Program Targets Oral Health Care for Low-income Pregnant Women

Oral health is integral to overall maternal health and well-being. Physiological and behavioral changes during pregnancy can adversely affect oral health, exacerbating dental caries and periodontal diseases. Oral diseases during pregnancy can cause pain, nutritional deficiencies, lost workdays and reduced employability, all of which affect a woman's quality of life. As six in 10 adults with low wages who lack dental coverage report that their oral health impedes job prospects, helping pregnant women address their dental needs can boost employment and family incomes (Maryland Department of Health, 2020).

Additionally, children born to mothers with poor oral health have an increased risk of developing dental caries, the most prevalent—but preventable—chronic disease among children in the United States. 

In Maryland, Medicaid provides dental coverage for pregnant women, yet only 29% of enrollees had a dental visit in 2019. Many of these women are unaware of Medicaid dental coverage during pregnancy and the importance of prenatal oral health care, and many cannot afford care or have difficulty finding a Medicaid dental provider. Currently, only 29% of Medicaid-enrolled Maryland dentists are actively providing oral health care to pregnant people, children and adolescents enrolled in Medicaid (Maryland Department of Health, 2020).

In response to these oral health inequities, the University of Maryland School of Dentistry (UMSOD) Dental Hygiene Program developed an interdisciplinary prenatal oral health program in partnership with the University of Maryland Women’s Health Center (UMWHC). This innovative program aims to decrease barriers to oral health care for an underserved and misserved community while providing educational experiences for dental and dental hygiene students treating patients whose health outcomes are impacted by social determinants.

The program was initiated in 2018 by dental hygiene students and faculty who provided oral health screenings and education in treatment rooms at UMWHC while pregnant patients waited to see their prenatal providers. In 2019, nurses and nurse-midwives were trained to integrate oral health risk assessments, screenings, fluoride varnish applications, education and referrals into their prenatal care protocol through the National Maternal and Child Oral Health Resource Center’s Partnership for Integrating Oral Health Care into Primary Care project. Concurrently, the UMSOD established case management protocols that link pregnant patients to urgent and comprehensive oral health care services at the UMSOD.

The program has been deemed a success because an interdisciplinary partnership has grown to effectively integrate oral health into a primary care protocol. Additionally, dental and dental hygiene students are gaining experience treating severe oral diseases, while managing patient issues impacted by racial/ethnic bias and low health literacy.

The table below shows recent data tracked to evaluate program effectiveness as of May 2021:

In 2021, Maryland’s Medicaid postpartum coverage for oral health was expanded to one year (it previously ended at the conclusion of pregnancy), beginning in January 2022. Also, a new law in 2019 allows dental hygienists to work in medical office settings. These important changes will create new opportunities for UMSOD program to expand to improve oral health equity for pregnant and postpartum women and their children in Maryland.

Funding:
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an annual award totaling $1,000,000 with no funding from nongovernmental sources. This information or content and conclusions are those of the author(s) and should not be construed as the official policy of HRSA, HHS or the U.S. government, nor should any endorsements be inferred. 

Funding was also provided by The Maryland Department of Oral Health to provide case management to link the patients to the dental school and then to coordinate their care.

To learn more about the program, check out this article published in UMSOD's Mdental magazine. 

References:
Maryland Department of Health. Maryland’s 2019 Annual Oral Health Legislative Report. Health-General Article, Section 13-2504(b) and HB 70 (Chapter 656 of the Acts of 2009), 2020.

Courtesy of Lisa Bress, RDH, M.S., Clinical Associate Professor, UMSOD Dental Hygiene Program; Katy Battani, RDH, M.S., Project Manager, Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC), National Maternal and Child Oral Health Resource Center (OHRC), Georgetown University; Marina Schmidt RDH, M.P.H., Clinic Instructor, UMSOD Dental Hygiene Program

Published on June 9, 2021