1. Beautiful Smiles! Healthy Babies! Improving Oral Health Among Pregnant Women on Medicaid Alison Buckser, MPH Public Health Solutions of RI Martha Dellapena, MS RI Department of Human Services Laurie Leonard, MS RI Department of Health

2. Oral Health Critical During Pregnancy Poor oral health during pregnancy may increase the risk of delivering a low birth- weight baby and other complications 18% of pre-term low-birth-weight babies might be attributable to periodontal disease NB: Early research is not yet conclusive Periodontal disease is both preventable and treatable during pregnancy Pregnancy is a “teachable moment” for children’s oral health

3. Problem Pregnant women often avoid all dental treatment due to the misconception that it could endanger the fetus. Only 30% of pregnant RI Medicaid recipients visited the dentist at least once during their pregnancy in 2006 Low Medicaid reimbursement for dental care

4. Pilot Initiative Short Term Goal: Increase the number of pregnant women on RI Medicaid who visit a dentist during their pregnancy Long Term Goal: Improve birth outcomes of Medicaid recipients Method: Have trusted professionals in the community tell pregnant women that it is safe and advisable to go to the dentist while pregnant Two pronged approach: Resource binder Training medical providers to refer to dental providers

5. Resource Binders Provide trusted professionals with handout materials showing the importance of good oral health Professionals would hand out materials during regular work with clients Materials help them refer their pregnant clients to community dental clinics for regular dental care Given in catchment area of health centers with dental clinics

6. Messages for Pregnant Women Go to the dentist when you are pregnant to protect your baby’s health. It is safe to go to the dentist when you are pregnant. If your gums bleed when you brush or if your teeth hurt, go to a dentist. Brush and floss your teeth every day. Eat fruits and vegetables. Chew sugarless gum after you eat. Medicaid may help pay for your visit.

7. Binder Design Designed for busy professionals to easily distribute as part of regular duties Written for low literacy populations Translated into English and Spanish Very low tech and easily reproducible Binder pockets for storing copies Originals in plastic sleeves for easy copying when copies ran out Some reference materials laminated for extra protection

8. Materials Development Used existing materials when appropriate and available Needed to create some new materials Few existing materials combined low literacy reading level, important information, bi-lingual, and attractively packaged Included simple materials to help clients make appointments and reach dental clinics Maps and stickers with telephone numbers

9. Five Binder Sections For Moms: Handouts for mothers on oral health; also stickers with dental clinic contact information For Providers: Reference materials on oral health For Kids: Oral health tips for kids from birth to age 6; info on special Medicaid oral health program for kids Medicaid Information: What is offered and how to sign up Public Transportation: Maps and schedules

10. Distribution Handed out 300 binders to CHCs and community leaders Gave CHCs dental supplies for their medical providers to give to pregnant patients when making referral to the CHC dental clinic This was to encourage medical providers to make referrals

11. Distribution 50 binders to one CHC’s catchment area. Recently expanded its dental clinic and had extra capacity Disseminated to school nurse teachers, family resource counselors, and home school liaisons All but one other RI CHC took between 12 and 50 binders for their own use Shared with community leaders Used by own staff

12. Comments on Binders Public transportation maps to the CHC dental clinics described as the most valuable part of the binders Binders would serve as a foundation in their goal to improve medical-dental communication and interaction Needed translation into French and Cambodian Important to give handouts to teen girls as well as adult women