Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3):239-248

DOI: http://dx.doi.org/10.4034/PBOCI.2014.143.08
ISSN 1519-0501

Original Article

Pregnant Women’s Knowledge of Baby’s Oral Health in a Basic Health

Unit, Fortaleza, Brazil

Germana Martins Sá Ramos1, Leandro Bonfim de Castro1, Cristiane Tomaz Rocha2, Beatriz
Gonçalves Neves2

1Dentist, Basic Health Unit, Fortaleza, CE, Brazil.

2Professor, School of Dentistry, Federal University of Ceará, Sobral, CE, Brazil.

Author to whom correspondence should be addressed: Beatriz Gonçalves Neves, Curso de

Odontologia, Universidade Federal do Ceará-Campus Sobral, Rua Stanislau Frota, s/n.º, Centro,
62010-560, Sobral, CE, Brasil. E-mail: beatriz_gneves@yahoo.com.br.

Academic Editors: Alessandro Leite Cavalcanti and Wilton Wilney Nascimento Padilha

Received: 16 September 2013 / Accepted: 24 April 2014 / Published: 08 September 2014

Abstract
Objective: To assess the knowledge of pregnant women on the oral health of the baby.
Material and Methods: The study sample consisted of pregnant women who took
prenatal exams in the period of data collection (n=125), randomly selected while using
the service at the health unit. Data were collected using a form with open- and closed-
ended question about pregnant women’s identification, socioeconomic characteristics
and knowledge of oral health of the baby. All information collected was processed in
Epi-Info version 3.5.1 TM, for Windows, and were presented with absolute and relative
frequency. Results: Data analyses showed that the surveyed women were aware of the
importance of breastfeeding and the need for early implementation of hygienic measures.
However, they were unaware of some fundamental concepts for effective promotion of
oral health of the baby, such as caries transmissibility, the optimal timing for the first
dental visit, use of bottle and etiological factors of dental caries. Furthermore, 81.6% of
the women were not instructed on oral health during prenatal care. Conclusion: It is
necessary to implement a strategy focused on oral health care for pregnant women,
because during pregnancy the woman is more receptive to new information and changes
habits that, in turn, will reflect in the promotion of their children’s oral health.

Keywords: Pregnant Women; Knowledge; Oral Health; Family Health Program.

.
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

Introduction
Dental caries is the most common chronic disease in childhood [1]. It may appear
aggressively from an early age, affecting health in general and the development of affected children
[2], representing a serious problem of public health [3]. In Brazil, although the prevalence of tooth
decay has decreased [4], the rates found for the first years of life still deserve special attention. SB
Brasil - the national epidemiological survey on oral health – observed in 2003 the prevalence of
almost 27% in the experience of tooth decay in children between 18 and 36 months old, and that, on
average, in this age group, one Brazilian child already has at least one decayed tooth [5]. In
Fortaleza, the prevalence of almost 10% and mean dmf index of 0.23 were observed in babies of 18-
36 months old [6]. In 2010, SB Brasil did not include babies in the analysis.
Today, with a broader concept, the tooth decay disease cannot be explained exclusively by
the interaction of primary factors, such as a susceptible host, cariogenic microorganisms and
fermentable carbohydrates modulated during a certain period. One factor that has deserved special
attention in tooth decay disease etiology is the socioeconomic level of the individual, once the social
determinant involved in the health-disease process, such as low educational and economic level and
low family income, has been described in the literature as an important risk factor to tooth decay
disease [7]. In this sense, pregnant women are also more vulnerable, once low educational level and
low family income affect the development of carious lesion [8,9], as well as lower age, considering
that many women get pregnant in adolescence [9].
With the progress of Cariology studies and better understanding of the health/disease
process dynamics, preventive methods of dental caries are consolidated; then, to prevent it, it is
necessary to know its etiology and risk factors for its development. Studies show that high
prevalence of tooth decay in children is closely related to misinformation, and maternal education is
the most effective way to prevent it [10].
Tooth decay is a disease strongly modulated by behavioral factors. Parent knowledge and
attitudes regarding oral health, especially of mothers, are absorbed by children, who maintain the
habits learned in childhood all their lives, influencing their oral health standards [10-13]. In
addition, the mother’s transmission of pathogenic microbiota is the main method of baby infection
[14]. Therefore, Dentistry has developed new ways to promote health, with services provided as
early as possible to mothers and children [10,15-17].
During pregnancy, women are psychologically more motivated and receptive to new
knowledge and changes in their habits, leading to the adoption of new and better health practices,
which will influence the general health development of the baby [11,14,18-20]. Such knowledge
acquired during pregnancy usually benefit the whole family, as mothers act as multipliers of
knowledge and information, especially related to health [11,20]. For this reason, pregnancy is
perceived as a moment that favors health education [17] and, during this period, pregnant women
should receive prenatal oral health care, including information about most common oral
manifestations [21].
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

The National Oral Health Policy provides guidelines for educational and preventive actions
with pregnant women to qualify their oral health and introduce good habits from early time of
children’s life. This document considers that mothers have an essential role in behavior standards
learned during early childhood [22].
For educational and preventive actions to be effective and fulfill the needs of pregnant
women, the knowledge and attitudes of these pregnant women in relation to oral health should be
evaluated and understood [15]. That will allow proper actions and resources allocated more
efficiently and democratically, favoring the participation of pregnant women in oral health-disease
process control.
These considerations justify this study, whose purpose is to evaluate the knowledge related
to the oral health of babies of pregnant women from a basic health unit of the city of Fortaleza (CE),
to support a positive intervention in the educational and preventive process of prenatal care provided
by the studied basic health unit, favoring the health of both mothers and children.

Material and Methods

This is a descriptive and quantitative cross-sectional study. The project of this study was
approved by the Research Ethics Committee of the State University of Acaraú (protocol 905/2010)
and is in compliance with Resolution 196/96 of the National Health Council. All participants signed
an informed consent term.
Data collection was conducted at Alarico Leite Basic Health Unit (UBS), located in Passaré,
in an extension of Executive Regional Secretariat (SER) VI, in the city of Fortaleza, Ceará. This UBS
has a defined coverage area and population served of 15,475 people to the four Family Health teams.
The study was conducted at the investigator’s workplace. Thus, it was possible to identify and
analyze the local activities developed to prevent early tooth decay in childhood, allowing proposals of
actions to be incorporated into the routine of health teams and dynamics of the territory.
The study sample consisted of pregnant women who took prenatal exams in the period of
data collection (n=125), randomly selected while using the service at the health unit.
Data were collected using a form with open- and closed-ended question about pregnant
women’s identification, socioeconomic characteristics and knowledge of oral health of the baby. The
participants were interviewed individually by a single investigator in a reserved room in the health
unit. After the interviews, the participants received guidance about oral health.
For a proper data collection, a pre-test was conducted to verify if the patients would
understand the language to be used and the questions made and to act as a training to the
investigator. Fifteen participants were included in this pilot study, who were not included in the
study sample.
All answers to open-ended questions were analyzed as categorical variables. All information
collected was processed in Epi-Info version 3.5.1 TM, for Windows, developed by the CDC (Centers
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

for Disease Control and Prevention. After that, they were presented with absolute and relative
frequency.

Results
Table 1shows the socioeconomic profile of pregnant women. Data show 53.6% of them are
20-29 years old. Their mean age was 24.3 ± 6.38, with minimum age 12 years old and maximum age
42 years old. More than half of interviewees (n=88; 70.4%) were housewives. Regarding their
educational level, 31.2% presented incomplete basic education and 61.6%presented family income up
to 1 minimum wage. Most pregnant women (45.6%) were in the third trimester of pregnancy and
40.8% expecting the first child (Table 2).

Table 1. Absolute and relative distribution of interviewees regarding their age,

occupation, educational level and family income. Fortaleza, CE.
Variable N %
Age group (years)
Up to 19 years 32 25.6
From 20 to 29 years 67 53.6
From 30 to 39 years 25 20.0
≥40 years 1 0.8
Total 125 100
Profession/ occupation
Housekeeper 88 70.4
Worker 27 21.6
Student 10 8.0
Total 125 100
Schooling
Illiterate 1 0.8
Incomplete Elementary school 39 31.2
Complete Elementary school 16 12.8
Incomplete High school 30 24.0
Complete High school 36 28.8
Incomplete higher education 2 1.6
Complete higher education 1 0.8
Total 125 100
Family income (minimum wages)
Up to 1 MW 77 61.6
>1 MW up to 3 MW 45 36.0
>3 SM up to 5 MW 1 0.8
Above 5 MW 2 1.6
Total 125 100

Regarding the values assigned by the pregnant women to their own oral health condition,
data show that 24% considered it “good”; 54.4% considered it “not bad” and 21.6% said their oral
health condition was “bad”. Most pregnant women (71.2%) knew there was a relation between their
oral health and the oral health of the baby. Despite that, during pregnancy, 78.4% of the interviewees
did not have any dental treatment and 52.8% did not know about tooth decay transmissibility.
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

Regarding breastfeeding, 97.6% of pregnant women considered it important for the oral
health of the baby. All pregnant women (100%) intend to breastfeed their children; 42.4% of them
intend to breastfeed them from 6 to 11 months old; 26.4% from 1 to 2 years old; 19.2% answered that
they would breastfeed the baby until the child wanted to; 4.8% from 1 to 5 months old; 4.8% until
they have milk and 0.8% did not know how to answer. In addition, 77.6% of the interviewees intend
to offer bottles to their babies one moment or another.

Table 2. Absolute and relative distribution of interviewees regarding their

gestational age and number of children. Fortaleza, CE.
Variable N %
Gestational age
First trimester 27 21.6
Second trimester 41 32.8
Third trimester 57 45.6
Total 125 100
Number of children
First pregnancy 51 40.8
Second pregnancy 42 33.6
Various pregnancies 32 25.6
Total 125 100

Baby oral cleaning was another aspect highlighted in this study. All pregnant women (100%)
intend to conduct baby oral cleaning, 50.4% of them will start it before tooth eruption, 30.4% when
the first tooth erupts, 13.6% when the baby is between 1 and 2 years old; 3.2% when the baby is
between 2 and 3 years old, 2.4% when the baby is over 3 years old. The methods mentioned to start
the baby oral cleaning were: cotton/cotton swabs (31.2%), brush (24.8%), diaper (20.8%), finger cot
(8%), gauze (7.2%), and 8% did not know how to answer.
Regarding the first dental visit, 18.4% of the pregnant women intend to take their children to
see a dentist for the first time in their first year of life, 36.8% when they are one to three years old,
13.6% after they are three years old, 8.8% when any problem appears and 22.4% did not know how to
answer. Regarding the main reasons reported by pregnant women to take their children to see a
dentist for the first time, most interviewees (59.2%) mentioned prevention, 12.8% tooth decay, 12%
did not know how to answer, 10.4% other reasons; 4.8% pain and 0.8% crooked tooth.
When asked about the etiological factors of dental caries, the lack of hygiene (76%) was
considerably mentioned and only 1.6% of the interviewees mentioned bacteria. Most pregnant
women said tooth decay could be prevented (89.6%), and oral hygiene (89.6%) was the most
mentioned prevention method. In our study, multiple answers were accepted to these questions
(Table 3).
When asked if they had received oral health guidance in pregnancy, 81.6% said that they had
not received any information. However, most participants (94.4%) said that they had participated in
educational sessions about the subject and 59.2% said that they would rather receive such guidance
from the dentist, in a group with other pregnant women (Table 4).
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

Table 3. Absolute and relative distribution of interviewees regarding

etiological factors and prevention methods of tooth decay. Fortaleza, CE.
Questions N %
What can cause dental caries?
Lack of hygiene 95 76,0
Sweet foods 47 37,6
Bacteria 2 1,6
Antibiotics 1 0,8
Can dental caries be avoided?
Yes 112 89,6
No 13 10,4
Total 125 100
How to avoid dental caries?
Dental hygiene 112 89,6
Go to the dentist 45 36
Avoid sweets 30 24,0
Use of fluoride 5 4,0

Table 4. Absolute and relative distribution of interviewees regarding oral health guidance in
pregnancy, Fortaleza, CE.
Questions N %
During pregnancy, you received guidance on oral health?
Yes 23 18.4
No 102 81.6
Total 125 100
If yes, from whom?
Dentist / ESB 6 26.1
Physician 6 26.1
Nurse 1 4.3
Other health professionals 2 8.7
Parents / family / friends 5 21.7
Media 3 13
Total 23 100
If there were educational sessions on oral health, would you participate?
Yes 118 94.4
No 7 5.6
Total 125 100
How you would like to receive guidance from the dentist for your baby?
In prenatal appointment with the doctor or nurse 20 16.0
In the dental office in another appointment 31 24.8
In a group with other pregnant women 74 59.2
Total 125 100

Discussion
The socioeconomic characteristics of pregnant women interviewed in this study, regarding
their age, educational level and occupation, were similar to the profile found in previously conducted
studies [23,24].Regarding their family income, 61.6% of the participants had up to one minimum
wage, which is lower than the income described by these authors [23,24].Then, the profile of this
sample of low educational level and low income family places them at a higher risk to tooth decay
[7,8], which may also influence the oral health of babies [23,24]. In addition, 25.9% of the
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

participants were under 19 years old, which may place them in a group of higher social vulnerability
[9].
A relevant aspect observed in this study was the fact that most pregnant women (78.4%) did
not have dental treatment during pregnancy, although only 24% considered their oral health
condition as good. Other studies also found high percentage of pregnant women that did not have
dental treatment during pregnancy [19,23,25].
The dental service during pregnancy is not only allowed, it is also recommended [23].
Pregnant women require dental care due to oral alterations that occur during pregnancy [25], either
due to the association with periodontal disease in pregnancy and prematurity and low birth weight
[26] or the relation between the tooth decay experience between mother and child [14].For this
reason, dental visit during prenatal exams should become part of the routine in the Family Health
Strategy (ESF), once it represents quality of life to both pregnant women and children.
The relation between the mother’s oral health and the baby’s oral health is known by 71.2%
of the interviewees. This understanding is positive and desirable in the perspective of health
promotion, as it encourages self-care, for the benefit of children. However, the way the interrelation
of mother and baby oral health occurs is a reason of doubt among pregnant women, as most of them
(52.8%) reports that tooth decay is not transmissible. Mothers are the main source of cariogenic
bacteria transmission to babies, and the earlier this contamination occurs, the greater the risk to
develop carious lesions [14]. However, some studies show that pregnant women are not well
informed about this subject [10,14,26]. The literature also indicates that pregnant women do not
know tooth decay and periodontal disease are oral infections [27].
The benefits related to breastfeeding are largely known and consolidated; it is considered the
best baby feeding method, regarding physiological, physical and psychological aspects [28].
Pregnant women showed that they are aware of the importance of breastfeeding, as all interviewees
showed their intention to breastfeed and only 4.8% intend to breastfeed for less than six months, and
97.6% of them consider breastfeeding important for the oral health of the baby. But 77.6% of the
participants intend to give bottles to their babies one moment or another, a result that agrees with
others found previously [16,24]. One study observed that only 39.3% of women knew that offering
bottles to a sleeping child could damage teeth [26].
The purpose of baby oral hygiene is to remove food waste and keep oral cavity healthy, and it
is important for the child to get used to mouth manipulation and become more receptive in the future
regarding oral health care [13]. In this study, all pregnant women intend to conduct baby oral
hygiene; 50.4% of them will start is before tooth eruption and 30.4% when the first toot erupts.
Similar results were found in other studies [13,14,16]. Most pregnant women evaluated recognize
the importance of early adoption of oral hygiene measures.
The interviewees do not know the best time for the first dental visit, only 18.4% of them
intend to take their children to see a dentist for the first time in their first year of life. In Brazil, for a
Brazilian Research in Pediatric Dentistry and Integrated Clinic 2014, 14(3): 239-248

long time, the first dental visit used to be recommended after the child was three years old
[13],when the primary dentition is already complete and the child can cooperate with the treatment;
however, in some cases, the carious process may already be consolidated in this period. Regarding
the main reasons reported by pregnant women to take their children to visit a dentist for the first
time, most of them (59.2%) mentioned prevention. One study presented similar data regarding this
aspect; however, it says that a very high prevalence of carious lesions in children is still observed,
and that few babies see dentists regularly [10].
Tooth decay has a dynamic character and it develops due to an unbalanced health process,
and not due to a fatality in a person’s life; then, it can be prevented. This conception is a reality in the
group analyzed in this study, since 89.6% of the pregnant women consider tooth decay can be
prevented. One study [16] observed the percentage of 100%, a considerable result that favors
motivation to oral health self-care. Regarding the etiological factors of tooth decay, only poor
hygiene was significantly mentioned (76%), followed by sweet foods (37.6%), and only 1.6%
associated bacteria with tooth decay. However, another study obtained different results regarding
this subject: sweet foods (66%), poor hygiene (60%) and use of bottles (2%) [29].
Table 4 shows that the activities of oral health education were not highlighted in pre-natal
support, since 81.6% of pregnant women did not receive guidance on the subject. These findings
were similar to those described in the literature [16,17,19], which concluded that during pregnancy,
information about oral health is scarce. However, the participants showed willing to receive
instructions about oral health, since 94.4% of them were interested in participating in educational
sessions about the subject, in agreement with a previously conducted study, which states that
pregnant women are open to receive information. Pregnant women should receive guidance about
oral health, as education may be essential for health promotion [17].

Conclusion
The pregnant women evaluated in this study are aware of the importance of breastfeeding
and early adoption of hygiene measures, but they do not know some essential concepts for the
effective promotion of baby oral health, such as transmissibility of decay disease, right moment of
first dental visit, use of baby bottle and etiological factors of tooth decay. In addition, 81.6% of them
did not receive guidance about oral health during pre-natal exams.
Although the specific results of this study are associated with the analyzed health unit, the
guidelines of the National Oral Health Policy recommend the implementation of an oral health care
strategy for pregnant women under the Family Health Strategy. Dentists, as members of the Family
Health Team, should act during pre-natal exams, providing clinical and dental support and health
promotion and education, considering that, during pregnancy, women are more receptive to new
knowledge and change of habits that will promote the oral health of their children.

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