1. 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

2. 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

3. 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

4. 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

5. 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

6. Participating States - 2003 www.cdc.gov/reproductivehealth/pramstates.htm 31 states plus New York City

7. 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

8. Demographic Information u Overall response rate73% u Mothers age l < 20 years11.4% l 20-34 years78.1% l > 35 years10.5% u Mothers race/ethnicity l White75.1% l Hispanic16.2% l Other8.6%

9. 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%

10. Demographics & Lifestyle u Family Income l < $15,00023.7% l $15,000 - $29,99926.0% l $30,000 - $49,99923.6% l > $50,00026.7% u Smoked during pregnancy16.0% u Alcohol in 3rd trimester9.3%

11. 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%

12. 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 69 61 31 39 Question% No% Yes I had my teeth cleaned in the last year5347

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

14. 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

15. Did NOT go to dentist... Income < $30,000 2.04 1.25 - 3.33 1.96 1.19-3.22 Hispanic 1.63 1.13-2.35 1.42 0.95-2.13 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

16. Oregon (2000) Compared to Other States (1998) Gaffield ML, et al. JADA 2001;132:1009-16.

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

18. Did NOT Have Teeth Cleaned in Last Year WIC Enrollment Smoked in 1st Trimester Late/No Prenatal Care Hispanic 1.69 1.96 1.69 1.85 1.28-2.22 1.47-2.63 1.22-2.38 1.35-2.56 Odds Ratio95% CI Multivariate Analysis PRAMS 2000 and 2001 Combined

19. Had Teeth Cleaned in Last Year

20. 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

21. 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