UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2025.e4586
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Braz Dent Sci 2025 Apr/Jun;28 (2): e4586
This is an Open Access article distributed under the terms of the Creative Commons Attribution license (https://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
Ansiedade odontológica e qualidade de vida relacionada à saúde bucal de gestantes: um estudo transversal
Gabriela de ARAUJO1 , Maísa CASARIN2 , Cristiane Medianeira SAVIAN3 , Bruno EMMANUELLI1 ,
Fernanda TOMAZONI1 , Bianca Zimmermann SANTOS3
1 - Universidade Federal de Santa Maria, Departamento de Estomatologia, Santa Maria, RS, Brasil.
2 - Universidade Federal de Pelotas, Departamento de Semiologia e Clínica, Pelotas, RS, Brasil.
3 - Universidade Franciscana, Curso de Odontologia, Santa Maria, RS, Brazil.
How to cite: Araujo G, Casarin M, Savian CM, Emmanuelli B, Tomazoni F, Santos BZ. Dental anxiety and oral health-related quality of
life among pregnant women: a cross-sectional study. Braz Dent Sci. 2025;28(2):e4586. https://doi.org/10.4322/bds.2025.e4586
ABSTRACT
Objective: This study investigated the association between dental anxiety and oral health-related quality of life
(OHRQoL) among pregnant women; Material and Methods: A cross-sectional study was conducted with pregnant
women who attended public health services in a Southern Brazilian city. A questionnaire was administered to
collect information on demographic, socioeconomic, and behavioral factors. The OHRQoL was measured using
the Oral Health Impact Prole (OHIP-14). The Dental Anxiety Scale (DAS) was used to assess the level of dental
anxiety. Dental caries was assessed by the Decayed, Missing, and Filled Surfaces (DMFS) index and gingivitis
was evaluated by the Gingival Bleeding Index (GBI). Poisson regression models assessed the association between
dental anxiety and OHIP-14 scores. The results are presented as Ratio Ratio (RR) using its respective 95%
condence intervals (CI); Results: The sample comprised 256 pregnant women. The mean total OHIP-14 score
was 8.74 (± 9.00). The average scores from specic domains ranged from 0.66 (functional limitation) to 2.20
(psychological discomfort). Pregnant women with dental anxiety (DAS ≥15) have 36% higher OHIP-14 scores
(RR 1.36; CI 95% 1.02-1.78) showing poorer OHRQoL. Besides, participants with gingivitis have also higher
OHIP-14 scores (RR 1.34; CI 95% 1.00-1.78); Conclusion: The present study showed that pregnant women with
dental anxiety and those with gingivitis were more likely to report a poorer OHRQoL.
KEYWORDS
Dental anxiety; Observational study; Oral health; Pregnant women; Quality of life.
RESUMO
Objetivo: Este estudo investigou a associação entre ansiedade odontológica e qualidade de vida relacionada à
saúde bucal (QVRSB) entre gestantes; Material e Métodos: Foi realizado um estudo transversal com gestantes
que frequentavam serviços públicos de saúde em uma cidade do sul do Brasil. Um questionário foi aplicado para
coletar informações sobre fatores demográcos, socioeconômicos e comportamentais. A QVRSB foi mensurada
através do Oral Health Impact Prole (OHIP-14). A Escala de Ansiedade Dentária (DAS) foi utilizada para avaliar
o nível de ansiedade odontológica. A cárie dentária foi avaliada pelo índice de superfícies cariadas, perdidas e
obturadas (CPOD) e a gengivite foi avaliada pelo índice de sangramento gengival (GBI). Os modelos de regressão
de Poisson avaliaram a associação entre a ansiedade dentária e as pontuações do OHIP-14. Os resultados são
apresentados como Ratio Ratio (RR) utilizando seus respectivos intervalos de conança (IC) de 95%; Resultados:
A amostra foi composta por 256 gestantes. A média da pontuação total do OHIP-14 foi de 8,74 (± 9,00). As
pontuações médias dos domínios especícos variaram entre 0,66 (limitação funcional) e 2,20 (desconforto
psicológico). As gestantes com ansiedade dentária tiveram pontuações do OHIP-14 36% mais elevadas (RR
1,36; IC 95% 1,02-1,78), o que revela uma pior QVRSB. Além disso, as participantes com gengivite também
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Araujo G et al.
Dental anxiety and oral health-related quality of life among pregnant women: a cross-sectional study
Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
apresentaram pontuações mais elevadas no OHIP-14
(RR 1,34; IC 95% 1,00-1,78); Conclusão: O presente
estudo mostrou que as mulheres grávidas com ansiedade
odontológica e aquelas com gengivite eram mais
propensas a relatar uma pior QVRSB.
PALAVRAS-CHAVE
Ansiedade odontológica; Estudo observacional; Saúde
bucal; Gestantes; Qualidade de vida.
INTRODUCTION
During pregnancy, women undergo
hormonal, physical, and emotional changes
that can impact on oral health [1]. Hormone
fluctuations, especially progesterone and
estrogen, increase proneness to inammatory
processes in the periodontium, especially if
adequate oral hygiene is not performed [2].
Moreover, hormonal changes in this period
increase the likelihood of mental health problems,
such as anxiety and depression [3].
Although dental care during pregnancy
is considered safe, it remains shrouded in
myths related to possible harm that could be
caused to the baby’s health, which can trigger
emotional problems in pregnant women [4].
In addition, dental anxiety can be one of the
factors that compromise oral health care [5,6].
Dental anxiety is dened as a state of persistent
tension accompanied by a sensation of imminent
disaster, which can lead to fear [5], and is
triggered specically by dental care [7]. Dental
anxiety has been related to worse oral outcomes
and poorer oral health-related quality of life
(OHRQoL) previously in the literature [5-8]. A
study that sought to assess the impact of mothers
and children’s dental anxiety on their infant’s
OHRQoL found that dental anxiety negatively
impacted OHRQoL [8].
Oral problems, such as periodontal disease,
and emotional problems as dental anxiety, can
exert an inuence on self-rated health and quality
of life in pregnant women and their fetus [9,10].
The impact of oral conditions on activities of daily
living, quality of life, and wellbeing is assessed
using OHRQoL [11], which is a multidimensional
construct involving the negative impact of
oral problems on oral functions, physical and
social aspects, appearance, the performance
of activities of daily living and self-rated oral
health status [11]. Studies have demonstrated
that oral diseases such as dental caries and
gingivitis negatively affect the quality of life
during pregnancy, impairing daily activities
and self-perception of oral health by pregnant
women [9,12]. Furthermore, studies have shown
that socioeconomic and demographic variables
can also impact the OHRQoL [9].
Although some studies have investigated
the impacts of dental anxiety and other factors
psychological in adults [5-7], and children [8],
data on dental anxiety in pregnant women are
scarce [3]. The physical and emotional wellbeing of
the future mother has repercussions for her health
as well as the adequate development of the infant,
enabling the child to grow up healthy [8,12]. It
is therefore relevant to identify factors associated
with OHRQoL in this population group. To the
best of our knowledge, no study has described the
association between dental anxiety and OHRQoL
among pregnant women.
Therefore, the present study aimed to
investigate the association of dental anxiety on
OHRQoL of pregnant women attending public
healthcare services. Our conceptual hypothesis
is that dental anxiety in pregnant women is
correlated with poor OHRQoL.
MATERIAL AND METHODS
Study design and participants
This cross-sectional study was nested in a
cohort study entitled “The oral health status of
pregnant women and their children” (data not
published yet). The cohort study was designed to
follow pregnant women who attended at public
health services (primary care units and Family
Health Strategy) in Santa Maria, RS, Brazil. The
cohort study aimed to follow these pregnant
women and their children through periodic
assessments of a set of health-related outcomes
in the mothers and children until the children
reach ve years of age.
At the onset of the cohort study in 2017, the
city had 273,489 residents, with an estimated
2,389 pregnant women attending primary care
units, according to official data from the city
government. A two-stage sampling procedure
was performed, where public healthcare centers
were considered the rst and pregnant women
were the second unit of sampling. Eighteen
of the 30 centers distributed among the eight
administrative districts of the city were randomly
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Dental anxiety and oral health-related quality of life among pregnant women: a cross-sectional study
Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
selected, considering the proportion of the
population size covered by each healthcare center.
All pregnant women regularly registered at public
primary health centers providing prenatal care
were considered eligible to participate in the
study. For recruitment, the researchers scheduled
visits to these health centers on days designated
for prenatal medical appointments. During
these visits, pregnant women were invited to
participate in the study, with every fth woman
attending the health center being selected. If a
selected woman declined to participate, the next
eligible pregnant woman was invited. As soon
as the pregnant women agreed to participate,
they were invited to sign the consent form at the
health center.
The sample size was calculated considering
the following parameters: 95% condence level,
power of 80%, the ratio of exposed and non-
exposed of 1:1, and an effect size of 0.5 [12].
Twenty percent was then added to compensate
for possible refusals and a design effect of 1.2 was
applied, resulting in a minimum sample of 184
pregnant women.
Eligibility criteria
Only pregnant women registered at
healthcare units were included in the present
study. Women with a need for antimicrobial
prophylaxis prior to the oral examinations, those
with a xed orthodontic appliance or retainer,
those who took medications associated with
an increase in gingival volume (nifedipine,
cyclosporin, and phenytoin) and those with
cognitive problems were excluded. In addition,
pregnant women with chronic diseases or
conditions that could compromise the study or
inuence its outcomes, such as kidney disease,
cardiovascular disease, and pre-pregnancy
diabetes, were excluded.
Calibration process and pilot study
Before the data collection, a pilot study
was conducted with 10 pregnant women to
determine the feasibility of the methods. Four
examiners were instructed to perform periodontal
assessments on 10 women, examining six sites on
each tooth (mesial-buccal, buccal, distal-buccal,
mesial-lingual, lingual, and distal-lingual) for all
permanent teeth, except the third molars. These
women were not included in the final study
sample. The Training addressed the denition of
the clinical and physical variables, measurement
instruments, proper measurement techniques
and the analysis of clinical photographs. An
experienced examiner was considered the “gold
standard” for the inter-examiner calibration of
the four examiners regarding Clinical Attachment
Loss. The Decayed, Missing and Filled Surfaces
(DMFS) index training and calibration were
performed following the method described
by the World Health Organization [13]. The
examiners underwent training by analyzing
clinical images of healthy and decayed teeth,
reviewing the index’s conceptual foundations,
and practicing on extracted teeth. The conceptual
basis of the index was discussed, followed by
training with extracted teeth. The DMFS index
calibration involved the clinical assessment of
10 women by the examiners and an experienced
researcher who served as the gold standard.
During this process, two examinations were
conducted, with a one-week interval between
them. The four examiners and the gold-standard
examiner performed periodontal and dental caries
assessments consecutively, and this procedure
was repeated the following week. Intra-examiner
reproducibility was evaluated through duplicated
examinations with a one-week interval, for which
Kappa coefficients ranged from 0.88 to 0.93.
Inter-examiner reproducibility was evaluated
through Kappa coefficients and ranged from
0.88 to 0.96. This reproducibility remained
consistent throughout the study.
Data collection and variables
After the pilot study, data collection was
performed between January 2017 and December
2018 by four teams composed of an examiner
(post-graduate students) and an interviewer
(undergraduate students).
Regarding the clinical variables, the DMFS
index and Gingival Bleeding Index (GBI) were
determined through an examination with the aid
of a at mouth mirror (Golgran, São Caetano do
Sul, SP, Brazil) and a millimeter periodontal probe
(CP 15 UNC, Neumar, São Paulo, SP, Brazil). All
participants were examined individually under
the same conditions seated on a common chair
in a room with both natural and articial lighting
as well as articial white light from the headlamp
and relative isolation [13].
The supragingival examination recorded
the GBI [14]. Clinical Attachment Loss was
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Dental anxiety and oral health-related quality of life among pregnant women: a cross-sectional study
Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
considered the distance from the cementoenamel
junction to the most apical portion of the pocket/
sulcus and was measured in millimeters and
rounded off to the closest whole millimeter.
Dental anxiety was measured using the
Dental Anxiety Scale (DAS) and the questionnaire
was applied through face-to-face interviews.
It is a psychometric scale composed of four
items addressing the reactions of the patient
in situations involving dental care. Each item
is scored from 1 to 5 points and the total score
ranges from 4 to 20 points, with a score of ≥15
points indicative of high dental anxiety [15].
An interview was held for the demographic
data gathering (age, skin color and education),
socioeconomic factors (monthly income, by
means of Brazilian monthly minimum wage
[BMMW]) and behavior information (smoking
during pregnancy, frequency of visits to a
dentist and previous endodontic treatment). The
interviewers and assistants were trained for the
questionnaire administration.
For the data analyses, the independent
variables were categorized: age was categorized
according to the WHO classification [16],
considering “adolescents” (< 20 years), “young
adults” (20-30 years) and “adults” (> 30 years);
skin color was assessed based on the IBGE
criteria [17], and then dichotomized into “white”
and “non-white”; education was collected in terms
of years of schooling and classied as (≥ 8 years
/ < 8 years, with the cutoff point corresponding
to the completion of primary school); household
income (≤ 2 BMMW / > 2 BMMW); smoking
during pregnancy (no/yes); frequency of dental
attendance (≥ 1 times per year / <1 time per
year); previous endodontic treatment (no/yes);
gingivitis (marginal bleeding < 10% / marginal
bleeding ≥ 10%) [18]; tooth loss (no missing
teeth / ≥ one missing tooth); decayed surface
(no decayed surface / ≥ one decayed surface);
Dental Anxiety Scale (DAS < 15 = low level of
anxiety / DAS ≥ 15 = high level of anxiety) [19].
Oral Health-Related Quality of Life
The dependent variable was the OHRQoL,
measured using the
Oral Health Impact Prole
(OHIP-14) [20]. The questionnaire was applied
through interviews and comprises 14 items
distributed among seven domains: functional
limitation (items 1 and 2), physical pain (items
3 and 4), psychological discomfort (items
5 and 6), physical disability (items 7 and 8),
psychological disability (items 9 and 10), social
disability (items 11 and 12) and handicap during
the performance of activities of daily living
(items 13 and 14). The answers are given on
a ve-point scale: never = 0; hardly ever = 1;
occasionally = 2; often = 3; very often = 4. The
total score possible range is from 0 to 56, with
higher scores representing a greater negative
impact on OHRQoL [20].
Statistical analysis
Data analysis was performed using STATA
14 (Stata Corporation, College Station, TX,
USA). Descriptive analysis (frequencies, mean
and standard deviation values) was performed
for the demographic, socioeconomic, behavioral,
and clinical variables and for DAS and OHIP-14
scores. The variation of overall and specific-
domains OHIP-14 scores by DAS and other
predictors was also estimated.
Poisson regression analysis was performed
to determine associations between OHRQoL
and the independent variables (demographic-
socioeconomic: age, skin color, education;
household income; behavioral: smoking during
pregnancy, frequency of dental attendance;
clinical: previous endodontic treatment, gingivitis,
tooth loss, decayed surface; and DAS). Variables
with a p-value < 0.20 in the bivariate Poisson
regression analysis were incorporated into the
multivariate model. The level of significance
was set at 5%. Rate Ratio (RR) was estimated
considering 95% condence intervals (CI). The
model’s quality of t was dened by deviance
(-2 log likelihood).
Ethical aspects
This study received approval from the Institu-
tional Review Board of
Universidade Franciscana
(protocol number: 55197616.7.0000.5306). All
participants provided informed consent. If the par-
ticipant was a minor, her legal guardian also signed
an informed consent form.
RESULTS
Two hundred fifty-six pregnant women
between 14- and 45-years old take part in the
study (72% of response rate). Most participants
were white (56.7%), had >more than 8 years of
formal education (77.3%), did not smoke during
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Dental anxiety and oral health-related quality of life among pregnant women: a cross-sectional study
Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
pregnancy (97.1%), had gingivitis (59.6%), with
dental caries (60.9%) and DAS < 15 (82.3%).
The detailed information is presented in Table I.
The OHIP-14 total mean was 8.74 (standard
deviation: 9.00). The domain means ranged from
0.66 (functional limitation) to 2.20 (psychological
discomfort) (Table II).
In the unadjusted analysis, skin color
(RR = 1.31; 95% CI: 1.02 to 1.69), gingivitis
(RR = 1.42; 95% CI: 1.08 to 1.85), dental caries
(RR = 1.35; 95% CI: 1.03 to 1.79) and higher
dental anxiety (DAS ≥ 15) (RR = 1.42 95% CI:
1.06 to 1.90) were associated with higher OHIP-
14 scores (Table III). Table IV presents the results
of the adjusted Poisson regression analyses.
Pregnant women with higher levels of dental
anxiety (DAS ≥ 15) had overall OHIP-14 scores
36% higher compared to their counterparts,
indicating poorer oral health-related quality of
life (OHRQoL). Similarly, pregnant women with
gingivitis had OHIP-14 scores 34% higher than
those without gingivitis, also reecting worse
OHRQoL.
DISCUSSION
The present study demonstrated that
pregnant women with higher levels of dental
anxiety had worse OHRQoL, which agrees with
our conceptual hypothesis. The results of this
study highlight the direct and indirect effects of
oral health conditions and psychological factors
on OHRQoL among pregnant women. Based
on the ndings, it is possible to hypothesize an
indirect relationship between dental anxiety
and OHRQoL, as pregnant women with a fear of
dental care may avoid dental services and neglect
oral hygiene practices [3]. This can lead to the
development of common oral diseases during
pregnancy, such as gingivitis [2]. Thus, factors
resulting from the hormonal and behavioral
changes typical of pregnancy, combined with
poor oral hygiene and limited access to dental
services, may facilitate the onset of oral diseases,
negatively impacting the quality of life and well-
being of pregnant women [1,12].
However, we showed that having a high
level of dental anxiety is related to a negative
impact on OHRQoL. Dental anxiety may limit
the use of dental services by pregnant women,
leading to the aggravation of oral problems
Table I - Sample distribution of pregnant women according to
demographic, socioeconomic, behaviors and clinical characteristics,
Santa Maria, Brazil (n=256)
Variables n %
Demographic and socioeconomic
Age
< 20 years
20-30 years
> 30 years
49
155
52
19.1
60.6
20.3
Skin color
White
Non-white
145
111
56.7
43.3
Educationª
> 8 years
< 8 years
198
58
77.3
22.7
Family incomeb
1-2 BMMW
>2 BMMW
177
74
70.5
29.5
Behaviors characteristics
Smoke during pregnancyc
No 237 97.1
Yes 7 2.8
Frequency of dental attendance
> 1 time per year 144 56.2
< 1 time per year 112 43.8
Oral health measures
Previous endodontic treatment
No
Yes
170
81
67.7
32.2
Gingivits
No (< 10% marginal bleeding)
Yes (≥ 10% marginal bleeding)
103
152
40.4
59.6
Tooth Loss
No
Yes
138
117
52.1
45.9
Decayed Surface
No
Yes
100
156
39.1
60.9
Dental Anxiety (DAS)
Low level (<15)
High level (≥15)
209
45
82.3
17.7
Values lower than 256 due to missing data. ªcorresponds to
primary school education; b BMMW, Brazilian monthly minimum
wages;cOnly smoke during pregnancy were investigated.
Table II - Oral health Impact Profile -14 (OHIP-14) total and domain-
specific scores description for pregnant women. Santa Maria, Brazil
(n=256)
OHIP-14 Mean (SD) Range
Functional limitation 0.66 (1.19) 0/6
Physical pain 1.85 (2.20) 0/8
Psychological discomfort 2.20 (2.54) 0/8
Physical disability 1.08 (1.92) 0/8
Psychological disability 1.29 (1.84) 0/8
Social disability 1.22 (1.89) 0/8
Handicap 1.22 (1.89) 0/8
Overall 8.74 (9.00) 0/42
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Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
as well as causing pain and discomfort, with a
direct impact on OHRQoL [4,7]. Studies have
demonstrated that dental anxiety can hurt
the mental wellbeing of pregnant women and
possibly exert an impact on OHRQoL. Some
authors suggest that mental health could be
more vulnerable in the nal stages of pregnancy
and the postnatal period [21]. Moreover, dental
anxiety together with a poor dental status can
exert a negative inuence on one’s self-condence
and mental well-being, implying low self-esteem
and embarrassment in the presence of a dentist
due to the fear of being judged [6,22]. Dental
anxiety can be aggravated by insecurity and a lack
of information that many women have, which is
related to the myth that dental care is not safe
during pregnancy and may cause harm to the
mother and child [4].
In our study, demographic and socioeconomic
characteristics were not associated with OHRQoL,
which may be explained by the fact that only
pregnant women at public healthcare services
were included, resulting in a homogenous
sample. Other authors have found similar
results [12]. However, our ndings contrast with
results reported in a previous study conducted
with pregnant adolescents, in which those with
low levels of education experienced a worse
OHRQoL [23]. Women’s self-perceptions may
be altered during pregnancy due to physical and
psychological changes related to this phase [1],
which may exert an impact on the results of
studies on OHRQoL.
Regarding clinical conditions, pregnant
women with gingivitis had poor OHRQoL.
Besides hormonal changes, pregnancy also has
repercussions for oral health. Pregnant women are
more susceptible to xerostomia, oral thrush and,
if proper oral hygiene is not performed, gingivitis
and dental caries can become aggravated, exerting
a negative impact on OHRQoL [9,12]. Gingivitis
was related to higher OHIP-14 mean scores,
which is compatible with findings described
in previous studies [2,24]. A cross-sectional
study conducted with 512 pregnant women in
Shanghai, China, found that more than a half
Table III - Unadjusted association between pregnant characteristics
and overall OHIP-14, determined using Poisson regression. Santa
Maria, Brazil (n=256)
Variables RRa (95% CI)bp-value
Demographic and socioeconomic
Age
< 20 years
20-30 years
> 30 years
1
0.95 (0.68-1.30)
1.10 (0.74-1.63)
0.622
Skin color
White
Non-white
1
1.31 (1.02-1.69)
0.030*
Educationc
8 years
≥ 8 years
1
0.99 (0.74-1.33)
0.959
Family incomed
1-2 BMMW
>2 BMMW
1
0.97 (0.73-1.28)
0.817
Behaviors characteristics
Smoke during pregnancye
No
Yes
1
1.24 (0.68-2.26)
0.487
Frequency of dental attendance
> 1 time per year
< 1 time per year
1
0.95 (0.74-1.23)
0.722
Oral health measures
Previous endodontic treatment
No
Yes
1
0.86 (0.65-1.15)
0.313
Gingivits
No (< 10% marginal bleeding)
Yes (≥ 10% marginal bleeding)
1
1.42 (1.08-1.85)
0.011*
Periodontitis
No
Yes
1
1.13 (0.86-1.48)
0.378
Tooth Loss
No
Yes
1
0.97 (0.75-1.26) 0.859
Decayed Surface
No
Yes
1
1.35 (1.03-1.79)
0.030*
Dental Anxiety (DAS)
Low level (<15)
High level (≥15)
1
1.42 (1.06-1.90)
0.017*
aRR, rate ratio; bCI, confidence interval; ccorresponds to primary
school education; dBMMW - Brazilian monthly minimum wages;
eOnly smoke during pregnancy were investigated.
Table IV - Adjusted Poisson Regression for the association between
pregnant characteristics and overall OHIP-14 scores. Santa Maria,
Brazil (n=256)
Variables RRa (95% CI)bp-value*
Demographic and socioeconomic
Skin color
White
Non-white
1
1.26 (0.98-1.60) 0.061
Oral health measures
Gingivitis
No (< 10% marginal bleeding)
Yes (≥ 10% marginal bleeding)
1
1.34 (1.00-1.78) 0.043*
Decayed Surface
No
Yes
1
1.22 (0.91-1.64) 0.181
Dental Anxiety (DAS)
Low level (<15)
High level (≥15)
1
1.36 (1.02-1.78) 0.033*
*p-value <0.05; aRR, rate ratio; bCI, confidence interval.
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Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
of the participants had gingival bleeding at
25% of sites and consequently reported a worse
impact on OHRQoL [2]. The literature describes
gingivitis in the gestational period as a signs of
hyperplasia, erythema, and gingival bleeding [2].
If a woman does not have adequate oral
hygiene during pregnancy, she is more likely
to develop gingivitis due to increased hormone
production which causes an increase in the
gingival blood supply and alters mediators of the
inammatory response [24]. In such cases, dental
care is recommended. Dental treatment is safe
and effective throughout the entire pregnancy
but should be preferably performed in the second
trimester, as the risk of embryological effects is
lower and pregnant women feel greater comfort
during dental care [25]. The effectiveness
of periodontal therapy during pregnancy to
reestablish oral health and exert a positive
effect on OHRQoL is widely discussed in the
literature [9].
The other clinical conditions evaluated in
the present study, such as dental caries, missing
teeth, and periodontitis, were not associated
with the pregnant OHRQoL. During pregnancy,
general health, such as risks to the fetus and
the possibility of systemic diseases, may exert
a greater impact on quality of life than oral
conditions, as women understand that problems
with the oral cavity do not directly threaten
the infant development, which may inuence
their self-perception of health [26]. Moreover,
this period is marked by symptoms of nausea,
vomiting and discomfort, which can have a
negative impact on the professional, social, and
family life of these women and may mask other
results related to oral health [2].
Some limitations must be considered. The
questionnaire used to assess OHRQoL records
oral health impacts in the last six months, and
some pregnant women included had a gestational
age lower than this period. Thus, this OHRQoL
may be related the pre-pregnancy period.
Furthermore, with our cross-sectional design, we
cannot establish any cause-and-effect relations.
Another limitation is related to our sample;
only public health services were assessed, which
prevented us from having a representative sample
of the population. However, in Brazil, the public
network covers a large part of the population,
as it is considered a free network with universal
access [27]. Despite the limitations, this is an
innovative study, as the association between
dental anxiety and OHRQoL has not previously
been investigated in pregnant women. Besides,
we have used valid methods and instruments to
assess the variables of interest. Studies should
investigate more in depth the consequences of
dental anxiety on pregnant OHRQoL as well
as the impact of this important aspect on the
infant’s oral health. It could be important since
dental anxiety can exert a negative impact on
the use of dental services and pregnant oral
health [3]. These aspects may also impact the
infant oral health considering that mothers are
the main ones responsible for the oral health of
their children, especially during the rst years
of life [8].
Regarding the practical implications of this
study, identifying the relation between high levels
of dental anxiety and poor OHRQoL underscores
the need for all health teams to plan oral health
promotion measures that reach this population.
Such measures should include strategic actions
that enable pregnant women to feel safe and
more at ease regarding prenatal dental care,
which would have a positive impact on their
OHRQoL, providing wellbeing for these women
and, consequently, for their developing infants.
CONCLUSION
In conclusion, our ndings indicated that
dental anxiety was associated with OHRQoL in
pregnant women attending public health centers.
Higher levels of dental anxiety and gingivitis can
lead to worse OHRQoL in pregnant women.
Acknowledgements
The authors thank all the pregnant women
and health services for their cooperation.
Author’s Contributions
GA: Investigation, Methodology, Writing –
Original Draft Preparation, Writing – Review &
Editing. MC: Formal Analysis, Software, Writing
– Review & Editing. CMS: Methodology, Writing –
Review & Editing. BE: Formal Analysis, Software,
Writing – Review & Editing. FT: Formal Analysis,
Software, Writing – Review & Editing. BZS:
Conceptualization, Methodology, Resources,
Supervision, Writing – Review & Editing.
8
Braz Dent Sci 2025 Apr/Jun;28 (2): e4586
Araujo G et al.
Dental anxiety and oral health-related quality of life among pregnant women: a cross-sectional study
Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
Conict of interest
The authors have no conicts of interest to
declare.
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies
of the Human Research Ethics Committee of
Universidade Franciscana
.
This study protocol was reviewed and
approved by the Human Research Ethics
Committee of
Universidade Franciscana
, approval
number 55197616.7.0000.5306.
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9
Braz Dent Sci 2025 Apr/Jun;28 (2): e4586
Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
Araujo G et al.
Dental anxiety and oral health-related quality of life among pregnant women: a cross-sectional study
Araujo G et al. Dental anxiety and oral health-related quality of life among
pregnant women: a cross-sectional study
Date submitted: 2024 Nov 20
Accept submission: 2025 May 13
Gabriela de Araujo
(Corresponding address)
Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
Email address: gabrielaadearaujo@gmail.com
