Oral health knowledge, attitudes, practices and behavioral factors associated with clinical oral health indicators in pregnant women: a cross-sectional study in Spain.

BACKGROUND

Oral health during pregnancy is relevant to maternal well-being and has been associated with perinatal and child oral health outcomes. This study examined associations between a CAPSOM-derived composite knowledge, attitudes, and practices (KAP) score, oral hygiene behaviors, and clinical oral health indicators in pregnant women attending primary health care centers in Lanzarote, Spain.

METHODS

An observational cross-sectional study included 293 pregnant women. Sociodemographic, pregnancy-related, anthropometric, behavioral, and smoking-related variables were collected. Thirteen items based on the Maternal Oral Health Knowledge, Attitudes and Practices Questionnaire (CAPSOM) were combined into a composite KAP score. Clinical outcomes included Plaque Index, Gingival Index, and Tricolor Index. Hierarchical multiple linear regression models were fitted, with sensitivity analyses addressing potential overlap between behavioral variables and the composite KAP score. Additional adjusted models examined night-time toothbrushing.

RESULTS

Mean age was 29.81 ± 6.09 years and mean toothbrushing frequency was 2.29 ± 0.98 times/day. Overall, 96.6% brushed at least once daily and 78.5% reported night-time toothbrushing. Final models explained 60.7% of Plaque Index, 53.1% of Gingival Index, and 69.2% of Tricolor Index variance. Toothbrushing frequency was independently associated with lower values for all three outcomes. The composite KAP score showed modest independent associations with Plaque Index (B = -0.006, ΔR2 = 0.006, p = 0.041) and Tricolor Index (B = -0.015, ΔR2 = 0.021, p < 0.001), but not Gingival Index (p = 0.401). In the six-item nonbehavioral sensitivity analysis, the association remained significant only for Tricolor Index (B = -0.034, p = 0.002). Night-time toothbrushing was independently associated with lower Plaque Index (B = -0.172, p < 0.001), Gingival Index (B = -0.132, p = 0.015), and Tricolor Index (B = -0.118, p = 0.036).

CONCLUSIONS

Oral hygiene behaviors, particularly toothbrushing frequency, showed stronger associations with clinical oral health indicators than the composite KAP score. The contribution of the composite score was modest and outcome dependent. These findings support combining oral health education with practical oral hygiene counseling in prenatal care.