Oral Health is Prenatal Health
Preventive, diagnostic, and restorative dental procedures are safe throughout pregnancy and effective in improving and maintaining oral health. However, more than half of mothers do not receive periodic dental cleaning during pregnancy. Education, race/ethnicity, dental insurance, and household income have all been associated with the usage of dental services and oral health outcomes. Some women are misinformed that all dental treatments should be delayed after delivery, and sometimes they worry about potential adverse effects of routine dental care to the fetus. Given the importance of oral health during pregnancy for the health and well-being of mothers and their babies, the American College of Obstetricians and Gynecologists (ACOG) in 2013 stated that ‘women should routinely be counseled about the safety and importance of oral health care during pregnancy, and should be referred for dental care as would be the practice with referrals to any medical specialists.’ ACOG made it clear that oral health is an integral part of prenatal care. Healthcare providers from both medicine and dentistry acknowledge that preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.
As a mother of a young child and pediatric dentist, I believe oral health knowledge among pregnant women is the key to securing the oral health of both women at childbearing age and their young children. In 2014, I was a pediatric dental resident at The Mount Sinai Hospital ; I was also pregnant. I had begun a prenatal oral health education program with prenatal coordinators in East Harlem and the Bronx that integrated oral health education and care coordination into CenteringPregnancy, their prenatal group oral health education model. Before I joined Mount Sinai in 2014, I was involved in the publication of the national oral health guidelines for pregnant women as a dental officer at the Department of Health and Human Services. Three years after this publication, I found that the majority of clinicians, both physicians and dentists, were not aware of these guidelines. Most of my pregnant friends in prenatal groups were told to go to the dentist after delivery, unless they had a dental emergency. I was surprised by the gap between science and practice and decided to investigate the root causes. Three levels of issues generated this gap: provider training, patient education, and practice coordination.
Bridging the Gap to Improve Prenatal Dental Care
First, dental providers, primary care providers, and administrative staff need to be trained based on the most updated guidelines to advance the oral health of expecting mothers and their babies. Pregnancy should not be a reason to avoid necessary dental care, but rather it needs to be seen as a teachable moment, empowering mothers to secure their oral health as well as their baby’s healthy smile. With the current national guidelines and published best practices, we can achieve this.
Secondly, we need to acknowledge that mothers, not the pediatric dentist, are often the primary care providers. They decide what to put in the bottle, which snacks to give, and how often to brush their child’s teeth. Because of this, pregnant women and mothers should be educated on the relationship between mother’s oral health and baby’s oral health and be encouraged to receive necessary dental care, and practice home oral hygiene activities along with a low-sugar diet.
Finally, we need to build a system that is meaningful and sensible to pregnant women and connect them to oral health care. Even if care providers know the importance of oral health and are willing to provide appropriate and necessary dental services and referrals, and even if pregnant women value oral health for themselves and their babies, low-income pregnant women may not be able to access dental services without system-level support. New York is one of the states that provides comprehensive dental care for pregnant women enrolled in Medicaid. However, how many of these low-income pregnant women actually know about this coverage? How many know how to find dental facilities who accept their insurance during pregnancy? These are the questions we need to consider. Coverage is important, but patients may need help in the interpretation and utilization of such coverage.
How COVID-19 Has Impacted Dental Care
Currently, we have a new challenge – dental care during and after the COVID-19 crisis. At the beginning of this outbreak, the New York Times published, “The Workers Who Face the Greatest Coronavirus Risk.” Dentists and dental hygienists were at the far-right corner of the graph were depicting that those in the profession have the most frequent exposure to COVID-19 and the closest proximity to others during their workdays. As dental settings have unique challenges that require specific infection control strategies, CDC published “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response” to resume non-emergency dental care, which was on hold during the initial outbreak of COVID-19 by state order. It recommends balancing the need to provide necessary services while minimizing risk to patients and dental health care personnel.
Mount Sinai dental clinics have been serving patients with emergency dental cases during the pandemic, and we are in the process of providing routine dental care.
Although we face many challenges, this can be a time of opportunity as well. Dentistry has centered on a “drill-fill-bill” model, where definitive treatments are incentivized. However, as dentists work to minimize aerosol exposure while preventing oral health diseases, dental procedures that focus on disease management and prevention are on the spot. These procedures include silver diamine fluoride application to arrest dental caries and indirect pulp cap with Hall technique crowns—which may not require high-speed dental drills. There are also many efforts within the Mount Sinai Health System to integrate oral health into its existing primary care and prenatal care strategies.
Since 2019, the CenteringPregnancy programs at The Mount Sinai Hospital and the Mount Sinai Adolescent Health Center have embraced an interactive oral health education model where pregnant women are connected to Mount Sinai dental facilities if they do not have a dental provider. Mount Sinai OBGYN providers, pediatricians, and prenatal care nurses plan to integrate oral health education and care navigation into their existing care models. While we continue to provide our patients with excellent, up-to-date dental care, we are committed to focusing on these upstream approaches where the new norm for children’s oral health becomes no caries. Furthermore, this new norm will include the systems of care that value health as well as health care.
Hyewon Lee, DMD, MPH is a former U.S. Public Health Service officer at the Department of Health and Human Services, a member of the Blavatnik Family Women’s Health Research Institute and an Assistant Clinical Professor at the Department of Dentistry at The Mount Sinai Hospital. Her goal is to integrate oral health into primary and prenatal care to advance the oral health of mothers and young children.