Oral Health Skills Framework for Pregnant Women: a Professional Consensus

Oral Health Skills Framework for Pregnant Women: a Professional Consensus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oral Health Skills Framework for Pregnant Women: a Professional Consensus Annabelle TENENBAUM, Mehrnoosh YAZDANBAKHSH, Iris CERDAN, Johann CAILHOL, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5348154/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Pregnancy is a period susceptible to oral pathologies such as periodontal disease and dental caries, which have been linked to adverse pregnancy outcomes. Research shows that a child’s oral health is shaped by complex individual and collective factors and is closely tied to the health of their parents, particularly their mothers. Although oral health education interventions are offered during pregnancy follow-ups, their effectiveness is difficult to assess. This study presents a competency framework for pregnant women through oral health education programs, serving as a resource for healthcare professionals. Methods A three-round Delphi method assessed professional experts' opinions. A literature review generated 40 resources that informed the first-round questionnaire, structured into two sections (pregnant woman and child). Three main families of skill (preventing, monitoring caries/periodontal disease, seeking dental care) were divided into 96 contributory learning objectives, categorized by knowledge, practices, and attitudes. Experts rated the usefulness of each objective on a 5-point Likert scale, with consensus set at 70%. The expert panel comprised 21 perinatal professionals (midwives, pediatricians, gynecologists, general practitioners, dentists, pharmacists). Results In the first round, 59% of objectives were rated very useful. Forty objectives failed to find consensus and were reformulated for the second round. Oral hygiene achieved better consensus than nutrition-related fields of application. After three rounds, four areas still lacked consensus: the risk of preeclampsia related to periodontal disease, breastfeeding’s impact on oral health, women's search for oral health information, and saliva's protective role. A consensus-based competency framework for pregnant women's oral health education was developed centered on three key competencies: preventing oral diseases, participating in care plans, and asserting rights. Conclusions Reaching a consensus on women's oral health skills is essential for a cross-disciplinary approach to common prevention strategies and oral health education during the perinatal period. Further work is needed to define implementation strategies environments and identify professionals suited for delivering brief oral health interventions during pregnancy follow-ups. Pregnancy Child Oral Health Health Education Program Prevention Perinatal Care Delphi Method Figures Figure 1 Figure 2 Background Caries disease has a worldwide prevalence of 40% across all ages, with high distribution in children [ 1 , 2 ]. Caries result from complex interactions between individual and collective determinants [ 3 , 4 ].Thus, oral health is influenced by several parameters, including individual genetic heritage, hygiene habits (presence of bacterial biofilm), dietary habits (sugar-rich diet), consumption of addictive substances (alcohol, tobacco), and socio-economic factors (income level, professional status, level of education, urban/rural housing, social security coverage)[ 5 ]. Caries damage is unevenly distributed across society, with the highest levels observed in the most socially vulnerable populations [ 6 , 7 , 8 , 9 ]. In addition, several studies have shown that children’s oral health is associated with that of their parents, particularly their mothers [ 10 , 11 ]. Microorganisms (including caries-initiating bacteria) can be found very early in newborns' oral cavity, possibly due to bacterial transmission from the mother’s oral cavity to the child [ 12 ]. Thus, the earlier oral bacterial transmission occurs from mother to child, the greater the risk of children developing caries lesions. Hence, improving children’s oral health implies acting during the perinatal period in the mother-to-be. Moreover, pregnancy is a susceptible period for oral pathologies (periodontal disease and caries). The prevalence of caries in pregnant women has been estimated to be 51%, which is similar to the rate found in the general adult population [ 13 ]. However, changes in dietary habits during pregnancy appear to be associated with an increased risk of developing carious lesions or advancing those already present [ 14 ]. Pregnant women have also been reported to bear a 50%-increased risk of developing gingivitis compared to the general population [ 15 , 16 ]. Studies have established links between periodontal disease (disease of the gums and supporting tissues of the teeth) and pregnancy outcomes (significantly higher risk of premature delivery, greater frequency of chorioamniotitis, pre-term preeclampsia, and risk of intrauterine growth retardation) through the action of inflammatory mediators that can penetrate the bloodstream and cross the placenta [ 17 – 24 ]. An exploratory review of pregnant women’s knowledge, attitudes, and practices regarding oral health revealed that consulting a dentist during pregnancy is primarily influenced by the information communicated by healthcare professionals during this period, pre-existing recourse habits, and family and socio-economic contexts [ 25 ]. The First 1000 Days of Life program of the perinatal and early childhood program of Sante Publique France and UNICEF emphasizes “the importance of this sensitive period, which contains the premises for the health and well-being of the individual throughout his or her life” and promotes early interventions in pregnancy monitoring [ 26 , 27 ]. In recent years, oral health education interventions have been organized as part of pregnancy follow-up. Studies have assessed the level of evidence for these interventions [ 28 , 29 ] and identified their formats and message content, the healthcare professionals involved, and resulting changes in the oral health knowledge, attitudes, and practices of pregnant women. The effectiveness of these interventions on women's and children's oral health, dental utilization, and quality of life remains uncertain [ 29 – 33 ]. A meta-analysis by Riggs (2019) found that children whose mothers (or other caregivers) had received an educational intervention regarding infant feeding practices were less likely to develop caries lesions between 0 and 6 years of age (a probable reduction of 15%) [ 34 ]. Despite these results, Vamos et al. have expressed doubts: the majority of studies have focused on individual interventions centered on the child’s oral health, neglecting the pregnant woman and failing to consider living environments, and actions have been oriented toward assessing knowledge and practices without considering literacy levels [ 35 ]. Most studies have provided very little description of the objectives of the educational intervention, the skills targeted, and the conduct of the sessions; moreover, comparison between studies is challenging due to the significant heterogeneity in the variables studied and the use of varied and non-systematically validated questionnaires. These articles often conclude by indicating a need for future studies focusing specifically on the design of educational interventions and the validation of the content covered. The present study aims to fill this data gap [ 29 , 36 ]. The objective of this work was to develop a competency framework that can be mobilized in pregnant women through oral health education programs and serve as a resource for healthcare professionals. Such programs would have the dual advantages of improving pregnant women's oral health and quality of life while promoting their unborn children's oral health. In addition, a reference framework could serve as a tool for harmonizing educational interventions regarding oral health in pregnant women to develop women's skills and autonomy to improve or maintain their oral health and that of their child through the adoption of favorable behaviors. Methods A research group dedicated to the oral health of mothers and children called P romoting O ral H ealth during P regnancy and Ch iL dhood (POHPiL) was formed. Its ambition was to bring together the various professionals working in the perinatal period, including two public health physicians, two midwives, three dentists specializing in oral public health, a nutritionist, and two hospital pharmacists and health education specialists, giving the group a multi-professional, multi-disciplinary focus. The group members are referred to as “researchers” in this report. The group’s work was performed in two phases. First, a literature review was undertaken to identify oral health recommendations for pregnant women. Second, a questionnaire based on this review was presented to a panel of professional experts specializing in perinatal care. These experts then participated in a Delphi study to reach a consensus regarding the oral health skills expected of pregnant women for themselves and their children (Fig. 1 ). Literature review A literature review was undertaken to identify oral health guidelines during pregnancy for healthcare professionals and pregnant women. The search methodology, including search terms and choice of databases, was developed in collaboration with a literature search engineer. The chosen databases, selected to specifically target resources written in the form of recommendations, were Trip Database (the only one to propose the term “guidelines” as a filter), PubMed and Web of Science, Dentistry & Oral Sciences Sources (DOSS), and French resources (Catalogue et Index des Sites Médicaux de langue Française CISMEF). This approach was complemented by a grey-literature search to identify material published by scholarly societies or institutional websites. The inclusion criteria specified that the study population should comprise pregnant women and that the subject should be oral health recommendations. Care protocols and research articles containing no recommendations were excluded. The literature review was performed between January and February of 2022. Selected references were read in full and analyzed independently by two authors (AT and SAL). In the event of disagreement, the opinion of a third researcher was sought (Fig. 2 ). The search strategy enabled us to identify 40 references (Table 1 ), including 27 educational guides or brochures, seven scientific articles or reports, and six resources from institutional sites or scholarly societies. Of these references, 28 were aimed at healthcare professionals, and 12 were aimed at pregnant women. In addition, 17 references provided information regarding children’s oral health. Some guides for professionals had adopted a multi-professional approach, simultaneously addressing perinatal and early-childhood caregivers and dental professionals. Six guides for pregnancy care included a chapter dedicated to oral health, while the other guides were monothematic, dealing solely with oral health. Data extracted from all resources included organization, authority or author, year, country, format, target audience, and oral health-specific content. The material was categorized into recommendations on preventive behaviors (hygiene, diet) and prevention pathways, use of healthcare professionals, and treatment of oral diseases. Table 1 Resources on oral health recommendations for pregnant women. Ressources Years Country Authors 1 BCPHP Obstetric Guideline 19, Maternity Care Pathway. 2010 Canada British Columbia Perinatal Health Program 2 Perinatal services BC, Newborn Guidelines 13, Newborn nursing care pathway 2015 Canada British Columbia Perinatal Services BC 3 Perinatal services BC, Provincial Perinatal Guidelines, Population and Public Health Prenatal Care Pathway 2014 Canada Perinatal Services BC 4 Your guide to a Healthy Pregnancy 2021 Canada Agence de la santé publique du Canada 5 Evidence review: dental health 2014 Canada British Columbia Ministry of Health 6 Santé bucco-dentaire et grossesse 2021 Canada Gouvernement du Canada 7 Pregnancy and dental health Et version française « Grossesse et santé dentaire » 2017 Canada HealthLink British Columbia 8 Mieux vivre avec votre enfant de la grossesse à 2 ans. Canada Institut national de santé publique du canada 9 Projet sourire en santé, enfants heureux 2007–2014 Canada Officiel regional de la santé Winnipeg 10 Conseils pour la santé bucco-dentaire des femmes enceintes 2018 Canada Agence de la santé publique du Canada 11 Oral Health during pregnancy & early childhood. Evidence-based guidelines for Health Professionals 2010 USA California Dental Association et American College of Obstetricians and Gynecologists 12 Guidelines for oral health care in Pregnancy 2006 USA Oregon Oral Health Coalition 13 VA/DOD Clinical Practice guideline for the management of pregnancy. 2018 USA USA Dept of veterans affairs, Dpt of Defense 14 Oral Health Care for pregnant women 2017 USA South Carolina, Oral Health Coalition, connecting Smiles Maternal and child health bureau 15 Oral Health during pregnancy. A summary of practice guidelines 2008 USA National maternal and child oral Health resource center, Georgetown university 16 Oral health care during pregnancy and early childhood. Practices Guidelines 2006 USA New York State Department of health 17 Guideline on Perinatal and Infant Oral health Care 2020 USA AAPD American Academy of Pediatric Dentistry 18 Oral health guidelines for pregnancy and early childhood. Information for providers 2016 USA Massachussetts dpt of public health 19 Oral health care during pregnancy: a national consensus statement expert workgroup 2012 USA Washington DC 20 Oral Health care during pregnancy and through lifespan 2013 USA ACOG American College of Obstetricians and Gynecologists 21 Oral Health campaign toolkit 2020 USA AAPD American Academy of paediatric dentistry 22 Pregnancy and oral health 2019 USA Centers for disease control and prevention 23 During pregnancy, the mouth matters: a guide to Michigan Perinatal Oral Health 2016 USA Michigan Department of Health and human services 24 Guideline on perinatal oral health care 2011 USA AAPD 25 Nutrition and Oral health Guidelines for pregnant women, infants and children 1998 USA Journal of the American dietetic association 26 Maternal and child nutrition. Public Health Guideline 2008 UK Nice: National Institute for Health and Care Excellence 27 Oral health: local authorities and partners 2014 UK Nice: National Institute for Health and Care Excellence 28 Teeth ang gums problems 2019 UK NHS 29 The relationship between oral health and pregnancy. Guidelines for oral-health professionals +/- 2017 Europe et UK European federation of periodontology & British society of periodontology 30 The relationship between oral health and pregnancy. Guidelines for oral-health professionals Europe European federation of periodontology 31 De dents saines pour la femme enceinte et son enfant Suisse Société Suisse d’Odontostomatologie 32 Oral health in pregnancy (guidelines to gynaecologists, general physicians & oral health care providers) 2011 Inde KANDAN P. J Pak Med Assoc 33 Examen Bucco-dentaire à destination des femmes enceintes « Un enfant une dent » le dicton n’est plus vrai 2014 France Assurance Maladie 34 Première consultation et suivi mensuel de grossesse 2021 France Assurance Maladie 35 Grossesse et Santé Orale Fiche 1,2,3,4 2022 France Société Française de parodontologie et d’implantologie orale & Collèges nationales des Sages-Femmes de France 36 Grossesse et Allaitement, Guide de prise en charge par le CD. 2016 France Association Dentaire de France ADF et Collège national des gynécologues et obstétriciens français 37 Grossesse et maladie parodontale (pour les CD) 2013 France Société Française de Parodontologie et Implantologie Orale 38 Prévention bucco-dentaire adaptée aux différents cycles de la vie 2019 France Assurance Maladie Languedoc – Roussillon / Occitanie URPS CD 39 Prévention de la carie dentaire avant 3 ans 2006 France DGS 40 Former et sensibiliser les professionnels impliqués en périnatalité à la santé et à l’hygiène bucco-dentaire des FE. France UFSBD - Table 1 should be placed here but, because of its length, is positioned at the end of the manuscript - Pedagogical positioning This work lies at the interface between a competency-based approach and the principles of behaviorist-inspired objective-based pedagogy [ 37 ]. The latter justifies using concepts such as contributory pedagogical objectives and the various types of knowledge mobilized (knowledge, practices, attitudes) to better characterize skill development. This choice reflects the desire to adopt an approach that articulates knowledge and skills while facilitating the collection of elements contributing to the evaluation of skills based on experts’ pedagogical experience. Indeed, the use of a method purely focused on the skills approach, such as analyzing skills components, reference situations, or development levels, could have introduced bias into the responses obtained. Delphi survey The Delphi method is a qualitative research approach that measures the degree of consensus and divergence among experts’ opinions on a specific topic, gradually facilitating the emergence of a consensus [ 38 , 39 , 40 ]. This method involves well-defined steps: choosing a topic and identifying the relevant experts; soliciting participation; formulating the problem as an initial question; developing the questionnaire; launching the first round of consultations by administering the questionnaire; collecting the ratings (level of agreement); analyzing the ratings; providing feedback to the experts; adapting the questionnaire accordingly and organizing a new consultation; and repeating this process until a consensus has been reached among the experts. The expert panel Participant selection followed a four-stage process: elaborating criteria for expert selection, establishing a list of potential experts, contacting selected experts, and inviting participants [ 39 ]. Twenty-one professional perinatal experts were invited (Fig. 1 ). Questionnaire design We used the literature review results to identify three key competencies: preventing, monitoring, and seeking dental care. These competencies are associated with specific pedagogical objectives, defining the critical learning to be achieved to enable optimal activation of each competency. The questionnaire was structured in two sections (pregnant woman and child), covering the three main families of skills (preventing, monitoring, seeking dental care), divided into 96 contributory learning objectives. Participants were asked to rate the usefulness of the contributory educational objectives on a 5-point Likert scale, ranging from “not at all useful” to “very useful.” Questionnaire distribution The questionnaire was distributed electronically and included a cover letter introducing the study and soliciting their participation, emphasizing the anonymity of responses. A period of 10 days was allowed between each round, with a reminder sent after one week. The experts were asked to rate their level of agreement with the proposed objectives on a discrete quantitative scale ranging from 1 (not at all useful) to 4 (very useful). The objectives with a score of 4 reaching 70% were retained (total agreement), those with a score of 1 reaching 70% were eliminated (definitive rejection), and the remaining items were reformulated for the next round. Between rounds, the researchers reviewed the results and redefined the objectives on which there had been no consensus. In this way, responses were consolidated through successive questionnaire rounds to achieve a satisfactory degree of consensus [ 40 ]. The final report was presented to the experts at a meeting to summarize the results and served as the basis for constructing the competency framework. Results Delphi survey The study ran from April 2022 to July 2022. Nineteen professionals participated in the first round, 15 in the second round, and 11 in the final round (Fig. 1 ). A consensus was reached after three rounds. In the first round, 57 contributory learning objectives out of 96 (59%) were rated “very useful,” with 33 out of 49 (67.3%) rated “very useful” for pregnant women and 24 out of 48 (50%) rated “very useful” for children (Table 2 ). Forty objectives failed to achieve consensus and were reformulated for the second round. Table 2 First Delphi round: experts' responses to the questionnaire Skills / usefulness score 1 Not at all useful 2 Not Useful 3 Useful 4 Very useful PART I : ABOUT THE MOTHER 1. Targeted skills for women : preventing caries and periodontal disease. A1. Knowledge In your opinion, is it useful for pregnant women to be aware of the following risk factors for caries and periodontal disease: - The presence of bacterial plaque on teeth 10.53% 0% 0% 89.47% - Reduced saliva on the teeth 15.79% 15.79% 21 .05% 47.37% - Smoking 0% 0% 5.26% 94.74% - Hormonal impregnation 0% 15.79% 26.32% 57.89% - The risk of preeclampsia due to periodontal disease 10.53% 21.05% 10.53% 57.89% In your opinion, is it useful for pregnant women to be aware of the following protective factors against caries and periodontal disease: - Tooth self-cleaning with saliva 15.79% 10.53% 26.32% 47.37% - Brushing to eliminate bacterial plaque build-up on teeth 0% 5 .26% 0% 94.74% - Fluoride toothpaste 0% 5 .26% 21.05% 73.68% - Smoking cessation 0% 0% 10.53% 89.47% - Regular dental check-ups during pregnancy 0% 0% 21.05% 78.95% - Certain dietary habits during pregnancy (such as adequate intake of calcium and vitamin D) 0% 5.26% 26.32% 68.42% A2. Attitudes Do you think it is useful for pregnant women to adopt the following attitudes to help prevent caries and periodontal disease? - Explain your diet to your family and friends 36.84% 26.32% 21.05% 15.79% - Search for preventive oral health information on a website, on ameli.... 5.26% 52.63% 26.32% 15.79% - Seek advice on dental health from a healthcare professional (midwife, nursery nurse, doctor, pharmacist, dentist, etc.). 0% 0% 21.05% 78.95% A3. Practices In your opinion, would it be useful for pregnant women to adopt the following practices to help prevent caries and periodontal disease: - Use a personal toothbrush 0% 5.26% 0% 94.74% - Choose foods that do not promote cavities when dividing food intake (to prevent the risk of nausea and vomiting). 10.53% 5.26% 31.58% 52.63% - Rinse mouth with bicarbonate or fluoride mouthwash, or simply with water if vomiting occurs. 5.26% 15.79% 5.26% 73.68% - Brush teeth after vomiting 10.53% 26.32% 26.32% 36.84% - Brush twice a day with fluoride toothpaste 0% 0% 15.79% 84.21% - Avoid sugary drinks outside mealtimes 0% 5.26% 21.05% 73.68% - Limit intake of sugary foods during meals 5.26% 26.32% 26.32% 42.11% - Drink water during and outside meals 0% 0% 0% 100% - Drink sparkling water rather than sugary soft drinks 0% 5.26% 26.32% 68.42% - Choose fruit rather than fruit juice to meet the recommended daily fruit intake. 5.26% 0% 5.26% 89.47% - Use sugar-free chewing gum 10.53% 31.58% 21.05% 36.84% 2. Targeted skills for women: monitoring caries and periodontal disease : B.1 Attitudes In your opinion, would it be useful for pregnant women to adopt the following attitudes to help monitor caries and periodontal disease: - Communicate with healthcare professionals and receive guidance if needed 0% 0% 0% 100% B.2 Practices Do you think it would be useful for pregnant women to adopt the following practices to help monitor caries and periodontal disease: - Identifying signs of decay 5.26% 0% 5.26% 89.47% - Identifying the signs of dental abscesses 5.26% 0% 10.53% 84.21% - Observe your mouth regularly 5.26% 10.53% 36.84% 47.37% - Identifying the signs of gingivitis 0% 5.26% 31.58% 63.16% - Be alert to dental discomfort or pain 0% 5.26% 15.79% 78.95% 3. Targeted skills for women: seeking dental care C.1 Knowledge In your opinion, is it useful for pregnant women to know the following factors concerning the use of dental care: - Dental care is safe during pregnancy 5.26% 5.26% 5.26% 84.21% - Scaling is safe during pregnancy 5.26% 5.26% 5.26% 84.21% - Dental anesthesia is safe during pregnancy 5.26% 0% 10.53% 84.21% - Dental care contributes to good general health and fetal development 0% 0% 15.79% 84.21% - Dental radiography can be performed using a lead apron during pregnancy 10.53% 5.26% 10.53% 73.68% - Dental care is important during pregnancy 0% 0% 10.53% 89.47% - It is important not to postpone treatment during pregnancy 0% 0% 5.26% 94.74% - Early treatment reduces transmission of bacteria from mother to child 5.26% 0% 21.05% 73.68% - No risk of premature delivery due to dental treatment 0% 10.53% 21.05% 68.42% - Dental care during pregnancy is covered under special conditions 0% 0% 21.05% 78.95% - A dental check-up is available during the 4th month of pregnancy. 0% 0% 5.26% 94.74% C.2 Attitudes In your opinion, is it useful for pregnant women to adopt the following attitudes regarding dental care: - Call in a dental surgeon for an emergency consultation if necessary 0% 0% 5.26% 94.74% - Call a dental surgeon in case of pain 0% 0% 10.53% 89.47% - Avoid self-medication for a dental problem without the advice of a healthcare professional informed of the pregnancy in progress 0% 0% 5.26% 94.74% - Claiming social security benefits 0% 10.53% 26.32% 63.16% C.3 Practices In your opinion, is it useful for pregnant women to adopt the following dental care practices: - Check-ups during pregnancy 0% 10.53% 5.26% 78.95% - Using a preventive dental check-up measure offered by the health insurance during pregnancy 0% 0% 10.53% 89.47% - Routine check-ups once a year for the rest of your life 0% 0% 21.05% 78.95% PART II: ABOUT THE CHILD (NEWBORNS, CHILDREN AGED 6 MONTHS TO THREE YEARS) 1. Targeted skills for women: preventing caries in children D1. Knowledge In your opinion, is it useful for a pregnant woman to know the following about preventing cavities in her child: - Teeth are formed before birth 0% 36.84% 10.53% 52.63% - Teeth evolve by piercing the gums 10.53% 42.11% 10.53% 36.84% - Mandibular incisors come first 10.53% 47.37% 10.53% 31.58% - All teeth must have erupted between 24 months and 3 years of age 10.53% 26.32% 21.05% 42.11% - Temporary teeth are an eruption guide for permanent teeth 10.53% 26.32% 21.05% 42.11% - Temporary teeth play a part in language acquisition 0% 21.05% 15.79% 63.16% - Temporary teeth contribute to the development of permanent teeth 0% 10.53% 36.84% 52.63% - Temporary teeth contribute to aesthetics, smile and school integration 15.79% 26.32% 21.05% 36.84% - Temporary teeth help with phonation and proper pronunciation 0% 15.79% 10.53% 73.68% - Brushing methods should be adapted to the child's age 0% 5.26% 15.79% 78.95% - Children's teeth should be brushed from the first tooth before bedtime. 0% 15.79% 5.26% 78.95% - Children's teeth should be brushed twice a day 0% 15.79% 5.26% 78.95% D2. Attitudes In your opinion, is it useful for pregnant women to adopt the following attitudes regarding the prevention of cavities in their children: - Educate and inform those around you about preventing the risk of dental caries in children 21.05% 15.79% 10 .53% 52.63% - Communicating with healthcare professionals to deal with difficulties encountered in prevention initiatives for children 10.53% 5.26% 10.53% 73.68% - Managing difficult moments when the child demands inappropriate food intake 5.26% 10.53% 10.53% 73.68% D3. Practices In your opinion, is it useful for pregnant women to adopt the following practices to prevent cavities in their children? - Use a teething ring or rub gums with clean fingers to reduce pain and discomfort 5.26% 31.58% 21.05% 42.11% - Use the cup from age 1 to drink water 5.26% 21.05% 31.58% 42.11% - Offer the child no more than 4 food intakes/day when the 4 meals are in place. 0% 10.53% 36.84% 52.63% - Do not extend on-demand breastfeeding beyond 1 year 36.84% 15.79% 21.05% 26.32% - Use a different spoon for each child's meal 5.26% 10.53% 21.05% 63.16% - Wash the pacifier with water, not with your mouth 5.26% 5.26% 15.79% 73.68% - Offer unsweetened beverages 0% 5.26% 5.26% 89.47% - Offer age-appropriate foods 0% 5.26% 10.53% 84.21% - Offer snack options that don't promote cavities 0% 10.53% 10.53% 78.95% - Offer dairy products 5.26% 15.79% 21.05% 57.89% - Avoid sweet and sticky foods such as candy and chewing gum. 0% 10.53% 5.26% 84.21% - Avoid dipping pacifiers in honey or other sweet products 0% 10.53% 5.26% 84.21% - Don't leave your child with a bottle at night 0% 5.26% 10.53% 84.21% - Use a soft-bristled toothbrush 5.26% 5.26% 15.79% 73.68% - Change your toothbrush as soon as the bristles become frayed 0% 15.79% 5.26% 78.95% - Use age-appropriate toothpaste (fluoride concentration) 0% 10.53% 0% 89.47% - To support children's tooth-brushing movements from age 2 0% 5.26% 15.79% 78.95% - Rinse toothbrush with water after every brushing session 5.26% 5.26% 10.53% 78.95% 2. Targeted skills for women: monitoring caries and oral health problems in children E.1 Knowledge In your opinion, would it be useful for a pregnant woman to know the following information about monitoring her child for cavities: - Tooth abnormalities (color changes, white or black stains, cavities, damaged teeth) 10.53% 10.53% 5.26% 73.68% - Presence of gum abnormalities (swelling, abscess, etc.) 10.53% 10.53% 5.26% 73.68% - Signs of pain that can interfere with sleep and feeding 10.53% 5.26% 5.26% 78.95% - Signs of rash: salivation or need to chew, irritation or redness on the face, bluish bubble of rash 10.53% 5.26% 21.05% 63.16% E2. Attitudes In your opinion, is it useful for the pregnant woman to adopt the following attitudes regarding the monitoring of the onset of caries in her child? - Care for temporary teeth even if they're about to fall out 10.53% 0% 10.53% 78.95% E3. Practices In your opinion, is it useful for the pregnant woman to adopt the following attitudes regarding the monitoring of the onset of caries in her child? - Recognize the signs of decay: cavity, color, pain, hot/cold sensitivity 15.79% 0% 10.53% 73.68% - Recognizing the signs of a dental abscess 15.79% 10.53% 15.79% 57.89% - Recognizing the signs of gingival inflammation 15.79% 10.53% 15.79% 57.89% - Recognize the signs of accidental tooth evolution 21.05% 26.32% 10.53% 42.11% - Recognizing the signs of dental malposition 21.05% 26.32% 21.05% 31.58% - Recognize the pain, discomfort, bleeding and masticatory difficulties that require dental care 15.79% 5.26% 10.53% 68.42% - Recognizing refusal to eat as a warning sign of oral health problems 15.79% 5.26% 21.05% 57.89% 3. Targeted skills for women: seeking dental care for the child F1. Attitudes In your opinion, is it useful for a pregnant woman to adopt the following attitudes regarding dental care for her child: - Ask your doctor to examine your child's teeth 5.26% 26.32% 31.58% 36.84% - A visit to the dentist from the age of 1 and then once a year 10.53% 5.26% 21.05% 63.16% F2. Practices In your opinion, is it useful for the pregnant woman to adopt the following practices regarding dental care for her child? - Apply the dental health insurance prevention program from age for all ages. 10.53% 0% 5.26% 84.21% - Table 2 should be placed here but, because of its length, is positioned at the end of the manuscript - Concerning the mother’s competence for herself At the end of the first round, 67.3% of the objectives had obtained a “very useful” consensus, distributed as follows: 52% for the “preventing” skill, 66.7% for the “monitoring” skill, and 88.9% for the “seeking oral care” skill (Table 2 and Table 3 ). Table 3 Consensus observed around the 3 categories of skills targeted by pregnant women to ensure good oral health for themselves and their child (Round 1). Target skills for pregnant women Consensus Round 1 Preventing caries and periodontal disease 52% Monitoring caries and periodontal disease 66.7% Seeking dental care 88.9% Target skills for pregnant women concerning the child Preventing caries in children 54.5% Monitoring caries and other oral health problems in children 41.7% Seeking dental care for children 33.3% Competence 'Preventing caries and periodontal disease’ Over 50% of the objectives related to oral hygiene achieved consensus, making it the most widely agreed-upon application area, while over 50% of the objectives related to nutrition failed to achieve consensus, making it the least agreed-upon application area. The only food-related objectives for which consensus was reached were related specifically to beverages (giving preference to water, avoiding sugary drinks outside mealtimes) and choosing fruit rather than fruit juice. Competence ‘Monitoring caries and periodontal disease' A consensus was reached regarding the usefulness of identifying signs of caries or dental abscesses and being alert to discomfort or pain. However, no consensus was reached in identifying signs of gingivitis and observing the mouth. Competence ‘Seeking dental care’ This competence achieved the highest level of consensus across knowledge, attitudes, and practices. The areas of application related to care, such as importance of care, type of care, anesthesia, X-rays, treatment modalities, prevention programs, seeking care, and avoiding self-medication, all received favorable utility scores. Only two objectives failed to achieve a consensus exceeding 70% agreement: the absence of risk of premature delivery because of dental care and the claiming of reimbursement. Objectives for which there had been no consensus were reformulated and resubmitted in rounds two (10 objectives) and in round three (six objectives). At the end of the final round, consensus had still not been reached on three competence preventing objectives: knowing the risk of preeclampsia associated with the presence of periodontal disease, knowing the protective role of saliva (and using chewing gum to stimulate its production), and seeking information regarding oral health. Concerning the mother’s skills for the child At the end of the first round, 50% of the objectives had received a “very useful” consensus, distributed as follows: 54.5% for the preventing competence, 41.7% for the monitoring competence, and 33.3% for the seeking oral care competence (Table 2 and Table 3 ). Competence 'Preventing caries and periodontal disease’ Hygiene application received an entirely favorable consensus, with all objectives judged “very useful.” The nutrition application area reached a moderate consensus, with over 50% of its objectives considered useful. The breastfeeding objective received the highest percentage for “not at all useful” (36.84%), with widely divergent opinions among experts. This objective was the only point for which the “not at all useful” score (36.84%) exceeded the “quite useful” score (26.32%). Some areas of application failed to achieve a consensus: knowing the masticatory and social functions of the oral cavity (social and aesthetic aspects), informing the child’s caregivers about preventing the risks of tooth decay, taking action to reduce discomfort during teething (use of a teething ring), and adopting specific feeding-related practices (number of food intakes, using a cup from age 1 to drink water, using a different spoon). Competence ‘Monitoring caries and periodontal disease' Over 70% of experts considered it “very useful” for women to monitor the onset of caries in children (e.g., the presence of anomalies on the teeth and gums and signs of pain). However, the usefulness of recognizing the signs of a dental problem (dental abscesses, gingival inflammation, dental malposition, eruption, and refusal to eat) was less appreciated, registering a “very useful” level below 60%. Competence ‘Seeking dental care’ At the end of the first round, no consensus had been reached regarding the proposed attitudes (asking the family doctor to examine the child’s teeth and scheduling a dental visit starting at age 1 and annually thereafter). However, seeking preventive care through a health insurance program (e.g., the French program “M’T Dents”) was judged “very useful.” At the end of the first round, consensus had not been reached in 24 areas of application concerning children. These areas were reformulated, and some were merged. In all, 20 areas were resubmitted for the second round of questionnaires. At the end of this second round, consensus had not been achieved in any of the 20 areas. Hence, some questions were reworded to make them easier to understand. For example, the terms “recognizing the signs of a dental abscess,” “inflammation,” “development of deciduous teeth,” and “malposition” were deemed too technical, and they were replaced by an overall generic term regarding the signs of a “dental problem.” At the end of the last round, the only area where there was no consensus was breastfeeding, in the preventing competence. Following the three consecutive rounds, a results feedback session with the experts was organized to discuss areas without consensus. The discussions focused primarily on the risk of preeclampsia linked to oral health and the difficulties encountered in communicating this point, as well as the issue of breastfeeding and, more generally, food intake and its consequences for oral health. It was decided to retain these areas of application but to integrated in a more global manner: the risk of preeclampsia was addressed in the context of the links between oral health and pregnancy, and the issue of breastfeeding was linked to the frequency of food intake. Presentation of results and discussion with experts After the three consecutive rounds, the results session identified the four areas of application where no consensus had been reached. Three in particular provoked debate: knowing the risk of preeclampsia associated with the presence of periodontal disease, identifying the effects of breastfeeding on oral health, and seeking information on oral health. The fourth area concerned the protective role of saliva. Regarding the oral health risk of preeclampsia, participants expressed concern regarding the hierarchy of messages to be conveyed to pregnant women: “everyone wants to use this time of pregnancy to pass on information, so we need to prioritize,” and “the pregnant woman receives a flood of information, many points of vigilance need to be integrated.” The professionals, who need to monitor timing, were concerned about being counterproductive. Some experts explained that preeclampsia is a difficult pathology to explain, making its association with oral health even more challenging to address. The discussion did not resolve this dissensus on the usefulness of pregnant women knowing the risk of preeclampsia in the event of periodontal disease, and the agreement reached addressed this point more comprehensively during pregnancy follow-up. Regarding breastfeeding, the experts highlighted the lack of consistency in the discourse between perinatal professionals (midwives, gynecologists, nursery nurses) and other healthcare professionals (pharmacists, general practitioners, dental surgeons, pediatricians, etc.). The practitioners noted that they are often confronted with a discrepancy between breastfeeding promotion recommendations and the information provided by the various professionals involved. For example, dentists advise spacing food intake to four times a day from diversification onwards to stabilize oral pH and allow remineralization of teeth [ 41 ]. There is a dichotomy between unclear food messages (concerning nutrition and the diets of pregnant women and newborns) and poorly understood links with oral health. Thus, professionals are unfamiliar with the links between milk intake (breast or reconstituted), frequency of food intake, and oral health. The risk of early-onset caries in children has not been clearly identified. The discussion failed to resolve this point of disagreement, as professionals feared contradicting each other and influencing messages promoting breastfeeding, for which France has one of the lowest rates in Europe. However, agreement was reached on the importance of establishing clearly identified food intakes from the time of diversification. The search for oral health information on the internet by women themselves was also a topic of discussion. The experts were concerned about users' ability to discern reliable information and their preference for relying on information from professionals. Knowledge of the protective role of saliva was not the subject of dissenting opinions, but the issue raises a more general point about oral health professionals’ training, which the experts judged to be almost nonexistent in their initial training. Competency framework The expert consensus research method enabled us to define a skills framework to be mobilized in pregnant women through oral health education programs, which can serve as a resource for healthcare professionals. The framework is structured around three competencies aimed at pregnant women concerning their oral health and the oral health of their child: preventing oral diseases (caries and periodontal pathologies) during pregnancy; participating in the implementation of the care plan; and the woman’s assertion of her rights. For each of these skills, essential components and contributing educational objectives were identified (Table 4 ). This framework could be used as an educational action tool to enable individuals to engage in the process of maintaining or improving their oral health [ 42 ]. Table 4 Reference framework of useful skills that can be mobilized in pregnant women through oral health education programs TARGETED ORAL HEALTH SKILLS FOR PREGNANT WOMEN Oral Health Skills Essential components Contributing educational objectives Preven t oral and dental diseases (caries and periodontal disease) during pregnancy • By clearly establishing the relationship between oral health and pregnancy Physiopathology - -Explain how hormonal changes during pregnancy affect the mouth (gum inflammation) and pregnancy outcomes (pre-eclampsia, low birth weight) • By effectively applying dietary recommendations to maintain good oral health during pregnancy Diet - Choose non-cariogenic foods (especially when splitting meals) - Avoid sugary drinks outside mealtimes and drink water instead Dental hygiene habits - - Brush teeth with fluoride toothpaste (twice daily); use sugar-free chewing gum. - In the event of vomiting: rinse mouth after vomiting with bicarbonate or fluoride mouthwash or simply with water Smoking - Initiate smoking cessation • By effectively monitoring warning signs - Inspect the mouth regularly - Early identification of gingival bleeding, tooth discoloration, incipient carious lesions, abscesses, and swollen gums - Identify dental discomfort and pain • By effectively mobilizing the principles of oral care specific to pregnant women - Treatment at every stage of pregnancy - Avoid self-medication for dental problems without the advice of a health professional • By making appropriate use of the healthcare system - Communicate with healthcare professionals - Seek advice on dental health from a healthcare professional (midwife, nursery nurse, doctor, pharmacist, dentist, etc.). - Ask for a referral to a dental surgeon - Call a dental surgeon for an emergency consultation if necessary - Plan a check-up during pregnancy and a routine visit once a year for the rest of your life Participate implementing the care plan • By using the healthcare system appropriately • By ensuring regular monitoring - Use the (national) prevention program, which provides access to an oral and dental check-ups during pregnancy Asserting one’s rights • By communicating with relevant professionals, either independently or with support • By appropriately mobilizing the resources of the medical-social sector - Communicate with professionals in the medical-social sector - Check entitlement to social security reimbursements and coverage of dental care. - Check with the dentist that “treatment carried out during pregnancy (specific quotation)” is mentioned TARGETED ORAL HEALTH SKILLS FOR PREGNANT WOMEN, FOCUSING ON THE ORAL HEALTH OF THEIR CHILDREN (NEWBORN TO 3 YEARS) Preven t children's oral diseases • By clearly establishing the functions of the orofacial sphere - Ensure normal masticatory and social functions (smile, aesthetics, school integration) - Ensure acquisition of language and phonation (good pronunciation) - Identify the signs of the appearance of temporary teeth - Reduce pain and discomfort during tooth eruption - Use a teething ring or rubbing gums with clean fingers • By clearly establishing the dynamic, evolving nature of children’s mouths Diet - Establishe four feedings a day and adapting breastfeeding frequency according to age and diversification - Provide age-appropriate foods - Avoid sweet and sticky foods such as candy and chewing gum. - Avoid sugary drinks - Provide non-cariogenic snack options • By effectively applying hygienic and dietary recommendations to maintain good oral health in children - Use a spoon reserved only for the child’s meal that should not be shared - Do not leave your child with a bottle at night Dental hygiene habits - Wash the teat with water, not with the mouth, and avoid dipping it in honey or other sweet products - Apply age-appropriate hygiene advice (method, type of brush, twice daily from first appearance of teeth) - Use age-appropriate fluoride toothpaste - Supervise and support the tooth-brushing process for children Childcare - Inform caregivers of ways to prevent caries (diet and hygiene) • By involving one’s child appropriately - Brush teeth (with supervision) - Express discomfort if a problem occurs in the mouth • By effectively monitoring warning signs - Inspect the child’s mouth regularly - Identify the presence of anomalies on the teeth (color changes, white or black stains, cavities, damaged teeth) and the gums (swelling, abscesses) and malposition • By effectively mobilizing the principles of oral care specific to children - Identify signs of pain that can interfere with sleep and feeding - Consider oral problems if the child refuses to eat. • By making appropriate use of the healthcare system - Care for a child’s temporary and permanent teeth - Consult a dental surgeon following oral trauma - Avoid self-medication for dental problems without the advice of a health professional. - Schedule an annual check-up with one’s dentist - Schedule a treatment appointment - Discuss a child’s oral health during visits to a general practitioner - Communicate with health professionals to address difficulties encountered when implementing prevention actions with children (e.g., managing difficult moments when the child demands inappropriate food, brushing the child’s teeth). Participate implementing the child's care plan • By using the healthcare system appropriately • By ensuring regular monitoring - Adopt the (national) prevention program, which provides access to an oral health check-up by a dental surgeon; learning about appropriate ages for consultations Asserting one’s rights • By communicating with the professionals concerned, either independently or with support • By appropriately mobilizing the resources of the medical-social sector - Communicate with professionals in the medical-social sector - Check entitlement to social security reimbursements and coverage - Check with the dentist that “treatment carried out for young children (specific quotation)” is mentioned - Table 4 should be placed here but, because of its length, is positioned at the end of the manuscript - Discussion Oral health education during pregnancy and in preparation for birth and parenthood remains variable and is sometimes nonexistent [ 43 , 44 ]. The lack of systematic integration of oral health into general health monitoring and early prevention programs made it difficult for families to access prevention services, adopt health-promoting behaviors, and quickly access treatment [ 45 ]. In addition, although there are oral health education initiatives during pregnancy, they lack scientific validity in terms of content and effectiveness for a genuine preventive strategy at both the community and individual levels. This study aimed to develop a useful competency framework to mobilize in pregnant women through oral health education programs, which can serve as a resource for healthcare professionals. In the first round of the Delphi, concerning pregnant women, professionals rated skills in monitoring caries and periodontal disease (66.6%) and seeking oral care (88.9%) as more useful than those in prevention (52%). Thus, the experts adopted a care-oriented stance, aligning with a highly medicalized model and a predominantly biomedical approach. The trend was the opposite for children (prevention 54.5%, monitoring 41.6%, care 33.3%), and twice as many dissenting opinions were recorded for areas of application concerning children as for mothers. During the feedback session, discussions on the two areas concerning the risk of preeclampsia and breastfeeding reflected inconsistencies between the messages conveyed by the different medical specialties [ 46 , 47 ]. On the one hand, dentists rarely address oral health prevention issues specific to pregnancy, childhood, and breastfeeding. On the orther hand, perinatal care professionals, such as those working in postpartum care, child maternal protection centers, or daycare centers, rarely integrate oral health prevention messages and are reluctant to discuss pregnancy-related oral health risks (preeclampsia) [ 48 – 52 ]. For example, oral hygiene is rarely included in the first hygiene practices taught in maternity hospitals. These exchanges highlighted differences of opinion among professionals and led to a broader reflection of the complexity of conveying and prioritizing prevention messages during the perinatal period. Furthermore, these professionals are insufficiently trained in common prevention strategies, whether in initial or ongoing training and are not always aware of existing prevention programs [ 53 , 54 ]. Hence, professionals tend to deliver primary prevention messages focused on a specific pathology and strictly linked to their discipline without placing the individual in a broader context with a global health vision. However, the interdisciplinarity and multi-professional training (initial and continuing) of professionals encourage the implementation of health promotion principles. Today's global health challenges transcend the strict boundaries of individual medical disciplines. Indeed, health education should not be limited to a single specialty but should integrate a holistic vision where midwives, dentists, pediatricians, and others work together to help families acquire parenthood skills. Initial and ongoing training for all healthcare professionals is necessary to ensure greater cohesion in prevention discourse and enable professionals to move beyond a siloed approach that is too paternalistic and curative. Multi-professional, interdisciplinary training in educational strategies and psychosocial skills, which also incorporates the user's perspective, would enable the provision of better support for the people concerned and foster their autonomy by supporting their commitment to health promotion. Moreover, interdisciplinarity strengthens the ability of care teams to take effective collective action while enhancing people's autonomy and power to act, in line with the principles of health promotion as defined by the World Health Organization [ 55 ]. According to Bernard, health education in perinatal care can be defined as a process centered on women, aimed at increasing their autonomy and facilitating the acquisition or maintenance of the skills they need to manage and adapt to the changes inherent in motherhood [ 56 ]. This health education is “an active process of reinforcing self-esteem and critical thinking skills, and the ability to make decisions and take action to act and improve one's health; in this case, to succeed in a health experience by welcoming the child and making the transition to parenthood” [ 57 ]. In his study on perinatal health education among French midwives, Bernard [2014] identified disparities between health education approaches, particularly between approaches limited to information-advice and accompaniment-support; he also identified inequalities in the information disseminated and the screening actions in which midwives participate. For many years, public health interventions focused solely on transmitting information about diseases and risks based on the rational assumption that once people were aware of the consequences, they would automatically adopt health-beneficial behaviors. However, this approach does not align with reality, since individual behavior does not follow this logic and is the result of many factors, both internal and external to the individual. Thus, adopting a strategy of health education and not just information delivery implies conferring an active process on the person concerned by considering their ability to access, understand, evaluate, and apply information to make decisions and apply this information to their own health (the notion of health literacy), environment, and life context [ 58 ]. The professionals who participated in this research do not share this concept of the individual as an active and committed player in their own healthcare. For example, the question of whether a pregnant woman should seek information independently generated disagreement among the experts. This reaction reflects professionals' traditional approach to the practitioner-patient relationship, thus questioning people's ability to seek and understand information independently. Professionals' reactions question their acceptance of the concept of health democracy [ 59 ] and consideration of individuals' power to act regarding their health [ 60 ]. Indeed, although the quality of online information varies, it allows “egalitarian access to information regardless of geographical location, temporal availability, socio-economic level or physical isolation” [ 61 ]. Thus, it's not only a way for pregnant women to find medical information quickly and easily, enabling them to be better prepared, but also a way of sharing experiences that can be seen in some aspects as social support [ 62 ]. Discussions with the experts on this issue have highlighted the need to raise awareness among healthcare professionals about psychosocial skills and how to integrate them into the prevention strategies they deploy with their patients. The search for information could be a theme incorporated into prenatal classes and would provide an opportunity to develop critical thinking skills to identify reliable sources [ 63 ]. This active approach would promote the pregnant woman's autonomy and empowerment [ 64 ]. To our knowledge, this is the first reference tool of its kind. Beyond the existing guides and resources identified in the literature review, which are merely vectors of information, this referential aid can be used as a tool in an educational intervention that enables women to engage in a process of maintaining or improving their oral health [ 42 ]. Formulated with regard to pedagogical skills and objectives, it is part of an educational approach that will enable professionals to position themselves as actors in oral health education and go beyond delivering advice-based information, which does not sufficiently support patients in their day-to-day health management. Accordingly, and in line with the INPES health education skills reference framework [ 42 ], this perinatal oral health reference framework could be integrated into a global educational approach and a common prevention culture deployed by a professional around four functions that integrate oral health. First, to identify and analyze situations that could give rise to educational action to maintain and preserve health. Second, to provide bespoke assistance to raise awareness and encourage commitment to a health education approach adapted to the situation. Third, to develop the organization and implementation of collective action as part of a health education approach. Fourth, to develop the professional practices required to implement health education actions. Despite its contributions, this study has limitations. The number of professionals meeting the criteria of the Delphi method decreased significantly during the third round (due to vacation period, retirement, etc.) Nevertheless, the careful selection of experts produced a representative panel of professionals working in the field of maternity and early childhood. In retrospect, the 96-question questionnaire was probably perceived as excessive, and this perception may have contributed to the loss of participants. Furthermore, categorizing skills into knowledge, attitudes, and practices may have generated misunderstandings or a sense of redundancy among the professionals, with some areas being questioned several times from different categories. Conclusion In conclusion, it is essential for pregnant women to acquire oral health skills for themselves and their children. The search for a consensus among professional experts on women's oral health skills is a first step toward a common, cross-disciplinary approach to oral health during the perinatal period. The skills repository, developed around coherent key messages, could help structure educational interventions in oral health for pregnant women, with the aim of developing their skills and autonomy to improve or maintain oral health through the appropriation of favorable behaviors. However, the specific modalities, settings, and professionals best suited to deliver brief oral health interventions during prenatal care remain to be determined. Declarations Consent for publication All authors give their consent to publication. Funding None Availability of data and materials Data is provided within the manuscript. The items included in the Delphi questionnaires are reflected in Table 2, the skill framework is presented in Table 4. Panel evaluations for subsequent Delphi cycles (i.e. round 2 and 3) are available from the corresponding author on reasonable request. Authors' contribution All authors designed the research and the structure of the study. A.T, S.A-L , A.M and R.G wrote the main manuscript text. V.D, I.C, M.Y and A.T structured the methodology. A.T, I.C, S.R, J.C, A.M and S.A-L interpreted the data and synthesised the data. A.T, R.G, P.L , T.M and S.A-L revised the work. R.G and P.L provided critical feedback for revision. All authors reviewed and approved the manuscript. Ethics approval and consent to participate Care was taken to ensure compliance with ethical standards throughout the research process. A note containing the essential information (research framework, objective, right of refusal, right of withdrawal without justification, right of access to the overall results, and researchers’ contact details) was sent by email, and the participants then signed a written consent form. Information was stored securely and temporarily. LimeSurvey software was used, hosted by Université Paris Cité, which provides data security. This software complies with the requirements of the General Data Protection Regulation (GDPR) and ensures the confidentiality and security of personal information. A request for authorization was submitted to the CNIL Commission Nationale de l’Informatique et des Libertés, and a favorable response was obtained, the reference number from is 2235880 v 0. Competing interests The authors declare no competing interests. Author details 1 Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430, Villetaneuse, Fance. 2 Department of Dental Public Health, Faculty of Dentistry, University Paris Cité, APHP-Pitié Salpétrière, Paris, France. 3 Public Health Department, Seine-Saint-Denis University Hospital, APHP, 93000 Bobigny, France. 4 Centre Hospitalier Universitaire de Lille, 59000 Lille, France.Haut du formulaireBas du formulaire 5 Ecole universitaire de recherche (EUR) Sciences Infirmières en Promotion de la Santé (SIePS), Université Sorbonne Paris Nord, 93000 Bobigny, France. References Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study. (2017). https://pubmed.ncbi.nlm.nih.gov/30496104/ Accessed 25 oct 2024 Petersen PE. 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Teaching strategies and learning environments for breastfeeding promotion: a scoping review. Educ Ther Patient/Ther Patient Educ. 2022;14(1):10501. Spiesser-Robelet L, Maurice A, Gagnayre R. Understanding Breastfeeding Women's Behaviors Toward Medication: Healthcare Professionals' Viewpoint. J Hum Lact . 2019;35(1):137-153. Anunciação BH, Azevedo MJ, Pereira M de L. Knowledge, attitudes, and practices of prenatal care practitioners regarding oral health in pregnancy-A systematic review. Int J Gynaecol Obstet. 2023;162(2):449‑61. Duarte ML, Dias KR, Ferreira DMTP, Fonseca-Gonçalves A. Knowledge of health professionals about breastfeeding and factors that lead the weaning: a scoping review. Cien Saude Colet. 2022;27(2):441‑57. George A, Dahlen HG, Reath J, Ajwani S, Bhole S, Korda A, et al. What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia. BMC Pregnancy Childbirth. 2016;16(1):382. Javed MQ, Bhatti UA, Riaz A, Chaudhary FA. Predictors of periodontal and caries related perinatal oral healthcare, investigation of dentists’ practices: a cross-sectional study. PeerJ. 2021;9:e12080. Bossouf A, Sabourin C, Fuchs F, Giraudeau N, Inquimbert C. Interprofessional survey on knowledge and attitudes of midwives regarding oral health, in France. Eur J Midwifery. 2023;7:37. Nancy J, Barsby T, Theillaud M, Barbey-Massin C, Thébaud NB. Early childhood caries prevention: non-dental health professionals’ viewpoint. Br J Nurs. 2020;29(15):884‑90. Cot S, Durand D, Daniel S, Paris S, Millot I, Binquet C. Prévention au premier trimestre de la grossesse : perspective des professionnels. Sante Publique . 2022;34(1):71-85. (2024). https://www.who.int/health-topics/health-promotion Accessed 25 oct 2024 Bernard MR, Eymard C. L’éducation pour la santé en périnatalité : enquête auprès des sages-femmes françaises. Santé Publique. 2014;26(5):591‑602. HAS Haute Autorité de Santé. Préparation à la naissance et à la parentalité. (2005). https://www.has-sante.fr/jcms/c_272500/fr/preparation-a-la-naissance-et-a-la-parentalite Accessed 25 oct 2024 Margat A, Pétré B, d’Ivernois JF, Lombrail P, Cailhol J, Gagnayre R. COVID-19 : Proposition d’un modèle d’éducation d’urgence. Educ Ther Patient/Ther Patient Educ. 2020;12(1):10402. Lefeuvre K, ROLAND O. La démocratie en santé en question(s) (Presses de l’EHESP). https://shs.cairn.info/la-democratie-en-sante-en-questions--9782810906383 Accessed 25 oct 2024 Gross Olivia. La santé en action. L’empowerment, accroissement du pouvoir d’agir, est-il éthique ? (2020) https://www.santepubliquefrance.fr/import/l-empowerment-accroissement-du-pouvoir-d-agir-est-il-ethique Accessed 25 oct 2024 Masella MA, Godard B. Enjeux éthiques du recours à Internet par les femmes enceintes dans leur suivi de grossesse. Sante Publique . 2020;32(2):171-182. Gross Olivia. 9. Les patients face aux écrans : risque majeur ou formidable levier pour la démocratie en santé ? In: La démocratie en santé en question(s). Presses de l’EHESP; (2018). https://shs.cairn.info/la-democratie-en-sante-en-questions--9782810906383-page-111 Accessed 25 oct 2024 Lima-Pereira P, Bermúdez-Tamayo C, Jasienska G. Use of the Internet as a source of health information amongst participants of antenatal classes. J Clin Nurs. 2012;21(3‑4):322‑30. Klima CS, Vonderheid SC, Norr KF, Park CG. Development of the Pregnancy-related Empowerment Scale. Nursing and Health. 2015;3(5):120‑7. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5348154","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374356832,"identity":"19d5ce44-2c89-4756-b377-ab7d54a21b89","order_by":0,"name":"Annabelle TENENBAUM","email":"","orcid":"","institution":"Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430 Villetaneuse","correspondingAuthor":false,"prefix":"","firstName":"Annabelle","middleName":"","lastName":"TENENBAUM","suffix":""},{"id":374356833,"identity":"c397ac80-8819-42fb-bec2-d2c6c3589282","order_by":1,"name":"Mehrnoosh YAZDANBAKHSH","email":"","orcid":"","institution":"Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430 Villetaneuse","correspondingAuthor":false,"prefix":"","firstName":"Mehrnoosh","middleName":"","lastName":"YAZDANBAKHSH","suffix":""},{"id":374356834,"identity":"8c404032-d285-4091-832d-e9e6ee35b4fa","order_by":2,"name":"Iris CERDAN","email":"","orcid":"","institution":"Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430 Villetaneuse","correspondingAuthor":false,"prefix":"","firstName":"Iris","middleName":"","lastName":"CERDAN","suffix":""},{"id":374356835,"identity":"1c349deb-1ce7-4634-9bd9-1eddee3d322c","order_by":3,"name":"Johann CAILHOL","email":"","orcid":"","institution":"Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430 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RIQUET","email":"","orcid":"","institution":"Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430 Villetaneuse","correspondingAuthor":false,"prefix":"","firstName":"Sébastien","middleName":"","lastName":"RIQUET","suffix":""},{"id":374356846,"identity":"3c1866cd-be55-4c2a-b030-7873875e1e26","order_by":11,"name":"Sylvie AZOGUI-LEVY","email":"","orcid":"","institution":"Sorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430 Villetaneuse","correspondingAuthor":false,"prefix":"","firstName":"Sylvie","middleName":"","lastName":"AZOGUI-LEVY","suffix":""}],"badges":[],"createdAt":"2024-10-28 15:08:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5348154/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5348154/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69460554,"identity":"22dd65e2-0f9b-463d-9efa-25d468f2cd2c","added_by":"auto","created_at":"2024-11-20 14:48:21","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":844015,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5348154/v1/67a1c56aba4856b48a2efad4.jpg"},{"id":69460555,"identity":"5d043e98-08e2-4d3d-a057-f5a74fc4bfcb","added_by":"auto","created_at":"2024-11-20 14:48:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":531353,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5348154/v1/9a45428f23004d7b8632437c.jpg"},{"id":69461986,"identity":"7e74f0fa-043f-488f-9b65-cda51f032c3e","added_by":"auto","created_at":"2024-11-20 14:56:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3038722,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5348154/v1/21548f72-0eee-441c-a49b-f6383ff77734.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral Health Skills Framework for Pregnant Women: a Professional Consensus","fulltext":[{"header":"Background","content":"\u003cp\u003eCaries disease has a worldwide prevalence of 40% across all ages, with high distribution in children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Caries result from complex interactions between individual and collective determinants [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Thus, oral health is influenced by several parameters, including individual genetic heritage, hygiene habits (presence of bacterial biofilm), dietary habits (sugar-rich diet), consumption of addictive substances (alcohol, tobacco), and socio-economic factors (income level, professional status, level of education, urban/rural housing, social security coverage)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Caries damage is unevenly distributed across society, with the highest levels observed in the most socially vulnerable populations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In addition, several studies have shown that children\u0026rsquo;s oral health is associated with that of their parents, particularly their mothers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Microorganisms (including caries-initiating bacteria) can be found very early in newborns' oral cavity, possibly due to bacterial transmission from the mother\u0026rsquo;s oral cavity to the child [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, the earlier oral bacterial transmission occurs from mother to child, the greater the risk of children developing caries lesions. Hence, improving children\u0026rsquo;s oral health implies acting during the perinatal period in the mother-to-be.\u003c/p\u003e \u003cp\u003eMoreover, pregnancy is a susceptible period for oral pathologies (periodontal disease and caries). The prevalence of caries in pregnant women has been estimated to be 51%, which is similar to the rate found in the general adult population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, changes in dietary habits during pregnancy appear to be associated with an increased risk of developing carious lesions or advancing those already present [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Pregnant women have also been reported to bear a 50%-increased risk of developing gingivitis compared to the general population [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies have established links between periodontal disease (disease of the gums and supporting tissues of the teeth) and pregnancy outcomes (significantly higher risk of premature delivery, greater frequency of chorioamniotitis, pre-term preeclampsia, and risk of intrauterine growth retardation) through the action of inflammatory mediators that can penetrate the bloodstream and cross the placenta [\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn exploratory review of pregnant women\u0026rsquo;s knowledge, attitudes, and practices regarding oral health revealed that consulting a dentist during pregnancy is primarily influenced by the information communicated by healthcare professionals during this period, pre-existing recourse habits, and family and socio-economic contexts [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe First 1000 Days of Life program of the perinatal and early childhood program of Sante Publique France and UNICEF emphasizes \u0026ldquo;the importance of this sensitive period, which contains the premises for the health and well-being of the individual throughout his or her life\u0026rdquo; and promotes early interventions in pregnancy monitoring [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In recent years, oral health education interventions have been organized as part of pregnancy follow-up. Studies have assessed the level of evidence for these interventions [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and identified their formats and message content, the healthcare professionals involved, and resulting changes in the oral health knowledge, attitudes, and practices of pregnant women. The effectiveness of these interventions on women's and children's oral health, dental utilization, and quality of life remains uncertain [\u003cspan additionalcitationids=\"CR30 CR31 CR32\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. A meta-analysis by Riggs (2019) found that children whose mothers (or other caregivers) had received an educational intervention regarding infant feeding practices were less likely to develop caries lesions between 0 and 6 years of age (a probable reduction of 15%) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Despite these results, Vamos \u003cem\u003eet al.\u003c/em\u003e have expressed doubts: the majority of studies have focused on individual interventions centered on the child\u0026rsquo;s oral health, neglecting the pregnant woman and failing to consider living environments, and actions have been oriented toward assessing knowledge and practices without considering literacy levels [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Most studies have provided very little description of the objectives of the educational intervention, the skills targeted, and the conduct of the sessions; moreover, comparison between studies is challenging due to the significant heterogeneity in the variables studied and the use of varied and non-systematically validated questionnaires. These articles often conclude by indicating a need for future studies focusing specifically on the design of educational interventions and the validation of the content covered. The present study aims to fill this data gap [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of this work was to develop a competency framework that can be mobilized in pregnant women through oral health education programs and serve as a resource for healthcare professionals. Such programs would have the dual advantages of improving pregnant women's oral health and quality of life while promoting their unborn children's oral health. In addition, a reference framework could serve as a tool for harmonizing educational interventions regarding oral health in pregnant women to develop women's skills and autonomy to improve or maintain their oral health and that of their child through the adoption of favorable behaviors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA research group dedicated to the oral health of mothers and children called \u003cb\u003eP\u003c/b\u003eromoting \u003cb\u003eO\u003c/b\u003eral \u003cb\u003eH\u003c/b\u003eealth during \u003cb\u003eP\u003c/b\u003eregnancy and Ch\u003cb\u003eiL\u003c/b\u003edhood (POHPiL) was formed. Its ambition was to bring together the various professionals working in the perinatal period, including two public health physicians, two midwives, three dentists specializing in oral public health, a nutritionist, and two hospital pharmacists and health education specialists, giving the group a multi-professional, multi-disciplinary focus. The group members are referred to as \u0026ldquo;researchers\u0026rdquo; in this report. The group\u0026rsquo;s work was performed in two phases. First, a literature review was undertaken to identify oral health recommendations for pregnant women. Second, a questionnaire based on this review was presented to a panel of professional experts specializing in perinatal care. These experts then participated in a Delphi study to reach a consensus regarding the oral health skills expected of pregnant women for themselves and their children (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLiterature review\u003c/h2\u003e \u003cp\u003e A literature review was undertaken to identify oral health guidelines during pregnancy for healthcare professionals and pregnant women. The search methodology, including search terms and choice of databases, was developed in collaboration with a literature search engineer. The chosen databases, selected to specifically target resources written in the form of recommendations, were Trip Database (the only one to propose the term \u0026ldquo;guidelines\u0026rdquo; as a filter), PubMed and Web of Science, Dentistry \u0026amp; Oral Sciences Sources (DOSS), and French resources (Catalogue et Index des Sites M\u0026eacute;dicaux de langue Fran\u0026ccedil;aise CISMEF). This approach was complemented by a grey-literature search to identify material published by scholarly societies or institutional websites. The inclusion criteria specified that the study population should comprise pregnant women and that the subject should be oral health recommendations. Care protocols and research articles containing no recommendations were excluded. The literature review was performed between January and February of 2022. Selected references were read in full and analyzed independently by two authors (AT and SAL). In the event of disagreement, the opinion of a third researcher was sought (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe search strategy enabled us to identify 40 references (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), including 27 educational guides or brochures, seven scientific articles or reports, and six resources from institutional sites or scholarly societies. Of these references, 28 were aimed at healthcare professionals, and 12 were aimed at pregnant women. In addition, 17 references provided information regarding children\u0026rsquo;s oral health. Some guides for professionals had adopted a multi-professional approach, simultaneously addressing perinatal and early-childhood caregivers and dental professionals. Six guides for pregnancy care included a chapter dedicated to oral health, while the other guides were monothematic, dealing solely with oral health. Data extracted from all resources included organization, authority or author, year, country, format, target audience, and oral health-specific content. The material was categorized into recommendations on preventive behaviors (hygiene, diet) and prevention pathways, use of healthcare professionals, and treatment of oral diseases.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResources on oral health recommendations for pregnant women.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRessources\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCPHP Obstetric Guideline 19, Maternity Care Pathway.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBritish Columbia Perinatal Health Program\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerinatal services BC, Newborn Guidelines 13, Newborn nursing care pathway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBritish Columbia Perinatal Services BC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerinatal services BC, Provincial Perinatal Guidelines, Population and Public Health Prenatal Care Pathway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePerinatal Services BC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYour guide to a Healthy Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAgence de la sant\u0026eacute; publique du Canada\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvidence review: dental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBritish Columbia Ministry of Health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSant\u0026eacute; bucco-dentaire et grossesse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGouvernement du Canada\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnancy and dental health\u003c/p\u003e \u003cp\u003eEt version fran\u0026ccedil;aise \u0026laquo;\u0026nbsp;Grossesse et sant\u0026eacute; dentaire\u0026nbsp;\u0026raquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealthLink British Columbia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMieux vivre avec votre enfant de la grossesse \u0026agrave; 2 ans.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInstitut national de sant\u0026eacute; publique du canada\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProjet sourire en sant\u0026eacute;, enfants heureux\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2007\u0026ndash;2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOfficiel regional de la sant\u0026eacute; Winnipeg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConseils pour la sant\u0026eacute; bucco-dentaire des femmes enceintes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAgence de la sant\u0026eacute; publique du Canada\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Health during pregnancy \u0026amp; early childhood. Evidence-based guidelines for Health Professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCalifornia Dental Association et American College of Obstetricians and Gynecologists\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuidelines for oral health care in Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOregon Oral Health Coalition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVA/DOD Clinical Practice guideline for the management of pregnancy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUSA Dept of veterans affairs, Dpt of Defense\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Health Care for pregnant women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSouth Carolina, Oral Health Coalition, connecting Smiles\u003c/p\u003e \u003cp\u003eMaternal and child health bureau\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Health during pregnancy. A summary of practice guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNational maternal and child oral Health resource center, Georgetown university\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral health care during pregnancy and early childhood. Practices Guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNew York State Department of health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuideline on Perinatal and Infant Oral health Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAAPD American Academy of Pediatric Dentistry\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral health guidelines for pregnancy and early childhood. Information for providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMassachussetts dpt of public health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral health care during pregnancy: a national consensus statement expert workgroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWashington DC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Health care during pregnancy and through lifespan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eACOG American College of Obstetricians and Gynecologists\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral Health campaign toolkit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAAPD American Academy of paediatric dentistry\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnancy and oral health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCenters for disease control and prevention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring pregnancy, the mouth matters: a guide to Michigan Perinatal Oral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMichigan Department of Health and human services\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuideline on perinatal oral health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAAPD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition and Oral health Guidelines for pregnant women, infants and children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJournal of the American dietetic association\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal and child nutrition. Public Health Guideline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNice: National Institute for Health and Care Excellence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral health: local authorities and partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNice: National Institute for Health and Care Excellence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeeth ang gums problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe relationship between oral health and pregnancy. Guidelines for oral-health professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+/- 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEurope et UK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEuropean federation of periodontology \u0026amp; British society of periodontology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe relationship between oral health and pregnancy. Guidelines for oral-health professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEuropean federation of periodontology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDe dents saines pour la femme enceinte et son enfant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSuisse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSoci\u0026eacute;t\u0026eacute; Suisse d\u0026rsquo;Odontostomatologie\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral health in pregnancy (guidelines to gynaecologists, general physicians \u0026amp; oral health care providers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInde\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKANDAN P. J Pak Med Assoc\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExamen Bucco-dentaire \u0026agrave; destination des femmes enceintes\u003c/p\u003e \u003cp\u003e\u0026laquo;\u0026nbsp;Un enfant une dent\u0026nbsp;\u0026raquo; le dicton n\u0026rsquo;est plus vrai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssurance Maladie\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePremi\u0026egrave;re consultation et suivi mensuel de grossesse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssurance Maladie\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrossesse et Sant\u0026eacute; Orale\u003c/p\u003e \u003cp\u003eFiche 1,2,3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSoci\u0026eacute;t\u0026eacute; Fran\u0026ccedil;aise de parodontologie et d\u0026rsquo;implantologie orale \u0026amp; Coll\u0026egrave;ges nationales des Sages-Femmes de France\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrossesse et Allaitement, Guide de prise en charge par le CD.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociation Dentaire de France ADF et Coll\u0026egrave;ge national des gyn\u0026eacute;cologues et obst\u0026eacute;triciens fran\u0026ccedil;ais\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrossesse et maladie parodontale (pour les CD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSoci\u0026eacute;t\u0026eacute; Fran\u0026ccedil;aise de Parodontologie et Implantologie Orale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePr\u0026eacute;vention bucco-dentaire adapt\u0026eacute;e aux diff\u0026eacute;rents cycles de la vie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssurance Maladie Languedoc \u0026ndash;\u003c/p\u003e \u003cp\u003eRoussillon / Occitanie URPS CD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePr\u0026eacute;vention de la carie dentaire avant 3 ans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDGS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormer et sensibiliser les professionnels impliqu\u0026eacute;s en p\u0026eacute;rinatalit\u0026eacute; \u0026agrave; la sant\u0026eacute; et \u0026agrave; l\u0026rsquo;hygi\u0026egrave;ne bucco-dentaire des FE.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUFSBD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e- Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e should be placed here but, because of its length,\u003c/p\u003e \u003cp\u003eis positioned at the end of the manuscript -\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePedagogical positioning\u003c/h3\u003e\n\u003cp\u003eThis work lies at the interface between a competency-based approach and the principles of behaviorist-inspired objective-based pedagogy [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The latter justifies using concepts such as contributory pedagogical objectives and the various types of knowledge mobilized (knowledge, practices, attitudes) to better characterize skill development. This choice reflects the desire to adopt an approach that articulates knowledge and skills while facilitating the collection of elements contributing to the evaluation of skills based on experts\u0026rsquo; pedagogical experience. Indeed, the use of a method purely focused on the skills approach, such as analyzing skills components, reference situations, or development levels, could have introduced bias into the responses obtained.\u003c/p\u003e\n\u003ch3\u003eDelphi survey\u003c/h3\u003e\n\u003cp\u003eThe Delphi method is a qualitative research approach that measures the degree of consensus and divergence among experts\u0026rsquo; opinions on a specific topic, gradually facilitating the emergence of a consensus [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This method involves well-defined steps: choosing a topic and identifying the relevant experts; soliciting participation; formulating the problem as an initial question; developing the questionnaire; launching the first round of consultations by administering the questionnaire; collecting the ratings (level of agreement); analyzing the ratings; providing feedback to the experts; adapting the questionnaire accordingly and organizing a new consultation; and repeating this process until a consensus has been reached among the experts.\u003c/p\u003e\n\u003ch3\u003eThe expert panel\u003c/h3\u003e\n\u003cp\u003eParticipant selection followed a four-stage process: elaborating criteria for expert selection, establishing a list of potential experts, contacting selected experts, and inviting participants [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Twenty-one professional perinatal experts were invited (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eQuestionnaire design\u003c/h3\u003e\n\u003cp\u003eWe used the literature review results to identify three key competencies: preventing, monitoring, and seeking dental care. These competencies are associated with specific pedagogical objectives, defining the critical learning to be achieved to enable optimal activation of each competency. The questionnaire was structured in two sections (pregnant woman and child), covering the three main families of skills (preventing, monitoring, seeking dental care), divided into 96 contributory learning objectives. Participants were asked to rate the usefulness of the contributory educational objectives on a 5-point Likert scale, ranging from \u0026ldquo;not at all useful\u0026rdquo; to \u0026ldquo;very useful.\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire distribution\u003c/h2\u003e \u003cp\u003eThe questionnaire was distributed electronically and included a cover letter introducing the study and soliciting their participation, emphasizing the anonymity of responses. A period of 10 days was allowed between each round, with a reminder sent after one week. The experts were asked to rate their level of agreement with the proposed objectives on a discrete quantitative scale ranging from 1 (not at all useful) to 4 (very useful). The objectives with a score of 4 reaching 70% were retained (total agreement), those with a score of 1 reaching 70% were eliminated (definitive rejection), and the remaining items were reformulated for the next round. Between rounds, the researchers reviewed the results and redefined the objectives on which there had been no consensus. In this way, responses were consolidated through successive questionnaire rounds to achieve a satisfactory degree of consensus [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The final report was presented to the experts at a meeting to summarize the results and served as the basis for constructing the competency framework.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDelphi survey\u003c/h2\u003e \u003cp\u003eThe study ran from April 2022 to July 2022. Nineteen professionals participated in the first round, 15 in the second round, and 11 in the final round (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A consensus was reached after three rounds. In the first round, 57 contributory learning objectives out of 96 (59%) were rated \u0026ldquo;very useful,\u0026rdquo; with 33 out of 49 (67.3%) rated \u0026ldquo;very useful\u0026rdquo; for pregnant women and 24 out of 48 (50%) rated \u0026ldquo;very useful\u0026rdquo; for children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Forty objectives failed to achieve consensus and were reformulated for the second round.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFirst Delphi round: experts' responses to the questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkills / usefulness score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003eNot at all useful\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003eNot Useful\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003eUseful\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003eVery useful\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePART I\u0026nbsp;: ABOUT THE MOTHER\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e1. Targeted skills for women\u0026nbsp;: preventing caries and periodontal disease.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA1. Knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to be aware of the following risk factors for caries and periodontal disease:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- The presence of bacterial plaque on teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Reduced saliva on the teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u0026nbsp;.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.37%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Hormonal impregnation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- The risk of preeclampsia due to periodontal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to be aware of the following protective factors against caries and periodontal disease:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Tooth self-cleaning with saliva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.37%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Brushing to eliminate bacterial plaque build-up on teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026nbsp;.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Fluoride toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026nbsp;.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Smoking cessation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Regular dental check-ups during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Certain dietary habits during pregnancy (such as adequate intake of calcium and vitamin D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA2. Attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDo you think it is useful for pregnant women to adopt the following attitudes to help prevent caries and periodontal disease?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Explain your diet to your family and friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Search for preventive oral health information on a website, on ameli....\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.63%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Seek advice on dental health from a healthcare professional (midwife, nursery nurse, doctor, pharmacist, dentist, etc.).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA3. Practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, would it be useful for pregnant women to adopt the following practices to help prevent caries and periodontal disease:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use a personal toothbrush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Choose foods that do not promote cavities when dividing food intake (to prevent the risk of nausea and vomiting).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.63%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Rinse mouth with bicarbonate or fluoride mouthwash, or simply with water if vomiting occurs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Brush teeth after vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Brush twice a day with fluoride toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Avoid sugary drinks outside mealtimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Limit intake of sugary foods during meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Drink water during and outside meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Drink sparkling water rather than sugary soft drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Choose fruit rather than fruit juice to meet the recommended daily fruit intake.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use sugar-free chewing gum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e2. \u003cb\u003eTargeted skills for women: monitoring caries and periodontal disease\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eB.1 Attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, would it be useful for pregnant women to adopt the following attitudes to help monitor caries and periodontal disease:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Communicate with healthcare professionals and receive guidance if needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eB.2 Practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDo you think it would be useful for pregnant women to adopt the following practices to help monitor caries and periodontal disease:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Identifying signs of decay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Identifying the signs of dental abscesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Observe your mouth regularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.37%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Identifying the signs of gingivitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Be alert to dental discomfort or pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e3. \u003cb\u003eTargeted skills for women: seeking dental care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eC.1 Knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to know the following factors concerning the use of dental care:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dental care is safe during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Scaling is safe during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dental anesthesia is safe during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dental care contributes to good general health and fetal development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dental radiography can be performed using a lead apron during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dental care is important during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- It is important not to postpone treatment during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Early treatment reduces transmission of bacteria from mother to child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- No risk of premature delivery due to dental treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dental care during pregnancy is covered under special conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- A dental check-up is available during the 4th month of pregnancy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eC.2 Attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to adopt the following attitudes regarding dental care:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Call in a dental surgeon for an emergency consultation if necessary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Call a dental surgeon in case of pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Avoid self-medication for a dental problem without the advice of a healthcare professional informed of the pregnancy in progress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Claiming social security benefits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eC.3 Practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to adopt the following dental care practices:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Check-ups during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Using a preventive dental check-up measure offered by the health insurance during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Routine check-ups once a year for the rest of your life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePART II: ABOUT THE CHILD (NEWBORNS, CHILDREN AGED 6 MONTHS TO THREE YEARS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e1. \u003cb\u003eTargeted skills for women: preventing caries in children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eD1. Knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for a pregnant woman to know the following about preventing cavities in her child:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Teeth are formed before birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.63%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Teeth evolve by piercing the gums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Mandibular incisors come first\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- All teeth must have erupted between 24 months and 3 years of age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Temporary teeth are an eruption guide for permanent teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Temporary teeth play a part in language acquisition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Temporary teeth contribute to the development of permanent teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.63%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Temporary teeth contribute to aesthetics, smile and school integration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Temporary teeth help with phonation and proper pronunciation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Brushing methods should be adapted to the child's age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Children's teeth should be brushed from the first tooth before bedtime.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Children's teeth should be brushed twice a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eD2. Attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to adopt the following attitudes regarding the prevention of cavities in their children:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Educate and inform those around you about preventing the risk of dental caries in children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u0026nbsp;.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.63%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Communicating with healthcare professionals to deal with difficulties encountered in prevention initiatives for children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Managing difficult moments when the child demands inappropriate food intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eD3. Practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for pregnant women to adopt the following practices to prevent cavities in their children?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use a teething ring or rub gums with clean fingers to reduce pain and discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use the cup from age 1 to drink water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Offer the child no more than 4 food intakes/day when the 4 meals are in place.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.63%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Do not extend on-demand breastfeeding beyond 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use a different spoon for each child's meal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Wash the pacifier with water, not with your mouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Offer unsweetened beverages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Offer age-appropriate foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Offer snack options that don't promote cavities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Offer dairy products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Avoid sweet and sticky foods such as candy and chewing gum.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Avoid dipping pacifiers in honey or other sweet products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Don't leave your child with a bottle at night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use a soft-bristled toothbrush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Change your toothbrush as soon as the bristles become frayed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use age-appropriate toothpaste (fluoride concentration)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- To support children's tooth-brushing movements from age 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Rinse toothbrush with water after every brushing session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e2. \u003cb\u003eTargeted skills for women: monitoring caries and oral health problems in children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eE.1 Knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, would it be useful for a pregnant woman to know the following information about monitoring her child for cavities:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Tooth abnormalities (color changes, white or black stains, cavities, damaged teeth)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Presence of gum abnormalities (swelling, abscess, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Signs of pain that can interfere with sleep and feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Signs of rash: salivation or need to chew, irritation or redness on the face, bluish bubble of rash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eE2. Attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for the pregnant woman to adopt the following attitudes regarding the monitoring of the onset of caries in her child?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Care for temporary teeth even if they're about to fall out\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eE3. Practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for the pregnant woman to adopt the following attitudes regarding the monitoring of the onset of caries in her child?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognize the signs of decay: cavity, color, pain, hot/cold sensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognizing the signs of a dental abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognizing the signs of gingival inflammation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognize the signs of accidental tooth evolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognizing the signs of dental malposition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognize the pain, discomfort, bleeding and masticatory difficulties that require dental care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Recognizing refusal to eat as a warning sign of oral health problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e3. \u003cb\u003eTargeted skills for women: seeking dental care for the child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF1. Attitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for a pregnant woman to adopt the following attitudes regarding dental care for her child:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Ask your doctor to examine your child's teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- A visit to the dentist from the age of 1 and then once a year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF2. Practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIn your opinion, is it useful for the pregnant woman to adopt the following practices regarding dental care for her child?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Apply the dental health insurance prevention program from age for all ages.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e- Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e should be placed here but, because of its length, is positioned\u003c/p\u003e \u003cp\u003eat the end of the manuscript -\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConcerning the mother\u0026rsquo;s competence for herself\u003c/h2\u003e \u003cp\u003eAt the end of the first round, 67.3% of the objectives had obtained a \u0026ldquo;very useful\u0026rdquo; consensus, distributed as follows: 52% for the \u0026ldquo;preventing\u0026rdquo; skill, 66.7% for the \u0026ldquo;monitoring\u0026rdquo; skill, and 88.9% for the \u0026ldquo;seeking oral care\u0026rdquo; skill (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsensus observed around the 3 categories of skills targeted by pregnant women to ensure good oral health for themselves and their child (Round 1).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget skills for pregnant women\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsensus\u003c/p\u003e \u003cp\u003eRound 1\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventing caries and periodontal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitoring caries and periodontal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeeking dental care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTarget skills for pregnant women concerning the child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventing caries in children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitoring caries and other oral health problems in children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeeking dental care for children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCompetence 'Preventing caries and periodontal disease\u0026rsquo;\u003c/h2\u003e \u003cp\u003e Over 50% of the objectives related to oral hygiene achieved consensus, making it the most widely agreed-upon application area, while over 50% of the objectives related to nutrition failed to achieve consensus, making it the least agreed-upon application area. The only food-related objectives for which consensus was reached were related specifically to beverages (giving preference to water, avoiding sugary drinks outside mealtimes) and choosing fruit rather than fruit juice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCompetence \u0026lsquo;Monitoring caries and periodontal disease'\u003c/h2\u003e \u003cp\u003eA consensus was reached regarding the usefulness of identifying signs of caries or dental abscesses and being alert to discomfort or pain. However, no consensus was reached in identifying signs of gingivitis and observing the mouth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCompetence \u0026lsquo;Seeking dental care\u0026rsquo;\u003c/h2\u003e \u003cp\u003eThis competence achieved the highest level of consensus across knowledge, attitudes, and practices. The areas of application related to care, such as importance of care, type of care, anesthesia, X-rays, treatment modalities, prevention programs, seeking care, and avoiding self-medication, all received favorable utility scores. Only two objectives failed to achieve a consensus exceeding 70% agreement: the absence of risk of premature delivery because of dental care and the claiming of reimbursement.\u003c/p\u003e \u003cp\u003eObjectives for which there had been no consensus were reformulated and resubmitted in rounds two (10 objectives) and in round three (six objectives). At the end of the final round, consensus had still not been reached on three competence preventing objectives: knowing the risk of preeclampsia associated with the presence of periodontal disease, knowing the protective role of saliva (and using chewing gum to stimulate its production), and seeking information regarding oral health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConcerning the mother\u0026rsquo;s skills for the child\u003c/h2\u003e \u003cp\u003eAt the end of the first round, 50% of the objectives had received a \u0026ldquo;very useful\u0026rdquo; consensus, distributed as follows: 54.5% for the preventing competence, 41.7% for the monitoring competence, and 33.3% for the seeking oral care competence (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCompetence 'Preventing caries and periodontal disease\u0026rsquo;\u003c/h2\u003e \u003cp\u003eHygiene application received an entirely favorable consensus, with all objectives judged \u0026ldquo;very useful.\u0026rdquo; The nutrition application area reached a moderate consensus, with over 50% of its objectives considered useful. The breastfeeding objective received the highest percentage for \u0026ldquo;not at all useful\u0026rdquo; (36.84%), with widely divergent opinions among experts. This objective was the only point for which the \u0026ldquo;not at all useful\u0026rdquo; score (36.84%) exceeded the \u0026ldquo;quite useful\u0026rdquo; score (26.32%).\u003c/p\u003e \u003cp\u003eSome areas of application failed to achieve a consensus: knowing the masticatory and social functions of the oral cavity (social and aesthetic aspects), informing the child\u0026rsquo;s caregivers about preventing the risks of tooth decay, taking action to reduce discomfort during teething (use of a teething ring), and adopting specific feeding-related practices (number of food intakes, using a cup from age 1 to drink water, using a different spoon).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCompetence \u0026lsquo;Monitoring caries and periodontal disease'\u003c/h2\u003e \u003cp\u003eOver 70% of experts considered it \u0026ldquo;very useful\u0026rdquo; for women to monitor the onset of caries in children (e.g., the presence of anomalies on the teeth and gums and signs of pain). However, the usefulness of recognizing the signs of a dental problem (dental abscesses, gingival inflammation, dental malposition, eruption, and refusal to eat) was less appreciated, registering a \u0026ldquo;very useful\u0026rdquo; level below 60%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCompetence \u0026lsquo;Seeking dental care\u0026rsquo;\u003c/h2\u003e \u003cp\u003eAt the end of the first round, no consensus had been reached regarding the proposed attitudes (asking the family doctor to examine the child\u0026rsquo;s teeth and scheduling a dental visit starting at age 1 and annually thereafter). However, seeking preventive care through a health insurance program (e.g., the French program \u0026ldquo;M\u0026rsquo;T Dents\u0026rdquo;) was judged \u0026ldquo;very useful.\u0026rdquo;\u003c/p\u003e \u003cp\u003eAt the end of the first round, consensus had not been reached in 24 areas of application concerning children. These areas were reformulated, and some were merged. In all, 20 areas were resubmitted for the second round of questionnaires. At the end of this second round, consensus had not been achieved in any of the 20 areas. Hence, some questions were reworded to make them easier to understand. For example, the terms \u0026ldquo;recognizing the signs of a dental abscess,\u0026rdquo; \u0026ldquo;inflammation,\u0026rdquo; \u0026ldquo;development of deciduous teeth,\u0026rdquo; and \u0026ldquo;malposition\u0026rdquo; were deemed too technical, and they were replaced by an overall generic term regarding the signs of a \u0026ldquo;dental problem.\u0026rdquo; At the end of the last round, the only area where there was no consensus was breastfeeding, in the preventing competence.\u003c/p\u003e \u003cp\u003eFollowing the three consecutive rounds, a results feedback session with the experts was organized to discuss areas without consensus. The discussions focused primarily on the risk of preeclampsia linked to oral health and the difficulties encountered in communicating this point, as well as the issue of breastfeeding and, more generally, food intake and its consequences for oral health. It was decided to retain these areas of application but to integrated in a more global manner: the risk of preeclampsia was addressed in the context of the links between oral health and pregnancy, and the issue of breastfeeding was linked to the frequency of food intake.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePresentation of results and discussion with experts\u003c/h2\u003e \u003cp\u003eAfter the three consecutive rounds, the results session identified the four areas of application where no consensus had been reached. Three in particular provoked debate: knowing the risk of preeclampsia associated with the presence of periodontal disease, identifying the effects of breastfeeding on oral health, and seeking information on oral health. The fourth area concerned the protective role of saliva.\u003c/p\u003e \u003cp\u003eRegarding the oral health risk of preeclampsia, participants expressed concern regarding the hierarchy of messages to be conveyed to pregnant women: \u0026ldquo;everyone wants to use this time of pregnancy to pass on information, so we need to prioritize,\u0026rdquo; and \u0026ldquo;the pregnant woman receives a flood of information, many points of vigilance need to be integrated.\u0026rdquo; The professionals, who need to monitor timing, were concerned about being counterproductive. Some experts explained that preeclampsia is a difficult pathology to explain, making its association with oral health even more challenging to address. The discussion did not resolve this dissensus on the usefulness of pregnant women knowing the risk of preeclampsia in the event of periodontal disease, and the agreement reached addressed this point more comprehensively during pregnancy follow-up.\u003c/p\u003e \u003cp\u003eRegarding breastfeeding, the experts highlighted the lack of consistency in the discourse between perinatal professionals (midwives, gynecologists, nursery nurses) and other healthcare professionals (pharmacists, general practitioners, dental surgeons, pediatricians, etc.). The practitioners noted that they are often confronted with a discrepancy between breastfeeding promotion recommendations and the information provided by the various professionals involved. For example, dentists advise spacing food intake to four times a day from diversification onwards to stabilize oral pH and allow remineralization of teeth [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. There is a dichotomy between unclear food messages (concerning nutrition and the diets of pregnant women and newborns) and poorly understood links with oral health. Thus, professionals are unfamiliar with the links between milk intake (breast or reconstituted), frequency of food intake, and oral health. The risk of early-onset caries in children has not been clearly identified. The discussion failed to resolve this point of disagreement, as professionals feared contradicting each other and influencing messages promoting breastfeeding, for which France has one of the lowest rates in Europe. However, agreement was reached on the importance of establishing clearly identified food intakes from the time of diversification.\u003c/p\u003e \u003cp\u003e The search for oral health information on the internet by women themselves was also a topic of discussion. The experts were concerned about users' ability to discern reliable information and their preference for relying on information from professionals.\u003c/p\u003e \u003cp\u003e Knowledge of the protective role of saliva was not the subject of dissenting opinions, but the issue raises a more general point about oral health professionals\u0026rsquo; training, which the experts judged to be almost nonexistent in their initial training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eCompetency framework\u003c/h2\u003e \u003cp\u003eThe expert consensus research method enabled us to define a skills framework to be mobilized in pregnant women through oral health education programs, which can serve as a resource for healthcare professionals. The framework is structured around three competencies aimed at pregnant women concerning their oral health and the oral health of their child: preventing oral diseases (caries and periodontal pathologies) during pregnancy; participating in the implementation of the care plan; and the woman\u0026rsquo;s assertion of her rights. For each of these skills, essential components and contributing educational objectives were identified (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This framework could be used as an educational action tool to enable individuals to engage in the process of maintaining or improving their oral health [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReference framework of useful skills that can be mobilized in pregnant women through oral health education programs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTARGETED ORAL HEALTH SKILLS FOR PREGNANT WOMEN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOral Health Skills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEssential components\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eContributing educational objectives\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003ePreven\u003c/b\u003et\u003c/p\u003e \u003cp\u003eoral and dental diseases\u003c/p\u003e \u003cp\u003e(caries and periodontal disease) during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By clearly establishing the relationship between oral health and pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysiopathology\u003c/p\u003e \u003cp\u003e- -Explain how hormonal changes during pregnancy affect the mouth (gum inflammation) and pregnancy outcomes (pre-eclampsia, low birth weight)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By effectively applying dietary recommendations to maintain good oral health during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiet\u003c/p\u003e \u003cp\u003e- Choose non-cariogenic foods (especially when splitting meals)\u003c/p\u003e \u003cp\u003e- Avoid sugary drinks outside mealtimes and drink water instead\u003c/p\u003e \u003cp\u003eDental hygiene habits\u003c/p\u003e \u003cp\u003e- - Brush teeth with fluoride toothpaste (twice daily); use sugar-free chewing gum.\u003c/p\u003e \u003cp\u003e- In the event of vomiting: rinse mouth after vomiting with bicarbonate or fluoride mouthwash or simply with water\u003c/p\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003cp\u003e- Initiate smoking cessation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By effectively monitoring\u003c/p\u003e \u003cp\u003ewarning signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Inspect the mouth regularly\u003c/p\u003e \u003cp\u003e- Early identification of gingival bleeding, tooth discoloration, incipient carious lesions, abscesses, and swollen gums\u003c/p\u003e \u003cp\u003e- Identify dental discomfort and pain\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By effectively mobilizing the principles of oral care specific to pregnant women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Treatment at every stage of pregnancy\u003c/p\u003e \u003cp\u003e- Avoid self-medication for dental problems without the advice of a health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By making appropriate use of the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Communicate with healthcare professionals\u003c/p\u003e \u003cp\u003e- Seek advice on dental health from a healthcare professional (midwife, nursery nurse, doctor, pharmacist, dentist, etc.).\u003c/p\u003e \u003cp\u003e- Ask for a referral to a dental surgeon\u003c/p\u003e \u003cp\u003e- Call a dental surgeon for an emergency consultation if necessary\u003c/p\u003e \u003cp\u003e- Plan a check-up during pregnancy and a routine visit once a year for the rest of your life\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipate\u003c/b\u003e\u003c/p\u003e \u003cp\u003eimplementing the care plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By using the healthcare system appropriately\u003c/p\u003e \u003cp\u003e\u0026bull; By ensuring regular monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Use the (national) prevention program, which provides access to an oral and dental check-ups during pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAsserting one\u0026rsquo;s rights\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By communicating with relevant professionals, either independently or with support\u003c/p\u003e \u003cp\u003e\u0026bull; By appropriately mobilizing the resources of the medical-social sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Communicate with professionals in the medical-social sector\u003c/p\u003e \u003cp\u003e- Check entitlement to social security reimbursements and coverage of dental care.\u003c/p\u003e \u003cp\u003e- Check with the dentist that \u0026ldquo;treatment carried out during pregnancy (specific quotation)\u0026rdquo; is mentioned\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTARGETED ORAL HEALTH SKILLS FOR PREGNANT WOMEN, FOCUSING ON THE ORAL HEALTH OF THEIR CHILDREN (NEWBORN TO 3 YEARS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003ePreven\u003c/b\u003et\u003c/p\u003e \u003cp\u003echildren's oral diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By clearly establishing the functions of the orofacial sphere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Ensure normal masticatory and social functions (smile, aesthetics, school integration)\u003c/p\u003e \u003cp\u003e- Ensure acquisition of language and phonation (good pronunciation)\u003c/p\u003e \u003cp\u003e- Identify the signs of the appearance of temporary teeth\u003c/p\u003e \u003cp\u003e- Reduce pain and discomfort during tooth eruption\u003c/p\u003e \u003cp\u003e- Use a teething ring or rubbing gums with clean fingers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By clearly establishing the dynamic, evolving nature of children\u0026rsquo;s mouths\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiet\u003c/p\u003e \u003cp\u003e- Establishe four feedings a day and adapting breastfeeding frequency according to age and diversification\u003c/p\u003e \u003cp\u003e- Provide age-appropriate foods\u003c/p\u003e \u003cp\u003e- Avoid sweet and sticky foods such as candy and chewing gum.\u003c/p\u003e \u003cp\u003e- Avoid sugary drinks\u003c/p\u003e \u003cp\u003e- Provide non-cariogenic snack options\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By effectively applying hygienic and dietary recommendations to maintain good oral health in children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Use a spoon reserved only for the child\u0026rsquo;s meal that should not be shared\u003c/p\u003e \u003cp\u003e- Do not leave your child with a bottle at night\u003c/p\u003e \u003cp\u003eDental hygiene habits\u003c/p\u003e \u003cp\u003e- Wash the teat with water, not with the mouth, and avoid dipping it in honey or other sweet products\u003c/p\u003e \u003cp\u003e- Apply age-appropriate hygiene advice (method, type of brush, twice daily from first appearance of teeth)\u003c/p\u003e \u003cp\u003e- Use age-appropriate fluoride toothpaste\u003c/p\u003e \u003cp\u003e- Supervise and support the tooth-brushing process for children\u003c/p\u003e \u003cp\u003eChildcare\u003c/p\u003e \u003cp\u003e- Inform caregivers of ways to prevent caries (diet and hygiene)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By involving one\u0026rsquo;s child appropriately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Brush teeth (with supervision)\u003c/p\u003e \u003cp\u003e- Express discomfort if a problem occurs in the mouth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By effectively monitoring warning signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Inspect the child\u0026rsquo;s mouth regularly\u003c/p\u003e \u003cp\u003e- Identify the presence of anomalies on the teeth (color changes, white or black stains, cavities, damaged teeth) and the gums (swelling, abscesses) and malposition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By effectively mobilizing the principles of oral care specific to children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Identify signs of pain that can interfere with sleep and feeding\u003c/p\u003e \u003cp\u003e- Consider oral problems if the child refuses to eat.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By making appropriate use of the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Care for a child\u0026rsquo;s temporary and permanent teeth\u003c/p\u003e \u003cp\u003e- Consult a dental surgeon following oral trauma\u003c/p\u003e \u003cp\u003e- Avoid self-medication for dental problems without the advice of a health professional.\u003c/p\u003e \u003cp\u003e- Schedule an annual check-up with one\u0026rsquo;s dentist\u003c/p\u003e \u003cp\u003e- Schedule a treatment appointment\u003c/p\u003e \u003cp\u003e- Discuss a child\u0026rsquo;s oral health during visits to a general practitioner\u003c/p\u003e \u003cp\u003e- Communicate with health professionals to address difficulties encountered when implementing prevention actions with children (e.g., managing difficult moments when the child demands inappropriate food, brushing the child\u0026rsquo;s teeth).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipate\u003c/b\u003e\u003c/p\u003e \u003cp\u003eimplementing the child's care plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By using the healthcare system appropriately\u003c/p\u003e \u003cp\u003e\u0026bull; By ensuring regular monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Adopt the (national) prevention program, which provides access to an oral health check-up by a dental surgeon; learning about appropriate ages for consultations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAsserting one\u0026rsquo;s rights\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; By communicating with the professionals concerned, either independently or with support\u003c/p\u003e \u003cp\u003e\u0026bull; By appropriately mobilizing the resources of the medical-social sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Communicate with professionals in the medical-social sector\u003c/p\u003e \u003cp\u003e- Check entitlement to social security reimbursements and coverage\u003c/p\u003e \u003cp\u003e- Check with the dentist that \u0026ldquo;treatment carried out for young children (specific quotation)\u0026rdquo; is mentioned\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e- Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e should be placed here but, because of its length, is positioned\u003c/p\u003e \u003cp\u003eat the end of the manuscript -\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOral health education during pregnancy and in preparation for birth and parenthood remains variable and is sometimes nonexistent [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. The lack of systematic integration of oral health into general health monitoring and early prevention programs made it difficult for families to access prevention services, adopt health-promoting behaviors, and quickly access treatment [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In addition, although there are oral health education initiatives during pregnancy, they lack scientific validity in terms of content and effectiveness for a genuine preventive strategy at both the community and individual levels. This study aimed to develop a useful competency framework to mobilize in pregnant women through oral health education programs, which can serve as a resource for healthcare professionals.\u003c/p\u003e \u003cp\u003eIn the first round of the Delphi, concerning pregnant women, professionals rated skills in monitoring caries and periodontal disease (66.6%) and seeking oral care (88.9%) as more useful than those in prevention (52%). Thus, the experts adopted a care-oriented stance, aligning with a highly medicalized model and a predominantly biomedical approach. The trend was the opposite for children (prevention 54.5%, monitoring 41.6%, care 33.3%), and twice as many dissenting opinions were recorded for areas of application concerning children as for mothers.\u003c/p\u003e \u003cp\u003eDuring the feedback session, discussions on the two areas concerning the risk of preeclampsia and breastfeeding reflected inconsistencies between the messages conveyed by the different medical specialties [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the one hand, dentists rarely address oral health prevention issues specific to pregnancy, childhood, and breastfeeding. On the orther hand, perinatal care professionals, such as those working in postpartum care, child maternal protection centers, or daycare centers, rarely integrate oral health prevention messages and are reluctant to discuss pregnancy-related oral health risks (preeclampsia) [\u003cspan additionalcitationids=\"CR49 CR50 CR51\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. For example, oral hygiene is rarely included in the first hygiene practices taught in maternity hospitals. These exchanges highlighted differences of opinion among professionals and led to a broader reflection of the complexity of conveying and prioritizing prevention messages during the perinatal period. Furthermore, these professionals are insufficiently trained in common prevention strategies, whether in initial or ongoing training and are not always aware of existing prevention programs [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Hence, professionals tend to deliver primary prevention messages focused on a specific pathology and strictly linked to their discipline without placing the individual in a broader context with a global health vision.\u003c/p\u003e \u003cp\u003eHowever, the interdisciplinarity and multi-professional training (initial and continuing) of professionals encourage the implementation of health promotion principles. Today's global health challenges transcend the strict boundaries of individual medical disciplines. Indeed, health education should not be limited to a single specialty but should integrate a holistic vision where midwives, dentists, pediatricians, and others work together to help families acquire parenthood skills. Initial and ongoing training for all healthcare professionals is necessary to ensure greater cohesion in prevention discourse and enable professionals to move beyond a siloed approach that is too paternalistic and curative. Multi-professional, interdisciplinary training in educational strategies and psychosocial skills, which also incorporates the user's perspective, would enable the provision of better support for the people concerned and foster their autonomy by supporting their commitment to health promotion. Moreover, interdisciplinarity strengthens the ability of care teams to take effective collective action while enhancing people's autonomy and power to act, in line with the principles of health promotion as defined by the World Health Organization [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to Bernard, health education in perinatal care can be defined as a process centered on women, aimed at increasing their autonomy and facilitating the acquisition or maintenance of the skills they need to manage and adapt to the changes inherent in motherhood [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. This health education is \u0026ldquo;an active process of reinforcing self-esteem and critical thinking skills, and the ability to make decisions and take action to act and improve one's health; in this case, to succeed in a health experience by welcoming the child and making the transition to parenthood\u0026rdquo; [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. In his study on perinatal health education among French midwives, Bernard [2014] identified disparities between health education approaches, particularly between approaches limited to information-advice and accompaniment-support; he also identified inequalities in the information disseminated and the screening actions in which midwives participate.\u003c/p\u003e \u003cp\u003eFor many years, public health interventions focused solely on transmitting information about diseases and risks based on the rational assumption that once people were aware of the consequences, they would automatically adopt health-beneficial behaviors. However, this approach does not align with reality, since individual behavior does not follow this logic and is the result of many factors, both internal and external to the individual. Thus, adopting a strategy of health education and not just information delivery implies conferring an active process on the person concerned by considering their ability to access, understand, evaluate, and apply information to make decisions and apply this information to their own health (the notion of health literacy), environment, and life context [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. The professionals who participated in this research do not share this concept of the individual as an active and committed player in their own healthcare. For example, the question of whether a pregnant woman should seek information independently generated disagreement among the experts. This reaction reflects professionals' traditional approach to the practitioner-patient relationship, thus questioning people's ability to seek and understand information independently. Professionals' reactions question their acceptance of the concept of health democracy [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e] and consideration of individuals' power to act regarding their health [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Indeed, although the quality of online information varies, it allows \u0026ldquo;egalitarian access to information regardless of geographical location, temporal availability, socio-economic level or physical isolation\u0026rdquo; [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Thus, it's not only a way for pregnant women to find medical information quickly and easily, enabling them to be better prepared, but also a way of sharing experiences that can be seen in some aspects as social support [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Discussions with the experts on this issue have highlighted the need to raise awareness among healthcare professionals about psychosocial skills and how to integrate them into the prevention strategies they deploy with their patients. The search for information could be a theme incorporated into prenatal classes and would provide an opportunity to develop critical thinking skills to identify reliable sources [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. This active approach would promote the pregnant woman's autonomy and empowerment [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first reference tool of its kind. Beyond the existing guides and resources identified in the literature review, which are merely vectors of information, this referential aid can be used as a tool in an educational intervention that enables women to engage in a process of maintaining or improving their oral health [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Formulated with regard to pedagogical skills and objectives, it is part of an educational approach that will enable professionals to position themselves as actors in oral health education and go beyond delivering advice-based information, which does not sufficiently support patients in their day-to-day health management. Accordingly, and in line with the INPES health education skills reference framework [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], this perinatal oral health reference framework could be integrated into a global educational approach and a common prevention culture deployed by a professional around four functions that integrate oral health. First, to identify and analyze situations that could give rise to educational action to maintain and preserve health. Second, to provide bespoke assistance to raise awareness and encourage commitment to a health education approach adapted to the situation. Third, to develop the organization and implementation of collective action as part of a health education approach. Fourth, to develop the professional practices required to implement health education actions.\u003c/p\u003e \u003cp\u003eDespite its contributions, this study has limitations. The number of professionals meeting the criteria of the Delphi method decreased significantly during the third round (due to vacation period, retirement, etc.) Nevertheless, the careful selection of experts produced a representative panel of professionals working in the field of maternity and early childhood. In retrospect, the 96-question questionnaire was probably perceived as excessive, and this perception may have contributed to the loss of participants. Furthermore, categorizing skills into knowledge, attitudes, and practices may have generated misunderstandings or a sense of redundancy among the professionals, with some areas being questioned several times from different categories.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, it is essential for pregnant women to acquire oral health skills for themselves and their children. The search for a consensus among professional experts on women's oral health skills is a first step toward a common, cross-disciplinary approach to oral health during the perinatal period. The skills repository, developed around coherent key messages, could help structure educational interventions in oral health for pregnant women, with the aim of developing their skills and autonomy to improve or maintain oral health through the appropriation of favorable behaviors. However, the specific modalities, settings, and professionals best suited to deliver brief oral health interventions during prenatal care remain to be determined.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors give their consent to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript. The items included in the Delphi questionnaires are reflected in Table 2, the skill framework is presented in Table 4. Panel evaluations for subsequent Delphi cycles (i.e. round 2 and 3) are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors designed the research and the structure of the study. A.T, S.A-L , A.M and R.G wrote the main manuscript text. V.D, I.C, M.Y and A.T structured the methodology. A.T, I.C, S.R, J.C, A.M and S.A-L interpreted the data and synthesised the data. A.T, R.G, P.L , T.M and S.A-L \u0026nbsp;revised the work. R.G and P.L \u0026nbsp;provided critical feedback for revision. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare\u0026nbsp;was\u0026nbsp;taken to ensure compliance with ethical standards throughout the research process. A note containing the essential information (research framework, objective, right of refusal, right of withdrawal without justification, right of access to the overall results, and researchers\u0026rsquo; contact details) was sent by email, and the participants then signed a written consent form. Information was stored securely and temporarily. LimeSurvey software was used, hosted by Universit\u0026eacute; Paris Cit\u0026eacute;, which provides data security. This software complies with the requirements of the General Data Protection Regulation (GDPR) and ensures the confidentiality and security of personal information. A request for authorization was submitted to the CNIL Commission Nationale de l\u0026rsquo;Informatique et des Libert\u0026eacute;s, and a favorable response was obtained, the reference number from is 2235880 v 0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSorbonne Paris Nord University, Laboratory Educations and Heath Promotion, UR 3412, 93430, Villetaneuse, Fance. \u003csup\u003e2\u003c/sup\u003eDepartment of Dental Public Health, Faculty of Dentistry, University Paris Cit\u0026eacute;, APHP-Piti\u0026eacute; Salp\u0026eacute;tri\u0026egrave;re, Paris, France. \u003csup\u003e3\u003c/sup\u003ePublic Health Department, Seine-Saint-Denis University Hospital, APHP, 93000 Bobigny, France.\u0026nbsp;\u003csup\u003e4\u003c/sup\u003eCentre Hospitalier Universitaire de Lille, 59000 Lille, France.Haut du formulaireBas du formulaire \u003csup\u003e5\u003c/sup\u003eEcole universitaire de recherche (EUR) Sciences Infirmi\u0026egrave;res en Promotion de la Sant\u0026eacute; (SIePS), Universit\u0026eacute; Sorbonne Paris Nord, 93000 Bobigny, France.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlobal, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study. 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Presses de l\u0026rsquo;EHESP; (2018). https://shs.cairn.info/la-democratie-en-sante-en-questions--9782810906383-page-111 Accessed 25 oct 2024\u003c/li\u003e\n\u003cli\u003eLima-Pereira P, Berm\u0026uacute;dez-Tamayo C, Jasienska G. Use of the Internet as a source of health information amongst participants of antenatal classes. J Clin Nurs. 2012;21(3‑4):322‑30.\u003c/li\u003e\n\u003cli\u003eKlima CS, Vonderheid SC, Norr KF, Park CG. Development of the Pregnancy-related Empowerment Scale. Nursing and Health. 2015;3(5):120‑7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pregnancy, Child, Oral Health, Health Education Program, Prevention, Perinatal Care, Delphi Method","lastPublishedDoi":"10.21203/rs.3.rs-5348154/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5348154/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePregnancy is a period susceptible to oral pathologies such as periodontal disease and dental caries, which have been linked to adverse pregnancy outcomes. Research shows that a child\u0026rsquo;s oral health is shaped by complex individual and collective factors and is closely tied to the health of their parents, particularly their mothers. Although oral health education interventions are offered during pregnancy follow-ups, their effectiveness is difficult to assess. This study presents a competency framework for pregnant women through oral health education programs, serving as a resource for healthcare professionals.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA three-round Delphi method assessed professional experts' opinions. A literature review generated 40 resources that informed the first-round questionnaire, structured into two sections (pregnant woman and child). Three main families of skill (preventing, monitoring caries/periodontal disease, seeking dental care) were divided into 96 contributory learning objectives, categorized by knowledge, practices, and attitudes. Experts rated the usefulness of each objective on a 5-point Likert scale, with consensus set at 70%. The expert panel comprised 21 perinatal professionals (midwives, pediatricians, gynecologists, general practitioners, dentists, pharmacists).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the first round, 59% of objectives were rated very useful. Forty objectives failed to find consensus and were reformulated for the second round. Oral hygiene achieved better consensus than nutrition-related fields of application. After three rounds, four areas still lacked consensus: the risk of preeclampsia related to periodontal disease, breastfeeding\u0026rsquo;s impact on oral health, women's search for oral health information, and saliva's protective role. A consensus-based competency framework for pregnant women's oral health education was developed centered on three key competencies: preventing oral diseases, participating in care plans, and asserting rights.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e Reaching a consensus on women's oral health skills is essential for a cross-disciplinary approach to common prevention strategies and oral health education during the perinatal period. Further work is needed to define implementation strategies environments and identify professionals suited for delivering brief oral health interventions during pregnancy follow-ups.\u003c/p\u003e","manuscriptTitle":"Oral Health Skills Framework for Pregnant Women: a Professional Consensus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 14:48:16","doi":"10.21203/rs.3.rs-5348154/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-05T12:11:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-01T06:21:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-01T06:20:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-10-28T14:52:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b4c6d10-5cb5-4080-a642-85b55f5a0726","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T20:08:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-20 14:48:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5348154","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5348154","identity":"rs-5348154","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}