Dental Care During Pregnancy Oregon 2000 Kathy R. Phipps, DrPH (1) Kenneth D. Rosenberg, MD, MPH (2) Alfredo P. Sandoval, MS, MBA (2) (1) Association of State & Territorial Dental Directors (2) Oregon Department of Human Services American Public Health Association, 131 st Annual Meeting, November 19, 2003, San Francisco

Background u A tooth for every pregnancy u Pregnancy & oral health l pregnancy gingivitis, pyogenic granuloma u Recent focus on l pregnancy & birth outcomes l transmission of mutans streptococci

Background u Little known about l oral health of pregnant women l use of dental services during pregnancy u Purpose of project l existing surveillance system - PRAMS l obtain state-level population-based data

What is PRAMS? u Pregnancy Risk Assessment Monitoring System u Collects state-specific information on l maternal attitudes and experiences u Improve the health of mothers and infants

Oregon PRAMS u Began in 1998 u Technical assistance from CDC l not part of the CDC system until 2003 u Majority of data is from 2000 l combined data set from 2000 and 2001

Participating States states plus New York City

Methods - Oregon PRAMS 2000 u Stratified random sample l 2,950 mothers with a recent live birth u Oral health questions l needed to see a dentist for a problem l went to a dentist l healthcare provider talked with them about the importance of seeing a dentist

Demographic Information u Overall response rate73% u Mothers age l < 20 years11.4% l years78.1% l > 35 years10.5% u Mothers race/ethnicity l White75.1% l Hispanic16.2% l Other8.6%

Demographic Information u Maternal Education l < 12 years18.1% l At least 12 years79.5% l Unknown2.4% u Marital status l Unmarried/divorced/annulled28.4% l Married or separated71.6%

Demographics & Lifestyle u Family Income l < $15, % l $15,000 - $29, % l $30,000 - $49, % l > $50, % u Smoked during pregnancy16.0% u Alcohol in 3rd trimester9.3%

Prenatal Care & Birth Outcomes u Prenatal care in 1st trimester81.8% u Normal birth weight95.2% u Payor for labor and delivery l Private insurance62.7% l Public insurance32.1% l No insurance/other5.2%

During your pregnancy... I needed to see a dentist for a problem7228 I went to a dentist or dental clinic5743 A healthcare worker talked with me about: a.the importance of seeing a dentist b.how to care for my teeth/gums Question% No% Yes I had my teeth cleaned in the last year5347

During your prenatal visits, did a health care worker talk with you about...

Needed to see a dentist... Needed to see a dentist because of a problem Did NOT go to dentist 40% Went to dentist 60% 11% of all women 28% of women

Did NOT go to dentist... Income < $30, Hispanic Univariate OR (95% CI) Multivariate OR (95% CI) Among women who said they needed care, those most likely NOT to see a dentist: PRAMS 2000 and 2001 Combined

Oregon (2000) Compared to Other States (1998) Gaffield ML, et al. JADA 2001;132:

How long has it been since you had your teeth cleaned by a dentist or hygienist?

Did NOT Have Teeth Cleaned in Last Year WIC Enrollment Smoked in 1st Trimester Late/No Prenatal Care Hispanic Odds Ratio95% CI Multivariate Analysis PRAMS 2000 and 2001 Combined

Had Teeth Cleaned in Last Year

Summary u Many pregnant women do not seek dental care even if they have a problem u Healthcare workers are not talking to women about oral health u Low-income and Hispanic women are less likely to seek dental care

Potential Recommendations u Educate health care workers u Educate pregnant women u Target high risk women u Develop a referral network u Medicaid dental for pregnant women u Oral health questions in PRAMS THE END