Prevalence of dental caries in pregnant Colombian women and its associated factors

This study, using data from the last population-based study of pregnant women in Colombia in 2014, has provided knowledge on the association between oral health, specifically dental caries, and the social determinants of oral health in pregnant women in Colombia. This study has as strengths the population design and representativeness of the study sample. The findings of this study show a high prevalence of dental caries in the evaluated pregnant women, observing that 59% have at least one tooth with dental caries, 70.9% have at least one tooth filled and 38.7% have lost at least one tooth due to caries. The age group that presented a higher prevalence (29.3%) and caries experience (43.3%) was 15–24 years, and these prevalences declined with age.

For the DMFT index, the median for this group is 4, increasing to 11 in the 35–45 age group. This is explained by the fact that the D component (decay) is higher in the younger population and lower in the older population. Concerning components F (filled) and M (missing), it is higher in the older population, with component F being the highest for this population, which indicates that this group regularly attends oral health services. The high count of filled teeth found in this study agrees with that found in the study by Thomas et al. 2008 [8] in Australia, Vera-Delgado et al. 2010 [9] in Spain, and Misrachi et al. 2009 [10] in Chile, where this DMFT component was the highest, unlike that found by Deghatipour et al. 2019 [11] in Iran, Gutpa et al. 2016 [12] and Ingle et al. in 2014 [13] in India, and Karunachandra et al. 2012 [14] in Sri Lanka. The latter are middle-income countries unlike medium-high-income countries Colombia and Iran, which may be the cause of the differences in access to health services and oral care patterns between countries with different levels of income. In addition, significant differences were found in the DMFT index according to the region of origin of the pregnant women, where it is observed that the region is the explanation for the differences found in the index, possibly due to socioeconomic and cultural differences between regions. This situation is similar to that found by Deghatipour et al. 2019 [11], where there were differences in the DMFT index according to the region of origin.

Regarding education, it was found that there was a relation between the level of education of the mother and the caries experience, observing that at a lower level of education, there was an increase in the count of decayed teeth, unlike what happens with the component of filled teeth, where having a lower level of education decreases the number of filled teeth. This is in agreement with the study by Deghatipour et al. in 2019 [11], who found a lower rate of caries and a greater number of fillings in pregnant women with an education level greater than 12 years of study. These results are similar to those found in this study where pregnant women whose maximum education level was a university degree have fewer decayed teeth and a greater number of filled teeth (p < 0.000). Kateeb et al. in 2018 [15] found that education is an important and significant factor in the experience of caries, observing that pregnant women who had a university degree had lower DMFT values than those who had completed high school, unlike this study where no difference was found in the DMFT (p = 0.392) according to education. This may be because in our population the number of teeth affected, treated, and lost due to caries is greater, which affects the index and therefore no difference can be seen in the index according to educational level. It should be noted that when it is evaluated in each of its components, educational level is an important and significant factor. Vera-Delgado et al. 2010 [9] observed that the more years of study the women had, the lower the number of active dental caries (p = 0.000), and the greater the number of teeth filled (p = 0.001).

In this study, 78.5% of pregnant women had attended a dental consultation within the previous six months, and the reason for the dental consultation was prenatal care in 40.3%. Regarding the association between the reason for consultation and the DMFT, it was found that attending for treatment increases the index count in this population. The same occurs with the count of filled and lost teeth where in the latter it is added to attend for emergencies, which could suggest that pregnant women come to the consultation with advanced caries lesions that lead to fillings and in some cases to tooth loss. Krüger et al. 2015 [16] found that of the 105 pregnant women evaluated in their study, 33.4% sought dental care, and the reason for such care in 47.6% was pain. These findings are similar to those of Ibrahim et al. 2012 [17] who found that 94.1% of pregnant women went to dental consultation for treatment and 5% for preventive or control reasons. Deghatipour et al. 2019 [11] observed that half of the pregnant women evaluated had not attended a dental consultation in the previous year, and in these women, a lower count of missing teeth was observed. These results are similar to those found in this study, where not having gone to the dentist decreased the count of teeth lost due to caries. This result may be because 35% of the pregnant women were not referred for dental check-ups during prenatal check-ups, and those who were referred (7.4%) did not obtain an appointment, which led to unresolved dental problems. This situation is similar to that found in the study by Boggess et al. 2010 [18] and Singhal et al. 2014 [19], who found that 25% and 48.2% of the pregnant women evaluated reported having attended the dentist for control during pregnancy, respectively, and 74% and 51.7%, respectively, reported not having attended for maintenance during pregnancy. The main reason subjects in the Boggess study gave was economic, and 7% reported not going because they were told not to go during pregnancy.

In the present study, it was found that 64.3% of pregnant women brushed their teeth three times a day or more, and 56.3% did not use dental floss; the latter was found to be associated with an increase in the DMFT index count of decayed and missing teeth as opposed to filled teeth. These findings indicate the importance of the use of dental floss as part of oral hygiene. In addition, these findings call attention to the fact that greater education should be carried out for pregnant women concerning oral hygiene and its importance because if they do not take care of themselves, they will probably not take care of their children’s oral hygiene. Okada et al. 2002 [20] found that the oral behaviors of the parents affected the oral behaviors of the children (p < 0.001) and the component of decayed teeth of children (p < 0.005) shows the importance of reinforcing the education of the parents to have a positive effect on subsequent generations.

Among the limitations of this study is that it is a cross-sectional study that does not allow establishing causal relationships since both the exposure and the outcome occurred before the start of the study, the directionality cannot be established, which means that whether the risk factor occurred before the outcome cannot be established.

Another limitation of the study is that the medical history was self-reported, which can lead to biases such as over/underreporting or recall bias. This study, being a national study, has particularities such as the Health Regime that are not comparable with other countries. Additionally, since the study was conducted in 2014, the age of the data may not represent the current reality.