Oral Health Care During Pregnancy: A Patient Safety Perspective

1. Oral Health Care During Pregnancy: A Patient Safety Perspective Katy Battani, RDH, MS Jonelle Grant, DDS, MPH

2. Objectives • Identify Maryland’s gaps in oral health care before and during pregnancy • Understand that oral health care is safe and important during pregnancy • Recognize practioner’s role in caring for a pregnant woman’s oral health • Recognize the impact of maternal oral health on the future oral health of the child (e.g., prevention of tooth decay) • Identify resources related to oral health and pregnancy • Understand when and how to access oral health care services during pregnancy

3. 2011 Maryland PRAMS • In the 12 months before pregnancy, 40% of women had not had a dental cleaning. • Dental Cleaning: • 1-5 years= 28% • 5 or more years ago= 7% • Never= 5% • Highest among: • Black Non Hispanic • Hispanic • Age 25-29 • Less than 12 years of education

4. Oral Health and Pregnancy • Approximately 40% of pregnant women have periodontal (gum) disease1 • Most prevalent during pregnancy among African American, cigarette smokers, and user of public assistance programs • Studies have been conflicting regarding an association between maternal periodontal disease and preterm birth; however, treatment of periodontal disease during pregnancy has not been associated with any adverse maternal or birth outcomes • Dental care during pregnancy has been associated with improvement of maternal oral health ACOG Committee Opinion 2013

6. ACOG Committee Opinion • Released August 2013 • Dental coverage: Women with Medicaid insurance have dental coverage during pregnancy • Dental care is SAFE during pregnancy • Prenatal counseling on oral health has been highly correlated with women obtaining dental care during pregnancy • Education about healthy habits • Pregnant Woman • Child

7. SAFETY

9. Practice Recommendations • First prenatal visit= assess woman’s oral health • Screening questions • Encourage and refer to a dental provider if it has been more than 6 months since last visit or if she has any dental issues • Oral Health Resource Guide 2103 • Reassure woman that dental care is SAFE and IMPORTANT • Oral Health During Pregnancy: A National Consensus Statement • Counseling: • Pregnant Woman • Brush twice daily with fluoride toothpaste • Floss daily • Limit sugary foods/drinks • Dental visits twice/year • Child

10. Infant Oral Health

11. Oral Hygiene Once teeth erupt= BRUSH with fluoride toothpaste Before teeth= WIPE gums

12. DentalHome by Age 1

13. Oral Health Resources • ACOG Committee Opinion: “Oral Health Care During Pregnancy and Through the Lifespan” (8/13) • http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_ • For_Underserved_Women/Oral_Health_Care_During_Pregnancy_and_Through_the_Lifespan • Oral Health Care During Pregnancy: A National Consensus Statement • http://www.mchoralhealth.org/PDFs/Oralhealthpregnancyconsensusmeetingsummary.pdf • Oral Health Resource Guide 2013 • http://phpa.dhmh.maryland.gov/oralhealth/Documents/OralHealthResourceGuide.pdf • Tips for Good Oral Health During Pregnancy • http://www.mchoralhealth.org/PDFs/OralHealthPregnancyHandout.pdf • Two Healthy Smiles: Tips to Keep You and Your Baby Healthy • http://www.mchoralhealth.org/PDFs/PregnancyBrochure.pdf • Oral Health Care During Pregnancy: At-a-Glance Reference Guide • http://phpa.dhmh.maryland.gov/oralhealth/Documents/Pregnant_Women_Reference_Guide.pdf • Oral Health Tips for Pregnant Women • http://phpa.dhmh.maryland.gov/oralhealth/docs1/DentalHealthTipsforPregnantWomen.pdf • Healthy Teeth, Healthy Kids website • http://healthyteethhealthykids.org/

14. Katy Battani, RDH, MS kbattani@mdac.us Jonelle Grant, DDS, MPH drgrant.mychildrenschoice@gmail.com