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1
Prenatal Care Advice to See a Dentist Results
from a Population-Based Study Meredith L.
Vandermeer1,2, Kenneth D. Rosenberg2,3, Alfredo
P. Sandoval2 1 Department of Public Health,
Oregon State University, Corvallis, Oregon 2
Office of Family Health, Oregon Department of
Human Services, Portland, Oregon 3 Oregon Health
Science University, Portland Oregon
Background Women should see a dentist during
pregnancy. Poor oral health for pregnant women is
associated with periodontal disease, pre-term low
birthweight, pre-eclampsia, and early childhood
caries. This study explores which women were
counseled during their prenatal care visits on
the importance of seeing a dentist. Methods We
analyzed data from Oregon PRAMS (Pregnancy Risk
Assessment Monitoring System). Women were asked
whether a prenatal care advisor talked with them
about the importance of seeing a dentist during
their pregnancy. Results In bivariate analysis,
women were more likely to be advised on the
importance of seeing a dentist if they obtained
their prenatal care from a private doctor or
Health Maintenance Organization (HMO), were late
initiators of prenatal care, less than 30 years
old, uninsured and had less than a highschool
degree. In multivariate analysis, women who
received their prenatal care from a health
department clinic remained more likely to receive
this information (adjusted OR1.83, 95 CI
1.36-2.46. Conclusions Health department
clinics seem to do a better job at informing
pregnant patients about the importance of seeing
a dentist. All women should be advised on the
importance of seeing a dentist.

• Why are health department clinic providers more
  likely to give this advice than private
  providers?
• More attuned to the conditions associated with
  poverty
• Focus of their work is prevention-based
• May see visible decay and periodontal disease
  more often than their private counterparts and
  therefore may be prompted to give this advice on
  a more regular basis
• Limitations of this study
• Recall bias women are likely to remember where
  they received their care, but they may not recall
  receiving advice on the importance of seeing a
  dentist

Abstract
Discussion
Methods

• Oregon PRAMS
• Population-Based survey of post-partum women
• Modeled after CDC PRAMS
• Asks questions about experiences before, during
  and after pregnancy
• Analyzed data from combined 2000 and 2001
  surveys
• 5367 women randomly selected from birth
  certificates, 3895 replied. Weighted response
  rate of 78.8
• Exclusions
• 228 women did not respond to dental advice
  question. Final sample size was 3667
• PRAMS Questions
• During any of your prenatal care visits, did a
  doctor, nurse of other health care worker talk
  with you about the importance of seeing a dentist
  during your pregnancy?
• Where did you go most of the time for your
  prenatal visits? Hospital clinic, health
  department clinic, private doctors office or HMO
  clinic, or other
• What is your family income, before deductions and
  taxes, before you got pregnant?
• Birth Certificate Variables
• Prenatal care initiation, maternal age, insurance
  coverage for delivery, maternal education,
  marital status, parity, and race/ethnicity
• Analysis
• Bivariate and multivariate analysis were
  performed to study the association between
  independent variables and being advised to see
  the dentist during pregnancy

• Good oral health during pregnancy is associated
  with improved outcomes for both mother and child
• Decreases in periodontal disease
• Decreases in preterm and/or low birthweight
• Decreases in pre-eclampsia
• Decreases in early childhood caries
• There are published guidelines that recommend
  that pregnant women receive oral health
  counseling during pregnancy
• American Academy of Pediatric Dentistry (2004)
• American Dietetic Association (1998)
• American College of Obstetrics and Gynecology
  (2005)
• Many women perceive a need to see a dentist but
  do not see one.
• Lack of counseling is associated with
  non-receipt of dental care.
• In this study we explore which women were most
  likely to receive advice on the importance of
  seeing a dentist during pregnancy.

Introduction
Good oral health is associated with
improved outcomes for both mother and
infant. Women should have good oral health
before and during pregnancy. Dental care during
pregnancy should be routine. Prenatal care
providers should advise all women to see a
dentist during pregnancy.
Conclusions

Results

• 32.7 of women in this study received prenatal
  care advice about the importance of seeing a
  dentist during pregnancy
• In bivariate analysis, women mostlikely to be
  told this advice received their prenatal care in
  a health department clinic, were late initiators
  of prenatal care, were less than 30 years of age,
  had less than a highschool degree, were
  uninsured, umarried, Hispanic, non-Hispanic black
  and non-Hispanic American Indian/Alaskan Native
• In multivariate analysis, women who visited a
  health department clinic remained significant.
  These women were 1.83 times more likely to have
  been given advice on the importance of seeing a
  dentist during pregnancy

Acknowledgments
 Tina Kent for her work with Oregon
PRAMS. Michelle Adler, MD Anna Jimenez, MD
Andy Osborn, MBA Kathy Phipps, DrPH Gordon
Empey, DMD, MPH Jane Mellor, RDH Susan
Sanzi-Schaedel, RDH, MPH John Buckmaster, MD
Mark Nichols, MD for their contributions.
Maternal and Child Health Bureau of the Health
Resources and Services Administration and the
Centers for Disease Control and Prevention for
their support of Oregon PRAMS.