Association Between Pregnant Women’s Knowledge of Oral Health Maintenance and Gingivitis Status: A Cross-Sectional Study in Surabaya, Indonesia
Abstract
Gingivitis is a common oral health condition during pregnancy and may be influenced by hormonal changes, oral hygiene practices, and knowledge of appropriate oral health maintenance. Inadequate knowledge may contribute to inappropriate preventive practices and increase the risk of gingival inflammation. This study aimed to determine the association between pregnant women’s knowledge of dental and oral health maintenance and their gingivitis status at Puskesmas Tembok Dukuh, Surabaya. A quantitative analytical observational study with a cross-sectional design was conducted among 36 pregnant women recruited using consecutive sampling. Knowledge was assessed using a structured 20-item questionnaire covering toothbrushing practices, fluoride toothpaste use, dietary habits, and routine dental examinations. Gingivitis status was clinically assessed using the Gingival Index based on the Loe and Silness method. Data were analyzed using Spearman’s correlation test with a significance level of 0.05. The results showed that 17 respondents (47.2%) had good knowledge, 12 (33.3%) had fair knowledge, and 7 (19.4%) had poor knowledge. Clinical examination showed that 15 respondents (41.7%) had mild gingivitis, 15 (41.7%) had moderate gingivitis, and 3 (8.3%) had severe gingivitis, while only 3 (8.3%) had healthy gingiva. Spearman’s correlation analysis demonstrated a statistically significant association between knowledge of dental and oral health maintenance and gingivitis status (p = 0.010; ρ = 0.426). Respondents with good knowledge predominantly presented with mild gingivitis, whereas moderate gingivitis was more frequently observed among those with fair or poor knowledge. These findings indicate that oral health knowledge is significantly associated with gingivitis status among pregnant women. Integrating oral health education, preventive counseling, and clinical oral health screening into antenatal care may strengthen maternal oral health promotion and support early prevention of gingival inflammation during pregnancy.
Full text article
References
[1] F. Yilmaz, O. C. Dorterler, S. E. Halici, B. Kasap, et al., “The effects of pregnancy on oral health, salivary pH and flow rate,” BMC Oral Health, vol. 24, no. 1, p. 1286, 2024, doi: 10.1186/s12903-024-05057-0.
[2] P. M. Pecci-Lloret, C. Linares-Pérez, M. R. Pecci-Lloret, F. J. Rodríguez-Lozano, and R. E. Oñate-Sánchez, “Oral manifestations in pregnant women: A systematic review,” Journal of Clinical Medicine, vol. 13, no. 3, p. 707, 2024, doi: 10.3390/jcm13030707.
[3] U. Schröter, D. Ziebolz, H. Stepan, and G. Schmalz, “Oral hygiene and oral health behavior, periodontal complaints and oral health-related quality of life in pregnant women,” BMC Oral Health, vol. 22, no. 1, p. 476, 2022, doi: 10.1186/s12903-022-02508-4.
[4] N. Navya, L. K. Chacko, R. P. Shenoy, et al., “Oral health status and quality of life among pregnant women with oral health problems: A descriptive study,” BMC Oral Health, vol. 25, p. 1264, 2025, doi: 10.1186/s12903-025-06654-3.
[5] Q.-A. Le, G. D. Eslick, K. M. Coulton, R. Akhter, G. Condous, J. Eberhard, and R. Nanan, “Does treatment of gingivitis during pregnancy improve pregnancy outcomes? A systematic review and meta-analysis,” Oral Health & Preventive Dentistry, vol. 19, pp. 565–572, 2021, doi: 10.3290/j.ohpd.b2183059.
[6] M. Radwan-Oczko, L. Hirnle, M. Szczepaniak, and I. Duś-Ilnicka, “How much do pregnant women know about the importance of oral health in pregnancy? Questionnaire-based survey,” BMC Pregnancy and Childbirth, vol. 23, p. 348, 2023, doi: 10.1186/s12884-023-05677-4.
[7] A. Tenenbaum and S. Azogui-Levy, “Oral health knowledge, attitudes, practices, and literacy of pregnant women: A scoping review,” Oral Health & Preventive Dentistry, vol. 21, 2023, doi: 10.3290/j.ohpd.b4100965.
[8] E. Chawłowska, M. Karasiewicz, A. Lipiak, R. Staszewski, et al., “Oral health behaviours, knowledge, and literacy of expectant mothers: A cross-sectional study among maternity ward patients,” International Journal of Environmental Research and Public Health, vol. 19, no. 18, p. 11762, 2022, doi: 10.3390/ijerph191811762.
[9] M. A. Javali, S. A. Saquib, M. A. Khader, I. Khalid, A. Y. AlShahrani, M. A. Kanji, and E. Asiri, “Oral health knowledge, attitude, and practice of pregnant women in Deccan, South India: A cross-sectional prenatal survey,” Journal of Medicine and Life, vol. 15, no. 3, pp. 420–424, 2022, doi: 10.25122/jml-2019-0095.
[10] M. G. Cagetti, C. Salerno, A. C. Ionescu, S. La Rocca, N. Camoni, S. Cirio, and G. Campus, “Knowledge and attitudes on oral health of women during pregnancy and their children: An online survey,” BMC Oral Health, vol. 24, p. 85, 2024, doi: 10.1186/s12903-023-03732-2.
[11] N. Phoosuwan, P. Bunnatee, and P. C. Lundberg, “Oral health knowledge, literacy and behavior of pregnant women: A qualitative study in a northeastern province of Thailand,” BMC Oral Health, vol. 24, p. 653, 2024, doi: 10.1186/s12903-024-04414-3.
[12] M. Deghatipour, Z. Ghorbani, A. H. Mokhlesi, S. Ghanbari, M. Namdari, et al., “Effect of oral health promotion interventions on pregnant women dental caries: A field trial,” BMC Oral Health, vol. 22, p. 280, 2022, doi: 10.1186/s12903-022-02292-1.
[13] A. N. Basheer, P. Jodalli, et al., “Effectiveness of motivational interviewing and cross platform messaging application in improving oral health knowledge, attitude and behaviours among pregnant women—A randomized controlled trial,” F1000Research, vol. 13, p. 871, 2024, doi: 10.12688/f1000research.153000.1.
[14] F. Mohammadkhah, R. Mardani Amirhajelu, M. Bakhtiar, S. Alempour Salemi, M. Kevenjan, et al., “The effect of training intervention based on the theory of planned behavior on oral and dental health behaviors in pregnant women,” BMC Oral Health, vol. 23, p. 521, 2023, doi: 10.1186/s12903-023-03239-w.
[15] N. C. Geurs, M. K. Jeffcoat, N. Tanna, M. L. Geisinger, S. Parry, et al., “A randomized controlled clinical trial of prenatal oral hygiene education in pregnancy-associated gingivitis,” Journal of Midwifery & Women’s Health, vol. 68, no. 4, pp. 507–516, 2023, doi: 10.1111/jmwh.13486.
[16] N. M. von Helde, M. L. Martins, M. da C. Motta, T. F. de Souza, M. B. Magno, L. C. Maia, and A. Fonseca-Gonçalves, “Are educational tools in oral health programs for pregnant women effective in improving the oral status of mothers and babies? A systematic review,” Evidence-Based Dentistry, vol. 25, p. 216, 2024, doi: 10.1038/s41432-024-01043-1.
[17] U. S. Bhadauria, S. Singh, P. Paswan, P. Bhattacharya, B. Purohit, and H. Priya, “Assessment of the quality of guidelines on oral health care during pregnancy: A systematic review,” Evidence-Based Dentistry, vol. 25, pp. 214–215, 2024, doi: 10.1038/s41432-024-01046-y.
[18] Y. Mohammadi Kamalabadi, M. K. Campbell, N. M. Zitoun, et al., “Unfavourable beliefs about oral health and safety of dental care during pregnancy: A systematic review,” BMC Oral Health, vol. 23, p. 762, 2023, doi: 10.1186/s12903-023-03439-4.
[19] S. Ahmed, H. Shah, A. Hussain, S. Riafat, M. N. Shaheen, et al., “Challenges in oral health referral during pregnancy: Perspectives from antenatal and dental care providers,” BMC Oral Health, vol. 25, p. 858, 2025, doi: 10.1186/s12903-025-06285-8.
[20] T. M. Williams, A. E. Babalola, O. Bolarinwa, V. A. Somoye, O. A. Azeez, et al., “Oral health knowledge, perceptions and attitudes of pregnant women in Sub-Saharan Africa: A systematic review,” BMC Oral Health, vol. 25, p. 937, 2025, doi: 10.1186/s12903-025-06249-y.
[21] A. Sharma et al., “A Consensus-Based Checklist for Reporting of Survey Studies (CROSS),” Journal of General Internal Medicine, vol. 36, no. 10, pp. 3179–3187, 2021, doi: 10.1007/s11606-021-06737-1.
[22] T. M. R. B. de Oliveira et al., “Correlation and causation for cardiothoracic surgeons: part 4—distinguishing relationships in data,” European Journal of Cardio-Thoracic Surgery, 2025.
[23] P. Bunnatee et al., “Factors associated with oral health care behaviors of pregnant women in a northeastern province in Thailand: A hospital-based cross-sectional study,” PLOS ONE, vol. 18, no. 8, e0290334, 2023, doi: 10.1371/journal.pone.0290334.
[24] M. A. Pecci-Lloret et al., “Relationship between oral health knowledge and maternal oral health with obstetric risk and breastfeeding,” International Journal of Environmental Research and Public Health, vol. 19, no. 13, p. 7797, 2022, doi: 10.3390/ijerph19137797.
[25] M. Radwan-Oczko, L. Hirnle, M. Szczepaniak, and I. Duś-Ilnicka, “How much do pregnant women know about the importance of oral health in pregnancy? Questionnaire-based survey,” BMC Pregnancy and Childbirth, vol. 23, p. 348, 2023, doi: 10.1186/s12884-023-05677-4.
[26] U. Schröter, D. Ziebolz, H. Stepan, and G. Schmalz, “Oral hygiene and oral health behavior, periodontal complaints and oral health-related quality of life in pregnant women,” BMC Oral Health, vol. 22, p. 476, 2022, doi: 10.1186/s12903-022-02508-4.
[27] M. Seyyedi et al., “Knowledge and attitude of pregnant women in Urmia, Iran, about oral health care during pregnancy,” Clinical and Experimental Dental Research, 2023, doi: 10.1002/cre2.804.
[28] M. Gammulle et al., “Periodontal health among pregnant women in Sri Lanka: A cross-sectional study,” Public Health Challenges, 2024, doi: 10.1002/puh2.209.
[29] W. Hu, Y. Wang, R. Chen, and T. Pan, “Oral health status and literacy/knowledge amongst pregnant women in Shanghai,” International Dental Journal, vol. 73, no. 2, pp. 212–218, 2023, doi: 10.1016/j.identj.2022.06.005.
[30] L. Gavic, A. Maretic, S. Putica, and A. Tadin, “Attitudes and knowledge of pregnant women about oral health,” Journal of Education and Health Promotion, vol. 11, p. 77, 2022, doi: 10.4103/jehp.jehp_382_21.
[31] A. Tenenbaum and S. Azogui-Levy, “Oral health knowledge, attitudes, practices, and literacy of pregnant women: A scoping review,” Oral Health & Preventive Dentistry, vol. 21, pp. 185–198, 2023, doi: 10.3290/j.ohpd.b4100965.
[32] P. Bunnatee, F. I. Abdulsalam, and N. Phoosuwan, “Factors associated with oral health care behaviors of pregnant women in a northeastern province in Thailand: A hospital-based cross-sectional study,” PLOS ONE, vol. 18, no. 8, e0290334, 2023, doi: 10.1371/journal.pone.0290334.
[33] M. G. Cagetti, C. Salerno, A. C. Ionescu, S. La Rocca, N. Camoni, S. Cirio, and G. Campus, “Knowledge and attitudes on oral health of women during pregnancy and their children: An online survey,” BMC Oral Health, vol. 24, p. 85, 2024, doi: 10.1186/s12903-023-03732-2.
[34] N. Phoosuwan, P. Bunnatee, and P. C. Lundberg, “Oral health knowledge, literacy and behavior of pregnant women: A qualitative study in a northeastern province of Thailand,” BMC Oral Health, vol. 24, p. 653, 2024, doi: 10.1186/s12903-024-04414-3.
[35] N. C. Geurs et al., “A randomized controlled clinical trial of prenatal oral hygiene education in pregnancy-associated gingivitis,” Journal of Midwifery & Women’s Health, vol. 68, no. 4, pp. 507–516, 2023, doi: 10.1111/jmwh.13486.
[36] P. M. Pecci-Lloret et al., “Oral manifestations in pregnant women: A systematic review,” Journal of Clinical Medicine, vol. 13, no. 3, p. 707, 2024, doi: 10.3390/jcm13030707.
Authors
Copyright (c) 2026 Sutra Aulia Damayanti, drg. Sri Hidayati. M.Kes, Dr. Imam Sarwo Edi, S.Si.T., M.Kes, Sunomo Hadi, S.Si.T., M.Kes, Mohammed Ismath
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlikel 4.0 International (CC BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).