Condição de saúde bucal de gestantes atendidas no Sistema Único de Saúde de Ponta Grossa –PR: estudo comparativo segundo o risco gestacional

Abstract

During pregnancy, women face physiological and psychological changes which can lead to damage for the baby’s health, at birth and later. The present study aimed to characterize and compare the oral health condition, the need for dental treatment (clinical and self-reported), and their impact on quality of life of women with low and high risk pregnancies, who underwent prenatal care at the Unified Health System in the municipality of Ponta Grossa - PR from 2017 to 2020. A cross-sectional study was carried out with a non-probabilistic convenience sample of 405 pregnant women, stratified into two groups according to their gestational risk, who answered a structured questionnaire about sociodemographic characteristics, self-reported oral health condition and need of dental treatment (“are you currently having any oral problems?” and “do you think you need any oral treatment?”), and the impact of oral condition on quality of life through OHIP-14 instrument (Oral Health Impact Profile). Clinical evaluation of caries experience and need for dental treatment was performed using the DMF-T index (Decayed, Missing and Filled Teeth), of periodontal condition using the CPI index (Community Periodontal Index) and of oral hygiene using the SOH-I (Simplified Oral Hygiene Index). Categorical data were analyzed using Pearson's Chi-square and Z tests, with Bonferroni's post-test. The differences between continuous variables were verified with the Mann-Whitney U test. The analysis of bivariate associations between exposure (gestational risk) and the outcomes (clinical and self-reported oral condition and dental treatment need) were estimated by prevalence ratios, through Poisson robust regression analysis, with 95% confidence interval. No significant differences were identified between low and high risk pregnant women regarding self-perceived oral health and dental treatment need. As for clinical conditions, there was no differences between groups regarding the presence of decayed teeth or the need for restorative treatment. However, the impact of oral health on quality of life (OHIP-14) was higher among women with high-risk pregnancies (p = 0.047), as well as the DMFT index (p <0.001), the presence of restored teeth (p = 0.012) and poor oral hygiene (p = 0.003). Low-risk pregnant women, in turn, had a greater amount of sextants with calculus and periodontal pockets (p <0.001), and more need for endodontic treatment and extractions (p = 0.003). These outcomes remained associated with gestational risk even after being controlled for age, gestational trimester, having more children or not, skin color/race and educational level, except the impact on quality of life, which did not show any difference between the groups after controlling. Despite the higher experience of caries, high-risk pregnant women showed better oral conditions. However, the greater amount of biofilm present in this group indicates that factors related to gestational risk can negatively interfere with oral hygiene, which demands attention from the health team during dental prenatal care.