By Holli Seabury, EdD, Executive Director of the Delta Dental Foundation
Good oral health is important for a healthy pregnancy. I learned firsthand how poor oral health can lead to dangerous maternal health and delivery complications when I was providing oral health training for nurses in Flint, Michigan that work with low-income pregnant women.
I'll never forget a story one nurse shared with me about how oral health during pregnancy had impacted her personally. She had developed an abscessed tooth at the end of her pregnancy and could not afford to have it treated. By the time she went into labor, she was running a high fever and the infection in her mouth had spread throughout her body. After her baby was born, a neonatologist explained that although her body could fight the infection, they were unsure if her baby could. Her son spent three weeks in the Neonatal Intensive Care Unit—thankfully, he survived. But I will never forget her tears as she said, "I almost lost my first child to a problem in my mouth, and I had no idea that could happen." This is just one personal example of the challenges many pregnant women face each year as a result of the link between oral health and maternal health—a topic that many do not sufficiently understand and fail to consider when thinking about the comprehensive health of pregnant women.
In 2013, the American College of Obstetrics issued a position statement stressing the connection between oral health and overall health and the risks dental decay and periodontal disease may pose to a woman in having a healthy, full-term pregnancy. The statement encouraged oral health counseling and dental referrals at prenatal visits.
But systemic inequalities can contribute to poor oral health. For example, women who have lower levels of education or are Black and Hispanic are less likely to have dental insurance and are twice as likely to have untreated dental decay that can lead to poor birth outcomes. Data from the Pregnancy Risk Assessment Monitoring System in 10 states show only 40 percent of pregnant women had a routine dental visit; for Black and Hispanic women, only about 25 percent had a routine dental visit.
For many at-risk pregnant women, Medicaid, the public health coverage provider for lower-income individuals, offers term-limited dental coverage during pregnancy. In fact, more than 40 percent of the babies born today are covered by Medicaid. But the reality is that many women who qualified for Medicaid during pregnancy can lose their Medicaid dental coverage weeks after giving birth.
Providing oral health counseling at prenatal visits has been shown to be effective and includes asking a patient if she has pain or other problems in her mouth; when she last saw a dentist; and if she needs help finding a dentist. Unfortunately, over 55 percent of pregnant women nationwide receive no oral health counseling. And even when an oral problem occurs, only half of pregnant women attend to it.
The multi-agency Michigan Initiative for Maternal and Infant Oral Health (MIMIOH), funded in part by the Delta Dental Foundation, an affiliate of Delta Dental of Michigan, Ohio, Indiana, and North Carolina, embeds a dental hygienist, with their own dental room, in a community health center. When pregnant women come in for their prenatal care, they also visit the dental hygienist, who is working out of the OB-GYN area. The hygienist provides preventive oral health, refers for additional dental care, teaches women about the importance of dental care during and after pregnancy, and stresses the importance of age-one dental visits.
While MIMIOH’s primary goal is to ensure the health of a woman’s mouth during pregnancy, a secondary goal is to find an affordable dental home that will treat both her and her child. Although data are still being evaluated, initial results demonstrate a correlation between receiving prenatal care at a MIMIOH site and seeking additional prenatal and infant dental care.
The long-term relationships created through home-visiting programs for pregnant women are ideal for oral health counseling and education. In Fort Wayne, Indiana, the DDF has funded the integration of Brush Oral Health materials into a home-visiting program for at-risk pregnant women. Home visitors receive training and low-literacy, interactive materials to use with their clients. Executive Director of Healthier Moms and Babies, Paige Wilkins, says, “Using the Brush oral health curriculum has been an integral part of our home-visiting strategy to improve birth outcomes. Our clients have gained the knowledge they need to improve their oral health and we have seen an increase in dental visits during pregnancy.”
Good oral health during pregnancy can decrease the risk factors for preterm birth and low birth weight—and establish healthy habits for years to come. Although the systemic problems that create oral health disparities and barriers to care are deeply entrenched, creative solutions—at the congressional and community levels—are working. Programs that address oral health literacy and integrate care create oral health solutions for mother and child.
Holli Seabury, EdD, has been the Executive Director of the Delta Dental Foundation since 2019. Previously, she was CEO of McMillen Health, a non-profit nationwide health education center, where she developed educational materials and training, primarily focused on Medicaid populations.
The Delta Dental Foundation (DDF) was established in 1980 as a nonprofit, charitable organization and serves as the philanthropic arm of Delta Dental of Michigan, Ohio, Indiana, and North Carolina. The DDF’s mission is to improve the oral health of the public and to advance dental science and the dental profession through research and education.