Through the gestational period, pregnant women are more susceptible to develop oral changes and periodontal diseases. So, when they are presenting as patients in dental clinics, they should be treated with utmost caution as any dental procedure carried out on them may not only affect them but also the child they are carrying (18). The main focus of our study was to evaluate the knowledge, attitude, and practice of dentists in Jordan toward oral health care during pregnancy. Looking at previous studies conducted in Jordan, two cross-sectional studies closely investigated the same research question of our survey but with a different target population; the first survey was to assess the knowledge, attitude, and practice of pregnant women in utilizing the dental services, while the second one examined the knowledge, attitude, and practice of medical doctors of the association between oral health and pregnancy outcomes (4, 21). As a result, this study is considered the first of its kind among dentists in Jordan.
Demographic variables of the study sample
The response rate was (54.7%) good enough and acceptable for an online survey. More females (56.9%) than males (43.1%) participated in our study. The vast majority (54.5%) were general practitioners, and high percentage of them (53.6%) had an experience of more than five years. The present study findings showed that more than three-quarters of the participants (79.5%) performed dental procedures for pregnant women. In contrast, (20.5%) did not provide any dental treatment due to their doubt and hesitation. Two previous studies had similar findings; a study in Kenya revealed that (90.0%) of the respondents had done dental procedures to expectant women whereas (10.0%) said they had not (22). Another study in Pakistan reported that the majority of dentists (82.0%) had no concerns regarding dental treatment for pregnant patients (3).
Knowledge of dentists about the treatment of pregnant women
With respect to the knowledge of dentists, interestingly, (91.2%) of them considered gingival bleeding a consequence of pregnancy. This satisfying proportion aligns with various international studies, which affirmed that more than (90.0%) of dentists recognized the association between pregnancy and bleeding gums (23, 24). Dentists in this survey had a limited understanding of oral health and its relation to pregnancy outcomes because (62.5%) of them believed that there was no association between periodontal diseases and adverse pregnancy outcomes. This result indicated that dentists in Jordan had not been updated with recent studies, which assured that periodontal diseases are risk factors for APO, including preterm birth, pre-eclampsia, low birth weight, and gestational diabetes(25). Several studies in the USA reported similar perceptions, where almost (40.0%) of dentists were uncertain about oral-conditions and their effects on pregnancy (26–28).
Attitude of dentists towards participating in training courses
Only (33.1%) were taught adequately about the same issue at their undergraduate dental collage, and more than three-quarters did not even participate in continuing education courses on the management of pregnant patients. This problem should be seriously taken into account, and management of pregnant patients should be included in dental school curricula. A similar pattern was also observed among dentists in India and Saudi Arabia, where dentists felt that they did not get enough instructions about dental treatment to pregnant women at their BDS courses (29, 30). Better findings were detected in a study conducted in Bengaluru, India, where more than half of dentists have been enrolled in educational courses related to periodontal disease and oral hygiene for pregnant patients (31). Moreover, participants who were less than 30 years old reported that they disregarded treating pregnant women more than older dentists. In general, these results are parallel with a study done in Mangalore city, India (30).
Practices of dentists regarding the treatment of pregnant women
The hesitation among participating dentists in this research was distinctly realized about performing certain dental procedures during pregnancy. Mixed opinions were observed regarding extractions and root canal treatment. In the present study, (60.0%) and (72.0%) agreed to perform extractions and root canal treatment in the2nd trimester, respectively. So far, in the 1st and 3rd trimester, the dentists were more doubtful. Therefore, their opinions were distributed between consulting gynecologists, referring to specialists, or delaying the treatment until giving birth. The current findings reflect better knowledge than in a study in India, where (69.0%) considered it safe to perform routine extractions in the 2nd trimester, and (56%) agreed to do root canal treatment(31). However, in other studies, the majority of dentists stated they preferred to postpone treatment till after delivery (28, 32, 33).
When asked about the safest trimester to offer dental treatment, the opinions of dentists were aligned with ADA, APA, and New York and California guidelines and recommendations. A high percentage of our participants (89.4%) believed that the 2nd trimester was the preferable period to do dental procedures. In the case of radiographs, the majority of dentists felt hesitant to perform them in spite of the fact that dental radiographs were taken with the recommended neck (thyroid) collar and abdomen shields during pregnancy (19). In the present study, only (22.5%) agreed it was safe to take radiographs at any stage during pregnancy. Data about diagnostic radiographs during pregnancy were heterogeneous among international dentists. In some countries, the proportion of dentists who were unsure of taking radiographs for pregnant women was (45.0%), whereas in other places such as Nigeria and Australia, (70.5%) agreed that radiographs could be performed during pregnancy (32, 34–36). Around (62.7%) of our respondents followed the guidelines in placing the pregnant women in a semi-supine position. Regarding drug prescription and anesthetics administration, there was a high level of understanding and awareness when compared with other studies except for administration of nitrous oxide sedation (3, 10, 35). The results of other studies are compatible with our research as the majority of dentists, regardless of their country of origin, preferred paracetamol and amoxicillin as the safest drugs during pregnancy (10, 32, 35–38). With regards to administration of nitrous oxide, more than half of the dentists did not know if it was safe to use it during pregnancy or not, although it was classified as category C in FDA classifications (39). It is also interesting to note that with older years of age, dentists in our sample were more conscious of prescribing medications than younger ones.
As a result, a development of clinical guidelines and treatment protocols for providing dental treatment among pregnant women in Jordan should take place. Accordingly, the new clinical guidelines and treatment protocols can be utilized by 1) antenatal care providers to coordinate oral health risk assessments and a referral system into routine antenatal care; 2) dental health practitioners to provide effective and proper treatment for pregnant women. So, these guidelines will empower health caregivers to work together as a team to improve the optimal care delivered to pregnant women, the forthcoming infants, and the entire society (19).