Oral health is KEY to overall health and the well-being of pregnant women and their babies. It is also a time when women are particularly vulnerable to poor oral health outcomes. It has long been known that hormonal changes commonly are associated with gingivitis (Löe, 1965). If left untreated, gingivitis may progress to periodontitis, which in turn may be associated with tooth loss (Russell, 2008), poor glucose control (Xiong, 1999) and preterm birth (Walia, 2015). Mothers with high rates of caries are also more likely to have children with high caries rates (Boggess, 2006) that may lead to pain and impact nutrition, speech development and permanent teeth eruption patterns.
Despite the overwhelming research that emphasizes the importance of maintaining effective oral hygiene, access to dental care during pregnancy remains limited. Many pregnant women forego oral care due to myths about the dangers of receiving dental care during pregnancy (Ressler-Maerlender et al., 2005), dentists’ fear of liabilities (National Maternal and Child Oral Health Policy Center, 2011) , and because of access barriers, including the lack of dental insurance, transportation and inability to take time off work (ACOG 2013). These myths and fears are associated with some staggering findings:
- 40% of pregnant women have some form of periodontal disease (Lieff et al., 2004)
- 25% pregnant women have dental caries (Silk et al., 2008)
- 75% incidence of gingivitis in pregnant women (Russell & Mayberry, 2008)
- Only 22-34% of 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
These shocking numbers underscore the huge need to educate pregnant women and their healthcare providers about the relationship between oral and overall health so that both moms and their newborns avoid needless suffering from oral disease.
Oral health equity may be achieved during pregnancy by positioning all women’s health providers (MDs, NPs, NMs, PAs RNs) as frontline providers of oral health care to pregnant women and their newborns. Multiple encounters throughout pregnancy provide numerous opportunities to include oral-systemic health in ante- and post-partum care, parent education and anticipatory guidance, thus preventing a number of oral health conditions that may have severe consequences for both mother and child. Because women’s health providers are equipped with a broad knowledge of general health problems, they can educate patients on the relationship between oral and overall health, simultaneously closing the existing gaps in oral healthcare and promoting the general health of the community.
To achieve a healthcare workforce that is ready to “put the mouth back in the head,” the Oral Health Nursing Education and Practice (OHNEP) program conducts yearly training workshops at the Annual American College of Nurse Midwives (ACNM) Meeting and Exhibition, an exciting meeting that brings together midwives and other women’s healthcare providers in an open forum to discover and discuss new ways to enhance the quality of care for women. During this interactive workshop, Midwives as Frontline Providers of Oral Health for Pregnant Women and Newborns, midwives from across the country gain clinical competencies related to oral health assessment, oral health promotion interventions for pregnant women, and develop collaborative partnerships with interprofessional community colleagues and resources.
Thanks to efforts such as these, OHNEP is expanding the network of midwives as oral health champions! In 2014, there were 23 out of 42 midwifery programs across the country integrating oral health into their midwifery program curriculum.
To learn more about how pregnancy can impact oral and general health, we encourage you to read the Oral Health Care during Pregnancy Consensus Statement, the result of extensive data review from an expert workgroup convened by the Health Resources and Services Administration (HRSA) in collaboration with American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA) in 2011.
You can also view our NYU panel of oral health champions as they speak about oral health during pregnancy and early childhood during the NYU Master’s Preceptor Recognition Breakfast and Development Day.