Abstract
Introduction
Knowledge gaps exist among providers and pregnant women about the importance and safety of oral health care around pregnancy. This article describes the current state of perinatal oral health and healthcare among underserved women in North Carolina (NC) and provides policy recommendations to improve their access to and utilization of dental services.
Methods
A descriptive analysis is provided using (a) 2016 oral health surveillance data of a convenience sample of 459 pregnant women across NC, (b) 2014–2016 Medicaid dental provider and dental services utilization data for the Medicaid for Pregnant Women (MPW) program, and (c) 2017 Medicaid dental benefits policy. Surveillance data was not linked to Medicaid dental services utilization data.
Results
Less than 20% of pregnant women surveyed reported having a dental visit during pregnancy and oral screenings revealed 33% had untreated caries. Medicaid data showed a steady decline since 2014 in percentage of MPW beneficiaries utilizing any dental service—less than 10% as of 2016. MPW dental benefits lapse at delivery because dental care is not considered pregnancy-related in NC policy. Only 20% of practicing NC dentists provided care to MPW beneficiaries in 2015.
Discussion
Inadequacies in oral health knowledge, beliefs and practices exist among pregnant women, health care professionals and policymakers. Statewide efforts are needed to promote a standard of perinatal care that emphasizes collaborative practice and addresses existing barriers at the patient, provider and policy levels.
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Data Availability
Raw data used in this study may be accessed from the following agencies: NC perinatal oral health assessment data—NC Oral Health Section (https://publichealth.nc.gov/oralhealth/contactUs/index.htm); NC Medicaid provider and dental services utilization data—NC Division of Health Benefits (https://medicaid.ncdhhs.gov/contact); NC dentist licensure data—NC Board of Dental Examiners (https://www.ncdentalboard.org/contact.htm).
References
American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women. (2013). Committee opinions. Oral health care during pregnancy and through the lifespan. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Oral-Health-Care-During-Pregnancy-and-Through-the-Lifespan.
Atchison, K. A., Rozier, G. R., & Weintraub, J. A. (2017). Integrating oral health, primary care and health literacy: Considerations for health professional practice, education and policy. Commissioned paper. The National Academies of Sciences, Engineering and Medicine. https://nationalacademies.org/hmd/~/media/Files/Activity%20Files/PublicHealth/HealthLiteracy/Commissioned%20Papers%20-Updated%202017/Atchison%20K%20et%20al%202017%20Integrating%20oral%20health%20primary%20care%20and%20health%20literacy.pdf
Azofeifa, A., Yeung, L. F., Alverson, C. J., & Beltrán-Aguilar, E. (2014). Oral health conditions and dental visits among pregnant and nonpregnant women of childbearing age in the United States, National Health and Nutrition Examination Survey, 1999–2004. Preventing Chronic Disease,11, 140212. https://doi.org/10.5888/pcd11.140212.
Azofeifa, A., Yeung, L. F., Alverson, C. J., & Beltrán-Aguilar, E. (2016). Dental caries and periodontal disease among US pregnant women and nonpregnant women of reproductive age, National Health and Nutrition Examination Survey, 1999–2004. Journal of Public Health Dentistry,76(4), 320–329.
Baker, S. D., Lee, J. Y., & Wright, R. (2019). The importance of the age one dental visit. American Academy of Pediatric Dentistry. https://www.aapd.org/globalassets/media/policy-center/year1visit.pdf.
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(S1), 169–174.
Boggess, K. A., Urlaub, D. M., Massey, K. E., Moos, M.-K., Matheson, M. B., & Lorenz, C. (2010). Oral hygiene practices and dental service utilization among pregnant women. Journal of the American Dental Association,141(5), 553–561.
Boggess, K. A., Urlaub, D. M., Moos, M.-K., Polinkovsky, M., El-Khorazaty, J., & Lorenz, C. (2011). Knowledge and beliefs regarding oral health among pregnant women. Journal of the American Dental Association,142(11), 1275–1282.
Chaffee, B. W., Gansky, S. A., Weintraub, J. A., Featherstone, J. D. B., & Ramos-Gomez, F. J. (2014). Maternal oral bacterial levels predict early childhood caries development. Journal of Dental Research,93(3), 238–244.
Children’s Dental Health Project. (September 17, 2018). Oral health during pregnancy: Oral health’s unanswered questions. Retrieved January 14, 2019 from https://www.cdhp.org/resources/339-issue-brief-oral-health-during-pregnancy.
Dye, B. A., Thornton-Evans, G., Li, X., & Iafolla, T. (2015). Dental caries and tooth loss in adults in the United States, 2011–2012. Centers for Disease Control and Prevention, National Center for Health Statistics: US Department of Health and Human Services.
Dye, B. A., Vargas, C. M., Lee, J. J., Magder, L., & Tinanoff, N. (2011). Assessing the relationship between children's oral health status and that of their mothers. The Journal of the American Dental Association,142(2), 173–183.
Eke, C., Mask, A., Reusch, C., Vishnevsky, D., & Quinonez, R. B. (2019) Coverage brief: Improving access to oral health care in pregnancy. Children’s Dental Health Project. https://www.cdhp.org/resources/384-coverage-brief-improving-access-to-oral-health-care-in-pregnancy
Eke, P. I., Dye, B. A., Wei, L., Slade, G. D., Thornton-Evans, G. O., Borgnakke, W. S., et al. (2015). Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. Journal of periodontology,86(5), 611–622.
Gaffield, M. L., Gilbert, B. J. C., Malvitz, D. M., & Romaguera, R. (2001). Oral health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system. The Journal of the American Dental Association,132(7), 1009–1016.
Garcia, R. L., Henshaw, M. M., & Krall, E. A. (2001). Relationship between periodontal disease and systemic health. Periodontology,2000(25), 21–36.
Gazmararian, J. (1999). Prenatal care for low-income women enrolled in a managed-care organization. Obstetrics & Gynecology,94(2), 177–184.
Institute of Medicine. (2011). Advancing oral health in America. Washington, DC: The National Academies Press.
Institute of Medicine and National Research Council. (2012). Improving access to oral health care for vulnerable and underserved populations. Washington, DC: The National Academies Press.
Kaiser Family Foundation. (March 2017). Births financed by Medicaid. Retrieved September 2017 from https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D.
Kristen, M. S., Fisher-Owens, S. A., Weintraub, J. A., Yu, Z., & Braveman, P. A. (2010). Most pregnant women in California do not receive dental care: Findings from a population-based study. Public Health Reports,125, 831–841.
Mattila, M.-L., Rautava, P., Sillanpää, M., & Paunio, P. (2000). Caries in five-year-old children and associations with family-related factors. Journal of Dental Research,79(3), 875–881.
National Center for Health Statistic. (2018). Births: Final data for 2016. National Vital Statistics Reports; vol 67, No 1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf
National Maternal and Child Oral Health Resource Center. (2012). Oral health care during pregnancy: A national consensus statement. https://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf
North Carolina Division of Health Benefits. (2017). Basic Medicaid eligibility. https://files.nc.gov/ncdma/documents/files/BASIC_MEDICAID_INCOME_ELIGIBLITY_CHART_2017_03_10.pdf.
North Carolina Division of Health Benefits. Medicaid income and resources requirements. Retrieved July 2017 from https://dma.ncdhhs.gov/medicaid/get-started/eligibility-for-medicaid-or-health-choice/medicaid-income-and-resources-requirements.
North Carolina State Center for Health Statistics. (June 14, 2018). 2016 survey results PRAMS. Oral Health. https://schs.dph.ncdhhs.gov/data/prams/2016/#17.5.
Prada Da Costa, E., Lee, J. Y., Rozier, R. G., & Zeldin, L. (2010). Dental care for pregnant women. Journal of the American Dental Association,141(8), 986–994.
Satcher, D. (2000). Oral health in America. A report of the surgeon general. Bethesda, MD: Office of Public Health and Science. United States Department of Health and Human Services.
South Carolina Department of Health and Environmental Control. PRAMS. Create a table, visited a dentist during pregnancy. Retrieved December 9, 2019 from https://scangis.dhec.sc.gov/scan/prams2/prams.aspx.
Vieira, D. R., de Oliveira, A. E., Lopes, F. F., & Lopes e Maia, M. D. F. (2015). Dentists’ knowledge of oral health during pregnancy: A review of the last 10 years’ publications. Community Dental Health,32(2), 77–82.
Virginia Department of Health. (2015). Virginia oral health report. https://www.vdh.virginia.gov/content/uploads/sites/67/2018/06/Virginia-Oral-Health-Report-2012-2015.pdf
West Virginia Department of Health and Human Resources. (2015). PRAMS 2009–2015 surveillance report. https://www.wvdhhr.org/wvprams/pdf/2009_2015_Annual_Report.pdf
Wilder, R., Robinson, C., Jared, H., Lieff, S., & Boggess, K. (2007). Obstetricians' knowledge and practice behaviors concerning periodontal health and preterm delivery and low birth weight. Journal of Dental Hygiene,81(4), 81.
Wooten, K., Lee, J., Jared, H., Boggess, K., & Wilder, R. (2011). Nurse practitioners’ and certified nurse midwives' knowledge, opinions and practice behaviors regarding periodontal disease and adverse pregnancy outcomes. Journal of Dental Hygiene,85(2), 122–131.
Acknowledgements
The authors would like to thank the NC Oral Health Section and its staff for conducting the 2016 prenatal oral health assessment and the local health departments that allowed access to their patients and facilities. Thank you to the NC Division of Health Benefits for providing Medicaid data, the NC Board of Dental Examiners for licensure data, and our team of reviewers, Drs. Mark Casey, Sarah Tomlinson, and Kelly Kimple. We also want to acknowledge the NC Perinatal Oral Health Task Force for its ongoing efforts to improve the health and well-being of pregnant women in the state.
Funding
The 2016 perinatal oral health assessment was supported by the Division of Public Health, North Carolina Department of Health and Human Services.
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Stephens, R., Quinonez, R., Boggess, K. et al. Perinatal Oral Health Among Underserved Women: A Call to Action for North Carolina Patients, Providers and Policymakers. Matern Child Health J 24, 351–359 (2020). https://doi.org/10.1007/s10995-019-02868-4
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DOI: https://doi.org/10.1007/s10995-019-02868-4