Factors Associated with Preventive Dental Visits Before and During Pregnancy

Oral Health of Women and Children: Progress, Challenges, and Priorities

INTRODUCTION

Tooth decay remains the most prevalent chronic disease in children and adults, even though it is largely preventable. Studies show that mothers' oral and overall health is linked to children's oral health and pregnancy outcomes. This paper examines achievements during the last 20 years, assesses current challenges, and discusses future priorities.

ORAL HEALTH STATUS

Data show a modest improvement in children's oral health during the last 20 years; however, tooth decay still affects more than half of adolescents. According to national survey data, about 26% of working-age adults had untreated tooth decay. Overall, significant oral health disparities by race/ethnicity and income persist.

DENTAL SERVICE UTILIZATION

The annual dental visit rate for children in the 2015 Medical Expenditure Panel Survey was 48%. Among children enrolled in Medicaid, dental visit rates increased from 18% in 1993 to nearly 50% in 2018. About 46% of women are estimated to receive teeth cleaning during pregnancy. Over the years, race or ethnicity and income-level differences in dental visits observed in the early 2000s have narrowed substantially in children but not among pregnant women.

DISCUSSION

Many effective interventions are available at the community and individual levels but are underutilized. Lack of integration of oral health into the overall health care system and programs, community conditions, poverty, and limited health literacy make it difficult for families to engage in healthy habits, use preventive interventions, and access treatment promptly.

CONCLUSION

To further improve oral health, policy and system reforms are needed to address the factors mentioned above. Therefore, we urge the federal Maternal and Child Health Bureau to take steps to convene a workshop to develop a framework for future actions.

Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned

The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.

Incarceration exposure and women's oral health experiences during pregnancy

RATIONALE

Prior research has documented an association between incarceration and poor oral health outcomes. Likewise, recent scholarship has also detailed that women exposed to incarceration either directly or vicariously through a partner during pregnancy incur worse health outcomes. However, no previous research has assessed the connection between incarceration exposure and oral health during pregnancy.

OBJECTIVE

The current study assesses the link between maternal incarceration exposure and oral health during pregnancy.

METHODS

Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2016-2019 (N = 60,342). Logistic regression was used to assess the relationship between incarceration and oral health.

RESULTS

Women exposed to incarceration exhibited worse oral health outcomes in the form of being more likely to report not knowing the importance of oral care, not having an oral health discussion with a provider, not getting a teeth cleaning, as well as being likely to report needing to see a dental provider, having visited a dental provider for a problem during pregnancy, and having more unmet dental care needs.

CONCLUSIONS

These findings add to a burgeoning literature that demonstrates a woman's prenatal exposure to incarceration poses risk for overall health and wellbeing. Given the influence of both incarceration exposure and oral health during pregnancy for maternal and infant health, the findings suggest that coordination between criminal justice, public health, and oral health experts can develop programmatic efforts that expand access to oral health care and improve oral health literacy among incarceration-exposed pregnant women.

Comprehensive pregnancy dental benefits improved dental coverage and increased dental care utilization among Medicaid-enrolled pregnant women in Virginia

Objectives

To evaluate the changes in dental insurance and utilization among pregnant women before and after the pregnancy Medicaid dental benefit policy implementation in 2015 in Virginia.

Methods

We used pooled cross-sectional data from six cycles of the Virginia Pregnancy Risk Assessment Monitoring System on women aged ≥21 years. Using logistic regression models and a difference-in-difference design, we compared the effects of policy implementation on dental insurance and utilization between pre-policy (2013–2014) and post-policy period (2016–2019) among women enrolled in Medicaid (treatment, N = 1,105) vs. those with private insurance (control, N = 2,575). A p-value of 0.05 was considered significant.

Results

Among Medicaid-enrolled women, the report of dental insurance (71.6%) and utilization (37.7%) was higher in the post-period compared to their pre-period (44.4% and 30.3%, respectively) estimates but still remained lower than the post-period estimates among women with private insurance (88.0% and 59.9%, respectively). Adjusted analyses found that Medicaid-enrolled women had a significantly greater change in the probability of reporting dental insurance in all post-period years than women with private insurance, while the change in the probability of utilization only became statistically significant in 2019. In 2019, there was a 16 percentage point increase (95% CI = 0.05, 0.28) in the report of dental insurance and a 17 percentage point increase (95% CI = 0.01–0.33) in utilization in treatment group compared to controls.

Conclusions

The 2015 pregnancy Medicaid dental benefit increased dental insurance and dental care utilization among Medicaid-enrolled women and reduced associated disparities between Medicaid and privately insured groups.

Food insecurity and oral health care experiences during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Food insecurity has emerged as a salient risk factor for poor oral health in adult populations. A separate area of research also details that both poor oral health and food insecurity during pregnancy can have adverse consequences for maternal and infant well-being. The authors examine the connection between food insecurity and women's oral health care experiences during pregnancy.

METHODS

Data from 2016 through 2019 came from the Pregnancy Risk Assessment Monitoring System (N = 21,080). Multivariable logistic regression analyses were used to assess the association between food insecurity and 6 indicators of oral health care experiences during pregnancy.

RESULTS

Food-insecure women reported worse oral health care experiences during pregnancy, including being more likely to need to see a dentist for a problem, going to see a dentist for a problem, not receiving dental prophylaxis, not talking with an oral health care provider about dental health, not knowing it was important to care for teeth, and having unmet oral health care needs.

CONCLUSIONS

Food-insecure women exhibit worse overall oral health outcomes and unmet oral health care needs during pregnancy.

PRACTICAL IMPLICATIONS

Considering the risk that both food insecurity and oral health problems pose for maternal and infant health, interventions that can reduce food insecurity and improve oral health and oral health care access among pregnant women are important steps in promoting greater health equity.

Oral Health Knowledge, Barriers to Dental Care, and Awareness of a Medicaid Pregnancy Dental Coverage Among Reproductive-Age Women

Objectives: Oral health is an integral part of women's health, yet many women face barriers and go without necessary dental care. The objectives of this study were to (1) examine and compare pregnancy-related oral health knowledge and barriers to dental care access during pregnancy among women with private and public insurance and (2) estimate awareness of available Medicaid pregnancy dental benefit among Medicaid-enrolled women and explore associated factors. Methods: A cross-sectional survey was administered to a convenience sample of 21- to 45-year-old women (n = 187) visiting a large urban academic health center in Virginia. Data on pregnancy-related oral health knowledge, barriers to dental care access, Medicaid dental benefit awareness, health insurance, socio-demographics, health information source, and last dental visit were collected. Chi-square tests, t-tests, and multivariable regression were used to examine associations at p ≤ 0.05. Results: More than half of the women reported private insurance (52.4%), 40.3% reported Medicaid, and 8.3% reported being uninsured. Medicaid-enrolled women reported a lower prevalence of a routine dental checkup in the past year (44% vs. 71%, p = 0.002), lower knowledge scores (2.9 vs. 3.6, p < 0.001), and more barriers to accessing dental care during pregnancy compared with privately insured women. One in every three Medicaid-enrolled women (34%) was unaware of the Medicaid pregnancy dental benefit. Benefit awareness was associated with the receipt of health information from a health care source (p = 0.030) and a high oral health knowledge score (p = 0.018). Conclusions: There was a significant gap in dental care use and knowledge between Medicaid-enrolled and private-insured women in our study sample. Targeted programs should be developed to educate women about the importance of oral health and share information about available Medicaid dental coverage to reduce barriers to dental care during pregnancy.

Oral Hygiene Practice among Hospitalized Patients: An Assessment by Dental Hygiene Students

Aim: An epidemiological study was carried out, in hospital wards, with the aim of assessing the oral health status of patients subjected to multiple medical treatments. Material and Methods: The study was conducted at Fondazione IRCCS Policlinico San Matteo (Pavia, Italy). A questionnaire was submitted to patients for the evaluation of oral hygiene devices used; then, a clinical examination was conducted to collect Decayed Missing Filled Teeth (DMFT) index, Plaque Index (PI), and Marginal Gingival Index (MGI) values. Results: Manual toothbrushes were used by a wide range of the sample study (65–100% among hospital wards), together with mouthwash (20–80%); interproximal aids were used by few patients (the lowest recorded value was 33.3%). Conclusion: dental hygienists could be integrated into hospital wards as oral hygiene procedure instructors, for the improvement of the oral health conditions of hospitalized patients.

Dental care utilization during pregnancy by Medicaid dental coverage in 26 states: Pregnancy risk assessment monitoring system 2014-2015

OBJECTIVE

To examine the association between Medicaid dental coverage for adult pregnant women with dental care utilization during pregnancy.

METHODS

Pregnancy risk assessment monitoring system (PRAMS) data (2014-2015) and the Medicaid-SCHIP state dental association (MSDA) national profiles (2014-2015) were used in this study. The study sample included 16,612 Medicaid-enrolled women, for a weighted number of 965,046 women from 26 states and New York City. State Medicaid dental coverage was categorized into (1) no coverage for the dental cleaning, (2) coverage for dental cleaning and fillings, (3) extended dental coverage. The adjusted prevalence ratios (aPR) for dental visits for cleaning during pregnancy were examined by Medicaid dental coverage level.

RESULTS

Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). Compared with women in state without dental coverage, Medicaid-enrolled women in states with extended dental coverage (aPR = 1.20, 95% CI [1.16-1.23]) and women in states with limited coverage (aPR = 1.10, 95% CI [1.06-1.14]) were more likely to visit dentists for cleaning during pregnancy when adjusted for other sociodemographic variables and adequacy of prenatal care. A similar pattern of association was observed for a dental visit to address dental problems during pregnancy.

CONCLUSIONS

This study highlights the importance of Medicaid dental coverage for adult pregnant women related to dental service utilization during pregnancy.

Validation of an instrument to determine oral health knowledge, attitudes, and practices during pregnancy

BACKGROUND

Oral health of the mother-infant dyad is important to preserve general health. However, there are few instruments in Spanish for the evaluation of knowledge, attitudes and practices that determine this construct. Therefore, this research aimed to develop and evaluate the psychometric properties of the Maternal Oral Health Knowledge, Attitudes and Practices Questionnaire (CAPSOM in Spanish).

METHODS

In this instrument development study that carried out in 2018-2019, involving pregnant women between the ages of 18 and 45 in the city of Leon, Guanajuato, Mexico. The sample size was calculated based on 10 women per questionnaire item (n = 10 k). The study used Cronbach's alpha, the modified Lawshe test of validity criteria, factor analysis, and the level of difficulty and discrimination of the items.

RESULTS

207 women took part with their signed, informed consent (25 ± 6 years). The internal consistency of the instrument, both total and by dimension was α = 0.70, α = 0.66 knowledge, α = 0.74 attitudes, and α = 0.66 practices. Values of Content Validity Ratio' ≥ 0.60 were obtained for the final 10 items and Content Validity Index' = 0.90. The average difficulty index of items was 0.40, and there were significant differences (Kruskall-Wallis, p < 0.001) in the discrimination test. Factor analysis demonstrated three main components.

CONCLUSIONS

A valid and reliable 10-item Spanish questionnaire was designed to measure pregnant women's oral health knowledge, attitudes, and practices.

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.

The Impact of Dental Insurance and Medical Insurance on Dental Care Utilization During Pregnancy

OBJECTIVE

To measure the association between dental and medical insurance with the receipt of dental cleaning during pregnancy.

METHODS

We analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2015 on 145,051 women with a recent live birth from 36 states. We used adjusted prevalence ratios [aPR] from multivariable regression to examine the association of dental and medical insurance with receipt of dental cleaning during pregnancy, controlling for selected covariates that influence dental care utilization.

RESULTS

Seventy-seven percent (77%) of all women reported having dental insurance during pregnancy. Receipt of dental cleaning before pregnancy was strongly associated with dental cleaning during pregnancy. Among women without pre-pregnancy dental cleaning who had dental insurance, those with Medicaid medical insurance had a significantly higher prevalence of dental cleaning during pregnancy [aPR = 1.42, 95% CI (1.32 - 1.52)], compared to those private medical insurance. Among women without pre-pregnancy dental cleaning, those without dental insurance but with Medicaid medical insurance were about 70% less likely to have dental cleaning during pregnancy compared to those with dental and private medical insurance.

CONCLUSIONS FOR PRACTICE

With or without dental insurance, pre-pregnancy dental cleaning was strongly associated with dental cleaning during pregnancy. Dental insurance was an important determinant of dental utilization. Medical insurance had an independent and positive effect. This effect varied by private versus Medicaid medical insurance. Programs which provide women with dental insurance both before and during pregnancy could improve the oral health of maternal and infant populations.

Oral Health Knowledge, Practices, and Awareness of Oral Health Guidelines and Dental Coverage Policies among Midwives

INTRODUCTION

Good oral health during the prenatal period translates into better oral and overall health for women and their infants. Although the importance of oral health during pregnancy is well established, oral health assessments are not routinely included in prenatal care visits. The purpose of this study was to explore prenatal care providers' practices regarding oral health assessments and identify reasons for the gap in oral health integration in prenatal care. Data were gathered from midwives in Virginia, United States. Information on midwives' knowledge about oral health, education, practices, and awareness of oral health guidelines and the pregnancy-related Medicaid dental benefit policy in Virginia was collected.

METHODS

An online survey was distributed to midwives practicing in Virginia through their state-level professional organization. The data were collected online, and descriptive data analyses were conducted.

RESULTS

A total of 30 midwives (mean age 51.9 years) participated in the survey for an overall response rate of 13.6%. Among survey participants, knowledge of oral health was high (score of 4.69 out of 5). Nearly 20% of participants reported receiving no education about oral health during professional training, and 72.4% reported no receipt of continuing education about oral health in the past year. Although 86% of the participants reported discussing oral health in clinical practice, only 10.3% reported conducting oral health assessments. Awareness of Virginia's Medicaid dental benefit policy was high (75.9%), but less than half of the participants were aware of oral health guidelines (44.1%). Although many midwives did not conduct oral health assessments, 79.3% reported that they provided oral health referrals to pregnant patients.

DISCUSSION

Enhancing and integrating education about oral health in the academic curriculum for midwives and providing them with opportunities for continuing education about oral health can improve their engagement with oral health. Sharing of evidence-based guidelines through organizational newsletters, meetings, and other venues can be ways to increase awareness of new guidelines and health coverage benefits among midwives.