Oral Health Status on among Pregnant Attending at Health Centers in Savannakhet Province, Lao PDR: A Cross Sectional Study

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 6, December – 2025, Page No. : 64 – 75 Corresponding Author: Thiphavanh Vongxay, ijdsir, Volume – 8 Issue - 6, Page No. : 64 – 75 Page64 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Oral Health Status on among Pregnant Attending at Health Centers in Savannakhet Province, Lao PDR: A Cross Sectional Study 1Thiphavanh Vongxay, 5Koukeo Phommasone, 1Soulideth Inthakone, 1Soutsada Songpadith, 1Souksida Xaykhambanh, 2Phimfalee Sayaxang, 2Viengsavanh Inthakoun, 3Amphaivanh Homsavath, 2Hue Vang, 4Thongsavanh Vetsouvanh 1Department of Restorative, Faculty of Dentistry, University of health Sciences, Vientiane, Lao PDR. 2Department of Dental Basic Sciences, Faculty of Dentistry, University of health Sciences, Vientiane, Lao PDR. 3Division of Academic, Faculty of Dentistry, University of health Sciences, Vientiane, Lao PDR. 4Department of Oral Surgery, Faculty of Dentistry, University of health Sciences, Vientiane, Lao PDR. 5Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos PDR. Corresponding Author: Thiphavanh Vongxay, Department of Restorative, Faculty of Dentistry, University of health Sciences, Vientiane, Lao PDR. Citation of this Article: Thiphavanh Vongxay, Koukeo Phommasone, Soulideth Inthakone, Soutsada Songpadith, Souksida Xaykhambanh, Phimfalee Sayaxang, Viengsavanh Inthakoun, Amphaivanh Homsavath, Hue Vang, Thongsavanh Vetsouvanh, “Oral Health Status on among Pregnant Attending at Health Centers in Savannakhet Province, Lao PDR: A Cross Sectional Study”, IJDSIRDecember – 2025, Volume – 8, Issue – 6, P. No. 64 – 75. Copyright: © 2025, Thiphavanh Vongxay, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Background: Oral health behavior and attitudes of pregnant women in Lao PDR are rarely examined, yet should be considered when designing preventative or therapeutic studies to reduce burden of oral diseases we aimed to understand dental care-seeking behavior, as well as oral heath knowledge and attitudes of oral health among pregnant women in Savannakhet Province, Lao PDR. Methods: In this cross-sectional study, was conducted in 3 District Health centers Savannakhet Province Lao PDR lasting for 12 months by using a simple random sampling for select participants, we Included criteria: Pregnant women who attending at the Health centers and without underlying medical disease, we excluded criteria: Private cases and women who seropositive for human immunodeficiency virus, Pregnant women who have diabetes or underlying medical disease, Who do not give consent or uncooperative. Data was collected using interviewer administered questionnaires and a clinical oral examination Patient’s decayed, missing and filled tooth (DMFT) index, plaque index (PI) and community periodontal index (CPI) was determined by using STATA version 12 is used for statistical analysis. Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Page65 Results: A total of the 323 pregnant women invited to participate in the study. The age ranged from 15 to 45 year, with a mean age of 27.7 years (SD±5.6). The prevalence of dental disease in pregnant women such as tooth decayed, tooth missing and tooth filling. The tooth decayed of pregnant women was (69.9%), tooth missing was (30%) and tooth filling was (6.5%). The mean DMFT were (3.4±3.5), with (2.6±3) decayed teeth, (0.6±1.1) missing teeth, and (0.1±0.5) filled teeth. The oral hygiene status in pregnant women assessed with plaque index (PI). The PI of 270 participants that had plaque on the tooth surface (83.6%). The mean of their PI was (4.44±2.33). The periodontal disease in pregnant women assessed with community periodontal index. Almost (47.7%) of pregnant women presented with calculus, healthy gum was (32.8%). While this was (13%) found that calculus & bleeding. The prevalence of periodontal pockets >6mm was (1.9%), and periodontal pockets 4-5mm was (0.6%). The mean SD of CPI was (1.74±1.59) for the pregnancy. Conclusion: The study points to need for preventive programmes, including oral health education during prenatal care, to increase awareness of oral health among pregnant women and improve oral health practice. Keywords: Periodontal Disease, Oral Health Knowledge, Oral Health Behaviors, Dental Care Seeking Behavior, Pregnancy. Introduction Pregnancy is an important milestone in the life course of a female with the dual factors of pregnancy affecting oral health and oral health affecting the pregnancy outcome. Pregnant women are vulnerable to common oral diseases such as periodontal disease and dental caries; if oral health is not well maintained during this period there are implications for oral health in the woman’s subsequent life1. Changes in dietary habits and oral hygiene practices can increase the risk of tooth decay during pregnancy2. A woman’s knowledge of and action on her own oral health are important for the oral health of her children3. Children whose mothers have poor oral health are 5 times more likely to have oral health problems than children whose mothers have good oral health4. Pregnant women are readily accessible as most of them have regular antenatal check-ups. Furthermore, their key position in the family enables them to have a great influence over the behavior of family members and they play very important role in educating the young generation5. Thus, educating pregnant women on oral health can be an affective way of conveying dental health education to the general public, starting at the individual level, then to the family and finally to the community level6. Objective The Objective of this study therefore want to assess the oral health status, knowledge, and practices among a sample of pregnant Lao women in order to obtain the base line data needed to establish an oral health preventive programme during pregnancy. Methodology In this cross-sectional study, was conducted in 3 District Health centers Savannakhet Province such as Outhoumphone district, Kaisone district, Champhone district, Savannakhet Province Lao PDR. Started from January to December 2023 lasting for 12 months by using a simple random sampling for select participants. Included Criteria we Included criteria pregnant women who attending at the Health centers and without underlying medical disease. Excluded Criteria we excluded criteria private cases and women who seropositive for human immunodeficiency virus, Pregnant women who have diabetes or underlying Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 Page66 medical disease, Who do not give consent or uncooperative. Sample size calculation The sample size calculation is based on a formula for estimation of single proportion. The prevalence of oral disease in pregnant women consider to be 65%, based on study conducted in Laos7. Therefore it is used for calculation of sample size. n = 𝑧2𝑝(1 − 𝑝) 𝑒2 n= Sample size z= Standard normal deviate of 1.96 for a confidence level set as 95% p= Anticipated proportion for oral disease e= Absolute precision required of the proportion. n = 1.962× 0.65(1 − 0.65) 0.052=349.52 n  350 To compensate 10% non respondents, Sample size = 350+10% n= 385. Data Collection process The participants were approached via their respective HC with the prior approval of the relevant. Wrote inform consent from the selected participants. After gave inform consent, all eligible pregnant women were sent to the location provided. The research is composed of two parts: face to face interview and clinical examination. Face to face interview: A structure questionnaire was use to assess their knowledge of oral health and appropriate behaviors. To conduct interviews using the structure questionnaire, which include queries about personal history, oral health knowledge and oral health behaviors. Clinical examination: DMFT (decay, missing, filling, tooth) index was use to evaluate dental caries, the dentists determine according to World Health Organization (WHO) criteria by using disposable plane mouth mirrors and probes. The results were recorded in oral health assessment forms designed by WHO 20138. To evaluate oral hygiene, the dentists determine the PI (Plaque index) introduced by Loe and Silness by using disposable plane mouth mirrors and dental explorers9. Examine four gingival areas such as disto-buccal, buccal, mesio-buccal and lingual of the teeth number 16, 12, 24, 36, 32 and 44. If one of the mentioned teeth is not present all the teeth will be examined. Then determine the score of each gingival area of the tooth base on the presence of plaque on the cervical third of the tooth as below: Score 0: No plaque, Score 1: A layer of plaque adhered to the free margin of gingiva and adjacent area of the tooth that could be seen only by probing, Score 2: Moderate accumulation of soft deposits within the gingival pocket, or on the tooth or gingival margin that could be seen with the naked eye, Score 3: Large amount of soft material with the gingival pocket, or on tooth or gingival margin. The mean of the scores given to the four gingival area of the examined tooth is consider as the PI of the tooth. The PI of each patient is determine by calculating the mean of the PI of all examine teeth. CPI (Community Periodontal index) was use to evaluate the patient gingival health status. The dentist determined the index after probing the teeth number 11, 16, 17, 26, 27, 31, 36, 37, 46 and 47. Dentist used a WHO probe to measure the depth of gingival sulcus of the index tooth. If one of the teeth is not present were examined the depth of gingival sulcus of all teeth presenting in that sextant of the mouth. After probing, give score the gingiva of each index tooth as follow Score 0: Healthy gingiva, Score 1: Gingival bleeding, Score 2: Calculus and gingival bleeding, Score 3: Shallow periodontal pockets (4 to 5 mm), Score 4: Deep periodontal pockets (6 mm or more). The patients CPI were determined as the highest score given to their gingiva10. Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Page67 Data Analysis STATA version 12 is used for statistical analysis. The data presentations consist of computation of frequency and percentages of variables, descriptive statistics such as mean, SD and 95% CI. A percentage is used to describe the prevalence of oral disease mean, SD are determined for DMFT, PI and CPI. Statistical significance is set at P<0.05. Results Descriptive data A total of the 323 pregnant women invited to participate in the study. The age ranged from 15 to 45 year, with a mean age of 27.7 years (SD±5.6). The majority of the participants were in the age range of 18-35 years (89.5%). Of the 323 participants were low land ethic group (96.9%). Most participants had 1st, 2nd or 3rd pregnancy, which was equal distribution (52.3%, 29.4%, and 10.2%). About (8%) of the participants had no schooling, (11.1%) had up to primary school, (46.7%) had high school and (34%) had higher education. Most participants (53.6%) were house wife, and (25.4%) were employed. About (42.4%) of the women were in their second trimester of pregnancy. Oral health knowledge Oral health knowledge of the participants, the majority of the women (40.2%) agreed that tooth brushing prevents bad smell, (35.9%) thought that the routines, (20.4%) prevents tooth decay and only (3.4%) thought that brushing was prevents gum disease and. Most of the women (58.5%) believed that the main cause of tooth decay was sugar and carbohydrate consumption, (24.5%) thought that was another cause and (17%) cause was bacteria. Just over haft (55.1%) of the women thought that tooth decay could be prevented by tooth cleaning and brushing, while (25.4%) thought it could be prevented by tooth brushing and regular checkups. A majority of the women (53.3%) thought that the cause of gum disease was tooth debris and unclean teeth and (40.2%) thought that gum disease could be prevented by tooth cleaning and brushing. The main sources of oral health knowledge were outdoor advertising (27.9%), television (25.7%), Dentist (15.2%) and family (12.7%). Oral health practices Oral health practices of the participants, the majority of the women (71.8%) reported that they brushed their teeth twice a day, while (26%) brushed more than twice a day and only (7%) brushed once a day. The most other oral hygiene method (40.6%) was used mouth wash and (24.1%) used toothpicks. A large proportion of the women (69%) had never visited a dentist in their life and (31%) they had visited a dentist before pregnancy, their main reason was scaling (8.7%). Only (13.6%) of the pregnant women had visited a dentist during pregnancy, the main reason for the visit was check-up. Of the 279 women who had not visited the dentist during pregnancy, (38.8%) had not time to visit the dentist, and (14.9%) they did not think that they needed dental care. Clinical examinations The prevalence of dental disease in pregnant women such as tooth decayed, tooth missing and tooth filling. The tooth decayed of pregnant women was (69.9%), tooth missing was (30%) and tooth filling was (6.5%). The mean DMFT were (3.4±3.5), with (2.6±3) decayed teeth, (0.6±1.1) missing teeth, and (0.1±0.5) filled teeth. The oral hygiene status in pregnant women assessed with plaque index (PI). The PI of 270 participants that had plaque on the tooth surface (83.6%). The mean of their PI was (4.44±2.33). The periodontal disease in pregnant women assessed with community periodontal index. Almost (47.7%) of pregnant women presented with calculus, healthy gum was (32.8%). While this was (13%) found that calculus & bleeding. The prevalence of Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 periodontal pockets >6mm was (1.9%), and periodontal pockets 4-5mm was (0.6%). The mean SD of CPI was (1.74±1.59) for the pregnancy. Table 1: Demographic data of the participants (n=323) Variable No % Age (Years) <18 6 1.9 18-35 289 89.5 >35 28 8.7 Mean (SD) 27.7 (5.6) Ethnic group High land 8 2.5 Middle land 2 0.6 Low land 313 96.9 Number of Pregnancy 1st 169 52.3 2nd 95 29.4 3rd 33 10.2 4th 18 5.6 5th 4 1.2 6th 3 0.9 7th 1 0.3 Educational level No schooling 26 8.0 Primary school 36 11.1 Secondary 63 19.5 High school 88 27.2 College 53 16.4 Bachelor’s degree & higher 57 17.6 Occupation House wife 173 53.6 Factory employee 11 3.4 Government employee 43 13.3 Private employee 28 8.7 other 68 21.1 Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Trimester of pregnancy 1st 52 16.1 2nd 137 42.4 3rd 134 41.5 Table 2. Oral health knowledge of pregnant women in Savannakhet province (n=323) Variable n % Advantages of tooth brushing Prevents bad smell 130 40.2 Prevents tooth decay 66 20.4 Prevents gum disease 11 3.4 Routines 116 35.9 Causes of tooth decay Sugar and carbohydrate consumption 189 58.5 Bacteria 55 17 Other 79 24.5 Methods to prevent tooth decay Tooth cleaning and brushing 178 55.1 Avoidance of sweet and sugar 22 6.8 Tooth brushing and mouth wash after meals and sweets 41 12.7 Tooth brushing and regular check ups 82 25.4 Causes of gum disease Food debris and unclean teeth 172 53.3 Bacteria 18 5.6 I don’t know 108 33.4 Other 25 7.7 Methods to prevent gum disease Tooth cleaning and brushing 130 40.2 Tooth-brushing and mouth wash after meals 41 12.7 Tooth cleaning and regular check ups 61 18.9 Mouth wash 11 3.4 I don’t know 65 20.1 Other 15 4.6 Source of knowledge Television 83 25.7 Radio 14 4.3 Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Family 41 12.7 Dentist 49 15.2 Magazine 19 5.9 School curriculum 27 8.4 Outdoor advertising 90 27.9 Table 3. Oral health practice of pregnant women in Savannakhet province (n=323) Tooth brushing n % Once 7 2.2 Twice 232 71.8 More than twice 84 26 Other oral hygiene method None 63 19.5 Dental floss 26 8 Tooth picks 78 24.1 Mouth wash 131 40.6 Miswak 22 6.8 Other 3 0.9 Dentist visit before pregnant Yes 100 31 No 223 69 Reasons for visit before pregnancy Check-up 8 2.5 Scaling 28 8.7 Toothache 25 7.7 Gum problem 5 1.5 Filling 14 4.3 Prosthetic 20 6.2 Last visit In last 3-6 months 32 9.9 In last 6-12 months 19 5.9 More than 1 year 49 15.2 Never 223 69 Dentist visit during pregnancy Yes 44 13.6 No 279 86.4 Reasons for visit during pregnancy Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Page71 Check up 17 5.3 Scaling 6 1.9 Toothache 7 2.2 Gum problem 0 0 Filling 9 2.8 Prosthesis 0 0 Other 5 1.5 Reasons for not visit dentist during pregnancy Afraid of the dentist 5 1.5 No need 48 14.9 My baby or myself may be harmed 15 4.6 No time 119 36.8 Financial reasons 11 3.4 No dentist in my town 11 3.4 Other 70 21.7 Oral health problems during pregnancy Decay 38 11.8 Pain 29 9 Bleeding gums 35 10.8 Bad odor 59 18.3 Gums swelling 12 3.7 Sensitivity 31 9.6 Noting 119 36.8 How long to brushing teeth 1 minute 79 24.5 2 minutes 164 50.8 More than 2 minutes 80 24.8 How often to change toothbrush Monthly 181 56 Three monthly 137 42.4 Yearly 2 0.6 More than yearly 3 0.9 Thiphavanh Vongxay, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Page72 Table 4. Dental disease, Oral hygiene status and Periodontal disease of pregnant women in Savannakhet province (n=323) Dental disease n % mean ± SD Tooth decayed 200 61.9 2.6 ± 3.0 Tooth missing 97 30 0.6 ± 1.1 Tooth filling 21 6.5 0.1 ± 0.5 DMFT 3.4 ± 3.5 Oral hygiene status No plaque on the tooth surface 53 16.4 Plaque on the tooth surface 270 83.6 PI (mean ± SD) 4.44±2.33 Periodontal disease Healthy gum 106 32.8 Bleeding gum 13 4 Calculus 154 47.7 4-5mm pockets 2 0.6 >6 mm pockets 6 1.9 Calculus & bleeding 42 13 CPI (mean± SD) 1.74±1.59 DMFT decayed, missing, and filled teeth PI Plaque Index CPI Community Periodontal Index Discussion This cross-sectional study evaluated the oral health status of pregnant women living in Savannakhet province. The present study revealed that the rates of dental caries, poor oral hygiene, and periodontitis disease these findings were consistent with the study done by George A et al. 11and others12,13. Kornman and Loeshe reported that one - fourth of the women of reproductive age had tooth decayed, a disease in which dietary carbohydrate is fermented by oral bacteria into acid that de-mineralizes enamel14. Pregnant women are at a higher risk of tooth decay for several reasons. The possible causes of caries during pregnancy are: changes in saliva and mouth flora, vomiting, neglected oral hygiene and nutritional changes and inadequate attention to oral health15. This study shows that the prevalence of tooth decayed, oral hygiene, gingivitis and periodontal disease in pregnant women. The prevalence of dental caries and periodontal disease in pregnant women may vary among different populations. Deghatipour et al. reported mean (SD) DMFT of 10.34 (5.10) in pregnant women in Varamin, Iran16, and this is substantially higher than in our study. In contrast, a hospital-based study in Sudan reported mean DMFT of 3.49 in pregnant women who were >20 years old17. Payal et al.18 reported mean CPI score of 2.16 in pregnant women in central India, which is similar to our result; however, our study revealed that 2.5% of pregnancy had pockets 4-5mm and pockets >6mm, which is lesser than the 36% reported from the study of Ethiopian immigrants19. Ethnics, food culture,