NC Department of Health and Human Services Perinatal Oral Health In North Carolina NC Oral Health Section Collaborative Practice is Essential A Training for Medical Professionals Objectives Educate ID: 766760
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NC Department of Health and Human ServicesPerinatal Oral HealthIn North Carolina NC Oral Health Section Collaborative Practice is Essential A Training for Medical Professionals
Objectives Educate Integrate Collaborate Improve Maternal-Child Outcomes
Agenda Background & Significance National Consensus Statement Collaborative Practice Framework What should the dental team do? What should the medical team do? Resources
Worst Case Scenario Comes True The Case for Improved Inter-professional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy 19 Year old at 17 weeks gestation Dental pain, dental treatment, underlying medical condition, medical treatment, dental complications, medical complications, repeated hospital admissions over the course of several weeks. Fetus loss of life Maternal loss of lifeEducation and prevention prior to pregnancy Better communication and coordination among health care providersCollaborative Practice Source: https://uncch.pure.elsevier.com/en/publications/the-case-for-improved-interprofessional-care-fatal-analgesic-over
Background 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 ?
Background 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 PhysiciansLack of compensation Unfamiliarity Absence of processes Dentists Differing consensuses Trimester, radiation, treatment Insurance policy knowledge Lawsuits
Baseline Surveillance Data 2016 survey of NC pregnant women Convenience sample: 459 women from the 68 health departments offering prenatal care services Questionnaire and visual-only oral screening
Key Findings Over 50% reported Fair to Very Poor oral healthOnly 17% had a dental visit during the pregnancy1/3rd had untreated decay 41% needed dental treatment Top Barriers : Cost (75%) No Dentist (26%) Fear (13%) 60% medical providers did not ask if patient had dentist
Oral Health Impacts Total Health Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88948/ https://www.adha.org/resources-docs/7838_Periodontal_Diseases_and_Adverse_Pregnancy_Outcomes.pdf
Another Case Report “Term Stillbirth caused by Oral Fusobacterium nucleatum ” 35 year old at 39.5 weeks gestationWeakened immune due to respiratory infection and low grade fever. Routine prenatal care, uncomplicated pregnancy other than a smaller placenta. Lack of movement, heart beat on ultrasound. Fetal loss of life – stillbornAutopsy revealed F. nucleatum in lungs and stomach; oral exam found F. nucleatum in mothers subgingival flora and no other locationsDue to placenta size and weakened immune response, fetus was susceptible to bacteria https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004155/ http://www.nbcnews.com/id/34979552/ns/health-oral_health/t/mothers-gum-disease-linked-infants-death/%20-%20.V-EtePkrLDc#.WdfOhGde6Uk
Possible Pregnancy Complications Source: https://www.adha.org/resources-docs/7838_Periodontal_Diseases_and_Adverse_Pregnancy_Outcomes.pdf
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 HealthSource: Photo credit AAFP.org Pyogenic Granuloma and Gingivitis
Mildest form of PDRed, 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 diabetesGingivitis 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
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. 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
In Response Several states have adopted perinatal oral health guidelines Educational resources Many national organizations have issued statements and recommendations to improve oral health care during pregnancy
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
Oral Health Care During Pregnancy: NC Collaborative Practice Framework Quick Reference Guides Request Form will be available at https://publichealth.nc.gov/oralhealth
Guidance for Perinatal Medical Providers Assess pregnant women’s oral health status . Advise pregnant women about oral health care. Offer a dental referral Work in collaboration with dental professionals.Provide support services/case management.Improve health services in the community.
Assess Pregnant Women’s Oral Health Status During initial prenatal evaluation Take oral health history and ask about oral health concerns Take a quick assessment of the mouth for problems Document findings in medical record
Within Normal Limits - No Alarm
Visually Concerning -Recommend Referral
Advise Pregnant Women About Oral Health Care Reassure pregnant women that oral health care is safe: Radiographs Local anesthesia Pain medications Encourage women to schedule a dental visit: provide referral , if needed
Advise Pregnant Women About Oral Health Care Advise women to seek regular oral health care and practice good oral hygiene Counsel women to follow oral health professionals’ recommendations
Work in Collaboration with Dental Professionals Establish relationships with oral health professionals. Exchange of appropriate and pertinent information.
Provide Support Services/Case Management Help complete applications for insurance, social services and other needs (i.e. transportation) Facilitate referrals to local dental offices that serve: pregnant women; Medicaid enrolled; or other public insurance enrolled programs
Improve Health Services in the Community Include oral health questions on the prenatal patient-intake form. Establish partnerships with community-based programs. Integrate oral health topics into prenatal classes Provide culturally and linguistically appropriate care.
Guidance to Share with Pregnant Women Establish a dental home for yourself now, and your baby by one year of age. Stop use of alcohol, tobacco products, recreational drugs, and avoid secondhand smoke. Rinse with a teaspoons of baking soda in a cup of water after vomiting or reflux. Do not brush right away. Floss and brush with fluoridated toothpaste twice daily Breastfeeding your baby is recommendedBegin brushing your baby’s first tooth with a smear of fluoridated toothpaste twice daily
Dental Insurance Coverage Private Insurance Check Benefits Public Insurance Medicaid for Pregnant Women Dental benefits during pregnancy only; discontinue at delivery Coverage before, during and after pregnancy Medicaid for Family & Children (MAF)
Resources
Prenatal Oral Health Program http://www.prenataloralhealth.org/index.php/dashboard/phcpvideo Create log in and use dashboard to navigate Prenatal Health Care Provider training video (19 minutes) Educational resources for providers Sample forms for office-to-office communicationsInformative video resources
Smile for Life:A National Oral Health Curriculum http://www.smilesforlifeoralhealth.org Integration of oral health and primary care Endorsed by national dental and medical organizations Course 5 - Oral Health and the Pregnant Patient Total of 8 courses offered for free CE credit
Patient Handouts from OHRC https://www.mchoralhealth.org/PDFs/oralhealthpregnancyresguide.pdf https://www.mchoralhealth.org/PDFs/HHHS_pregnancy.pdf https://www.mchoralhealth.org/PDFs/pregnancybrochurefullpage.pdf
Key Points: Perinatal oral health is a matter of maternal-child oral health Comprehensive dental treatment is essential and safe throughout pregnancy Collaborative practice is key to improved maternal-child oral health outcomes
Questions? Your Name: Contact Information: Perinatal Oral Health Coordinator Barbara Smith, MS, RDH 919-707-5492