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“Too Many Pregnant Women Are Not Getting Timely Dental Care.” -The New York Times the Midwifery Profession Frontline Promoters of Oral Health for Women and Newborns

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“Too Many Pregnant Women Are Not Getting Timely Dental Care.” -The New York Times the Midwifery Profession Frontline Promoters of Oral Health for Women and Newborns “Too Many Pregnant Women are not getting timely dental care.” -The New York Times The Midwifery Profession Frontline Promoters of Oral Health for Women and Newborns Judith Haber, PhD, APRN, BC, FAAN Associate Dean of Graduate Programs The Ursula Springer Leadership Professor in Nursing New York University College of Nursing Oral Health in America (2000) IOM Reports (2011- 2015) Delivering the Facts • ~130 million US adults and children lack dental coverage (National Association of Dental Plans 2014) • More than 75% of pregnant women were declined dental services because of pregnancy (Morgan et al., 2009) • Gingivitis affects 60-75% of pregnant women (American Dental Association Council on Access, Prevention and Interprofessional Relations, 2006) • ECC is one of the most common chronic diseases (Centers for Medicare & Meicaid Services, 2015) • Application of fluoride varnish can reduce caries by 25-45% (Marya & Dahiya, 2006) • 50 million school hours per year lost b/c of oral health related illness (pain, infection) (Gift, 1997) Leading Health Topics • Access to Health Services • Clinical Preventive Services • Environmental Quality • Injury and Violence • Maternal, Infant, and Child Health • Mental Health • Nutrition, Physical Activity, and Obesity • Oral Health • Reproductive and Sexual Health • Social Determinants • Substance Abuse • Tobacco HRSA Report (2014) Haber, J., Hartnett, E., Allen, K., HEENOT Hallas, D., Dorsen, C., Lange-Kessler, article J., … Wholihan, D. (2015). Putting the Mouth Back in the Head: HEENT to HEENOT. American Journal of Public Health, 105(3), 437–41. Interprofessional Patient Care Team Building Interprofessional Oral Health Workforce Capacity Model Increased Oral and Overall Health Outcomes Community Health & Education Increased Access to Systems Oral Healthcare, Reduced Oral Health Collaborative Disparities Builds Practice Primary Care Oral Health Workforce IP Oral-Systemic Capacity Fragmented Education Oral Healthcare System National Oral Health Needs Adapted from : World Health Organization (WHO). (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Geneva: World Health Organization Curriculum Overview www.smilesforlifeoralhealth.org 8 annotated 50 minute modules: 8 annotated 50 minute modules: Web and Powerpoint Web and Powerpoint • Relationship• Risk assessment, of oral tofluoride systemic varnish health and •anticipatoryOral to Systemic guidance Health • Child, Adult• Children’s & geriatric Oral Health oral health • The oral examination • Dental• Adult’s emergencies Oral Health • Interactive• Acute cases, Dental test Problems questions, post• Oral test health CME & creditthe pregnant with certificate patient • Pregnant Patient • Instructors guide,• Fluoride implementation Varnish aids, iPhone apps, examination videos, patient education• Oral Exam materials • Geriatric Oral Health Curriculum Impact www.smilesforlifeoralhealth.org • Downloads • In over 100 schools & training programs • Core curriculum for NIIOH - Nurses - Midwives - Physicians - Physician assistants - Dentists -Dental Hygienists IPEC Competencies (2011) Today’s Overview • Oral Health in Pregnancy • Tips for Moms • Oral Healthcare Integration into Education American Dental Association Council on Access, Prevention and Interprofessional Relations. (2006). Women’s oral health issues. American Dental Association. Retrieved from http://www.ada.org/prof/resources/topics/healthcare_ womens.pdf. References Centers for Medicare & Medicaid Services. (2015). Reducing Early Childhood Tooth Decay: An Overview for State Policymakers. Issue Brief. Retrieved from www.medicaid.gov/medicaid-chip-program-information/by- topics/benefits/downloads/ecc-overview.pdf Clark M.B, Douglass A.B., Maier R., Deutchman, M., Douglass, J.M., Gonsalves, W., Silk, H., Tysinger, J.W., Wrightson, A.S., Quinonez, R. (2010). Smiles for Life: A National Oral Health Curriculum. 3rd Edition. Society of Teachers and Family Medicine. Available on Smilesforlifeoralhealth.org Gift HC. Oral health outcomes research—challenges and opportunities. (1997). In: Slade GD, editor. Measuring oral health and quality of life. Chapel Hill: University of North Carolina Department of Dental Ecology. Haber, J., Hartnett, E., Allen, K., Hallas, D., Dorsen, C., Lange-Kessler, J….& Wholihan, D. (2015). Putting the Mouth Back in the Head: HEENT to HEENOT. American Journal of Public Health, 105(3), 437-441. Institute of Medicine. (2015). Measuring the Impact of Interprofessional Education (IPE) on Collaborative Practice and Patient Outcomes. Retrieved from https://www.iom.edu/Reports/2015/Impact-of-IPE.aspx Institute of Medicine. (2013). Oral Health Literacy. Workshop Summary. Retrieved from https://www.iom.edu/Reports/2013/Oral-Health-Literacy.aspx Institute of Medicine. (2011a). Advancing oral health in America. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/Advancing-Oral-Health-in-America.aspx Institute of Medicine. (2011b). Improving access to oral health care for vulnerable and underserved populations. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/Improving-Access-to-Oral-Health-Care-for-Vulnerable-and- Underserved-Population Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Retrieved from http://www.aacn.nche.edu/Education/pdf/IPECReport.pdf Marya, C. M., & Dahiya, V. (2007). Fluoride Varnish: A Useful Dental Public Health Tool. The Internet Journal of Dental Science, 4(2). Morgan, M. A., Crall, J., Goldenberg, R. L., & Schulkin, J. (2009). Oral health during pregnancy. Journal of Maternal-Fetal and Neonatal Medicine, 22(9), 733-739. National Association of Dental Plan. (2014). 126.7 Million Americans in Need of Dental Care Options. [Press Release]. Retrieved from http://www.reuters.com/article/2014/02/10/idUSnMKWBy7tZa+1e2+MKW20140210 Satcher, D. (2000). Oral health in America. A Report of the Surgeon General. Office of Public Health and Science. United States Department of Health and Human Services. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2014). Integration of oral health and primary care practice. Rockville, MD: Health Resources and Services Administration. Retrieved fromhttp://www.hrsa.gov/publichealth/clinical/oralhealth/primarycare/integrationoforalhealth.pdf World Health Organization (WHO). (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Geneva: World Health Organization “It is vital for medical professionals caring for pregnant women to understand the relationship between oral infections and birth outcomes.” -Robert Kovarik, DMD, MS Oral Health in Pregnancy Mimi Niles, CNM, MSN, MPH New York University College of Nursing REALITY A pregnant woman’s physical and oral health are key to responsible health planning and promotion. GOAL Ensure that every pregnancy is a healthy pregnancy. Oral Oral Health & Pregnancies Health • Access to dental care is directly related Care to income level (ACOG, 2013) Numbers • Yet, 40% of pregnant women have some form of periodontal disease (Lieff et al., 2004) • 22-34% of all pregnant women visit the dentist (Silk et al., 2008) • Only 50% of pregnant women with dental problem visit a dentist (Gaffield et al., 2001) • Even among women with dental insurance, dental care declines during pregnancy Oral Health Care • You shouldn’t have any dental work done during pregnancy Myths • For every pregnancy, you lose a tooth • Fetus will be harmed by x-rays or medications used during dental visit Oral Health • Optimal maternal oral hygiene during the perinatal period may decrease the Care amount of caries-producing oral bacteria Facts transmitted to the baby • Studies show a possible association between periodontal infection and preterm birth • Evidence fails to show improvement in outcomes after dental treatment after pregnancy • NO research demonstrates negative effect of periodontal treatment during pregnancy Risks • Dental caries: 1 out of 4 women In (Silk et al., 2008) Pregnancy • Gingivitis: most common oral disease with 75% incidence(Russell & Mayberry, 2008) • Periodontitis: 1 out of 3 women (Stefanac, 2001) Gingivitis and Periodontal Disease • Gingivitis affects 25 – 75% of pregnant women (Clark et al., 2010) • Periodontitis is a severe form of gum disease causing destruction of gums and bones leading to tooth loss • You don’t have to lose a tooth with each pregnancy! Untreated Periodontal Disease • Bacteria from the mothers’ mouth can reach the systemic blood stream and consequently reach the baby. When left untreated it may be associated with: • Pre Term Labor • Pre Term Birth • Poor glycemic control Enamel Erosion and Pregnancy Granulomas • Enamel erosion: Caused by vomiting or reflux & can be reduced by having woman rinse with water or water with baking soda after vomiting. • Granuloma: 5% of pregnant women are affected (Clark et al., 2010) • Usually resolves itself after delivery. • If bleeding or problems with chewing occur, refer for removal • Caries: Mothers with high rates of caries are more likely to have children with high rates of caries. What’s a Midwife to do? • Address dental hygiene as a part of well women health • Include HEENOT exam every trimester • Proactively recommend dental care during pregnancy • Reassure patients that prevention, diagnosis and
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