Socio-demographic characteristics
A total of 346 healthcare professionals participated in this online study. The socio-demographic characteristics of the participants included age, gender, ethnicity, occupation, and year of work experience (Table 1). More than a third of the participants were of age ranging from 31 to 40 years old (39.5%). Most of the healthcare professionals that took part in the survey were females (91.8%) and were of Malay ethnicity (81.9%). Almost a third of the total number of healthcare professionals who participated were nurses (37.8%).
Table 1
Demographics characteristics of the healthcare professionals recruited
Variables | n | % |
Age (years) (n = 261) | | |
20–30 | 39 | 14.9 |
31–40 | 103 | 39.5 |
41–50 | 70 | 26.8 |
More than 50 | 49 | 18.8 |
Gender (n = 281) | | |
Male | 23 | 8.2 |
Female | 258 | 91.8 |
Ethnicity (n = 282) | | |
Malay | 231 | 81.9 |
Chinese | 10 | 3.5 |
Indian | 3 | 1.1 |
Others | 38 | 13.5 |
Occupation (n = 275) | | |
Doctor | 31 | 11.3 |
Nurse | 104 | 37.8 |
Midwife | 49 | 17.8 |
Nurse (Midwife) | 66 | 24.0 |
Dentist | 10 | 3.6 |
Dental Hygienist and Therapist | 15 | 5.5 |
Work Experience (n = 262) | | |
< 10 years | 104 | 39.7 |
> 10 years | 158 | 60.3 |
Participants’ inclusion of dental/oral health history questions
More than half of the healthcare professionals (59.0%) responded that they did include dental/oral health questions in the health assessment of their prenatal/antenatal patients. The top three healthcare professionals with the most prevalence of including dental/oral health questions were dentists (87.5%), dental hygienist and therapists (72.7%), and nurses (58.1%). About two-thirds of the participants had a working experience of over 10 years (64.0%). There was a significant association between age, occupation and year of work experience with the inclusion of dental/oral health history questions in the health assessment of their prenatal/antenatal patients. In terms of age, there was significantly higher assessment of dental/oral health history of prenatal/antenatal mothers for those over 40 years old (68.1% of those 41 to 50 years old vs. 42.0% of those 31 to 40 years old) (p < 0.001). In terms of occupation, the highest significance of the assessment of dental/oral health history was by the dentists whereas lowest significance measured was by doctors (87.5% of dentists vs. 10.5% of doctors) (p = 0.001). In terms of year of working experience, a significantly higher assessment of dental/oral health history was done by the healthcare professionals who had over 10 years of working experience (64.0% more than 10 years of work experience vs. 38.4% less than 10 years of work experience) (p < 0.001).
Participants’ willingness to add dental/oral related questions
Most of the participants (89.1%) responded that they were willing to add questions regarding dental/oral health to their health assessments. The top three healthcare professionals who responded with their willingness to add dental/oral health questions were doctors (100.0%), midwives (100.0%), and nurses (94.1%). Though, no significant association had been identified between these variables with the willingness to add dental/oral health questions.
Participants’ frequency on discussing the importance of dental/oral health in prenatal/antenatal care
A third of the healthcare professionals (32.3%) responded that they only did it sometimes, 18.5% responded with ‘always’, whereas 16.2% responded with ‘frequently’. The results from the responses of healthcare professionals on sometimes discussing with the prenatal/antenatal patients was significantly associated with age, occupation and year of working experience. In terms of age, a significantly higher association was for those over 40 years old (45.5% of those 41 to 50 years old vs. 25.0% of those more than 50 years old) (p < 0.001). In terms of occupation, there was significantly higher frequency of discussion done by the nurse (midwives) (47.8% of nurse (midwives) vs. 0.0% dentists) (p < 0.001). In terms of year of working experience, those who had over 10 years of working experience had higher significance compared to those who had less than 10 years of work experience (40.6% more than 10 years of work experience vs. 25.3% less than 10 years of work experience) (p < 0.001).
Participants’ practice of looking into patient’s mouth for signs of dental/oral problems
Just over a quarter of the healthcare professionals (26.2%) responded that they looked into their patients’ mouth for any signs of dental/oral problems. The most prevalence of healthcare professionals that did look into their patients’ mouth was nurse (midwives) (25.0%) whereas the least prevalence of healthcare professional that looked into the patients’ mouth were doctors (13.0%). Though, there was no significant association between occupations with looking into the patients’ mouth. Significant association had been found between looking into the patients’ mouth with age and year of work experience. In terms of age, there was significantly higher significance for those more than 50 years old (36.8% of those more than 50 years old vs. 16.1% of those 20 to 30 years old) (p = 0.016). In terms of year of work experience, there was a higher significance for those who had over 10 years of working experience (23.4% more than 10 years of work experience vs. 15.1% less than 10 years of work experience) (p = 0.003).
Table 2
Factors associated with the healthcare professionals’ incorporation of dental/oral care in their prenatal/antenatal patients’ health assessments. (n = 346)
| n (%) |
1. Does your prenatal/antenatal patient health assessment include questions regarding dental/oral health history? (YES) | 204 (59.0) |
2. If Yes to Question 1, how willing are you to add a question to your health assessment regarding patient dental/oral health history? [Willing/Very willing] | 156 (89.1) |
3. How often do you discuss with your patients the importance of dental/oral health as being a part of their prenatal/antenatal care? | |
Always | 72 (18.5) |
Frequently | 63 (16.2) |
Sometimes | 126 (32.3) |
4. During the prenatal/antenatal visit/administration to the ward, do you look in your patient’s mouth for signs of dental/oral health problems? [Applicable for all respondents except for Dentists and Dental Hygienist and Therapist] | 97 (26.2) |
Participants’ reasons regarding their action on looking/not looking into patient’s mouth
Almost three-quarters of the healthcare professionals (73.3%) responded with having dental/oral health screenings integrated for their prenatal/antenatal patients at their clinic as being their reason for looking into their patients’ mouth to look for dental/oral problems. The highest prevalence of healthcare professionals who responded with this option were nurses (84.6%) and those who had more than 10 years of working experience (73.0%). Though, there was no significant association between occupation and year of work experience with having dental/oral health screenings integrated at their clinic. There was significant association between having dental/oral health screenings with age. Healthcare professionals aged more than 40 years old had more dental/oral health screenings at their clinic (83.3% of those 41 to 50 years old vs. 20.0% of those 20 to 30 years old) (p = 0.041).
Most participants responded with not being trained to complete dental/oral health screenings as being their reason for not doing so (85.5%). All doctors (100.0%) responded with this as being their reason. Almost all healthcare professionals who had less than 10 years of work experience (92.1%) also responded with this as being their reason. Though, no significant association had been identified between choosing this option as their reason with occupation and year of work experience. Not believing that dental/oral health was an important component of prenatal/oral health was the least chosen as to being the reason for them not to conduct dental/oral health screenings (13.7%). The results from the response that they did not believe dental/oral health was an important component for prenatal/antenatal health was significantly associated with ethnicity. All healthcare professionals who were of Indian ethnicity responded with this option (100.0% are of Indian ethnicity vs. 0.0% are of Chinese and others ethnicity) (p = 0.013). 51.3% of the healthcare professionals responded with not having the time to do dental/oral health screenings during their prenatal/antenatal patients’ appointments. There was a significant association between these options as being their reason for not looking into their prenatal/antenatal patients’ mouth with age. In terms of age, there was a significantly higher number of healthcare professionals who were of age more than 50 years old that responded with not having the time (81.8% of those more than 50 years old vs. 39.1% of those 41 to 50 years old) (p = 0.034).
Table 3
Factors associated with the healthcare professionals’ decision to look into prenatal/antenatal patients’ mouth to look for dental/oral problems [Applicable for all respondents except for Dentist and Dental Hygienist and Therapist]. (n = 321)
| n (%) |
5. If Yes to Question 4, what helped you decide to do this? Please choose all that apply | |
a) I know dental/oral health is an important component of prenatal/antenatal health care | 108 (93.1) |
b) I know dental/oral health is an important component for infant health | 95 (91.3) |
c) I could visibly see a dental/oral health problem | 87 (83.7) |
d) I have received training and feel competent to deliver a prenatal/antenatal dental/oral health | 28 (27.7) |
e) Dental/Oral health screenings are integrated into prenatal/antenatal care plans at the clinic where I practice | 74 (73.3) |
f) The patient mentioned a dental/oral health issue/problem | 86 (78.2) |
6. If No to Question 4, please tell us why you do not do this? Please choose all that apply | |
a) I don’t believe it’s an important component of prenatal/antenatal health care | 25 (13.7) |
b) I do not have time to complete dental/oral health screenings during prenatal/antenatal care appointments | 97 (51.3) |
c) I have not received training to complete dental/oral health screenings | 207 (85.5) |
d) I do not feel competent completing dental/oral health screenings on my prenatal/antenatal patients | 163 (74.4) |
e) This procedure is not included in my scope of practice | 212 (82.8) |
Participants’ frequency on receiving referrals
More than half of the dental professionals (55.0%) responded that they sometimes received referrals of prenatal/antenatal patients. Most of the healthcare professionals (80.0%) (who responded with this answer) had more than 10 years of working experience. There was no significant association between the frequency of receiving referrals with year of work experience. However, there was a significant association with ethnicity, i.e., highest number of receiving referrals was among dentists with Indian ethnicity (100.0% Indian ethnicity vs. 0.0% Chinese and others ethnicity) (p = 0.007).
Table 4
Factors associated with dental/oral health assessments for Dentist and Dental Hygienist and Therapist only. (n = 25)
| n (%) |
i. Please choose all that apply; | |
a) I know dental/oral health is an important component of prenatal/antenatal health care | 19 (95.0) |
b) I know dental/oral health is an important component for infant health | 19 (95.0) |
c) I could visibly see a dental/oral health problem | 19 (95.0) |
d) I have received training and feel competent to deliver a prenatal/antenatal dental/oral health screening | 15 (75.0) |
e) Dental/Oral health screenings are integrated into prenatal/antenatal care plans at the clinic where I practice | 15 (75.0) |
f) The patient mentioned a dental/oral health issue/problem | 17 (89.5) |
ii. Please choose all that apply; | |
a) I don’t believe it’s an important component of prenatal/antenatal health care | 1 (5.0) |
b) I do not have time to complete dental/oral health screenings during prenatal/antenatal care appointments | 3 (15.0) |
c) I have not received training to complete dental/oral health screenings | 2 (10.0) |
d) I do not feel competent completing dental/oral health screenings on my prenatal/antenatal patients | 2 (10.0) |
e) This procedure is not included in my scope of practice | 8 (40.0) |
iii. How often do you get referrals of prenatal/antenatal patients? | |
Frequently | 1 (5.0) |
Sometimes | 11 (55.0) |
Participants’ practice of referring their patients to the dentist
More than half of the participants (54.3%) responded that they did refer their prenatal/antenatal patients to the dentist when they identified dental/oral problems. The top three prevalence of healthcare professionals who responded with this option were doctors (69.6%), nurses (51.1%), and midwives (50.0%). Though, there was no signification association between referring the prenatal/antenatal patients with occupation. 13.2% of healthcare professionals responded that they sometimes referred their prenatal/antenatal patients if they identified dental/oral problems. There was significant association between this decision with age, occupation, and year of work experience. In terms of age, there was a significantly higher association of this option with those aged between 20 to 30 years old (26.5% of those 20 to 30 years old vs. 8.8% of those 41 to 50 years old) (p = 0.007). In terms of occupation, the top three healthcare professionals who were of high significance were dentists (37.5%), nurse (midwives) (21.3%) and doctors (17.4%) (p = 0.029). In terms of year of work experience, there was a significantly higher association of referring the prenatal/antenatal patients with those who had less than 10 years of work experience (18.7% of those less than 10 years of work experience vs. 11.0% of those more than 10 years of work experience) (p = 0.007).
Participants’ reason for referring their patients
Most healthcare professionals responded that it was a professional obligation to refer the prenatal/antenatal patients (88.2%). Another highly chosen reason for referring the patients was that they had access to the list of dental/oral clinics that accepted referrals of the pregnant women (85.0%). The top three prevalence of healthcare professionals who chose this option as their reason were dental hygienist and therapists (100.0%), nurses (91.3%), and midwives (84.0%). Though, there was no significant association between choosing this reason with occupation. There was significant association between having access to a list of dental/oral clinics that accepted prenatal/antenatal patient referrals with ethnicity and year of work experience. In terms of ethnicity, there was highest significance for healthcare professionals of Indian and others ethnicity (100.0% of those are of Indian and others ethnicity) (p = 0.012). In terms of year of work experience, there was higher significance for those who had over 10 years of work experience (91.7% more than 10 years of work experience vs. 67.7% less than 10 years of work experience) (p = 0.005).
Participants’ reason for not referring their patients
More than three-quarters of healthcare professionals (76.7%) responded that referring their patients to the dental clinic was not part of their professional obligation. The top three prevalence of healthcare professionals who chose this as their reason were nurse (midwives) (94.7%), midwives (84.2%), and nurses (74.4%). Though, there was no significant association between this reason with occupation. 73.9% of healthcare professionals responded that they did not have referral arrangements. There was significant association between this response with occupation. In terms of occupation, there were two highest significant healthcare professionals which were nurse (midwives) (100.0%) and dental hygienist and therapists (100.0%) (p = 0.049).
Participants’ frequency on referring their patients to the dentist
More than a third of the healthcare professionals (36.5%) responded that they sometimes referred their prenatal/antenatal patients who were not receiving dental/oral care to the dentist. Most number of healthcare professionals who sometimes referred their patients was nurse (midwives) (43.1%). Though, there was no significant association between the frequency of referring prenatal/antenatal patients with occupation. There was significant association between this frequency of referrals with age. In terms of age, there was highest significant frequency of referrals for those over 40 years old (46.3% of those 41 to 50 years old vs. 22.5% of those more than 50 years old) (p = 0.040).
Table 5
Factors associated with referrals of prenatal/antenatal patients.
| n (%) |
7. During the prenatal/antenatal visit/admission to the ward, do you currently refer your patients to a dentist if a dental/oral health problem is identified? | |
Yes | 210 (54.3) |
Sometimes | 51 (13.2) |
8. If Yes to Question 7, what helped you decide to do this? Please choose all that apply | |
a) There is a list of Dental/Oral Clinics that accept referrals of pregnant women requiring dental/oral health care | 164 (85.0) |
b) Referring patients to a dental/oral clinic is a professional obligation | 172 (88.2) |
c) I work in a clinic/ward that is equipped to provide dental/oral health care | 103 (56.0) |
d) Professional dental/oral health care is integrated within my patients prenatal/antenatal care plan | 141 (78.8) |
9. If No to Question 7, please tell us why you do not currently refer your prenatal/antenatal patients to a dentist if a dental/oral health problem is identified. Please choose all that apply | |
a) I do not have referral arrangements with dentist(s) in my clinic/ward | 85 (73.9) |
b) The referral process is too time consuming | 40 (42.6) |
c) There is not enough time during a prenatal/antenatal care visit to discuss dental/oral referral options | 57 (58.8) |
d) This is not my professional obligation | 92 (76.7) |
10. How often do you refer your prenatal/antenatal patients to a dental/oral provider if they are not receiving dental/oral care? [Applicable for all respondents except for Dentist and Dental Hygienist and Therapist] | |
Always | 40 (11.0) |
Frequently | 47 (13.0) |
Sometimes | 132 (36.5) |
Participants’ professional referral arrangements
15.7% of healthcare professionals responded that they had established professional referral arrangements. There was significant association between this response with age. A higher significance was identified for those more than 50 years old (35.6% of those more than 50 years old vs. 5.7% of those 20 to 30 years old) (p = 0.003).
Participants’ collaboration/engagement in professional discussions
More than a third of the participants (37.4%) responded that they had collaborations and did engage in professional discussions with other healthcare professionals for the care of a mutual patient. The top three prevalence of healthcare professionals who engaged in collaborations and discussions were dentists (66.7%), nurses (55.6%), and nurse (midwives) (40.0%). Almost half of the healthcare professionals (41.5%) had work experience of over 10 years. Though, there was no significant association between having collaborations and engaging in professional discussions with occupation and year of work experience.
Participants’ frequency of collaborating/engaging in professional discussions
Less than two-thirds of the healthcare professionals (60.0%) responded that they engaged in these professional collaborations and discussions once a year. The most healthcare professionals who engaged in these collaborations was nurse (midwives) (85.7%). Almost three-quarters of the healthcare professionals (73.1%) had work experience of over 10 years. Though, there was no significant association between the frequency of engaging in professional collaborations with occupation and year of work experience.
Participants’ attitude towards enhancing their knowledge
Less than three-quarters of the healthcare professionals (71.5%) responded that they were interested to receive additional information regarding prenatal/antenatal dental/oral care. The top three prevalence of healthcare professionals who expressed their interest were dentists (100.0%), doctors (86.4%), and nurse (midwives) (78.0%). There was significant association between having interest on gaining of dental/oral care for prenatal/antenatal mothers with occupation. The highest significant response was by the dentists (100.0% dentists vs. 54.4% midwives) (p = 0.025).
Participants’ preferred format to enhance their knowledge
More than three-quarters of the healthcare professionals (78.8%) responded that they would prefer to attend a Continuous Professional Development (CPD) course whereas almost a fifth of the respondents (20.2%) preferred to gain the information through reading or research articles. There was significant association with the preference of reading to gain dental/oral care knowledge with ethnicity. The highest significant ethnic group who was interested to gain new knowledge through reading were Indians (100.0% Indian ethnicity vs. 20.5% Malay ethnicity) (p = 0.004).
Participants’ interest on interprofessional collaboration activities
A little over three-quarters of healthcare professionals (75.1%) responded that they were interested to attend interprofessional collaboration activities with dental/oral healthcare providers. The top three prevalence of healthcare professionals who was interested were dental hygienist and therapists (83.3%), doctors (81.8%) and nurse (midwives) (81.7%). Most of the healthcare professionals had work experience of less than 10 years (81.9%). Though, there was no significant association between having interest in joining interprofessional collaboration activities with occupation and year of work experience.
Participants’ attitude towards importance of dental/oral health in prenatal/antenatal care
Most healthcare professionals (94.3%) considered dental/oral healthcare to be an important part of prenatal/antenatal care plan. The top three prevalence of healthcare professionals who agreed on this statement were dentists (100.0%), dental hygienist and therapists (100.0%), and midwives (97.8%). Though, there was no significant association between considering the importance of dental/oral care in prenatal/antenatal care plan with occupation.
Table 6
Factors associated with the collaboration between healthcare professionals on the dental/oral care of prenatal/antenatal patients. (n = 346)
| n (%) |
11. Do you have professional referral arrangements established with local dentist(s) to whom you can refer your prenatal/antenatal patients? [Answer options combined – 1 & 1/more] | 61 (15.7) |
12. If Yes to Question 11, do you collaborate or engage in professional discussions with referring dentist(s) regarding care for a mutual patient? | 43 (37.4) |
13. If Yes to Question 12, how often do you collaborate or engage in professional discussions with referring dentist(s) regarding care for a mutual patient | |
1x per year | 39 (60.0) |
2-4x per year | 15 (23.1) |
More than 4x per year | 11 (16.9) |
14. Are you interested in receiving additional information to enhance your knowledge regarding prenatal/antenatal dental/oral healthcare? | 274 (71.5) |
15. Please tell us how and/or what type of format you would like to receive information regarding prenatal/antenatal dental/oral healthcare | |
a) I would attend a Continuous Professional Development (CPD) course(s), such as a one-day workshop or seminar that is focused on current best practices regarding prenatal/antenatal dental/oral healthcare | 246 (78.8) |
b) I would prefer to read information/research articles on current best practices regarding prenatal/antenatal dental/oral healthcare | 63 (20.2) |
16. Are you interested in attending interprofessional collaboration activities such as professional networking, Continuous Professional Development (CPD) course(s), and meetings etc. with dental/oral healthcare providers in your clinic/ward? | 293 (75.1) |
17. “I consider dental/oral health care to be an important part of a prenatal/antenatal care plan.” | 366 (94.3) |