1. Oral Health Care During Pregnancy: A National Consensus Statement
Summary of an Expert Workgroup Meeting

2. Background: Pregnant Women
Many do not understand that oral health care is an important component of a healthy pregnancy.
Belief that poor oral health status during pregnancy is normal.
Often do not seek or receive oral health care.
In many cases, pregnant women do not understand that oral health care is an important component of a healthy pregnancy. There is the common belief that poor oral health during pregnancy is normal. And pregnant women, some with obvious signs of oral disease, often don’t seek or receive oral health care.
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3. Background: Health Professionals
Many do not understand that oral health care is an important component of a healthy pregnancy.
Lack of routine assessment of pregnant women’s oral health status by perinatal care health professionals and referrals to oral health professionals.
Oral health professionals tend to postpone providing oral health care to pregnant women.
Like pregnant women, many health professionals do not understand that oral health care is an important component of a healthy pregnancy. Also, perinatal care health professionals do not routinely assess pregnant women’s oral health status or refer them to oral health professionals, and oral health professionals often postpone providing oral health care to pregnant women.
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4. Importance of Oral Health Care During Pregnancy
Educating pregnant women about preventing and treating dental caries is critical.
Most young children acquire caries-causing bacteria from their mothers.
Counseling may reduce transmission of bacteria from mothers to young children, thereby delaying or preventing onset of caries.
Educating pregnant women about preventing and treating dental caries is critical. Evidence suggests that most infants and young children acquire caries-causing bacteria from their mothers. Providing pregnant women with counseling to promote healthy oral health behaviors may reduce transmission of such bacteria from mothers to infants and young children, thereby delaying or preventing the onset of caries.
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5. In Response
Several states developed guidelines for oral health care during pregnancy.
New York (2006)
South Carolina (2009)
Washington (2009)
California (2010)
Educational resources were created for health professionals and pregnant women.
Several states, including New York, South Carolina, Washington, and California have developed guidelines for oral health care for pregnant women. These states also produced supplemental resources for health professionals (such as policy briefs, articles, and curricula) and for pregnant women (such as handouts and bookmarks).

6. In Response
Many national organizations have issued statements and recommendations created to improve oral health care during pregnancy.
American Academy of Pediatric Dentistry
American Academy of Pediatrics
American Academy of Periodontology
American Academy of Physician Assistants
American College of Nurse-Midwives
American College of Obstetricians and Gynecologists
American Dental Association
Many national organizations have issued statements and recommendations for improving oral health care during pregnancy, including the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, the American Academy of Periodontology, the American Academy of Physician Assistants, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, and the American Dental Association.
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7. Consensus Development Expert Workgroup Meeting
Convened by the Health Resources and Services Administration in collaboration with the American College of Obstetricians and Gynecologists and the American Dental Association.
Met on October 18, 2011, in Washington, DC.
Reviewed policies, literature, and guidelines on oral health care during pregnancy.
Identified common ground to increase health professionals’ awareness of importance and safety of oral health care during pregnancy.
The Oral Health Care During Pregnancy Consensus Development Expert Workgroup Meeting was convened by the Health Resources and Services Administration in collaboration with ACOG and ADA. The meeting was held on October 18, 2011, in Washington, DC. Participants reviewed policies from federal agencies and national organizations, recent literature, and existing guidelines on oral health care during pregnancy. Participants also identified common ground to increase health professionals’ awareness of the importance and safety of women’s oral health care during pregnancy through the promotion of evidence-based science, which resulted in the national consensus statement.

8. National Consensus Statement: Purpose
Help health professionals improve the provision of oral health care services during pregnancy.
Bring about changes in the health-care-delivery system.
Improve the overall standard of care.
The purpose of the national consensus statement is to help health professionals, program administrators and staff, policymakers, advocates, and other stakeholders respond to the need for improvements in the provision of oral health services to women during pregnancy, bring about changes in the health-care-delivery system, and improve the overall standard of care. The consensus statement includes guidance for prenatal care health professionals and for oral health professionals.

9. National Consensus Statement: Key Messages
Pregnancy is a unique period characterized by physiological changes, which may adversely affect oral health.
Oral health is key to overall health and well-being.
Preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy.
Pregnancy is a unique period during a woman’s life and is characterized by complex physiological changes, which may adversely affect oral health. At the same time, oral health is key to overall health and well-being. Preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health
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10. Guidance for Prenatal Care Health Professionals
Assess pregnant women’s oral health status
Advise pregnant women about oral health care
Work in collaboration with oral health professionals
Provide support services (case management) to pregnant women
Improve health services in the community
Prenatal care health professionals can help ensure that pregnant women receive high-quality oral health care by assessing pregnant women’s oral health status and advising them about oral health care, working in collaboration with oral health professionals, providing support services to pregnant women, and improving health services in the community.
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11. Guidance for Prenatal Care Health Professionals
Assess Pregnant Women’s Oral Health Status
Take oral health history.
Check mouth for problems (e.g., swollen or bleeding gums, untreated tooth decay, mucosal lesions, signs of infection, or trauma).
Document findings in the medical record.
Prenatal care health professionals can assess pregnant women’s oral health status by taking an oral health history, checking the mouth for problems (for example, swollen or bleeding gums, untreated tooth decay, mucosal lesions, signs of infections, or trauma), and documenting findings in the woman’s medical record.
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12. Guidance for Prenatal Care Health Professionals
Advise Pregnant Women About Oral Health Care
Reassure women that oral health care is safe throughout pregnancy.
Advise women about scheduling appointment with a dentist.
Provide referral, if needed.
Encourage women to seek oral health care, practice good oral hygiene, eat healthy foods, and attend prenatal classes during pregnancy.
Counsel women to follow oral health professionals’ recommendations.
Prenatal care health professionals can advise women about oral health care by reassuring them that oral health care is safe throughout pregnancy; advising them about scheduling an appointment with a dentist; providing a referral to an oral health professional, if needed; encouraging them to seek oral health care, practice good oral hygiene, eat healthy foods, and attend prenatal classes during pregnancy; and counseling them to follow oral health professionals’ recommendations.

13. Guidance for Prenatal Care Health Professionals
Work in Collaboration with Oral Health Professionals
Establish relationships with oral health professionals in the community.
Develop a formal referral process.
Share pertinent information about pregnant women.
Coordinate care.
Prenatal care health professionals can work in collaboration with oral health professionals by establishing relationships with oral health professionals in the community, developing a formal referral process, sharing pertinent information about pregnant women, and coordinating care.
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14. Guidance for Prenatal Care Health Professionals
Provide Support Services (Case Management) to Pregnant Women
Help pregnant women complete applications for insurance and other coverage, social services, or other needs.
If the woman does not have a dental home, explain the importance of oral health during pregnancy and help her obtain care.
Prenatal care health professionals can provide support services to pregnant women by helping them complete applications for insurance and other coverage, social services for example, domestic violence services), or other needs (for example, transportation or translation). If a woman doesn’t have a dental home, prenatal care health professionals can explain the important of oral health care during pregnancy and help her obtain care.
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15. Guidance for Prenatal Care Health Professionals
Improve Health Services in the Community
Include questions about oral heath on the prenatal patient-intake form.
Establish partnerships with community-based programs.
Provide a referral to a nutrition professional if counseling would help.
Integrate oral health topics into prenatal classes.
Provide culturally and linguistically appropriate care.
Prenatal care health professionals can improve services in the community by including oral health questions on the prenatal patient-intake form (for example, reason for and date of last dental visit, and previous dental procedures) and establishing partnerships with community-based programs (for example, Special Supplement Nutrition Program for Women, Infants and Children [WIC] and Early Head Start). Prenatal care health professionals can also improve services by providing a referral to a nutrition professional if counseling would be beneficial (for example, guidance on food choices or nutrition-related health problems), integrating oral health topics into prenatal classes, and providing culturally and linguistically appropriate care.

16. Guidance for Oral Health Professionals
Assess pregnant women’s oral health status
Advise pregnant women about oral health care
Work in collaboration with prenatal care health professionals
Provide oral disease management and treatment
Oral health professionals can help ensure that pregnant women receive high-quality oral health care by assessing pregnant women’s oral health status and advising them about oral health care, working in collaboration with prenatal care health professionals, providing support services (case management), and improving health services in the community.
Provide support services (case management).
Improve health services in the community
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17. Guidance for Oral Health Professionals
Assess Pregnant Women’s Oral Health Status
Take oral health history.
Review medical and dietary histories, including use of tobacco, alcohol, and recreational drugs.
Perform comprehensive oral examination.
Take radiographs when clinically indicated.
Oral health professionals can assess pregnant women’s oral health status by taking an oral health history; reviewing medical and dietary histories, including use of tobacco, alcohol, and recreational drugs; performing a comprehensive oral examination; and taking radiographs when clinically indicated.
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18. Guidance for Oral Health Professionals
Advise Pregnant Women About Oral Health Care
Reassure pregnant women that oral health care is safe during pregnancy, including
Radiographs
Pain medication
Local anesthesia
Encourage women to seek oral heath care, eat healthy foods, and attend prenatal classes.
Oral health professionals can advise pregnant women about oral health care by reassuring them that oral health care, including radiographs, pain medication, and local anesthesia, is safe during pregnancy and encouraging them to seek oral health care, practice good oral hygiene, eat healthy foods, and attend prenatal classes during pregnancy.
Photograph is copyrighted and may not be reproduced.

19. Guidance for Oral Health Professionals
Work in Collaboration with Prenatal Care Health Professional
Establish relationships with prenatal care health professional in the community.
Develop a formal referral process.
Share pertinent information about pregnant women
Coordinate care.
Consult with prenatal care health professionals, as necessary.
Oral health professionals can work in collaboration with prenatal care health professionals by establishing relationships with prenatal care health professionals in the community; developing a formal referral process; sharing pertinent information about pregnant women; coordinating care; and consulting with prenatal health care professionals, as necessary.

20. Guidance for Oral Health Professionals
Provide Oral Disease Management and Treatment to Pregnant Women
Provide emergency or acute care at any time during pregnancy.
Discuss benefits and risks of treatment and alternatives.
Develop and provide a comprehensive care plan.
Oral health professionals can provide oral disease management and treatment to pregnant women by providing emergency or acute care at any time during pregnancy, discussing benefits and risks of treatment and alternatives, and developing and providing a comprehensive care plan.
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21. Guidance for Oral Health Professionals
Provide Oral Disease Management and Treatment to Pregnant Women
Use standard practice when placing restorative materials.
Use rubber dam during endodontic and restorative procedures.
Position pregnant woman comfortably when providing care.
Follow up with pregnant women.
Oral health professionals can provide oral disease management and treatment to pregnant women by using standard practice when placing restorative materials, using a rubber dam during endodontic procedures and restorative procedures, positioning pregnant women appropriately during care, and following up with pregnant women.

22. Guidance for Oral Health Professionals
Provide Support Services (Case Management) to Pregnant Women
Help pregnant women complete applications for insurance or other sources of coverage, social services, or other needs.
If the woman does not have a prenatal care health professional, explain the importance of care, and facilitate referrals.
Oral health professionals can provide support to pregnant women by helping them complete applications for insurance or other sources of coverage, social services, or other needs, and, if a woman does not have a prenatal care health professional, explaining the importance of care and facilitating referrals.
Photograph is copyrighted and may not be reproduced.

23. Guidance for Oral Health Professionals
Improve Health Services in the Community
Record prenatal care health professional’s name and contact information on the patient-intake form.
Accept women enrolled in Medicaid and other public insurance programs.
Establish partnerships with community-based programs that serve pregnant women with low incomes.
Refer to nutrition professional, if beneficial.
Provide culturally and linguistically appropriate care.
Oral health professionals can improve health services in the community by recording the name and contact information of the prenatal care health professional on the prenatal patient-intake form, accepting women enrolled in Medicaid and other public insurance programs, establishing partnerships with community-based programs that serve pregnant women with low incomes; providing a referral to a nutrition professional if counseling would be beneficial, and providing culturally and linguistically appropriate care.

24. Pharmacological Considerations
Pharmacological agents: 
Analgesics
Antibiotics
Anesthetics
Over-the-counter antimicrobials
Pharmacological agents that can be used for pregnant women include analgesics, antibiotics, anesthetics, and over-the-counter antimicrobials.
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25. Guidance for Health Professionals to Share with Pregnant Women
Tips for Good Oral Health During Pregnancy and After the Baby Is Born
Get oral health care.
Practice good oral hygiene.
Eat healthy foods.
Practice other healthy behaviors.
Take care of her mouth and her baby’s mouth after the baby is born.
Tips for good oral health care for pregnant women include getting oral health care, practicing good oral hygiene, eating healthy foods, practicing other health behaviors, and taking care of her mouth and her baby’s mouth after the baby is born. The tips for good oral health care are also available as a separate handout.
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26. Outreach Tools Outreach Tools Announcement Talking points
Powerpoint slides
Document cover image
Graphic badges
Available at nsus_statement.html
Outreach tools to help promote the availability of the consensus statement and share it with others are available. The tools include an announcement to insert into a newsletter or other promotional materials, talking points about the development of the consensus statement, Powerpoint slides that provide a thorough overview of the consensus statement, and an image of the publication cover. Graphic badges are also available to post on a website with a direct link to the online order form to request single or bulk copies of the consensus statement.
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27. National Maternal and Child Oral Health Resource Center
Acknowledgments
Presentation prepared by
National Maternal and Child Oral Health Resource Center
This presentation was made possible by grant number H47MC from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.
Please note that the photographs used in this presentation are copyrighted and may not be reproduced.