Volume 24, Issue 3 (12-2025)
TB 2025, 24(3): 86-98 |
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Ethics code: IR.ZAUMS.REC.1402.407
Clinical trials code: این مطالعه از نوع کارازمایی بالینی نمی باشد
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Ebrahimzadeh R, Daghati Pour M, Bozorgmehr E, Sokhavar N. Assessment of Facilitators and Barriers to Dental Visits Among Pregnant Women: A Cross-Sectional Study in Zahedan, Iran. TB 2025; 24 (3) :86-98
URL: http://tbj.ssu.ac.ir/article-1-3807-en.html
URL: http://tbj.ssu.ac.ir/article-1-3807-en.html
Zahedan university of medical sciences , elhambozorgmehr.e.a@gmail.com
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Assessment of Facilitators and Barriers to Dental Visits Among Pregnant Women: A Cross-Sectional Study in Zahedan, Iran
Roya Ebrahimzaheh(DDS)1, Marzieh Daghati‑Pour(Ph.D.)2, Elham Bozorgmehr(Ph.D.)3, Nahid Sakhavar(MD,OB‑GYN)4
1.Dentist, Oral and Dental Research Center, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
2.Assistant Professor, Oral and Dental Research Center, School of Dentistry, Department of Oral Health and Community Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
3.Corresponding Author :Assistant Professor, Oral and Dental Research Center, School of Dentistry, Department of Oral Health and Community Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
Email:elhambozorgmehr.e.a@gmail.com Tel: +98‑915‑190‑6654
4.Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract
Introduction: Pregnancy is associated with an increased risk of oral health problems; therefore, dental visits during pregnancy are essential. This study aimed to determine the facilitators and barriers affecting dental attendance among pregnant women in Zahedan.
Methods: This descriptive–analytical study was conducted in 2023 on pregnant women attending gynecologists’ offices in Zahedan. The sample size included 188 participants selected through convenience sampling. Data were collected using a researcher-made questionnaire whose validity was confirmed by ten oral health experts from various faculties, and reliability was verified in a group of pregnant women. Data were analyzed using SPSS version 24. Descriptive statistics, Mann–Whitney test, and logistic regression were applied at a significance level of 0/05.
Results:The main facilitating factors for dental visits among pregnant women were the midwife’s recommendation (30/3%; P=0.04) and the healthcare provider’s recommendation (26/1%; P=0.03). Misconceptions about the safety of dental services during pregnancy (50%; P=0.021) and unfavorable pregnancy health (21/8%; P=0.04) were identified as barriers. According to the regression model, midwife’s recommendation (coefficient=0/16; P=0.005), healthcare provider’s recommendation (coefficient=0/19; P=0.005), and obstetrician’s recommendation (coefficient=0/14; P=0.017) had significant positive effects on dental attendance, whereas poor pregnancy health (coefficient=0/21;P=0.02) and misconceptions (coefficient=0/19; P=0.005) were the main barriers.
Conclusion: Recommendations by the health team (midwives, healthcare providers, obstetricians) play a crucial role in facilitating dental visits among pregnant women; conversely, misconceptions about dental safety during pregnancy and unfavorable pregnancy health are the most significant barriers to such visits.
Keywords: Pregnancy, Oral Health, Dental Health Services
Conflict of interest: The authors declared no conflict of interest.
References
1-Kamalabadi YM, Campbell MK, Zitoun NM & et al. Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review. BMC Oral Health. 2023;23(1):762.
2-Ahmed S, Shah H, Hussain A & et al. Challenges in oral health referral during pregnancy: perspectives from antenatal and dental care providers. BMC Oral Health. 2025;25(1):858.
3-Susanto A, Bawono CA, Putri SS. Hormonal changes as the risk factor that modified periodontal disease in pregnant women: a systematic review. J Int Oral Health. 2024;16(3):189‑95.
4-World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022.
5-Behluli E, Veseli E, Veseli A. Evaluation of oral health status in pregnant women and its correlation with calcium and phosphate levels. Folia Medica. 2024;66(2):203‑12.
6-Mohammadi Kamalabadi Y. Self‑perceived Oral Health Status and Oral Healthcare Services Utilization among an Underserved Sample of Pregnant Women in London, Ontario [thesis]. London (ON): University of Western Ontario; 2023.22(3):125-29.
7-Kong AC, Ramjan L, Sousa MS & et al. The oral health of Indigenous pregnant women: a mixed‑methods systematic review. Women Birth. 2020;33(4):311‑22.
8-Barkensjö M, Greenbrook JT, Rosenlundh J & et al. The need for trust and safety‑inducing encounters: a qualitative exploration of women’s experiences of seeking perinatal care when living as undocumented migrants in Sweden. BMC Pregnancy Childbirth. 2018;18(1):217.
9-Cagetti MG, Salerno C, Ionescu AC & et al. Knowledge and attitudes on oral health of women during pregnancy and their children: an online survey. BMC Oral Health. 2024;24(1):85.
10-Gu C, Wang X, Li L & et al. Midwives’ views and experiences of providing midwifery care in the task shifting context: a meta‑ethnography approach. Global Health J. 2020;4(3):96‑106.
11-Frey‑Furtado L, Fonseca M, Melo P & et al. Oral healthcare access: self‑perceived barriers faced during pregnancy—a systematic review. BMC Public Health. 2025;25(1):1394.
12-Aragaw FM, Amare T, Teklu RE & et al. Magnitude of unintended pregnancy and its determinants among childbearing age women in low and middle‑income countries: evidence from 61 countries. Front Reprod Health. 2023;5:5‑2023.
13-Kamalabadi YM, Campbell MK, Gratton R & et al. Oral health status and dental services utilisation among a vulnerable sample of pregnant women. Int Dent J. 2025;75(2):524‑36.
14-Lee H, Tranby E, Shi L. Dental visits during pregnancy: Pregnancy Risk Assessment Monitoring System analysis 2012–2015. JDR Clin Transl Res. 2022;7(4):379‑88.
15-Testa A, Jackson DB. Adverse childhood experiences and dental cleaning during pregnancy: Findings from the North and South Dakota PRAMS, 2017–2021. Public Health Rep. 2024;84(2):198‑205.
16-Wagner KJP, Reses MdLN, Boing AF. Prevalence of dental visits and associated factors during prenatal care: a cross‑sectional study with puerperal women in hospitals covered by the Brazilian National Health System, Santa Catarina State, Brazil, 2019. Epidemiol Serv Saúde. 2021;30:e2021146.
17-Onwuka C, Onwuka CI, Iloghalu EI & et al. Pregnant women utilization of dental services: still a challenge in low resource setting. BMC Oral Health. 2021;21(1):384.
18-Naavaal S, Brickhouse TH, Hafidh S & et al. Factors associated with preventive dental visits before and during pregnancy. J Womens Health (Larchmt). 2019;28(12):1670‑8.
19-Albasry Z, Alhaddad B, Benrashed MA & et al. A cross‑sectional analysis of dental care utilization among pregnant women in Saudi Arabia. Open Access Maced J Med Sci. 2019;7(23):4131.
20-Wilson A, Davies C, Bettiol S & et al. Why aren’t antenatal care providers adopting oral health guidelines? A qualitative exploration. Community Dent Oral Epidemiol. 2025;53(3):286‑95.
21-Barman D, Ranjan R, Kundu A. Factors associated with dental visit and barriers to utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: a cross‑sectional study. J Indian Soc Periodontol. 2019;23(6):562‑8.
22-Swathi K, Koothati RK, Motor RR & et al. Knowledge and experience of women about dental services utilization during pregnancy: a cross‑sectional questionnaire study. J Pharm Bioall Sci. 2021;13(Suppl 2):S1042‑6.
23-Liu PP, Wen W, Yu KF & et al. Dental care‑seeking and information acquisition during pregnancy: a qualitative study. Int J Environ Res Public Health. 2019;16(14):2621.
24-Lee H, Deshpande R, Benn EK & et al. Race, ethnicity, and other barriers to access dental care during pregnancy. J Racial Ethn Health Disparities. 2024;11(2):1‑9.
25-Sasaki N, Surdu S, Moore J & et al. Exploring barriers in dental care and treatment for pregnant women and their associations with hypertensive disorders. In: 2024 Annual Research Meeting; 2024 Jun; Washington (DC): AcademyHealth; 2024;16(2):225-29.
26-Jing Q, Yang H, Chen Y & et al. Predictors and barriers to prenatal dental care among pregnant women in two regions of China. JDR Clin Transl Res. 2025;10(3):337‑66.
Roya Ebrahimzaheh(DDS)1, Marzieh Daghati‑Pour(Ph.D.)2, Elham Bozorgmehr(Ph.D.)3, Nahid Sakhavar(MD,OB‑GYN)4
1.Dentist, Oral and Dental Research Center, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
2.Assistant Professor, Oral and Dental Research Center, School of Dentistry, Department of Oral Health and Community Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
3.Corresponding Author :Assistant Professor, Oral and Dental Research Center, School of Dentistry, Department of Oral Health and Community Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
Email:elhambozorgmehr.e.a@gmail.com Tel: +98‑915‑190‑6654
4.Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract
Introduction: Pregnancy is associated with an increased risk of oral health problems; therefore, dental visits during pregnancy are essential. This study aimed to determine the facilitators and barriers affecting dental attendance among pregnant women in Zahedan.
Methods: This descriptive–analytical study was conducted in 2023 on pregnant women attending gynecologists’ offices in Zahedan. The sample size included 188 participants selected through convenience sampling. Data were collected using a researcher-made questionnaire whose validity was confirmed by ten oral health experts from various faculties, and reliability was verified in a group of pregnant women. Data were analyzed using SPSS version 24. Descriptive statistics, Mann–Whitney test, and logistic regression were applied at a significance level of 0/05.
Results:The main facilitating factors for dental visits among pregnant women were the midwife’s recommendation (30/3%; P=0.04) and the healthcare provider’s recommendation (26/1%; P=0.03). Misconceptions about the safety of dental services during pregnancy (50%; P=0.021) and unfavorable pregnancy health (21/8%; P=0.04) were identified as barriers. According to the regression model, midwife’s recommendation (coefficient=0/16; P=0.005), healthcare provider’s recommendation (coefficient=0/19; P=0.005), and obstetrician’s recommendation (coefficient=0/14; P=0.017) had significant positive effects on dental attendance, whereas poor pregnancy health (coefficient=0/21;P=0.02) and misconceptions (coefficient=0/19; P=0.005) were the main barriers.
Conclusion: Recommendations by the health team (midwives, healthcare providers, obstetricians) play a crucial role in facilitating dental visits among pregnant women; conversely, misconceptions about dental safety during pregnancy and unfavorable pregnancy health are the most significant barriers to such visits.
Keywords: Pregnancy, Oral Health, Dental Health Services
Conflict of interest: The authors declared no conflict of interest.
References
1-Kamalabadi YM, Campbell MK, Zitoun NM & et al. Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review. BMC Oral Health. 2023;23(1):762.
2-Ahmed S, Shah H, Hussain A & et al. Challenges in oral health referral during pregnancy: perspectives from antenatal and dental care providers. BMC Oral Health. 2025;25(1):858.
3-Susanto A, Bawono CA, Putri SS. Hormonal changes as the risk factor that modified periodontal disease in pregnant women: a systematic review. J Int Oral Health. 2024;16(3):189‑95.
4-World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022.
5-Behluli E, Veseli E, Veseli A. Evaluation of oral health status in pregnant women and its correlation with calcium and phosphate levels. Folia Medica. 2024;66(2):203‑12.
6-Mohammadi Kamalabadi Y. Self‑perceived Oral Health Status and Oral Healthcare Services Utilization among an Underserved Sample of Pregnant Women in London, Ontario [thesis]. London (ON): University of Western Ontario; 2023.22(3):125-29.
7-Kong AC, Ramjan L, Sousa MS & et al. The oral health of Indigenous pregnant women: a mixed‑methods systematic review. Women Birth. 2020;33(4):311‑22.
8-Barkensjö M, Greenbrook JT, Rosenlundh J & et al. The need for trust and safety‑inducing encounters: a qualitative exploration of women’s experiences of seeking perinatal care when living as undocumented migrants in Sweden. BMC Pregnancy Childbirth. 2018;18(1):217.
9-Cagetti MG, Salerno C, Ionescu AC & et al. Knowledge and attitudes on oral health of women during pregnancy and their children: an online survey. BMC Oral Health. 2024;24(1):85.
10-Gu C, Wang X, Li L & et al. Midwives’ views and experiences of providing midwifery care in the task shifting context: a meta‑ethnography approach. Global Health J. 2020;4(3):96‑106.
11-Frey‑Furtado L, Fonseca M, Melo P & et al. Oral healthcare access: self‑perceived barriers faced during pregnancy—a systematic review. BMC Public Health. 2025;25(1):1394.
12-Aragaw FM, Amare T, Teklu RE & et al. Magnitude of unintended pregnancy and its determinants among childbearing age women in low and middle‑income countries: evidence from 61 countries. Front Reprod Health. 2023;5:5‑2023.
13-Kamalabadi YM, Campbell MK, Gratton R & et al. Oral health status and dental services utilisation among a vulnerable sample of pregnant women. Int Dent J. 2025;75(2):524‑36.
14-Lee H, Tranby E, Shi L. Dental visits during pregnancy: Pregnancy Risk Assessment Monitoring System analysis 2012–2015. JDR Clin Transl Res. 2022;7(4):379‑88.
15-Testa A, Jackson DB. Adverse childhood experiences and dental cleaning during pregnancy: Findings from the North and South Dakota PRAMS, 2017–2021. Public Health Rep. 2024;84(2):198‑205.
16-Wagner KJP, Reses MdLN, Boing AF. Prevalence of dental visits and associated factors during prenatal care: a cross‑sectional study with puerperal women in hospitals covered by the Brazilian National Health System, Santa Catarina State, Brazil, 2019. Epidemiol Serv Saúde. 2021;30:e2021146.
17-Onwuka C, Onwuka CI, Iloghalu EI & et al. Pregnant women utilization of dental services: still a challenge in low resource setting. BMC Oral Health. 2021;21(1):384.
18-Naavaal S, Brickhouse TH, Hafidh S & et al. Factors associated with preventive dental visits before and during pregnancy. J Womens Health (Larchmt). 2019;28(12):1670‑8.
19-Albasry Z, Alhaddad B, Benrashed MA & et al. A cross‑sectional analysis of dental care utilization among pregnant women in Saudi Arabia. Open Access Maced J Med Sci. 2019;7(23):4131.
20-Wilson A, Davies C, Bettiol S & et al. Why aren’t antenatal care providers adopting oral health guidelines? A qualitative exploration. Community Dent Oral Epidemiol. 2025;53(3):286‑95.
21-Barman D, Ranjan R, Kundu A. Factors associated with dental visit and barriers to utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: a cross‑sectional study. J Indian Soc Periodontol. 2019;23(6):562‑8.
22-Swathi K, Koothati RK, Motor RR & et al. Knowledge and experience of women about dental services utilization during pregnancy: a cross‑sectional questionnaire study. J Pharm Bioall Sci. 2021;13(Suppl 2):S1042‑6.
23-Liu PP, Wen W, Yu KF & et al. Dental care‑seeking and information acquisition during pregnancy: a qualitative study. Int J Environ Res Public Health. 2019;16(14):2621.
24-Lee H, Deshpande R, Benn EK & et al. Race, ethnicity, and other barriers to access dental care during pregnancy. J Racial Ethn Health Disparities. 2024;11(2):1‑9.
25-Sasaki N, Surdu S, Moore J & et al. Exploring barriers in dental care and treatment for pregnant women and their associations with hypertensive disorders. In: 2024 Annual Research Meeting; 2024 Jun; Washington (DC): AcademyHealth; 2024;16(2):225-29.
26-Jing Q, Yang H, Chen Y & et al. Predictors and barriers to prenatal dental care among pregnant women in two regions of China. JDR Clin Transl Res. 2025;10(3):337‑66.
Type of Study: Research |
Subject:
Dental
Received: 2025/07/8 | Accepted: 2025/09/9 | Published: 2025/09/22
Received: 2025/07/8 | Accepted: 2025/09/9 | Published: 2025/09/22
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