Incorporating Oral Health into Prenatal Care

June 23, 2009

When you think of prenatal care, you might think of things like ultrasounds, nutrition, dealing with chronic conditions, and other checking and rechecking of vital signs and changes throughout a pregnancy. I recently read, however, about a program in rural Kentucky that incorporates dental care into a CenteringPregnancy approach to prenatal care.

The CenteringPregnancy model of prenatal care typically involves participants with similar due dates, who meet in group sessions for physical examination, education, and group discussion and support on pregnancy and childbirth.

In a recent issue of the Journal of Health Care for the Poor and Underserved, one article describes the implementation of such a program with an added oral health component, led by a nurse midwife at a women’s health clinic in Kentucky. The authors explain:

…oral health information and treatment was incorporated into eight of the 10 group sessions. Topics included the oral systemic health link, myths and realities, plaque and how it causes disease, plaque removal techniques, dentition development, oral anatomy, caries and prevention, periodontal disease and prevention, and care for baby’s teeth. Second, a dental operatory was established within the CWH, so that every pregnant mother enrolled in CPS™ [CenteringPregnancySmiles] was given a dental examination approximately 14 weeks into their pregnancy, followed by therapeutic intervention to provide control of oral infections.

The authors report that at the first dental examination (around 13-16 weeks), nearly 70% of the women (primarily rural Medicaid recipients) had active caries (cavities), and many had tooth pain, infections, abscesses, gum inflammation and other dental concerns. By 34-38 weeks, however, the oral health of participants had improved considerably. For example, the percent of participants with bleeding points around the gums fell from more than 60% to 35%, and more than half of the oral infections were completely resolved.

The authors also noted lower rates of preterm birth and low birth weight among participants compared to the general population – although this is a preliminary finding requiring further investigation, the authors explain that “previous studies on the effect of oral infections on PTB and LBW pregnancy outcomes have estimated that up to 20% of these adverse birthing outcomes could be related to oral infections.”

I thought this was a neat approach to providing needed care that might have otherwise been unavailable or inaccessible to these women.

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