something to smile about: preconception and...

SOMETHING TO SMILE

ABOUT: PRECONCEPTION

AND PERINATAL ORAL

HEALTH

Danielle Little

Eastern Regional Coordinator

Barbara Smith, MS, RDH

Perinatal Oral Health Coordinator

Oral Health Section, Division of Public Health

MARCH OF DIMES NORTH CAROLINA PRECONCEPTION HEALTH CAMPAIGN

A statewide initiative aimed at improving birth outcomes in NC by reaching out to women with important health messages before they become pregnant

Formerly functioned as the NC Folic Acid Campaign

Goals of the Campaign are to reduce infant mortality, birth defects, premature birth, and chronic health conditions in women, while also aiming to increase intended pregnancies in NC

Seeks to raise awareness and inspire positive action among the general public, health care professionals, and community agencies

• This training was developed by the March of Dimes North

Carolina Preconception Health Campaign, under a contract

and in collaboration with the North Carolina Division of Public

Health, Women’s Health Branch.

• In partnership with the Oral Health Section of the Division of

Public Health, NC Department of Health and Human Services

• Wake AHEC for their support in providing continuing

education credit for this webinar

ACKNOWLEDGEMENTS

Neither Barbara Smith nor Danielle Little, have any relationship

with commercial companies that could be perceived as a conflict

of interest (within the past 12 months).

DISCLOSURES

• Obtaining continuing education certification:

If attending as a group, everyone must sign-in

on Wake AHEC Roster and email to:

[email protected]

Must be present for whole training

Complete Survey up on receipt

• Questions

HOUSEKEEPING

mailto:[email protected]

Nursing: 1.5 Contact Hours

Wake Area Health Education Center (AHEC) Nursing Education is an approved provider of continuing nursing

education by the North Carolina Nurses Association, an accredited approver by the American Nurses

Credentialing Center’s Commission on Accreditation.

Wake AHEC CEU: Wake AHEC will provide 0.2 CEU to participants upon completion of this activity.

National Association of Social Workers (NASW)

NC AHEC is a 2019 NASW-NC approved provider of distance continuing education. This program has been

approved for 1.5 contact hours

A participant must attend 100% of the webinar to receive credit. Partial session credit will not be awarded.

Contact Hours: Wake AHEC will provide up to 1.5 Contact Hours to participants.

Wake AHEC is part of the North Carolina AHEC Program.

CREDITS

• Recognize the role of preconception health counseling in women’s

health services

• Understand the importance of implementing reproductive life

planning as an opportunistic preconception health counseling tool

• Describe the significance of preconception oral health and the

impact it may have on overall maternal health

• Improve preconception oral health counseling skills as a

component of reproductive life planning

• Explain how perinatal oral health may impact birth outcomes

• Describe how maternal oral health impacts the child’s oral health

OBJECTIVES

• Preconception care is for every woman of childbearing age (15-44) every time she is seen

• Every woman, every time

Pregnancy Info.net (2018). Childbearing. What are Child Bearing Years? Retrieved from http://www.pregnancy-info.net/childbirth-history/childbearing.html

“OPPORTUNISTIC” CARE

http://www.pregnancy-info.net/childbirth-history/childbearing.html

• The CDC encourages all men

& women to have a

reproductive life plan whether

or not they plan to have a

baby one day.

• A reproductive life plan is

more than birth control

Johnson K et al, Recommendations to Improve Preconception Health and Health Care-United States A Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care, MMWR Reports and Recommendations, April 21,

www.cdc.gov/preconception/index.html

PRECONCEPTION HEALTH: REPRODUCTIVE LIFE PLANNING

CDC RECOMMENDATIONS TO IMPROVE PRECONCEPTION HEALTH

1. Encourage men and women to have a reproductive life plan.

2. Increase public awareness about preconception health.

3. Provide risk assessment and counseling during primary-care visits.

4. Increase the number of women who receive interventions after risk screening.

5. Use the time between pregnancies to provide intensive interventions to women who have had a pregnancy that resulted in infant death, low birth weight, or premature birth.

6. Offer one pre-pregnancy visit.

7. Increase health insurance coverage among low-income women.

8. Integrate preconception health objectives into public health programs

9. Augment research.

10. Maximize public health surveillance.

• Lack of planning for

pregnancy and poorly

managed chronic conditions,

as well as…

• Failure to manage…

– Health conditions affecting

pregnancy outcomes

– Diabetes

– Oral Disease

– Hypertension

– Negative health behaviors

affecting pregnancy outcomes

• Leads to:

– Unintended pregnancies

– Increased risk for premature

births

– Increased risk for low-birth

weight births

– Increased rates of birth

defects

– Poor health status for

women

– Increased health disparities

Guttmacher Institute (2016). Fact Sheet. Unintended Pregnancy in the United Stateshttps://www.guttmacher.org/sites/default/files/factsheet/fb-unintended-pregnancy-us_0.pdf

WHY IS REPRODUCTIVE LIFE PLANNING IMPORTANT?

CIRCLE OF CARE

Reproductive Life Plan

Healthy Woman

Pregnancy Intendedness

Healthy Pregnancy

Better Birth Outcome

Healthy Woman

NCDHHS, Division of Public Health/Adult Oral Health 13

NC Department of Health and Human Services

Perinatal Oral Health

In North Carolina

NC Oral Health Section




Preconception and Perinatal Oral Health:

We Care!


Women who will be mothers

in 2025 are in high school

now!

What are they doing NOW to

protect their oral health

and future birth outcomes?


Upon completion of this presentation, the participants will be able to:

• Describe the significance of preconception oral

health and the impact it may have on overall

maternal health

• Explain how perinatal oral health may impact

birth outcomes

• Describe how maternal oral health impacts the

child’s oral health

• Recommend oral health care for those of

reproductive age


Perinatal Oral Health Evidence

• 2000 Surgeon General’s report Oral Health Report in America: oral health is mirror for

general health and well-being

• American Dental Association affirms importance of oral health during pregnancy

• Maintaining oral health may have positive effect on cardiovascular disease, diabetes and

other disorders

• AAP and ACOG Guidelines for Perinatal Care, 8th Edition

• Maternal periodontal infection may be linked to preterm low birth weight babies

• Association between maternal oral health and oral health of her children

Source: Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569. American College of Obstetricians and

Gynecologists. Obstet. Gynecol 2013; 122:417-22.


• Educate

• Integrate

• Collaborate

• Improve Maternal-Child

Outcomes


National Perinatal Oral Health Data

• 2007-2009, 35% of U.S. women did not have a dental visit

within the past year

• 56% of women did not visit a dentist during pregnancy (PRAMS

survey data in 10 states)

• 59% of most did not receive any oral health counseling during

pregnancy

• 94% obstetricians did not routinely refer all patients to a dentist

Source: Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569. American College of Obstetricians and

Gynecologists. Obstet. Gynecol 2013; 122:417-22.


NC PRAMS 2017 Oral Health Data

• 58% of NC pregnant women did not have a

dental prophylaxis during pregnancy

• 50% reported that a health care worker did not

talk to them about oral health care during

pregnancy

2016 Pregnancy Risk Assessment Monitoring System Report


Perinatal Oral Health Task Force

• Established in January of 2016

• Examine how to improve oral health in

pregnant women

• Impact birth outcomes by addressing perinatal

oral health

• Develop practice guidance for health care

providers who treat pregnant women


Perinatal Oral Health Assessment 2016

• Utilized a questionnaire and visual screening

• Total of 459 women participated in 68 county health

departments across the state


NC Perinatal Oral Health Data

• 17% stated they had a dental visit during the

current pregnancy

• 39% were asked by a medical provider if they

had a dental home

• Less than half (40%) reported having dental

insurance

• 54% identified their oral health as Fair to Very

Poor


NC Perinatal Oral Health Data

• The cost was the single most common barrier

identified

• Based on oral screening, one third of pregnant

participants had untreated tooth decay

• Nearly 30% reported experiencing bleeding

gums

Fear 13%

Cost 75%

No Dentist 26%


Concerns Identified

Pregnant Women

• Many do not understand

importance of oral health

• Belief that poor oral health

status during pregnancy is

normal

• Only approximately 44%

visit a dentist during

pregnancy*

Source: Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569.

American College of Obstetricians and Gynecologists. Obstet. Gynecol 2013; 122:417-22.

Will the xrays harm my

baby?

Can I have anesthesia?

My back will hurt..

What can I take for pain?

How will I get dental care?


Concerns Identified

Health Professionals

• Many do not understand the

oral-systemic link

• Lack of assessment and/or

referrals to oral care

• Dental providers tend to

postpone care until after birth

Physician

• Lack of compensation

• Unfamiliarity

• Absence of processes

Dentists

• Differing opinions on

trimester, radiation,

treatment, etc.

• Lack of insurance policy

knowledge

• Lawsuits


Preconception & Interconception Prevention

• Periodontal disease and decay prevalent during pregnancy –

low income, minority women

• Destructive Periodontal disease affects 15% of women in

childbearing age

• Maternal-child oral health connection

• Ethnic minority women have higher rate of low birth weigh

babies

• Preterm birth associated with maternal smoking, maternal

infections, low maternal body mass index

• There is a suggested relationship between maternal

periodontal infection and preterm, low birth weightSource: Boggess, K; Edelstein, B. Oral Health in Women During Preconception and Pregnancy: Implications for Birth Outcomes

and Infant Oral Health. Maternal Child Health Journal. 2006 Sep; 10 (Suppl 1): 169-174


Periodontal Disease

• Impact of periodontal disease on reproductive

outcomes

• Possible association with higher rates of preterm birth

• ACOG suggests that preconception treatment trials

needed to determine impact on preterm birth (ACOG

CO # 569, 2013 (2015)


• Mildest form of PD

• Red, swollen gums that bleed easily

• Often no discomfort

• Poor oral hygiene most common cause

• Many other contributing factors, including

diabetes*

• REVERSIBLE

Periodontal Diseases

*Diabetes increases risk of PD and PD can decrease control of diabetes

Gingivitis Periodontitis

• Untreated gingivitis can lead to

periodontitis

• Chronic inflammation – destruction of

bone loss – tooth loss

• Shifting of teeth; change in bite

• Red, swollen gums, bleed easily

• Pus between teeth; bad breath

• IRREVERSIBLE


• Hormone Levels= Increase

risk for Periodontal Diseases

(PD) and Pyogenic

Granulomas

• Nausea and Vomiting =

Xerostomia (dry mouth) and

enamel erosion increases risk

for tooth decay

• Gestational Diabetes =

Increases risk for PD due to

increased susceptibility to

infection

Pregnancy Impacts on Oral Health

Source: Photo credit AAFP.org

Pyogenic Granuloma and Gingivitis


Preconception and Oral Health

• Only 22% of US women report receiving preconception

care

• When prenatal care begins, often too late to modify

many of the risk factors associated with poor birth

outcomes.

• Where is oral health?

Source: Sukanya, S; Schlar, L. Delivering Interconception Care During Well Child Visits: An IMPLICIT

NetworkStudy. Journal of the American Board of Family Medicine. 2018 March 31: 201-210.


Preconception and Oral Health• Oral health and general health and well being: oral health care

should be a goal for all individuals.

• Periodontal therapy best if considered before or in very early

pregnancy

• Anticipatory guidance before pregnancy – effective time for

behavior change

• Power of prevention

• Consider preconception and pregnancy treatment of oral

conditions as a mechanism to improve women’s oral health,

general health, pregnancy outcomes and oral health of her

children.

Source: Boggess, K; Edelstein, B. Oral Health in Women During Preconception and Pregnancy: Implications for Birth Outcomes and Infant Oral Health. Maternal Child Health Journal. 2006

Sep; 10 (Suppl 1): 169-174


Oral Health Impacts Maternal Total Health

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88948/

Arteries

Atherosclerosis

Cardiovascular Disease

Joints

Arthritis

GI System

Diabetes

Lungs

Bacterial

Pneumonia

Brain Tissue

Cerebrovascular Disease


Possible Pregnancy Complications

Source: https://www.adha.org/resources-docs/7838_Periodontal_Diseases_and_Adverse_Pregnancy_Outcomes.pdf

Amniotic Fluid

Preterm Delivery

Low Birth Weight

Preeclampsia

Gestational Diabetes


Maternal-Child Connection

Sources: Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:417-22.

Dye BA, Vargas CM, Lee JJ, Magder L,Tinanoff N. Assessing the Relationship Between Children’s Oral Health Status and That of Their Mothers. The Journal Of the American Dental Association. 2011: 142(2), 173-183.

Mothers with high levels of Untreated

Caries

Mothers with high levels of Tooth

Loss

Children more than 3x likely to

have greater Caries Experience

• Most young children acquire caries-causing bacteria from their mothers

• Mothers with poor oral health likely to have children with poor oral health

• Counseling and dental care may reduce transmission of bacteria, thereby delaying or preventing onset of childhood caries


Organizations Supporting Perinatal Oral Health

• American Dental Association

• American College of Nurse Midwives

• American College of Obstetricians and Gynecology

• American Academy of Pediatric Dentistry

• American Academy of Pediatrics

• American Academy of Periodontology

• American Academy of Physician Assistants


Oral Health Care During Pregnancy:A National Consensus Statement

• Released in 2012 by the Health Resources and

Services Administration in collaboration with the

American College of Obstetricians and Gynecologists

(ACOG) and the American Dental Association (ADA)

https://www.mchoralhealth.org/materials/consensus

_statement.php

https://www.mchoralhealth.org/materials/consensus_statement.php


Oral Health Care During Pregnancy: NC Collaborative Practice Framework

Oral Health Care During

Pregnancy: North Carolina

Collaborative Practice

Framework 2018

https://publichealth.nc.gov/oralhealth/docs/NCOH-PracticeGuidelines-Revised120618-WEB.PDF


Perinatal Guidance: Medical Providers/Non-Dental

Assess pregnant women’s oral health status.

Advise pregnant women about oral health care.

Work in collaboration with oral health professionals.

Provide support services/case management.

Improve health services in the community


Perinatal Guidance: Dental Providers

Assess pregnant women’s oral health status.

Advise pregnant women about oral health care.

Work in collaboration with prenatal care health

professionals.

Provide oral disease management and treatment.

Provide support services/case management.

Improve health services in the community.


Framework Also Includes

• Oral health guidance for pregnant women

• Postpartum oral care

• Infant/Child oral care

• Pharmacological considerations during

pregnancy


Provider Resources

Perinatal Oral Health Program (pOHP):

http://www.prenataloralhealth.org/index.php

Smile for Life: A National Oral Health Curriculum:

http://www.smilesforlifeoralhealth.org

National Maternal & Child Oral Health Resource Center

https://www.mchoralhealth.org

Association of State and Territorial Dental Directors

https://www.astdd.org

http://www.prenataloralheatlh.org/index.php

http://www.smilesforlifeoralhealth.org/

https://www.mchoralhealth.org/

https://www.astdd.org/


Questions?

If you have any question, please contact:



[email protected]

919-707-5492

SUMMARY

Reproductive Life Plan

Healthy Woman

Pregnancy Intendedness

Healthy Pregnancy

Better Birth Outcome

Healthy Woman

QUESTIONS/

COMMENTS?

THANK YOU!

For more information about the Campaign and other preconception health topics visit: NCPreconceptionHealth.org, EveryWomanNC.org, and Latinasana.org

@everywomannc and @latinasananc

THANK YOU!

something to smile about: preconception and...

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