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 Table of Contents  
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 169-174

Analysis of oral health knowledge improvement of pregnant mothers using oral health monitoring mobile application

1 Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
2 Graduate Student of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
3 Resident of Oral Maxillofacial Surgey Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
4 Resident of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Date of Submission02-Oct-2018
Date of Decision30-Apr-2020
Date of Acceptance18-May-2020
Date of Web Publication17-Apr-2021

Correspondence Address:
Dr. Raden Darmawan Setijanto
Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Jl Prof Dr Moestopo No. 47, Surabaya.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_234_18

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Aims and Objectives: The aim of this study was to analyze the effectiveness and contributing factors of the oral health knowledge improvement of pregnant mother using mobile application. Materials and Methods: A presented cross-sectional analytical study had 47 respondents that were obtained using simple random sampling from pregnant mother population in the health center in Surabaya, Indonesia. Data were collected by examining periodontal health using Community Periodontal Index (CPI) questionnaires to assess the risk factors, and pre- and posttest to measure the knowledge increment. The pretest was conducted before the respondents were given counseling about this oral health monitoring mobile application. Pregnant women are given educational material about the importance of maintaining oral health, especially the health of periodontal tissue during pregnancy. Statistically, descriptive test was used to describe the respondent distribution data. Paired t test was used to compare the knowledge improvement between pretest and posttest scores. Linear regression test was used to analyze the contributing factors of knowledge improvement of the respondents. Results: There was a significant (P < 0.05) improvement in the mean score of posttest (87%) compared to pretest (56%). The contributing factors in respondents’ knowledge improvement were their number of dental visits (P = 0.04) and their experience in periodontal disease as shown in their CPI score (P = 0.010). Conclusion: Oral health monitoring mobile application can be used as dental health promotion media of pregnant women, supported with their dental checkup and periodontal disease experience.

Keywords: Community, Knowledge, Mobile Application, Periodontal Disease, Pregnant Women

How to cite this article:
Setijanto RD, Bramantoro T, Ramadhani A, Setyaji AM, Rusyidina Z, Nawira &. Analysis of oral health knowledge improvement of pregnant mothers using oral health monitoring mobile application. J Int Oral Health 2021;13:169-74

How to cite this URL:
Setijanto RD, Bramantoro T, Ramadhani A, Setyaji AM, Rusyidina Z, Nawira &. Analysis of oral health knowledge improvement of pregnant mothers using oral health monitoring mobile application. J Int Oral Health [serial online] 2021 [cited 2022 Aug 17];13:169-74. Available from:

  Introduction Top

Dental health is an integral part of overall health that can affect the quality of life of individuals.[1] During pregnancy, changes in the oral cavity are associated with hormonal changes, diet, behavior, and complaints, such as cravings, nausea, and vomiting. Pregnant women become very vulnerable to periodontal disease due to the habit of neglecting dental and oral hygiene.[2] Changes in pregnancy also affect the quality of life of pregnant women.[3]

The prevalence of periodontal disease in Indonesia is still very high at 73.50%. Of all patients with periodontal disease in Indonesia, 4-5% have reached the highest level of periodontitis severity. One symptom of severe periodontal disease is mobility in the teeth. Meanwhile, according to data from Dupak Puskesmas, it was found that 31.7% of patients had periodontal disorders, and around 42.8% were pregnant women. PDGI stands for Persatuan Dokter Gigi Indonesia or Indonesian Dentist Association notes that periodontitis is a dental and oral problem commonly experienced by pregnant women.[4]

The group of pregnant women belongs to the vulnerable category, so special attention is needed regarding health, including oral health, for both the health of the mother herself and the baby.[5] Oral health problems with pregnancy primarily include gingivitis, pregnancy granuloma, and periodontitis.[6],[7] Pregnant women with periodontitis may be at a higher risk of preterm birth weight/low birth weight.[8],[9] Most of the studies have shown that individuals during pregnancy with severe periodontal disease have the greater risk for preterm birth and low weight.[10] Pregnant women must understand the importance of health, both for themselves and for the prospective baby. This is because the mother’s health condition will affect the baby’s health condition.[11] Women who develop periodontitis during pregnancy may have a higher risk of adverse pregnancy outcomes (APOs), such as low birth weight,[12] preeclampsia, and being small for gestational age.[13],[14] Periodontitis is an inflammatory response of the host to the presence of dental plaque.[15] Pregnancy-associated periodontitis is similar, but estrogen and progesterone can exacerbate gingival edema and vasculature.[16],[17] Recent studies established changes in putative pathogens of periodontitis during pregnancy. Another recent study measured bacteria loading of pregnant women and the relationship with estradiol levels. The results concluded that Campylobacter rectus was higher in pregnant women.[17] Periodontal pockets are a reservoir of oral microbiota. Modifications in oral microbiota may be considered a potential mechanism for developing periodontitis during pregnancy.

Infection in periodontal tissues (periodontitis) is due to the occurrence of oral dysbiosis in bacterial pathogenic periodontal tissue found in the oral cavity. In fact, the oral cavity is one way into the body system, so it does not rule out the possibility that bacterial dysbiosis in the oral cavity can continue the infection to other organs in the body through the bloodstream.[18] When the bacteria in the oral cavity experience dysbiosis, these bacteria become pathogens and cause damage to the oral membrane, thus it can reach blood flow.[19] Inflammatory mediators will activated body’s immune response, specifically the one that interact with the innate immune system, as a reaction to the presence of pathogenic bacteria. This will activate inflammatory mediators, which can also affect other systemic disorders, such as cardiovascular and metabolic diseases. This can lead to a poor health status, locally or systemically, including neoplastic response.[20],[21] This makes periodontitis to not only have an impact on the oral cavity but also have an impact on the systemic body. Pregnant women as vulnerable individuals who have a tendency to experience periodontitis need to be given special attention regarding this disease, which affects the mother and the fetus. People who have systemic abnormalities need also be given special attention as they may get worse by this condition of oral dysbiosis. Therefore, it is important to promote oral health knowledge among pregnant women.[11]

It is unfortunate that the knowledge about oral health in several places is still relatively low, including the community of pregnant women. Pregnant women should have a regular health check up during pregnancy, but only 55.9% had examined their dental health.[5]

The same thing happened at Dupak Public Health Center. On the basis of Dupak Public Health Center dental report, only 8.2% of 322 pregnant women in the Dupak working area visited the dentist. In the preliminary survey, questionnaire data were also taken about the risk factors causing periodontal disease in pregnant women. The results state that the lack of knowledge of pregnant women affects the health of their peridontal tissue. For this reason, it is mandatory to produce a dental and oral health guidance in mobile application form for pregnant women. Therefore, the researchers intended to improve the knowledge of pregnant women about dental and oral health through empowerment program based on mobile application. Through this application, it is expected that there will be an increase in knowledge about the oral health of pregnant women, so that this application can be applied at the public health center. The aim of this research was to observe how effective this application is in increasing the knowledge of pregnant women regarding oral health.

  Materials and Methods Top

Setting and design

This was an analytic cross-sectional study with 6 months of follow-up. The samples of this study were 47 pregnant women, aged 17–45 years, in the subdistrict area in Surabaya City, Indonesia. Ethical approval for performing this study was obtained from Research Ethic Committee of Faculty of Dentistry Universitas Airlangga (No. 122/KKEPK.FKG/IX/2013). This research was approved by the head of public health center in Dupak Village, Krembangan District, Surabaya City, East Java Province, and the head of municipality, and the written informed consent was signed by the respondents.

Sampling criteria

The respondents in this study were selected from the population of pregnant woman in the local public health center in Surabaya, Indonesia. The research samples were calculated using analytic research formula:

A total of 47 respondents (counted from α = 0…1 and Zα [adjusted standard deviation for α] = 1.96) were chosen from the population of pregnant women in the working area of health center in Surabaya. This study used a large cross-sectional research sample formula and obtained a minimum sample size of 32. There are 47 respondents who were pregnant women that came to the Health Center. We excluded the pregnant women who were not registered as local public health patients. From these results, a simple random sampling technique was performed to determine the research sample.

Study method and observational parameters

The data collection techniques used in this study include intraoral examination, questionnaire, and pretest and posttest. For intraoral examination, Community Periodontal Index (CPI) was used to measure the periodontal health of the respondents indicated in four score categories including: 0 for normal periodontal condition, 1 for bleeding on probing condition, 2 for the existence of supra- or subgingival calculus (with less than 3 mm periodontal pocket), 3 for a periodontitis with between 4 and 5 mm periodontal pocket, and 4 for periodontitis with more than 6 mm periodontal pocket.

The questionnaire was used to gain the risk factors data including the “number of dental visits,” “job,” “experience on pregnancy,” and “pregnancy period.” The pretest was conducted before the respondents were given counseling about this oral health monitoring mobile application.

For measuring the effectiveness of mobile application, we conducted pretest and posttest for the respondents. The respondents were asked to do pretest before being given the counseling about oral health education using mobile application. After the counseling, the posttest was conducted. The scores of pretest and posttest were analyzed using comparative test.

The questionnaire used in this study has been tested for its validity. The validity test for the questionnaire is performed by finding a correlation between the scores of each question (r result) with the r value in the table. The validity test is done twice until all questions are considered valid. Each question is declared valid if r results have a positive value and r results > r table at the significance level of 5% for n = x; the value of r table = x. To be declared valid, all questions must have a positive r value and value > x. The results of the validity test show that all questions were valid[15] [Table 1].
Table 1: Validity test of questionnaire

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Statistical analysis

The statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) software, version 22.0 (IBM, Armonk, New York). Descriptive analysis, paired t test, and linear regression analysis were conducted. The descriptive test was used to describe the respondent distribution data. Paired t test was used to compare the knowledge improvement indicated in the scores of pretest and posttest. Linear regression test was used to analyze the contributing factors in the knowledge improvement of the respondents with confidence interval of 95% and P value of <0.05.

  Results Top

[Table 2] and [Table 3] show the questionnaire and intraoral examination results, indicating that 55% of respondents regularly did dental checkups, 81% of the respondents were unemployed, 83% of the respondents have been pregnant for 1–3 times, 49% of the respondents were in their third trimester of pregnancy, and 70.2% of the respondents had Grade 3 of CPI score.
Table 2: Distribution of respondents crosstab with their experience to dentist

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Table 3: Results of respondents’ community periodontal index

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In the pre-post test results, obtained an increase in the post-test scores of the respondents. Before being given educational material, the average post-test score of respondents was only 56%. It can be concluded that there was an increase in value of 31%. The paired t test was used to analyze the difference between pretest and posttest score. The result indicated a significant difference between pretest and posttest (P = 0.00) as can be seen in [Table 4].
Table 4: Paired t test analysis of pretest and posttest score using oral health monitoring application

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[Table 5] shows a linear regression analysis to analyze the contributing factors in the knowledge improvement of the respondents. From the five variables analyzed, “number of dental visits” and “CPI score” had a significant result for contributing in the knowledge improvement of pregnant women (P < 0.05).
Table 5: Linear regression analysis of the knowledge improvement and contributing factors

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  Discussion Top

Health promotion is an effort to increase one’s knowledge about health. It is also carried out in the fields of medicine and dental health. For pregnant women, the promotion of oral health can increase their knowledge about oral health, and prevent them from systemic health problems caused by dental disease. Health promotion is also needed to persuade pregnant women to check their oral health during pregnancy.[22],[23]

This mobile application for monitoring dental and oral health for pregnant women is based on the Health Belief Model (HBM). HBM suggests that individuals will take action if they perceive themselves to be susceptible to the illness (perceived susceptibility), in which illness will have serious consequences (perceived severity), a course of taking action will minimize consequences (perceived benefits), and the benefit of taking action will outweigh the cost or barriers (perceived barrier).[24] This android-based application contains materials about oral health, especially relating to pregnancy, good food for dental health, recording the condition of pregnant women, as well as pregnancy checkup visits to the community health center. All respondents were asked to download this application on their mobile phones. The dentist checked the health records of pregnant women at every routine checkup, and added a schedule of the next visit, so that pregnant women could see and remember their schedule. Commitment to using this application was done by evaluating the health records in the application during each visit. With the compatibility of mobile application, pregnant women can access much information whenever and wherever they need based on their health condition. The information shown is much easier to learn and receive. The results of this study are in accordance with the theory, where there is an increase in post test scores after the respondents were given educational material through mobile application. This oral health monitoring mobile application is considered effective to improve the knowledge of the users.

Other than the content of mobile application, there are some related contributing factors to the knowledge improvement. In this study, these contributing factors included the number of dental visits and the periodontal health. Dental experience was gained by visiting the dentist. By visiting the dentist, their knowledge of health can be improved. It can also decrease the anxiety and establish the dentist–patient trust. Therefore, the new information given by the doctor or dentist is easier to receive.[25]

Knowledge is information acquired through experience or education.[26] Respondents who have periodontal disease can relate more the health education materials with their condition. Mother’s knowledge can improve through dental health education.[27]

Therefore, the provision of dental and oral hygiene based applications can improve the knowledge of pregnant women. The factors that contribute to improve the knowledge are the number of dental visits and their periodontal health status. It is expected to affect the behavior of pregnant women’s visits to dental and oral health services during pregnancy. It is recommended that pregnant women should increase awareness in maintaining oral hygiene during pregnancy. Prospective pregnant women are expected to access the application to improve knowledge about oral and dental health during pregnancy. The Public Health Center can add or update information on the mobile application, so users can receive the latest information about their dental health and pregnancy. Limitation of this study was the number of respondents and the instrument. For further research, this study may add more variables and find specific respondents.


We acknowledge the Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga and Dupak Health Center, Surabaya for making this study happen. We also express our gratitude to PKL students in Dupak working area for contributing to this study.

Financial support and sponsorship

This study was self-funded.

Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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