Oral-Systemic Health During Pregnancy: Exploring Prenatal and Oral Health Providers’ Information, Motivation and Behavioral Skills


Pregnancy is identified as a sensitive period of increased risk for poor oral health among mothers and offspring. Subsequently, both medical and dental associations have re-endorsed consolidated, inter-professional guidelines promoting oral health during pregnancy. The objective was to explore prenatal and oral health providers’ information, motivation and practice behaviors related to oral health during pregnancy. Twenty-two in-depth interviews were conducted with prenatal and oral health providers based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Providers held variable knowledge with regards to identified oral-systemic connections and implications. Most providers were unaware of the guidelines; however, some oral health providers reported avoiding specific treatment behaviors during this period. Motivation to address oral-systemic health during pregnancy included: prevention; healthy pregnancy/birth outcomes; patient’s complaint/question as cue to action; comprehensive, patient-centered, and family-centered care; ethical duty; and professional governing body. Oral health providers reported assessing, educating, and communicating with patients about oral health issues; whereas prenatal providers rarely addressed oral health but reported signing approval forms to receive such care. A few oral health providers highlighted lifecourse implications and the need for family-centered care when addressing poor oral health among pregnant patients. Findings suggest gaps in oral health prevention information and behaviors among prenatal and oral health providers. Future efforts should examine effective dissemination and implementation strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improve oral-systemic health among women and their offspring across the lifecourse.

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  1. 1.

    Barnett, M. L. (2006). The oral-systemic disease connection. An update for the practicing dentist. Journal of the American Dental Association, 137(S2), 5S–6S.

    Article  PubMed  Google Scholar 

  2. 2.

    Nicolau, B., Thomson, W. M., Steele, J. G., & Allison, P. J. (2007). Life-course epidemiology: Concepts and theoretical models and its relevance to chronic oral conditions. Community Dentistry and Oral Epidemiology, 35(4), 241–249.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Lieff, S., Boggess, K. A., Murtha, A. P., Jared, H., Madianos, P. N., Moss, K., et al. (2004). The oral conditions and pregnancy study: Periodontal status of a cohort of pregnant women. Journal of Periodontology, 75(1), 116–126.

    Article  PubMed  Google Scholar 

  4. 4.

    Lachat, M. F., Solnik, A. L., Nana, A. D., & Citron, T. L. (2011). Periodontal disease in pregnancy: Review of the evidence and prevention strategies. The Journal of Perinatal & Neonatal Nursing, 25(4), 312–319.

    Article  Google Scholar 

  5. 5.

    Kloetzel, M. K., Huebner, C. E., & Milgrom, P. (2011). Referrals for dental care during pregnancy. Journal of Midwifery & Women’s Health, 56(2), 110–117.

    Article  Google Scholar 

  6. 6.

    U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, Office of Research on Women’s Health. Moving into the future with new dimensions and strategies: A vision for 2020 for women’s health research, volume II—Regional scientific reports. Bethesda, MD: National Institutes of Health, 2010 Contract No.: 10-7606-B.

  7. 7.

    Xiong, X., Buekens, P., Fraser, W., Beck, J., & Offenbacher, S. (2006). Periodontal disease and adverse pregnancy outcomes: A systematic review. BJOG, 113(2), 135–143.

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Boggess, K. A., Lieff, S., Murtha, A. P., Moss, K., Beck, J., & Offenbacher, S. (2003). Maternal, periodontal disease is associated with an increased risk for preeclampsia. Obstetrics and Gynecology, 101(2), 227–231.

    Article  PubMed  Google Scholar 

  9. 9.

    Moore, S., Ide, M., Coward, P. Y., Randhawa, M., Borkowska, E., Baylis, R., et al. (2004). A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome. British Dental Journal, 197(5), 251–258.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Offenbacher, S., Lieff, S., Boggess, K. A., Murtha, A. P., Madianos, P. N., Champagne, C. M., et al. (2001). Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction. Annals of Periodontology, 6(1), 164–174.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Xiong, X., Buekens, P., Vastardis, S., & Pridjian, G. (2006). Periodontal disease and gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 195(4), 1086–1089.

    Article  PubMed  Google Scholar 

  12. 12.

    Polyzos, N. P., Polyzos, I. P., Mauri, D., Tzioras, S., Tsappi, M., Cortinovis, I., et al. (2009). Effect of periodontal disease treatment during pregnancy on preterm birth incidence: A metaanalysis of randomized trials. American Journal of Obstetrics and Gynecology, 200(3), 225–232.

    Article  PubMed  Google Scholar 

  13. 13.

    Michalowicz, B. S., Hodges, J. S., DiAngelis, A. J., Lupo, V. R., Novak, M. J., Ferguson, J. E., et al. (2006). Treatment of periodontal disease and the risk of preterm birth. New England Journal of Medicine, 355(18), 1885–1894.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Sanz M, Kornman K, Working group 3 of the Joint EFP/AAP Workshop. Periodontitis and adverse pregnancy outcomes: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of Clinical Periodontology. 2013; 84(4 Suppl):S164–S9.

  15. 15.

    Madianos, P. N., Bobetsis, Y. A., & Offenbacher, S. (2013). Adverse pregnancy outcomes (APOs) and periodontal disease: Pathogenic mechanisms. Journal of Clinical Periodontology, 84(4 Suppl), S170–S180.

    Google Scholar 

  16. 16.

    Castañeda, H., Carrion, I. V., Kline, N., & Tyson, D. M. (2010). False hope: Effects of social class and health policy on oral health inequalities for migrant farmworker families. Social Science and Medicine, 71(11), 2028–2037.

    Article  PubMed  Google Scholar 

  17. 17.

    Boggess, K. A., & Edelstein, B. L. (2006). Oral health in women during preconception and pregnancy: Implications for birth outcomes and infant oral health. Maternal and Child Health Journal, 10(5 Suppl), S169–S174.

    Article  PubMed  Google Scholar 

  18. 18.

    American Academy of Periodontics. (2011). Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. Pediatric Dentistry, 34(6), 50–52.

    Google Scholar 

  19. 19.

    Task Force on Periodontal Treatment of Pregnant Women, American Academy of Periodontology. (2004). American Academy of Periodontology statement regarding periodontal management of the pregnant patient. Journal of Periodontology, 75(3), 495.

  20. 20.

    Council on Clinical Affairs. (2011). Guideline on perinatal oral health care. American Academy of Pediatric Dentistry: Reference Manual, 33(6), 11–12.

    Google Scholar 

  21. 21.

    American Dental Association. (2011). Oral health during pregnancy. Journal of the American Dental Association, 142(5), 574.

    Article  Google Scholar 

  22. 22.

    American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. (2007). Guidelines for perinatal care (6th ed., pp. 123–124). Washington, DC: American College of Obstetricians and Gynecologists; Elk Grove Village, IL: American Academy of Pediatrics.

  23. 23.

    Hwang, S., Smith, V., McCormick, M., & Barfield, W. (2011). Racial/ethnic disparities in maternal oral health experiences in 10 states, pregnancy risk assessment monitoring system, 2004–2006. Maternal and Child Health Journal, 15(6), 722–729.

    Article  PubMed  Google Scholar 

  24. 24.

    Morgan, M., Crall, J., Goldenberg, R., & Schulkin, J. (2009). Oral health during pregnancy. Journal of Maternal-Fetal and Neonatal Medicine, 22(9), 733–739.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Strafford, K. E., Shellhaas, C., & Hade, E. M. (2008). Provider and patient perceptions about dental care during pregnancy. Journal of Maternal-Fetal and Neonatal Medicine, 21(1), 63–71.

    Article  PubMed  Google Scholar 

  26. 26.

    Wilder, R., Robinson, C., Jared, H. L., Lieff, S., & Boggess, K. (2007). Obstetricians’ knowledge and practice behaviors concerning periodontal health and preterm delivery and low birth weight. Journal Dental Hygiene, 81(4), 81.

    Google Scholar 

  27. 27.

    Huebner, C. E., Milgrom, P., Conrad, D., & Lee, R. S. (2009). Providing dental care to pregnant patients: a survey of Oregon general dentists. Journal of the American Dental Association, 140(2), 211–222.

    Article  PubMed  Google Scholar 

  28. 28.

    Pina, P., & Douglass, J. (2011). Practices and opinions of Connecticut general dentists regarding dental treatment during pregnancy. General Dentistry, 59(1), e25–e31.

    PubMed  Google Scholar 

  29. 29.

    Oral Health Care During Pregnancy Expert Workgroup. (2012). Oral health care during pregnancy: A national consensus statement—Summary of an Expert Workgroup Meeting. Washington, DC: National Maternal and Child Oral Health Resource Center.

    Google Scholar 

  30. 30.

    Fisher, J., & Fisher, W. (2002). The Information-Motivation-Behavioral Skills Model. In R. DiClemente, R. Crosby, & M. Kegler (Eds.), Emerging theories in health promotion practice and research: Strategies for improving public health. San Francisco, CA: Wiley.

    Google Scholar 

  31. 31.

    QSR (Version 10) [Computer software]. International Pty Ltd. NVivo. 2012.

  32. 32.

    Glaser, B. G. (1965). The constant comparative method of qualitative analysis. Social Problems, 12(4), 436–445.

    Article  Google Scholar 

  33. 33.

    George, A., Shamim, S., Johnson, M., Ajwani, S., Bhole, S., Blinkhorn, A., et al. (2011). Periodontal treatment during pregnancy and birth outcomes: A meta-analysis of randomised trials. International Journal of Evidence‐Based Healthcare, 9(2), 122–147.

    Article  PubMed  Google Scholar 

  34. 34.

    Jiang, H., Xiong, X., Su, Y., Zhang, Y., Wu, H., Jiang, Z., et al. (2013). A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes. BMC Pregnancy and Childbirth, 13, 228.

    Article  PubMed Central  PubMed  Google Scholar 

  35. 35.

    Institute of Medicine. (2011). Advancing oral health in America. Washington, D.C.: The National Academies Press.

    Google Scholar 

  36. 36.

    Abernethy, A. P., Herndon, J. E., Wheeler, J. L., Patwardhan, M., Shaw, H., Lyerly, H. K., et al. (2008). Improving health care efficiency and quality using tablet personal computers to collect research-quality, patient-reported data. Health Services Research, 43(6), 1975–1991.

    Article  PubMed Central  PubMed  Google Scholar 

  37. 37.

    Wofford, J. L., Smith, E. D., & Miller, D. P. (2005). The multimedia computer for office-based patient education: A systematic review. Patient Education and Counseling, 59(2), 148–157.

    Article  PubMed  Google Scholar 

  38. 38.

    Lewis, D. (1999). Computer-based approaches to patient education: A review of the literature. Journal of the American Medical Informatics Association, 6(4), 272–282.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. 39.

    Richter, J. G., Becker, A., Koch, T., Nixdorf, M., Willers, R., Monser, R., et al. (2008). Self-assessments of patients via Tablet PC in routine patient care: Comparison with standardised paper questionnaires. Annals of the Rheumatic Diseases, 67(12), 1739–1741.

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Ratzan SC, Parker RM. Introduction. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services2000 Contract No.: CBM 2000-1.

  41. 41.

    Vamos, C. A. (2011). Applying a health literacy lens to preventative children’s oral health programming. Umwelt und Gesundheit, 4, 30–34.

    Google Scholar 

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Correspondence to Cheryl A. Vamos.

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Vamos, C.A., Walsh, M.L., Thompson, E. et al. Oral-Systemic Health During Pregnancy: Exploring Prenatal and Oral Health Providers’ Information, Motivation and Behavioral Skills. Matern Child Health J 19, 1263–1275 (2015). https://doi.org/10.1007/s10995-014-1632-7

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  • Oral health
  • Pregnancy
  • Guidelines
  • Providers