Background: Women should see a dentist during pregnancy. Poor oral health for pregnant women is associated with periodontal disease, pre-term low birthweight, pre-eclampsia, and early childhood caries. This study explores which women were counseled during their prenatal care visits on the importance of seeing a dentist.

Methods: We analyzed data from Oregon PRAMS (Pregnancy Risk Assessment Monitoring System). Women were asked whether a prenatal care advisor talked with them about the importance of seeing a dentist during their pregnancy.

Results: In bivariate analysis, women were more likely to be advised on the importance of seeing a dentist if they obtained their prenatal care from a private doctor or Health Maintenance Organization (HMO), were late initiators of prenatal care, less than 30 years old, uninsured and had less than a highschool degree. In multivariate analysis, women who received their prenatal care from a health department clinic remained more likely to receive this information (adjusted OR=1.83, 95% CI: 1.36-2.46.

Conclusions: Health department clinics seem to do a better job at informing pregnant patients about the importance of seeing a dentist. All women should be advised on the importance of seeing a dentist.

Why are health department clinic providers more likely to give this advice than private providers?

•More attuned to the conditions associated with poverty

•Focus of their work is prevention-based

•May see visible decay and periodontal disease more often than their private counterparts and therefore may be prompted to give this advice on a more regular basis

Limitations of this study:•Recall bias – women are likely to

remember where they received their care, but they may not recall receiving advice on the importance of seeing a dentist

Prenatal Care Advice to See a Dentist: Results from a Population-Based Study

Meredith L. Vandermeer1,2, Kenneth D. Rosenberg2,3, Alfredo P. Sandoval2

1 Department of Public Health, Oregon State University, Corvallis, Oregon 2 Office of Family Health, Oregon Department of Human Services, Portland, Oregon

3 Oregon Health & Science University, Portland OregonAbstract Discussion

Acknowledgments

Oregon PRAMS• Population-Based survey of post-partum women• Modeled after CDC PRAMS• Asks questions about experiences before, during and after pregnancy• Analyzed data from combined 2000 and 2001 surveys• 5367 women randomly selected from birth certificates, 3895 replied. Weighted response rate of 78.8%

Exclusions• 228 women did not respond to dental advice question. Final sample size was 3667

PRAMS Questions• During any of your prenatal care visits, did a doctor, nurse of other health care worker talk with you

about the importance of seeing a dentist during your pregnancy?• Where did you go most of the time for your prenatal visits? Hospital clinic, health department clinic,

private doctor’s office or HMO clinic, or other• What is your family income, before deductions and taxes, before you got pregnant?

Birth Certificate Variables• Prenatal care initiation, maternal age, insurance coverage for delivery, maternal education, marital

status, parity, and race/ethnicity

Analysis• Bivariate and multivariate analysis were performed to study the association between independent

variables and being advised to see the dentist during pregnancy

Methods

Good oral health during pregnancy is associated with improved outcomes for both mother and child:

• Decreases in periodontal disease• Decreases in preterm and/or low birthweight• Decreases in pre-eclampsia• Decreases in early childhood caries

There are published guidelines that recommend that pregnant women receive oral health counseling during pregnancy:

• American Academy of Pediatric Dentistry (2004)

• American Dietetic Association (1998)• American College of Obstetrics and

Gynecology (2005)

Many women perceive a need to see a dentist but do not see one.

Lack of counseling is associated with non-receipt of dental care.

In this study we explore which women were most likely to receive advice on the importance of seeing a dentist during pregnancy.

Introduction

ResultsTable 1. Advised on the importance of seeing a dentist by maternal characteristics, Oregon PRAMS 2000-2001 Characteristic n* Percent Advised on

the Importance of Seeing a Dentist

(weighted)

Bivariate OR (95% CI)

Multivariate OR† (95% CI)

Number of Respondents 3667 32.7% --- --- PNC Source

Private Doctor/HMO 1980 30.5% Referent Referent Health Dept Clinic 634 46.5% 1.98 (1.49-2.63) 1.83 (1.36-2.46) Hospital Clinic 750 32.3% 1.08 (0.80-1.47) Other 259 33.8% 1.16 (0.72-1.88) Prenatal Care Initiation

After first trimester 754 40.1% 1.47 (1.11-1.94) 1.49 (1.05-2.12) First trimester 2886 31.3% Referent Referent Age

Less than 30 2544 34.9% 1.36 (1.06-1.73) 30 and older 1123 28.4% Referent Insurance for Delivery

Uninsured 213 48.0% 2.12 (1.37-3.29) Public insurance 1422 35.4% 1.26 (0.99-1.60) Private Insurance Coverage

2025 30.3% Referent

Maternal Education

Less than 12 years 970 40.5% 1.53 (1.19-1.97) 12 years or more 2697 30.8% Referent Income ‡

Less than $20,000 1445 35.6% 1.25 (0.98-1.58) $20,000 or greater 1880 30.8% Referent OR indicates odds ratio; CI, confidence interval; AI/AN, American Indian/Alaska Native; PI, Pacific Islander * Unweighted number of respondents † Covariates remaining in final multivariate model ‡ Family income before pregnancy and before deductions and taxes § Non-Hispanic

 Tina Kent for her work with Oregon PRAMS.

Michelle Adler, MD; Anna Jimenez, MD; Andy Osborn, MBA; Kathy Phipps, DrPH; Gordon Empey, DMD, MPH; Jane Mellor, RDH; Susan Sanzi-Schaedel, RDH, MPH; John Buckmaster, MD; Mark Nichols, MD for their contributions.

Maternal and Child Health Bureau of the Health Resources and Services Administration and the Centers for Disease Control and Prevention for their support of Oregon PRAMS.   

Good oral health is associated with improved outcomes for both mother and infant.

Women should have good oral health before and during pregnancy.

Dental care during pregnancy should be routine.

Prenatal care providers should advise all women to see a dentist during pregnancy.

Conclusions

• 32.7% of women in this study received prenatal care advice about the importance of seeing a dentist during pregnancy

• In bivariate analysis, women mostlikely to be told this advice received their prenatal care in a health department clinic, were late initiators of prenatal care, were less than 30 years of age, had less than a highschool degree, were uninsured, umarried, Hispanic, non-Hispanic black and non-Hispanic American Indian/Alaskan Native

• In multivariate analysis, women who visited a health department clinic remained significant. These women were 1.83 times more likely to have been given advice on the importance of seeing a dentist during pregnancy