memos as well as the participants’ actions
were supplied a complementary non-verbal source of
data. In this regard we looked around and described what
is happening in the setting. We tried to discover what
women were doing and saying (for example, speech patterns,
facial expressions, gestures, etc.).
We assigned a number to each script and changed each
participant’s name to a pseudonym with the aim of maintaining
complete confidentiality. Only the first author
[OF] had access to the women’s actual names, addresses,
and phone numbers.
Data analysis
All audio-recorded interviews, memos, and field notes
were transcribed verbatim and checked for accuracy.
Data were analyzed using the interpretative phenomenological
analysis (IPA) approach [30, 31]. The IPA
was undertaken due to its emphasis on understanding
a phenomenon as it is experienced and given meaning
in the lived experience of participants [32]. Based on
this approach, we were not seeking to confirm the prior
Fakheran et al. BMC Oral Health (2020) 20:294 Page 4 of 11
themes but we allowed the themes to emerge organically.
The analysis process began with listening and iterative
cycle of reading interviews a number of times by the primary
investigator to ensure that a general sense of story
was acquired. In the next steps, the codes were applied
to the data and the emergent themes were initially noted.
The analysis was managed in MAXQDA software (version
10). As the analysis continued, the earlier transcripts
were reviewed in the light of the findings of the later
transcripts. Then, connections between the preliminary
themes were found for each participant and superordinate
themes were identified. The final stage involved
naming the themes and translating them into a narrative
account [31].
Rigor enhancement
Four criteria of credibility, dependability, transferability,
and confirmability were implemented through established
procedures to confirm the study rigor. Prolonged
engagement with the pregnant women participating in
this study, considering enough time for immersing in
the data, as well as checking the findings with the participants
(member check) and 3 coauthors (peer debriefing)
were established to improve the credibility of the
study. In this regard, using maximum variation sampling
strengthened the credibility and confirmability of the
findings. With the aim of ensuring the transferability of
data, results were checked by five pregnant women who
had not taken part in the research.
Results
Participant characteristics
Twenty-seven pregnant women with an age range of
17–41 years were interviewed. Twenty-two interviews
were conducted in the healthcare centers and five interviews
were carried out in the participants’ residence.
Eight interviews were conducted in the presence of close
relatives upon the request of participants. The mean
Table 1 key characteristics and self-rated oral health of participants
Woman Age range Pregnancy trimester Highest educational
level achieved
Job Status Gravida status self-rated
oral
health
1 21–25 2nd trimester University Degree Employed Primigravida Fair
2 26–30 2nd trimester Diploma Employed Multigravida Fair
3 21–25 2nd trimester Diploma Housewife Primigravida Good
4 31–35 3rd trimester University Degree Employed Multigravida Excellent
5 26–30 1st trimester Diploma Housewife Primigravida Good
6 21–25 1st trimester Diploma Housewife Primigravida Good
7 21–25 3rd trimester Upper secondary Housewife Primigravida Poor
8 21–25 2nd trimester Diploma Housewife Primigravida Good
9 26–30 1st trimester Diploma Housewife Primigravida Poor
10 21–25 2nd trimester University Degree Housewife Primigravida Good
11 31–35 3rd trimester Diploma Employed Multigravida Fair
12 26–30 3rd trimester University Degree Employed Multigravida Fair
13 31–35 1st trimester Diploma Housewife Multigravida Poor
14 18–20 3rd trimester Upper secondary Housewife Primigravida Good
15 36–40 3rd trimester University Degree Employed Multigravida Fair
16 21–25 2nd trimester University Degree Employed Primigravida Excellent
17 36–40 1st trimester Diploma Employed Multigravida Good
18 18–20 2nd trimester Upper secondary Housewife Primigravida Poor
19 21–25 2nd trimester Upper secondary Housewife Multigravida Good
20 21–25 2nd trimester Upper secondary Housewife Primigravida Fair
21 36–40 1st trimester University Degree Employed Multigravida Excellent
22 18–20 3rd trimester Upper secondary Housewife Primigravida Good
23 36–40 3rd trimester Diploma Employed Multigravida Poor
24 31–35 1st trimester Diploma Employed Multigravida Good
25 26–30 3rd trimester University Degree Housewife Primigravida Poor
26 26–30 2nd trimester Diploma Housewife Primigravida Fair
27 36–40 2nd trimester Diploma Housewife Multigravida Fair
Fakheran et al. BMC Oral Health (2020) 20:294 Page 5 of 11
duration of the interview was 47 min (range: 34–58). The
socio-demographic and obstetric profiles of the participants
are shown in Table 1.
Findings
From the diverse experiences of participants, we identified
three main aspects affecting the OHRQoL during
pregnancy: present issues affecting the OHRQoL during
pregnancy, regrets affecting the OHRQoL during pregnancy,
and future concerns affecting the OHRQoL during
pregnancy.
The present issues affecting the OHRQoL during pregnancy
included soft tissue problems and gingival bleeding,
dental pain and discomfort, disturbance in doing the
daily activities, psychological disorders disrupting interactions
and causing social disability, and barriers to utilizing
dental care services.
Regrets affecting the OHRQoL of pregnant women
included regrets about not doing dental checkups and
not learning oral health knowledge before pregnancy.
And finally, future concerns affecting the OHRQoL during
pregnancy consisted of concerns about fetal health
and concerns about postponing dental treatment.
Figure 1 shows a summary of various factors affecting
OHRQoL during pregnancy based on the results of this
study.
Present Issues affecting OHRQoL during pregnancy
Soft tissue problems and gingival bleeding
Gingival Inflammation and bleeding were one of the
most important problems declared by the women. The
occurrence of pregnancy tumors was another issue
in this regard. Finding blood in oral cavity makes the
women nervous and prevents them from doing routine
oral hygiene.
I used to brush my teeth regularly before pregnancy
and had no problems, but my gums got swollen after
pregnancy, especially in the last months of pregnancy,
and started bleeding as soon as they were in
contact with a toothbrush. Sometimes when I got up
in the morning, I saw blood in my mouth and my
pillow was stained with blood.
(P7, 3rd trimester).
Dental Pain and discomfort
Acute pulpal pain was one the worst experiences of
women during pregnancy. Almost all of the women,
who experienced dental pain, didn’t seek any treatment
or consume enough drugs to keep their unborn baby
healthy. Existence of toothache and the sense of inability
to controlling pain was a unique terrible experience
reported by the participants.
Fig. 1 A Conceptual frame work of factors affecting OHRQoL in pregnant women
Fakheran et al. BMC Oral Health (2020) 20:294 Page 6 of 11
My tooth was abscessed and my cheek got swollen.
I didn’t take painkillers to avoid fetal damage due
to drugs. I just tolerated the pain and suffered. My
toothache continued for several nights in a row. I just
liked someone could extract my tooth, but nobody
accepted my treatment.
(P23, 3rd trimester).
Disturbance in doing daily activity
All participants described how oral health problems
resulted in increasing restrictions on daily activities, both
within their professional environment and the household.
These restrictions not only affected the participants’
life, but also affected the lives of their relatives and
co-workers.
When I feel pain in my gums or teeth, I cannot do
my housework. In such conditions, I can’t even stand
my children and can’t handle their tasks. Toothache
makes me impatient and I can’t do anything.
(P18, 2nd trimester).
The Disturbances classified to five sub-themes including
disturbance in speaking, disturbance in doing oral
hygiene behaviors, disturbance in nutritional status, sleep
disturbance and disturbances related to Xerostomia or
Ptyalism.
Disturbance in speaking Speaking is one of the critical
skills in daily life. Any pain or problem in oral cavity can
lead to speaking restriction. Some participants emphasized
the speaking impairment during pregnancy due to
dental pain or gingival bleeding.
When I have a toothache, I put my hands on my face
and can’t speak until my pain is relieved.
(P25, 3rd trimester).
Disturbance in doing oral hygiene behaviors Based on
the women’s narrations, the practice of oral self-care was
largely influenced by pregnancy consequences. Gingival
bleeding during brushing the teeth, nausea and vomiting
of pregnancy and feeling pain in gums after flossing were
the most common obstacles of routine oral self-care.
When I put the toothbrush in my mouth, I feel nauseous
quickly. For this reason, I rarely brush my
teeth. Further, as soon as I floss my teeth, my gums
start bleeding, so I don’t use dental floss a lot.
(P5, 1st trimester).
Disturbance in nutritional status The alteration in taste
sensation during pregnancy deeply influenced the nutritional
behaviors of participated women. The changes
in senses of smell and taste were very varied among the
participants, but anyway they did occur in all of them.
Moreover, based on the narrations, the oral disease symptoms
such as gingival bleeding and toothache reduced the
chewing ability of some informants.
From the beginning of pregnancy, I feel the taste of
foods has changed, so I don’t enjoy most of the foods
… Moreover, when I have a toothache, I get very
nervous and don’t like to eat anything at all.
(P9, 1st trimester).
Sleep disturbances One of the common problems in
almost all of the participants was low sleep quality. Sleep
disturbance caused by dental pain and gingival itching
was highlighted among the narrations. All of the oral
health issues which could influence on the sleep quality
or sleep duration of pregnant women were classified in
this section.
I can’t sleep at all during the nights I have a toothache.
I can’t take strong drugs because they are
harmful to the child. For this reason, I don’t have
energy and can’t do my works.
(P15, 3rd trimester).
Disturbances due to Xerostomia and Sialorrhea Saliva
disorders were common among the participants. These
disorders were very different among the interviewed
women. In some cases the reduction in saliva secretion
and its related outcomes such as disturbance in chewing
food and speaking were reported. However some others
talked about the increased salivation which leads to nausea
and vomiting, especially in the first trimester of pregnancy.
Interestingly, the participants considered these
problems as normal consequences of pregnancy and they
never sought any treatment in this regard.
My saliva has increased since I got pregnant … At
night when I sleep, my saliva flows onto my pillow.
(P16, 2nd trimester).
Psychological disorders
The analysis of narrations apparently showed that oral
health problems caused several psychological disorders
for pregnant women.
These psychological themes, apart from the physical
conditions, independently emerged from the narrations.
Fear and anxiety Experience of dental pain during previous
or current pregnancy, created some fear and anxiFakheran
et al. BMC Oral Health (2020) 20:294 Page 7 of 11
ety in the participants. The high acute pain of pulpitis and
believing in impossibility of dental treatment during pregnancy
were the two main elements of this fear. Visiting the
dentists who were apparently reluctant to treat pregnant
women was another reason of this phobia among participants.
In my previous pregnancy, I had a toothache, a terrible
experience for me. Doctors couldn’t do anything
for me. Therefore, I treated my caries teeth before the
current pregnancy. However, I am always worried
about toothache and the same old problems.
(P4, 3rd trimester).
Negative feelings toward pregnancy The occurrence of
untreated oral health problems and remaining in such
situation for several days particularly increased the negative
feelings about pregnancy in participants. The sense
of inability to cope with the problem and considering the
growing fetus as the reason of this suffering apparently
emerged from the words of pregnant women.
I was very excited during my first pregnancy. I
always talked to my child in my belly and loved her
a lot. But in the current pregnancy, I have no sense of
motherhood because I have had toothache from the
beginning of pregnancy. I am always suffering and
can’t do anything. I wish it would end sooner so that
I can repair my teeth.
(P18, 2nd trimester).
Impaired interactions and social disability
The oral health conditions deeply affected the social
life of pregnant women and altered their interactions
with other people during pregnancy. Two sub-themes
emerged in this regard from the narrations are self-perceived
halitosis and esthetic consideration.
Halitosis The participants commonly reported some
problems about their bad breath. The halitosis in pregnant
women might be true halitosis detected by the relatives or
the self-perceived halitosis. Both of these disorders significantly
decreased the women’s self-esteem and resulted
in impaired interactions with other people.
From the very beginning of pregnancy, I smell blood
in my mouth. That’s why when I want to talk to
someone, I try not to get too close to him/her.
(P10, 2nd trimester).
Esthetic considerations The oral soft tissue appearance,
specially the swallowing and alteration of the color
in anterior gingiva were one of the important concerns
among the pregnant women.
Since my gums are red and swollen, I think it
is disgusting for others. I never want to go out or
see someone. I try not to laugh to hide my gums.
I always put my hands in front of my mouth and
talk (she laughs and unconsciously puts her hands
in front of her mouth).
(P20, 2nd trimester).
Barriers to utilization of dental care services
The importance of accessing to dental care services and
barriers to utilization of professional dental treatments
strongly emerged from the narrations. Based on the
analysis of data the obstacles of delivering dental treatments
to pregnant women summarized in three subthemes.
All of these concepts could efficiently affect the
OHRQoL of participants during pregnancy.
Lack of knowledge and believing myths about professional
dental care Unsupported misconceptions about
professional dental treatments during pregnancy were
common among the participants in this sample. Participants
believed that routine dental procedures would
harm them or their baby. The origin of such misconception
was rooted in the beliefs of their husbands and
elder family members.
When I got gingival bleeding, my husband didn’t
let me go to a dentist. My husband and I think
dental treatment harms the baby. In my opinion,
anesthetics, dental materials and devices can have
negative effects on baby’s health.
(P20, 2nd trimester).
High cost of dental treatment Economic problems
of family and the high cost of dental treatments were
another obstacles of attending dental offices. Based on
the opinions of participants, dental treatment didn’t
have high priority compared with other health issues.
Moreover, many of them didn’t have any information
about the free dental health services which is available
in public healthcare centers for pregnant women.
I am very upset that I have decayed teeth. However,
I can’t help it because my husband has a low
income. The costs of other pregnancy tests and
sonography are very high. I may be able to repair
my teeth after pregnancy when other costs are
reduced.
(P27, 2nd trimester).
Fakheran et al. BMC Oral Health (2020) 20:294 Page 8 of 11
Dentists’ refusal to treat pregnant women Another
important obstacle of accessing dental care services is the
refusal of treatment by dentists during pregnancy. Based
on the common experience of women, dentists were obviously
reluctant to treat pregnant women.
When my tooth was abscessed, I referred to some
dentists but none accepted my treatment. All of
them said it is not possible to treat teeth during
pregnancy.
(P25, 3rd trimester).
Regrets affecting OHRQoL during pregnancy
Based on the analyzing of narrations, some concerns of
women during their pregnancy were rooted in the past
and before pregnancy. These issues were mostly the
regrets about the past. The regrets were created based
on the hard experiences of dental problems during pregnancy.
The two main regrets affecting the OHRQoL were
“Dental checkups” and “Learning oral health behaviors”
before pregnancy. The women considered these themes
as the opportunity which had been lost.
I have done all medical care before pregnancy. The
only thing I haven’t done is referring to a dentist to
check my teeth, something that has annoyed me a
lot.
(P11, 3rd trimester).
Now that I am pregnant and have gingival bleeding
and pain, I highly regret why I haven’t learned the
preventive methods for these problems before.
(P2, 2nd trimester).
Future Concerns affecting OHRQoL during pregnancy
Worry about the future problems caused by the current
oral cavity problems were another theme which has been
extracted from the narrations. These worries could be
classified as “Concerns about postponing dental treatment”
and “Concerns about fetus health”. The inability of
treating teeth during pregnancy made women to think
about the consequences of delay in treatment. Women
believed that postponing of dental treatment would
cause more severe problems and morbidities for themselves.
On the other hand, they were seriously concerned
about the negative impacts of their oral disease on baby’s
health. Almost all of the participants believed that the
presence of dental caries and gingival bleeding in mother’s
mouth would be harmful for the unborn baby.
… I am worried that my severe toothache will shock
the baby…
(P15, 3rd trimester).
It is not possible to treat my teeth during pregnancy.
I am worried that I will have more decayed
teeth until three months later when my child will be
borne! I’m worried that my teeth will fall out during
this time!
(P7, 3rd trimester).
Discussion
This qualitative study was conducted to describe the
OHRQoL of women during pregnancy. It sought to
examine the subjective experience of pregnant women
about their OHRQoL during the gestation period using
the phenomenological qualitative approach. Inductive
qualitative analysis of lived experiences allowed the
discovery of the most important domains of OHRQoL
according to pregnant women.
Based on the results of this study, the themes which
may affect OHRQoL during pregnancy can be classified
in three main categories named as “present issues”,
“regrets” and “future concerns”. Many of these factors
previously have been met in classic measures such as
OHIP-14 and OIDP. The themes such as dental pain and
discomfort, disturbance in doing the daily activities, psychological
disorders and social disability are similar with
issues included in generic OHRQoL instruments [17, 18].
Some domains of OHRQoL found in this study were specific
to pregnant women and might not emerge from the
generic scales such as OHIP-14 or OIDP. Domains such
as “dentists’ refusal to treat pregnant women”, “negative
feelings toward pregnancy”, and “concerns about fetal
health” are in line with the results of previous studies
related to oral health issues in pregnant women. Another
qualitative study conducted in Iran reported the dentists’
avoidance of treating pregnant women [33]. In this
report, the dentists’ fear of “legal consequences of potential
complaints about their practice” was mentioned
as the reason for this issue [33]. In a qualitative study
among pregnant adolescent women in the United States
of America, one of the main themes was “believing myths
and having misconceptions about oral health” [27]. This
theme was also reported in another qualitative study
in Kuwait [34]. The result of a systematic review also
showed that the “myths about dental treatment safety”
and “dentists’ unwillingness to treat women during their
pregnancy” beside some other factors were the main barriers
to professional dental care during pregnancy [35].
The OHRQoL in pregnant women has been previously
studied using quantitative methods. All of these studies
have used the routine generic questionnaires which
have been designed for general populations [13, 36, 37].
Fakheran et al. BMC Oral Health (2020) 20:294 Page 9 of 11
Therefore, it is obvious that these studies could not have
found any new specific issue related to the quality of
life in pregnant women. Almost all of these studies have
reported that the oral health status of pregnant women
is significantly associated with their OHRQoL scores [13,
36, 37]. It means that the OHRQoL during pregnancy can
be negatively influenced by periodontal diseases and dental
caries [12, 38, 39]. However, in this phenomenological
investigation we sought to find out the subjective factors
in this regard. The results of this study clearly showed
the perceptions and feelings of pregnant women about
their oral health problems. These findings were critical
as pregnant women might not be asked to describe their
oral health-related emotional and social problems during
routine examinations or at busy clinics. For instance,
finding the regrets about past events and the future concerns
related to the OHRQoL could be obtained only
through the interpretative phenomenological approach
used in this study. It should be noted that the current
generic questionnaires may not cover these aspects of
OHRQoL during pregnancy. In order to properly assess
the OHRQoL during pregnancy, we should take into
account not only the general aspects of the OHRQoL,
which is available in generic scales, but also the specific
issues emerged from this qualitative study.
The results of this study can also help clinicians to better
understand the actual and perceived issues, problems,
limitations, restrictions, and adaptation strategies specific
to pregnant women. Understanding the factors impacting
the pregnant women outside the dental office can help to
achieve person-centered care and improved oral health
outcomes [40, 41]. Furthermore, data obtained from this
study may help future investigations regarding the needassessment
for developing a pregnancy specific OHRQoL
measure.
It should be mentioned that clinical dental examinations
of women before pregnancy and during the gestation
period should not be neglected [38]. All pathologic
changes in the oral cavity, including dental caries, periodontal
diseases, or pregnancy tumors, can negatively
impact the women’s OHRQoL during pregnancy [13, 36,
37]. Hence, the results of qualitative investigations in the
field of OHRQoL can be taken only as complementary
outcomes beside clinical parameters.
The present study showed the importance of oral health
care knowledge and behaviors before pregnancy. The
results of cross-sectional studies around the world have
also highlighted the lack of oral health knowledge among
pregnant women [42–44]. Accordingly, some clinical trials
have suggested that proper education methods for
women before pregnancy can significantly increase their
oral health knowledge and consequently improve their
oral health status during pregnancy [45–48].
A limitation of this study was that it was undertaken
in four public healthcare centers of a single city where
primary oral health care services are free for the pregnant
women. Further, the women referring to non-governmental
health care centers during their pregnancy
might have different restrictions, adaptation strategies,
or perceived issues regarding the OHRQoL. The experiences
of pregnant women might also be very different
in other cultural or socioeconomic environments.
It should be noted that many studies have investigated
the pregnancy issues and concerns, but few studies
have focused on the OHRQoL. Also, there is no qualitative
study on the OHRQoL during pregnancy. Hence,
in order to better understand the factors affecting the
OHRQoL during pregnancy, it is essential to conduct
several qualitative studies in different places to confirm
the findings of the present study.
Conclusion
This qualitative study shows specific issues related to
the OHRQoL in pregnant women based on their lived
experiences. The findings help to better understand
the oral health issues impacting women during their
pregnancy and to achieve person-centered care and
improved oral health outcomes in pregnant women.
Abbreviation
OHRQoL: Oral health related quality of life.
Acknowledgements
The authors wish to thank Dr. Mandana Dehghannejad who facilitated
the official procedures and the informants who generously shared their
experiences.
Authors’ contributions
OF: Conceptualization, Methodology, Formal analysis, Investigation, Software,
Writing—Original Draft, MK: Conceptualization, Methodology, Formal analysis,
Investigation, Writing—Review & Editing, Supervision. ZSM: Conceptualization,
Formal analysis, Investigation, Writing—Review & Editing, Project administration.
AK: Conceptualization, Formal analysis, Investigation, Writing—Review &
Editing, Supervision, Funding acquisition. All authors read and approved the
final manuscript.
Funding
Isfahan University of Medical Sciences and Clinician-Scientist Program office
(Project ID: IR.MUI.REC. 396722).
Availability of data and materials
The dataset supporting the conclusions of this article available and will be
presented based on request.
Ethics approval and consent to participate
The study was approved by the local Research and Ethics Committee from the
Isfahan University of Medical Sciences (IR.MUI.REC. 396722). The purpose and
Protocol of the study was explained to each participant, and written consent
was obtained from participants before each interview.
Consent for publication
Not applicable.
Fakheran et al. BMC Oral Health (2020) 20:294 Page 10 of 11
Competing interests
The authors declare that they have no competing interests.
Author details
1 Department of Oral Health and Community Dentistry, Dental Implant
Research Center, Dental Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran. 2 Department of Health Services Management, Social
Determinants of Health Research Center, Isfahan University of Medical Sciences,
Isfahan, Iran. 3 Department of Oral Health and Community Dentistry,
School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. 4 Dental
Research Center, Department of Endodontics, Dental Research Institute,
Faculty of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
Received: 21 April 2020 Accepted: 21 October 2020
References
1. Locker D, Allen F. What do measures of ‘oral health-related quality of
life’measure? Community Dent Oral Epidemiol. 2007;35(6):401–11.
2. Haag D, Peres K, Balasubramanian M, Brennan D. Oral conditions
and health-related quality of life: a systematic review. J Dent Res.
2017;96(8):864–74.
3. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss
and oral health-related quality of life: a systematic review and metaanalysis.
Health Quality Life Outcomes. 2010;8:126.
4. Ferreira MC, Dias-Pereira AC, Branco-de-Almeida LS, Martins CC, Paiva
SM. Impact of periodontal disease on quality of life: a systematic review. J
Periodontal Res. 2017;52(4):651–65.
5. Cervino G, Terranova A, Briguglio F. Diabetes: oral health related quality of
life and oral alterations. 2019, 2019:5907195
6. Hartnett E, Haber J, Krainovich-Miller B, Bella A, Vasilyeva A, Kessler JL. Oral
health in pregnancy. J Obstet Gynecol Neonatal Nurs. 2016;45(4):565–73.
7. Giglio JA, Lanni SM, Laskin DM, Giglio NW. Oral health care for the pregnant
patient. J Can Dental Assoc. 2009;75(1):43–8.
8. Mills LW, Moses DT. Oral health during pregnancy. MCN Am J Maternal/
Child Nurs. 2002;27(5):275–80.
9. Lee A, McWilliams M, Janchar T. Care of the pregnant patient in the dental
office. Dent Clin N Am. 1999;43(3):485–94.
10. Russell SL, Mayberry LJ. Pregnancy and oral health: a review and recommendations
to reduce gaps in practice and research. MCN Am J Maternal/
Child Nurs. 2008;33(1):32–7.
11. Hughes D. Oral health during pregnancy and early childhood: barriers to
care and how to address them. J Calif Dental Assoc. 2010;38(9):655–60.
12. Moimaz SA, Rocha NB, Garbin AJ, Garbin CA, Saliba O. Influence of oral
health on quality of life in pregnant women. Acta Odontologica Latinoamericana
AOL. 2016;29(2):186–93.
13. Geevarghese A, Baskaradoss JK, Sarma PS. Oral health-related quality of
life and periodontal status of pregnant women. Matern Child Health J.
2017;21(8):1634–42.
14. Acharya S, Bhat PV. Oral-health-related quality of life during pregnancy. J
Public Health Dent. 2009;69(2):74–7.
15. Cornejo C, Rossi G, Rama A, Gomez-Gutierrez N, Alvaredo G, Squassi A,
Klemonskis G. Oral health status and oral health-related quality of life in
pregnant women from socially deprived populations. Acta odontologica
latinoamericana : AOL. 2013;26(2):68–74.
16. Fakheran O, Saied-Moallemi Z, Khademi A, Sahebkar A. Oral healthrelated
quality of life during pregnancy: a systematic review. Curr Pharm
Des 2020;26(32):4014–21. https ://doi.org/10.2174/13816 12826 66620
05231 71639 .
17. Slade GD, Spencer AJ. Development and evaluation of the Oral Health
Impact Profile. Community Dent Health. 1994;11(1):3–11.
18. Adulyanon S, Sheiham A, Slade G. Measuring oral health and quality of
life. Chapel Hill: University of North Carolina, Dental Ecology; 1997. p.
1–160.
19. Benson PE, Cunningham SJ, Shah N, Gilchrist F, Baker SR, Hodges SJ,
Marshman Z. Development of the Malocclusion Impact Questionnaire
(MIQ) to measure the oral health-related quality of life of young
people with malocclusion: part 2–cross-sectional validation. J Orthod.
2016;43(1):14–23.
20. Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC, Sarode
GS, Patil S. Impact of oral submucous fibrosis on oral health-related quality
of life: a condition-specific OHRQ oL-OSF instrument analysis. Oral Dis.
2018;24(8):1442–8.
21. Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC, Saode
GS. Comparison of generic and condition-specific oral health-related
quality of life instruments in patients with oral submucous fibrosis. Qual
Life Res. 2019;28(8):2281–8.
22. He S, Wang J, Wei S, Ji P. Development and validation of a conditionspecific
measure for chronic periodontitis: Oral health impact profile for
chronic periodontitis. J Clin Periodontol. 2017;44(6):591–600.
23. Sischo L, Broder H. Oral health-related quality of life: what, why, how, and
future implications. J Dent Res. 2011;90(11):1264–70.
24. Guyatt GH, Bombardier C, Tugwell PX. Measuring disease-specific quality
of life in clinical trials. CMAJ. 1986;134(8):889–95.
25. IPA O. Exploring lived experience. Psychologist 2005;18(1):20.
26. Smith JA. Beyond the divide between cognition and discourse: using
interpretative phenomenological analysis in health psychology. Psychol
Health. 1996;11(2):261–71.
27. Murphey C. Oral health experiences of pregnant and parenting
adolescent women: a qualitative descriptive study. Int J Nurs Stud.
2013;50(6):768–75.
28. The WHOQOL Group. The development of the WHOQOL. In: Orley J,
Kuyken W, editors. Quality of life assessment: International perspectives.
Berlin: Springer; 1994. p. 41–57.
29. Mauthner NS, Doucet A. Reflexive accounts and accounts of reflexivity in
qualitative data analysis. Sociology. 2003;37(3):413–31.
30. Biggerstaff D, Thompson AR. Interpretative phenomenological analysis
(IPA): A qualitative methodology of choice in healthcare research. Qual
Res Psychol. 2008;5(3):214–24.
31. Smith JA, Shinebourne P. Interpretative phenomenological analysis.
Washington: American Psychological Association; 2012.
32. Smith JA, Osborn M. Interpretative phenomenological analysis as a useful
methodology for research on the lived experience of pain. Br J Pain.
2015;9(1):41–2.
33. Ghorbani Z, Pakkhesal M, Arshi S, Eghbal MJ, Deghatipour M, Tennant
M, Ardakani HM. Challenges impeding integration of oral health into
primary health care. East Mediterr Health J. 2017;23(12):802–8.
34. Al Khamis S, Asimakopoulou K, Newton J, Daly B. Oral health knowledge,
attitudes, and perceptions of pregnant Kuwaiti women: a qualitative
study. JDR Clin Transl Res. 2016;1(3):211–7.
35. Rocha JS, Arima L, Chibinski AC, Werneck RI, Moysés SJ, Baldani MH. Barriers
and facilitators to dental care during pregnancy: a systematic review
and meta-synthesis of qualitative studies. Cadernos de saude publica.
2018;34:e00130817.
36. Lu HX, Xu W, Wong MC, Wei TY, Feng XP. Impact of periodontal conditions
on the quality of life of pregnant women: a cross-sectional study. Health
Quality Life Outcomes. 2015;13:67.
37. Acharya S. Oral health-related quality of life and its associated factors in
an Indian adult population. Oral Health Prev Dent. 2008;6(3):175–84.
38. Martinez-Beneyto Y, Montero-Martin J, Garcia-Navas F, Vicente-Hernandez
A, Ortiz-Ruiz AJ, Camacho-Alonso F. Influence of a preventive program
on the oral health-related quality of life (OHRQoL) of European pregnant
women: a cohort study. Odontology. 2019;107(1):10–6.
39. Musskopf ML, Milanesi FC, Rocha JMD, Fiorini T, Moreira CHC, Susin C,
Rosing CK, Weidlich P, Oppermann RV. Oral health related quality of
life among pregnant women: a randomized controlled trial. Braz Res.
2018;32:e002.
40. Bedos C, Loignon C. Patient-centred approaches: new models for new
challenges. J (Can Dental Assoc). 2011;77:b88.
41. Lee H, Chalmers NI, Brow A, Boynes S, Monopoli M, Doherty M, Croom
O, Engineer L. Person-centered care model in dentistry. BMC Oral Health.
2018;18(1):198.
42. Gonik B, Wilson E, Mayberry M, Joarder BY. Pregnant patient knowledge
and behavior regarding perinatal oral health. Am J Perinatol.
2017;34(7):663–7.
43. Lubon AJ, Erchick DJ, Khatry SK, LeClerq SC, Agrawal NK, Reynolds MA,
Katz J, Mullany LC. Oral health knowledge, behavior, and care seeking
Fakheran et al. BMC Oral Health (2020) 20:294 Page 11 of 11
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among pregnant and recently-delivered women in rural Nepal: a qualitative
study. BMC Oral Health. 2018;18(1):97.
44. Penmetsa GS, Meghana K, Bhavana P, Venkatalakshmi M, Bypalli V, Lakshmi
B. Awareness, attitude and knowledge regarding oral health among
pregnant women: a comparative study. Niger Med J J Nigeria Med Assoc.
2018;59(6):70–3.
45. Jeihooni AK, Jamshidi H, Kashfi SM, Avand A, Khiyali Z. The effect of
health education program based on health belief model on oral health
behaviors in pregnant women of Fasa City, Fars Province, South of Iran. J
Int Soc Prev Community Dent. 2017;7(6):336–43.
46. Vamos CA, Thompson EL, Avendano M, Daley EM, Quinonez RB, Boggess
K. Oral health promotion interventions during pregnancy: a systematic
review. Commun Dent Oral Epidemiol. 2015;43(5):385–96.
47. Deshpande AN, Dhillon SJ, Somanna KS, Dave BH, Porwal PA, Macwan
CS. Impact of perinatal oral health care education programme on the
knowledge, attitude and practice behavior amongst gynaecologists of
Vadodara City. J Indian Soc Pedodont Prev Dent. 2015;33(2):122–7.
48. Al Khamis S, Asimakopoulou K, Newton T, Daly B. The effect of dental
health education on pregnant women’s adherence with toothbrushing
and flossing—a randomized control trial. Commun Dent Oral Epidemiol.
2017;45(5):469–77.
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