Maternal and child oral health status: investigation of the effect of parity and socio-behavioural factors
Date
2020
Authors
Obhioneh, Oziegbe Elizabeth
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Abstract
Background: Reproduction in women is associated with physiologic, metabolic and nutritional changes due to adjustments during pregnancy, breastfeeding and childrearing. These changes are thought to be potentially cumulative when parity is high and may have negative effects on the general health of women. It is likely that maternal oral health is affected as well, as ‘a tooth for every child’ is a common adage in many cultures. Even so, there is limited information on the relationship between parity and maternal oral health status. The available evidence is largely from European populations. Most research investigated tooth loss in women of fairly low parities and failed to consider caries and periodontal disease or the behaviours that are likely confounders affecting oral health status. Furthermore, there are no studies on the beliefs of high parity mothers regarding parity and tooth loss.
Aim: The aim of this study was to determine the relationship between parity level and oral health status in a high parity population. Age, nutritional status, socio-economic status and oral health practices (frequency of consumption of refined sugar and tooth brushing, use of fluoridated toothpaste and number of dental visits) were considered when investigating tooth loss, dental caries and periodontitis levels in Nigerian Hausa mothers. Early childhood caries was evaluated for mother-child dyads. Women participated in focus group discussions to elicit qualitative data used to contextualise the study for the Hausa cultural environment. Materials and methods: This was a cross-sectional study with a mixed methods design. A total of 635 married Hausa women of all parity levels aged 13-80 years and 346 accompanying children aged less than 72 months were recruited. Women with 5 or more children were considered high parity while those with less than 5 children were regarded as low parity. Information on the socio-demographic status and oral health behaviour/practices of the women was obtained using a structured interviewer-administered questionnaire. A separate questionnaire was used to obtain information from the mother on the child’s socio-demographic profile and oral health behavior/practices. The weight and height of the participants were measured to calculate their BMI status (kg/m2). The oral hygiene status of the mothers and their children was assessed using the Simplified Oral Hygiene Index (OHI-S) of Greene and Vermillion. All teeth present in the mouth excluding the third molars were recorded, and all missing teeth were recorded regardless of the reason for tooth loss. Women’s caries status was determined using the Decayed Missing Filled Tooth (DMFT) index. Periodontal status was assessed with a lightweight periodontal probe using the Community Periodontal Index (CPI).
Caries in the children was also assessed using the dmft index. Women’s beliefs on causes of tooth loss and any link between parity and tooth loss were explored through a qualitative analysis using a grounded theory approach through focus-group discussions with 33 women of differing parities. Data were analyzed using SPSS (version 16) software for Windows. Analyses included frequencies, cross-tabulations and regressions. Statistical significance was inferred at p<0.05. Associations between categorical variables were determined using chi-square tests while those between continuous variables were tested with Student’s t-tests and ANOVA. The mean DMFT scores and tooth loss with standard deviation were computed for the different age cohorts, parity levels, parity groups (high and low) and nutritional statuses. Comparisons between parity groups were done using
Student’s t-tests, while comparisons between age cohorts and nutritional statuses were tested using ANOVA. In addition, the mean number of sextants with CPI scores of 0-3 and 4 was determined for the different age groups, parity levels and nutritional status. Comparisons across age groups, parity levels and nutritional status were done using ANOVA. Linear regression was performed to predict the factors that best contribute to caries, periodontal disease and tooth loss in the women with caries,
periodontal disease and tooth loss modeled as dependent variables (each in separate analyses) and socio-demographic variables, oral health behaviour/practices, reproductive parameters and nutritional status as independent variables. Information obtained through focus group discussions on causes of tooth loss, parity and tooth loss were analyzed thematically using ATLAS-ti. Associations between caries experience in mother-child dyads were tested using Fisher’s exact tests. Binary logistic regression was done to predict factors that best contribute to early childhood caries (ECC) in the children. Results: Women in the earlier reproductive stages (18-37 years) characterize the study population (65.1%) with 55.7% of them of low parity. The mean parity (4.33±3.04) was slightly below what is regarded as high parity. There was limited variability in the SES and BMI of the participants. Both measures were associated with age, as older women were typically of middle SES and higher BMI. SES and BMI were not associated with caries experience, periodontal disease or tooth loss Hausa women generally had low prevalences of caries, serious periodontal disease and tooth loss, despite their poor oral hygiene and limited use of dental care facilities. A traditional diet that is low in refined sugars, along with good enamel quality, may contribute to this oral health profile. While tooth loss in the Hausa women was generally low, older and higher parity
women experienced significantly more tooth loss. In addition, increased duration of reproduction was significantly related to fewer remaining teeth. The contributory weights of age, duration of reproduction and parity to tooth loss were 13.6%, 1.2% and 1.0%, respectively. Caries experience in the women was also low, yet higher parity women were found to experience significantly more caries. Women’s age contributed 8.5%, while parity
accounted for 0.8% of their caries experience. The prevalence of some level of periodontal disease in the participants was very high. The majority had calculus deposits (code 2), although those with periodontal pockets
(codes 3 and 4) were few. Age, level of education and frequency of tooth cleaning were significantly associated with periodontal disease. Notably, parity was not significantly associated with periodontal disease. The caries frequency (ECC) in the children was very low. Binary logistic regression
analysis revealed that only the age of the child was significantly associated with ECC. The mother’s caries experience was not related to ECC in the child.
The focus group participants did not associate parity per se with tooth loss, although they believed that payar baka (vomiting during childbirth) resulted in loss of teeth. The women perceived other causes of tooth loss to be dirty mouth, tooth worm, ageing and sugar cravings. Conclusion: The cumulative effects of high parity, as observed in older women, were associated with maternal oral health status (caries and tooth loss) in a fairly homogenous sample of Hausa women with low variation in oral hygiene status, diet,
oral health practices, SES and BMI. Thus, reproductive history is an important
determinant of oral health conditions in Hausa women.
Description
A thesis submitted in fulfilment of the requirements for the degree of
Doctor of Philosophy in Medicine to the Faculty of Health Sciences, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, 2020