The overall awareness of pregnant women about children’s orodental health was low in their first pregnancy. Therefore, the null hypothesis of the study was rejected.
Since children’s behaviors during the early days of life form their lifestyle and attitudes in adulthood and considering the role of deciduous teeth in children’s general health, increasing the knowledge of breastfeeding mothers has a critical role in decreasing dental caries rate in the community. Therefore, parents, especially mothers, have a pivotal role in their children’s orodental health, and their awareness can establish healthy behaviors in their children . In the present study, pregnant women's awareness was evaluated in five domains, including awareness of children’s orodental health, awareness of children’s orodental problems, awareness of children’s dental caries, awareness of prevention and dental treatments, and awareness of the proper time to refer to a dentist. The highest awareness was recorded in the domain on children’s orodental health, and the lowest was recorded in awareness about the proper time to refer to a dentist.
Determining the mean awareness score of mothers during their first pregnancy about children’s orodental health showed that the mean score on ‘children’s orodental health’ was 0.442±0.301; i.e., >50% of the mothers had proper knowledge in this domain or had no knowledge, with the least frequency of misinformation. Consistent with the present study, studies by Chu et al.  and Lloyd et al.  showed a moderate level of mothers’ awareness about children’s orodental health, which might be explained because studies in this field have shown that cultural factors and the geographic location do not affect the results, and mothers exhibited a moderate level of awareness about children’s orodental health.
The mean score of the mothers’ awareness about ‘children’s orodental problems’ was 0.936±0.238. Besides, the mothers’ awareness about the adverse effects of alcohol use and cigarette smoking during pregnancy and the use of pacifiers or thumb sucking on children’s orodental problems was higher than other fields, and the lowest awareness related to the effect of mothers’ viral diseases during pregnancy on children’s dental problems. Also, concerning tooth eruption, the mothers exhibited the highest misinformation. Consistent with the present study, a study by Retnakumari et al.  showed a significant relationship between sleeping with a pacifier and the incidence of dental problems in children, with the mothers participating in the study being aware of the problem. Therefore, the mothers in both these studies were aware of children’s orodental problems and the etiologic factors involved and were able to help improve their children’s orodental health by decreasing the factors responsible for these problems. Therefore, it might be concluded that mothers can help prevent and solve their children’s orodental problems by gaining knowledge about these problems and taking the necessary precautions.
The mothers’ mean awareness score for ‘children’s dental caries’ was 0.375±0.205. Evaluation of the questions in this domain showed that the mothers were aware that breastfeeding and use of a milk bottle nightlong led to dental caries in children and giving water to the child after feeding him/her with milk and attention to the restoration and preservation of deciduous teeth can decrease dental caries in children. In this context, Togoo et al.  showed that almost half of the mothers fully agreed that giving milk to the child immediately before sleep causes dental caries. In contrast, the participants had low awareness and wrong beliefs about sharing a spoon between the mother and infant and the adverse effects of iron drops on children’s dental caries. Mazaheri et al.  reported that mothers in Shiraz believed that iron drops were the primary etiologic agent for dental caries. In addition, they provided correct responses about the deciduous teeth’ lack of need for restoration because they shed spontaneously, which is different from a study by Sultan et al. 
The mothers’ mean awareness score about ‘prevention and dental treatments’ was 0.315±0.347. On the other hand, the frequency distribution of the responses to the questions in this domain showed that mothers had moderate awareness about fluoride therapy at 18–24 months of age; however, they had misinformation and insufficient knowledge about preventive measures for dental caries and the effect of using xylitol chewing gums during pregnancy. Consistent with the present study, two studies by Thakare et al.  and Mounissamy et al.  showed that mothers were unaware of the benefits of oral hygiene habits and preventive measures and dental treatments. Besides, a study by Mani et al.  in Malaysia showed that only 1.96% of parents had positive attitudes towards routine examinations by dentists to prevent children's dental caries. However, the study by Mazaheri et al.  showed that more than half of the mothers of 1 to 3-year-old children in Shiraz had proper knowledge about the therapeutic use of fluoride, such as fluoride varnishes in children, which is different from the present study. Such a discrepancy might be attributed to the statuses of the mothers evaluated, the city they resided in, etc. because in the present study, only pregnant women in their first pregnancy were evaluated. Mothers with several pregnancies and raising their children might have exhibited different knowledge levels because their experience would increase to help them gain adequate information in raising their children. Mothers in their first pregnancy might not have adequate knowledge in this field. Therefore, it is necessary to train these women during pregnancy and provide them with information in this field. Educating children in dental and oral care and observing oral hygiene by young children is considered an investment in children’s health with long-term benefits. Therefore, mothers must pay adequate attention to these subjects and issues and gain adequate knowledge because parents, especially mothers, have a crucial role in improving their children's oral hygiene habits. Previous studies have also provided ever-increasing evidence about bacteria's role, especially Streptococci, in inducing dental caries. Streptococcus mutans can produce large amounts of acid, is highly durable in acidic environments, and is mainly responsible for dental caries in human beings. This bacterial species is more prevalent in pregnant women, which is very important because pregnant women can transmit infections to the fetus, causing unfavorable complications. Therefore, preventive measures should be adopted in pregnant women.
The mothers’ score on awareness about ‘the correct time to refer to a dentists’ was 0.157±0.295, with many mothers having misinformation or inadequate knowledge in this respect.
The mothers in this study had the least awareness about the correct time to take their children to a dentist. Mazaheri et al.  reported that only 8.9% of mothers were aware that a dentist should examine their infants before one year of age, and most mothers were not aware of this, consistent with studies by Thakare et al.  and Mounissamy et al. .
Besides, the mothers participating in the present study were unaware of the proper pregnancy trimester during which non-emergency dental procedures could be carried out, consistent with studies by Kandan et al.  and Gonik et al. . Considering these two studies and since pregnancy might increase susceptibility to gingival diseases and dental caries and by considering the misinformation, many pregnant women believe that routine dental treatments are dangerous to the fetus, and it is necessary to provide them with the necessary information and ask them to refer to a dentist at the correct time by the care providers. This can decrease the complications of gingival diseases, including increased risk of low birth weight.
The mother’s mean score on their ‘overall awareness of children’s orodental health’ was 8.66±4.33. Consistent with the present study, Mohebbi et al.  reported mothers’ low awareness despite using various data sources about children’s oral health. Besides, studies by George et al.  and Pothnie et al.  are consistent with the present study.
Torabi et al.  evaluated the awareness and performance of mothers concerning children’s orodental health. A total of 400 mothers were included in the study in Kerman. The results showed that mothers’ awareness about children’s orodental health was favorable, which is different from the present study results. Such a discrepancy might be attributed to differences in sample sizes between the two studies and inattention to the number of pregnancies.
Finally, evaluating the relationship between demographic factors, such as age, educational level, and family’s economic status with mothers’ scores of overall knowledge about children’s orodental health, showed a direct and significant relationship between mothers’ age and their knowledge about children’s orodental health. However, Nazari et al.  showed no significant relationship between mothers’ age and their knowledge and attitude scores about children’s orodental health. Although the results of the studies above are different from the present study concerning the results of the present study, it might be pointed out that since younger mothers have inadequate knowledge about children’s orodental health and the relevant care due to their inadequate experience, mother’s aging has resulted in increased awareness about their children’s orodental health.
Furthermore, mothers’ educational level exhibited a direct and significant relationship with their knowledge about children’s orodental health. Nagarajapa et al.  reported from India that mothers with low educational level had poor knowledge and attitudes towards children’s orodental health; in contrast, mothers with higher educational levels exhibited positive attitudes towards children’s orodental health and had good performance concerning the care of their children’s teeth, with a significant relationship between knowledge and mothers’ educational level. To explain this finding, education is one of the most critical socio-economic parameters that affect knowledge, attitudes, and the necessary skills to adopt proper health-related behaviors. Therefore, educated parents are more sensitive about their children’s health, resulting in more regular visits to evaluate health status. The family’s economic status was significantly related to the mothers’ overall knowledge about their children’s orodental health. Consistent with the present study, Kallestal et al.  reported a direct correlation between the economic status, gender, residential area, ethnicity, social status, and parents’ occupation with the parents’ performance concerning their children’s orodental health. To explain this finding, there was a significant relationship between the economic status and the overall awareness of mothers about children’s orodental health. Besides, according to previous studies, a better economic status of mothers and their employment results in their higher rate of communication with other community members and their access to data sources and better education, increasing their awareness and improving their performance concerning their children’s orodental health.
The present study evaluated only pregnant women referring to the private obstetrics offices and clinics in Isfahan, which is considered one of the present study's limitations. Since the data collection tool in the present study was a questionnaire, some participants might not have provided accurate responses to the same questions. It is suggested that similar studies be carried out in different cities of the country with larger sample sizes to evaluate whether these findings are valid in other parts of the country or not. Since many children <6 years of age are looked after in kindergartens, it is suggested that a similar study be carried out to evaluate the kindergarten nurses’ awareness of children’s orodental health.