figure a

Good oral health of mothers is essential for their overall health and that of their young children [1, 2]. A mother’s oral health, oral health knowledge, oral health literacy, attitudes, behaviors, and socioeconomic status influence children’s health; they are important determinants of childhood caries. Thus, the life course approach focusing on cross-generational intervention is critical [3,4,5,6,7,8,9,10]. Previous research has demonstrated that untreated dental caries in mothers can lead to a higher risk for dental caries in young children [3, 11,12,13,14,15]. There is also a potential association between periodontal (gum) diseases during pregnancy and adverse birth outcomes [9, 13, 16,17,18,19,20,21,22,23,24,25]. Future research needs to define this association as current results are mixed [26,27,28,29,30].

In addition to those biological links, what matters the most is to create a system of health care and health promotion for mothers and children to achieve oral health and oral health equity. When children grow in an environment with adequate family and community support that promotes a proactive attitude towards oral health, their overall health, wellbeing, and development thrives [4, 5, 8,9,10, 31,32,33,34,35]. Such an environment nurtures and encourages optimal oral hygiene practices and healthy diets through mothers and other caregivers from the early stages of life onward. To emphasize these contextual aspects of maternal oral health, WFPHA recently analyzed existing maternal and oral health frameworks and published “Maternal oral health framework: integration of oral health into perinatal care,” and highlighted the primary elements in achieving maternal and child oral health. This includes contextual and enabling factors for the integration of oral health into primary and antenatal health systems for women in pre-pregnancy (preconception), pregnancy, and post- pregnancy stage of life [10].

Pregnancy is a critical time for oral health interventions and serves as a “teachable moment” to motivate expecting mothers to adopt healthy behaviors [4, 36]. This may also be a time for them to access primary health care on a regular basis as WHO recommends at least four prenatal visits during pregnancy [37, 38]. However, there are multiple challenges in accessing dental care for women and children globally and these challenges disproportionately affect women and children in communities with limited resources and a lack of health care systems. Cost of care, lack of health literacy, and limited access to dental facilities and dental workforce availability are some of these barriers [9, 39, 40]. Many women do not seek or cannot access dental care during pregnancy in both high-income countries and low- and middle-income countries [1, 2, 9, 39,40,41,42,43,44,45,46,47,48]. In the U.S. only 40% of mothers visited dentists for cleaning during pregnancy [49] and there was a significant racial disparity among black women compared to white women [50]. Women in high-income and low- and middle-income countries may have challenges in finding dental providers.

Dental providers have been hesitant to offer dental care for pregnant patients and postpone necessary care due to lack of knowledge and understanding of current guidelines and evidence-based recommendations or concerns about liability [37, 51,52,53,54,55]. In low- and middle-income countries, especially in rural communities, dental care during pregnancy can be challenging; access and utilization of any health care services are limited, a dental workforce is lacking, as is awareness of the importance of good oral health during pregnancy [43, 56, 57]. Also, most national public health surveillance systems lack data collection structure to assess oral health status and access to dental care during pregnancy [37, 58]. Therefore, it is critical that oral health be positioned as an integral part of primary health and antenatal health, focused on prevention for women in pre-pregnancy (preconception), pregnancy, and post-pregnancy stages of life. Doing so will require connecting existing dental and primary care teams to deliver dental care to set lifelong oral hygiene habits [4, 37, 58, 59]. The new norm needs to be a caries-free mouth.

Historically, oral health is a neglected public health topic, globally. Yet, oral health can affect everyday life, social interactions, and general health [58]. Dental caries in permanent teeth is the most prevalent disease, affecting 2 billion people worldwide with the estimated global average prevalence of 29% [58]. Dental caries is also the single most common chronic childhood disease, affecting 514 million children worldwide with a global average prevalence of 43% [58]. The direct cost of care for oral diseases is $387 billion annually, and the combined estimated number of cases of oral diseases globally is about 1 billion higher than cases of all five major non-communicable diseases, including diabetes and cardiovascular diseases [58]. Evidence has demonstrated significant oral health inequities impacting vulnerable and disadvantaged populations [60]. The WHO Global Oral Health Status Report and the Lancet issue on global oral health have highlighted the gross neglect of oral health globally as a major public health challenge that needs to be addressed [58, 60].

With this incredible burden of oral disease, WHO recently published the Global Strategy on Oral Health and the Global Oral Health Action Plan to tackle oral health diseases by 2030 by using coordinated measures and best practices [61, 62]. This action plan also emphasizes the need to “facilitate social mobilization and engage and empower a diverse range of actors, including women as change agents in families and communities” [62]. This is a rare opportunity for public health professionals to highlight the importance of oral health in the public health context. This initiative will enhance the global oral health momentum by creating collaborative efforts to integrate oral health into maternal and child health agendas. These efforts will include changes in policy, community participation, and clinical care. The WFPHA Oral Health Workgroup and Women, Children, and Adolescents Workgroup agreed on the following recommendations.

Recommendations

  1. 1.

    WFPHA launched the global and maternal and child oral health initiative at the World Congress Public Health in Rome, May 4th, 2023, to achieve oral health equity, and seek endorsements beyond those already in place.

  2. 2.

    WFPHA supports WHO’s universal health coverage that includes oral health care and calls on all member associations to advocate for timely and affordable access to personal preventive resources including fluoridated toothpaste and toothbrushes, and essential oral health care services for women of childbearing age and young children.

  3. 3.

    WFPHA recommends integrating oral health education and services into existing maternal health care systems and training both dental and non-dental health care providers to participate in such efforts.

  4. 4.

    WFPHA encourages both health and educational sectors to increase oral health literacy, especially for socially marginalized populations, and

  5. 5.

    WFPHA recommends all member associations to advocate for integration of oral health care into health systems through care coordination and dental homes.

Conclusions

We believe women are the key change agents that secure and improve the oral health of their children and families, and we call for action by health professionals and policymakers to improve maternal oral health by integrating oral health care into the existing and future antenatal health systems for women in pre-pregnancy (preconception), pregnancy, and post-pregnancy stage of life.

Hyewon Lee, DrPH, DMD, is a director at the Global Maternal and Child Oral Health Center at the Seoul National University Dental Research Institute and School of Dentistry, Seoul, South Korea, and the chair of Oral Health Workgroup of the World Federation of Public Health Association, Geneva Switzerland; hyewonlee@snu.ac.kr

Khabiso J. Ramphoma, B.Ch.D, M.Ch.D, is a senior lecturer and specialist in Community Dentistry at the University of the Western Cape, Cape Town, South Africa

Alice M. Horowitz, PhD, MA, RDH, is a research professor at the School of Public Health University of Maryland, Maryland, United States

Deborah Walker, EdD, is an ajunct professor at Boston University and Tufts University, Boston, USA and the Chair of Women, Children, and Youth Working Group, World Federation of Public Health Association, Geneva, Switzerland