Medical Provider Promotion of Oral Health and Women’s Receipt of Dental Care During Pregnancy

Race, Ethnicity, and Other Barriers to Access Dental Care During Pregnancy

BACKGROUND

Historically, women of color showed poorer oral health and lower dental service utilization in the USA. These barriers to dental care during pregnancy included dental coverage, primary language, dental provider availability, safety concerns, affordability of dental care, and perceived oral health benefits during pregnancy.

METHODS

The purpose of this study is to examine whether race/ethnicity modified the associations between barriers to accessing dental care and dental service utilization during pregnancy. This cross-sectional study sample included 62,189 women aged 20 and older with a recent birth history in 21 states from the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019. We introduced a race/ethnicity by barrier interaction term to our multiple logistic regression models.

RESULTS

After adjusting for other confounders, dental insurance during pregnancy and perceived oral health benefits were associated with 4.0- and 5.6-fold higher odds, respectively, of dental service utilization during pregnancy. Statistically significant effect modification by race/ethnicity was observed in crude and adjusted analyses of the relationship between dental service utilization for all barriers included in the interaction analyses with all adjusted p-values < 0.001.

CONCLUSION

The interaction analysis found that racial/ethnic disparity in visiting dentists during pregnancy was significant among women who reported these dental barriers. In contrast, such racial/ethnic disparity was substantially attenuated among women who did not report such barriers.

PRACTICAL IMPLICATIONS

The observed racial/ethnic disparities could be mitigated by such supporting mechanisms: dental coverage, provider availability and willingness to treat pregnant women, oral health education on the safety of dental care during pregnancy, and affordable dental care costs.

Perceptions and determinants of oral health care among Iranian pregnant women: a qualitative study

OBJECTIVES

This study aimed to gain a comprehensive understanding of the determinants that influence oral healthcare behaviours among Iranian pregnant women.

STUDY DESIGN

Qualitative study.

SETTING

Comprehensive health service centres.

PARTICIPANTS

A sample consisting of all people involved in the process of oral care during pregnancy, 18 pregnant women, 7 midwives/healthcare workers, 3 supervisors of prenatal care services and 3 dentists) were purposefully sampled in terms of demographic characteristics.

METHODS

The qualitative content analysis study conducted 31 semistructured individual interviews in 2022, utilising MAXQDA V.10.

RESULTS

The participants identified 3 main categories and 11 subcategories: individual and physiological determinants (care needs, perceived importance, motivation, oral health literacy and inherent pregnancy limitations), organisational determinants (costs, access to equipment and services, review of service delivery process and professional behaviour) and social-cultural determinants (educational services and support from family and friends).

CONCLUSIONS

The results can be used in interventions to improve oral healthcare for pregnant women. This study highlights the importance of addressing individual, organisational and social-cultural determinants to improve oral healthcare during pregnancy.

The effect of pregnant women's status of receiving preconception care on pregnancy stress

In the study, we aimed to determine the effect of pregnant women's status of receiving preconception care on their pregnancy stress. This is a descriptive, correlational, and cross-sectional design study, we were conducted with the participation of 409 pregnant women between June-December 2019. The Pregnancy Stress Rating Scale total score mean was found to be 30.72 ± 20.26. Individuals who received medication and vitamins as part of preconceptional care had significantly higher scores (p < 0.05; p < 0.001) compared to those who did not receive them for total pregnancy stress, postpartum social support, infant health, and infant identity-care stress. Similarly, individuals who received medical treatment and regular checkups had significantly higher scores (p < 0.05) compared to those who did not for total pregnancy stress, postpartum social support, infant identity-care, body image and psychological state during pregnancy stress scores. In addition, individuals who maintained a healthy lifestyle had significantly higher scores (p < 0.05; p < 0.001) compared to others for infant health, infant identity-care, and psychological distress during pregnancy. It was determined that women who made preparations for their pregnancy experienced more stress related to their babies (baby's health, baby's identity and care), psychological status in pregnancy, prenatal and postnatal social support, and body image.

Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers

BACKGROUND

Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types.

METHODS

Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS.

RESULTS

Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers.

CONCLUSIONS

Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.

The role of oral and prenatal healthcare providers in the promotion of oral health for pregnant women

BACKGROUND

Hormonal alterations and lowered immunity during pregnancy aggravated by poor oral hygiene increase the risk of pregnant women of developing oral diseases. We conducted this cross-sectional study to examine the role of oral and prenatal health providers in promoting dental care for pregnant women attending primary healthcare centers (PHCs) in Saudi Arabia.

METHODS

An online questionnaire was sent to a random sample of women who attended PHCs in Jeddah, during 2018-2019. From a total of 1350 women who responded to our questionnaire, 515 women reported having a dental visit before pregnancy. These women comprised our study sample. Bivariate analyses and multiple logistic regression models were conducted to examine associations between oral practices of dental and prenatal health providers (exposures) and women's utilization of dental care during pregnancy (outcome). Covariates included age, education (< 12 years of education, 12 years of education, and > 12 years of education), family income (≤ 5,000, 5,001-7,000, 7,001-10,000, and > 10,000 Saudi Riyals), health insurance (yes/no), nationality (Saudi Arabian/non-Saudi Arabian), and presence of dental problems, such as toothache, dental caries, gingival inflammation, and the need for dental extractions.

RESULTS

Only 30.0% of women were informed by a dentist during their dental visit before pregnancy about the importance of visiting a dentist during pregnancy. About 37.0% of women were asked about oral health, 34.4% were informed about the importance of dental care during pregnancy, and 33.2% had their mouths inspected by prenatal health providers. Women informed by dentists about the importance of dental visits during pregnancy were twice as likely (Odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.63-3.60) to visit a dentist during pregnancy. Women who were referred to dentists, had their mouth inspected, or were advised to visit a dentist during pregnancy by prenatal providers were 4.29 (95% CI: 2.67-6.88), 3.79 (95% CI: 2.47-5.82), and 3.37 (95% CI: 2.16-5.27) times as likely to visit a dentist during pregnancy.

CONCLUSION

The partaking of oral and prenatal healthcare providers in evidence-based oral health promotion practices, antenatal-dental collaboration, and closing the referral loop increase pregnant women's access to and utilization of preventive and treatment dental services.

Factors influencing adoption of oral health promotion by antenatal care providers in Moyo district, North-Western Uganda

BACKGROUND

Oral health promotion (OHP) during pregnancy is an important global public health and basic human right issue related to quality of life. Several statements and guidelines have been published emphasizing the need for improved oral health care of pregnant mothers, prenatal care providers have missed this critical opportunity. In this study, we assessed factors influencing adoption of oral health promotion by antenatal care providers.

MATERIALS AND METHODS

A descriptive cross-sectional study design that employed both quantitative and qualitative data collection methods and analysis. 152 samples determined using Yamane's 1967 and stratified sampling technique was used. Three FGDs and six KI interviews were held. Univariate, bivariate and multivariate analyses were done using SPSS (20.0) and ATLAS Ti for qualitative analysis.

RESULTS

Adoption of OHP was low 28% (42). Factors influencing adoption were age of respondents (OR = 0.066, 95%CI = 0.009-0.465, p = 0.006*), level of care of health facility (OR = 0.050, 95%CI = 0.008-0.322, p = 0.002*), good understanding between dentists and ANC providers (OR = 0.283, 95%CI = 0.084-0.958, p = 0.042*), availability of practice guideline for OHP in ANC (OR = 0.323, 95%CI = 0.108-0.958, p = 0.043*), number of years at work (p = 0.084), being knowledgeable (OR = 2.143, 95%CI = 0.864-5.311, p = 0.100), having skills to advance OHP(OR = 0.734, 95%CI = 0.272-1.984, p = 0.542), Management being good at influencing new practices (OR = 00.477.734, 95%CI = 0.227-2.000, p = 0.477). More emphasis on national and local of oral health issues, continuous staff training on oral health, dissemination of National oral health policy (NOHP) were some of key issues that emerged from the qualitative results.

CONCLUSION

Adoption of OHP was low. This was attributed to age, number of years spent at work, level of health facility, having good understanding between dentists and ANC providers, availability of practice guidelines, dissemination of National oral health policy, continuous staff training. We recommend the current NOHP to be reviewed, develop prenatal OHC guidelines, enhance the capacity of ANC providers through training, collaboration with dentists and launch official adoption of OHP.

Effect of oral health promotion interventions on pregnant women dental caries: a field trial

BACKGROUND

Dental caries is a costly and very common disease, especially in pregnant women. Reasons such as not paying attention to oral health, poor diet and also lack of adequate education in this regard cause this to happen. Performing well-designed educational interventions using primary health system's forces, can improve oral health of pregnant women and help control this disease. We conducted this study to evaluate the effectiveness of some oral health interventions on pregnant women dental caries.

METHODS

A field trial study was done in comprehensive Health Centers in Varamin, Tehran, Iran to assess 439 mothers' dental health status from pregnancy up to 2 years after delivery in intervention (n = 239) and control groups (n = 200). Mothers in intervention groups received oral health-related education consisted of nutritional and behavioral messages via either of four methods: A: comprehensive method including all following methods together (n = 74), B: group discussion by dentists (n = 59), C: face to face education by primary health care providers (n = 53), and D: social network applications (n = 53); while those in control group only received routine maternal and oral health care. We used a questionnaire to collect mothers' demographic, socioeconomic and dental care behavior data and also performed oral examinations to assess their DMFT at baseline and 24 months after delivery to evaluate the effectiveness of these educational oral health interventions.

RESULTS

From 454 mothers participated the examination session, 18 pregnant women discontinued during the follow-ups and 439 were remained with mean age of 27.47. In the intervention group, the frequency of daily brushing among women increased from 64% at baseline to 85.6% at the last follow-up and the mean D significantly decreased nearly 1unit at same period (P < 0.05). Most and least dental caries changes were in comprehensive intervention group and social network intervention group compared to other intervention groups, respectively.

CONCLUSIONS

Performing educational interventions during and after pregnancy using various message delivery methods and messengers (oral health professionals and trained PHCPs), could improve oral health status and behaviors of pregnant and lactating mothers in a feasible and applicable manner.

Correlation of the Oral Health Scoring-based Pregnant Oral Self-Care – package (POSC-p) Model with the Motivation to Seek Oral Health Treatment in Pregnant Women

Background:

Uncomprehensive oral health evaluation instruments and measurement and the low motivation for seeking dental and oral treatment for pregnant women; all require comprehensive measurement instruments that will increase the motivation for seeking oral health treatment for pregnant women. POSC-p model was developed for the Oral Health Scoring (OHS) to assess pregnant women's perceived needs, clinical examination, and salivary state.

Objectives:

The research objective was to analyse the correlation between the POSC-p model with the motivation for seeking oral health care in pregnant women.

Methods:

Cross-sectional research was conducted by a non-probability sampling technique using the consecutive sampling method. The sample size was determined based on the correlation analysis sample size calculation formula. The study variables were POSC-p model built with three dimensions; POSC-p score section 1 was felt needs, POSC-p score section 2 was normative needs, and POSC-p score section 3 was saliva condition. In addition, motivation to seek treatment with intrinsic and extrinsic motivation dimensions. All data were analysed using the Spearman rank correlation test.

Results:

A significant correlation was found between the POSC-p model with intrinsic and a combination of treatment-seeking motivation (p=0.026); a combined score of the POSC-p model with intrinsic (p=0.008) and a combination of treatment-seeking motivation (p=0.032).

Conclusion:

There is a correlation between the POSC-p with motivation for seeking oral health treatment in pregnant women.

Oral Health: Opportunities for Lifestyle Medicine Highlighted by the SARS-CoV-2 Pandemic

A significant amount of illness has origins in oral microorganisms. The current SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic has reduced the general population's access to and use of routine and nonemergency dental care. This creates a dangerous situation in which oral bacteria, fungi, and viruses may remain unchecked and allowed to flourish, which in turn increases risks for several systemic diseases as well as negative outcomes for pregnancies and surgical patients. This situation presents opportunities for health maintenance and disease prevention by individuals as well as for dental health professionals to use anti-infective treatments and procedures. Lifestyle medicine professionals have a chance to encourage behaviors that individuals can undertake to promote good oral health outside of the dentist's office as well as shaping public perceptions about and reinforcing the importance of resuming dental visits as governmental restrictions allow.

Dental Visits during Pregnancy: Pregnancy Risk Assessment Monitoring System Analysis 2012-2015

OBJECTIVES

This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status.

METHODS

This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015.

RESULTS

Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80-0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52-0.58).

CONCLUSION FOR PRACTICE

Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds.

KNOWLEDGE TRANSFER STATEMENT

The current study updated the previous findings with more recent multiyear PRAMS data (2012-2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.

Dental visits in Medicaid-enrolled youth with mental illness: an analysis of administrative claims data

Background

State Medicaid plans across the United States provide dental insurance coverage to millions of young persons with mental illness (MI), including those with attention deficit hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder, and schizophrenia. There are significant oral health challenges associated with MI, and providing dental care to persons with MI while they are young provides a foundation for future oral health. However, little is known about the factors associated with the receipt of dental care in young Medicaid enrollees with MI. We aimed to identify mental and physical health and sociodemographic characteristics associated with dental visits among this population.

Methods

We retrospectively analyzed administrative claims data from a Medicaid specialty health plan (September 2014 to December 2015). All enrollees in the plan had MI and were ≥ 7 years of age; data for enrollees aged 7 to 20 years were analyzed. We used two-level, mixed effects regression models to explore the relationships between enrollee characteristics and dental visits during 2015.

Results

Of 6564 Medicaid-enrolled youth with MI, 29.0% (95% CI, 27.9, 30.1%) had one or more visits with a dentist or dental hygienist. Within youth with MI, neither anxiety (Adjusted odds ratio [AOR] = 1.15, p = 0.111), post-traumatic stress disorder (AOR = 1.31, p = 0.075), depression (AOR = 1.02, p = 0.831), bipolar disorder (AOR = 0.97, p = 0.759), nor schizophrenia (AOR = 0.83, p = 0.199) was associated with dental visits in adjusted analyses, although having ADHD was significantly associated with higher odds of dental visits relative to not having this condition (AOR = 1.34, p < 0.001). Age, sex, race/ethnicity, language, and education were also significantly associated with visits (p < 0.05 for all).

Conclusions

Dental utilization as measured by annual dental visits was lower in Medicaid-enrolled youth with MI relative to the general population of Medicaid-enrolled youth. However, utilization varied within the population of Medicaid-enrolled youth with MI, and we identified a number of characteristics significantly associated with the receipt of dental services. By identifying these variations in dental service use this study facilitates the development of targeted strategies to increase the use of dental care in – and consequently improve the current and long-term wellbeing of – the vulnerable population of Medicaid-enrolled youth with MI.

A Qualitative Study of Health Care Providers' Views on Integrating Oral Health into Prenatal Care

OBJECTIVE

Providing preventive oral health during prenatal care is a recognized strategy for improving pregnant women's access to oral health care. This study sought to qualitatively explore the views of health care providers in British Columbia (BC), Canada, on strategies for integrating preventive oral health into prenatal care.

METHODS

Twenty-four purposefully selected health care providers (13 oral health and 11 prenatal care providers) in Vancouver and Surrey BC participated in audio-recorded semistructured interviews. Interviews lasted from 31 to 61 min, were transcribed verbatim, and were analyzed using an inductive thematic analysis with N-Vivo software. Study validity was ensured via memoing, fieldnotes, member checking, and external audit.

RESULTS

Thematic analysis revealed 5 major themes: perception of integrated care, relevance of integrated prenatal oral health, strategies for achieving integrated prenatal oral health, drivers of the integration process, and barriers to integrating oral health during pregnancy. Interprofessional collaboration based on information sharing and communication was identified as a critical factor for integrated care. Oral health checks should be a component of prenatal assessments for achieving integrated prenatal oral health. Participants recommended that prenatal providers should offer oral health education and use screening questions to identify the pregnant woman's oral health needs. The establishment of referral systems was advocated, while dental assessments and oral prophylaxis via the medical services plan were proposed. The inclusion of dental providers in prenatal teams and educating health care providers on interprofessional collaboration were also supported.

CONCLUSION

Oral health and prenatal providers in BC are positively disposed to adopting integrated preventive prenatal oral health care based on interprofessional collaborative practices. The inclusion of oral health providers in prenatal teams was suggested.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by policymakers for advocacy and decision making when planning care delivery programs for women during pregnancy. Including the suggested strategies could lead to increased access to, and utilization of, oral health services among pregnant women.