Dental Care During PregnancyOregon 2000

Kathy R. Phipps, DrPH (1)

Kenneth D. Rosenberg, MD, MPH (2)

Alfredo P. Sandoval, MS, MBA (2)(1) Association of State & Territorial Dental Directors

(2) Oregon Department of Human Services

American Public Health Association, 131st Annual Meeting, November 19, 2003, San Francisco

Background

A tooth for every pregnancy Pregnancy & oral health

pregnancy gingivitis, pyogenic granuloma

Recent focus on pregnancy & birth outcomes transmission of mutans streptococci

Background

Little known about oral health of pregnant women

use of dental services during pregnancy

Purpose of project existing surveillance system - PRAMS

obtain state-level population-based data

What is PRAMS?

Pregnancy Risk Assessment Monitoring

System

Collects state-specific information on maternal attitudes and experiences

Improve the health of mothers and

infants

Oregon PRAMS

Began in 1998

Technical assistance from CDC not part of the CDC system until 2003

Majority of data is from 2000 combined data set from 2000 and 2001

Participating States - 2003

www.cdc.gov/reproductivehealth/pramstates.htm

31 states plus New York City

Methods - Oregon PRAMS 2000

Stratified random sample 2,950 mothers with a recent live birth

Oral health questions needed to see a dentist for a problem went to a dentist healthcare provider talked with them

about the importance of seeing a dentist

Demographic Information

Overall response rate 73% Mothers age

< 20 years 11.4% 20-34 years 78.1% > 35 years 10.5%

Mothers race/ethnicity White 75.1% Hispanic 16.2% Other 8.6%

Demographic Information

Maternal Education < 12 years 18.1% At least 12 years 79.5% Unknown 2.4%

Marital status Unmarried/divorced/annulled 28.4% Married or separated 71.6%

Demographics & Lifestyle

Family Income < $15,000 23.7% $15,000 - $29,999 26.0% $30,000 - $49,999 23.6%

> $50,000 26.7% Smoked during pregnancy 16.0% Alcohol in 3rd trimester 9.3%

Prenatal Care & Birth Outcomes

Prenatal care in 1st trimester 81.8% Normal birth weight 95.2% Payor for labor and delivery

Private insurance 62.7% Public insurance 32.1% No insurance/other 5.2%

During your pregnancy...

I needed to see a dentist for a problem 72 28

I went to a dentist or dental clinic 57 43

A healthcare worker talked with me about:a. the importance of seeing a dentistb. how to care for my teeth/gums

6961

3139

Question % No % Yes

I had my teeth cleaned in the last year 53 47

30.6

44.6

51.8

0

10

20

30

40

50

60

Importance ofseeing a dentist

Physical abuseby husband

Using a seat belt

PercentYes

During your prenatal visits, did a health careworker talk with you about ...

Needed to see a dentist ...

Needed to see a dentistbecause of a problem

Did NOT goto dentist

40%

Wentto dentist

60%

11% of all women

28% ofwomen

Did NOT go to dentist ...

Income < $30,000 2.041.25 - 3.33

1.961.19-3.22

Hispanic 1.631.13-2.35

1.420.95-2.13

UnivariateOR (95% CI)

MultivariateOR (95% CI)

Among women who said they needed care, those most likely NOT to see a dentist:

PRAMS 2000 and 2001 Combined

0

10

20

30

40

50

Oregon Illinois Louisiana New Mexico

Had dental problem Went for dental care

Oregon (2000) Comparedto Other States (1998)

Gaffield ML, et al. JADA 2001;132:1009-16.

46.5

23.6

16.4

8.54.9

05

101520253035404550

< 1 Year 1-2 Years 2-5 Years 5+ Years Never

How long has it been since you had yourteeth cleaned by a dentist or hygienist?

Did NOT Have Teeth Cleaned in Last Year

WIC Enrollment

Smoked in 1st Trimester

Late/No Prenatal Care

Hispanic

1.69

1.96

1.69

1.85

1.28-2.22

1.47-2.63

1.22-2.38

1.35-2.56

Odds Ratio 95% CIMultivariate Analysis

PRAMS 2000 and 2001 Combined

Had Teeth Cleaned in Last Year

46.5

66.5 69.0

0

10

20

30

40

50

60

70

80

Oregon PRAMS Oregon BRFSS National BRFSS

Pre

cen

t o

f R

esp

on

den

ts

Summary

Many pregnant women do not seek dental care even if they have a problem

Healthcare workers are not talking to women about oral health

Low-income and Hispanic women are less likely to seek dental care

Potential Recommendations

Educate health care workers Educate pregnant women Target high risk women Develop a referral network Medicaid dental for pregnant women Oral health questions in PRAMS

THE END