Dental Care During Pregnancy Oregon 2000

1
Dental Care During PregnancyOregon 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, 131st Annual
  Meeting, November 19, 2003, San Francisco

2
Background

• A tooth for every pregnancy
• Pregnancy oral health
• pregnancy gingivitis, pyogenic granuloma
• Recent focus on
• pregnancy birth outcomes
• transmission of mutans streptococci

3
Background

• Little known about
• oral health of pregnant women
• use of dental services during pregnancy
• Purpose of project
• existing surveillance system - PRAMS
• obtain state-level population-based data

4
What is PRAMS?

• Pregnancy Risk Assessment Monitoring System
• Collects state-specific information on
• maternal attitudes and experiences
• Improve the health of mothers and infants

5
Oregon PRAMS

• Began in 1998
• Technical assistance from CDC
• not part of the CDC system until 2003
• Majority of data is from 2000
• combined data set from 2000 and 2001

6
Participating States - 2003
31 states plus New York City
www.cdc.gov/reproductivehealth/pramstates.htm
7
Methods - Oregon PRAMS 2000

• Stratified random sample
• 2,950 mothers with a recent live birth
• Oral health questions
• needed to see a dentist for a problem
• went to a dentist
• healthcare provider talked with them about the
  importance of seeing a dentist

8
Demographic Information

• Overall response rate 73
• Mothers age
• 20-34 years 78.1
• 35 years 10.5
• Mothers race/ethnicity
• White 75.1
• Hispanic 16.2
• Other 8.6

9
Demographic Information

• Maternal Education
• At least 12 years 79.5
• Unknown 2.4
• Marital status
• Unmarried/divorced/annulled 28.4
• Married or separated 71.6

10
Demographics Lifestyle

• Family Income
• 15,000 - 29,999 26.0
• 30,000 - 49,999 23.6
• 50,000 26.7
• Smoked during pregnancy 16.0
• Alcohol in 3rd trimester 9.3

11
Prenatal Care Birth Outcomes

• Prenatal care in 1st trimester 81.8
• Normal birth weight 95.2
• Payor for labor and delivery
• Private insurance 62.7
• Public insurance 32.1
• No insurance/other 5.2

12
During your pregnancy...
Question
No
Yes
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
I needed to see a dentist for a problem
72
28
I went to a dentist or dental clinic
57
43
I had my teeth cleaned in the last year
53
47
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
28 of women
Did NOT go to dentist 40
Went to dentist 60
11 of all women
15
Did NOT go to dentist ...
Among women who said they needed care, those most
likely NOT to see a dentist
Univariate OR (95 CI)
Multivariate OR (95 CI)
Income 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
PRAMS 2000 and 2001 Combined
16
Oregon (2000) Compared to Other States (1998)
Gaffield ML, et al. JADA 20011321009-16.
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
Odds Ratio
95 CI
Multivariate Analysis
WIC Enrollment
1.69
1.28-2.22
Hispanic
1.96
1.47-2.63
Late/No Prenatal Care
1.69
1.22-2.38
Smoked in 1st Trimester
1.85
1.35-2.56
PRAMS 2000 and 2001 Combined
19
Had Teeth Cleaned in Last Year
20
Summary

• Many pregnant women do not seek dental care even
  if they have a problem
• Healthcare workers are not talking to women about
  oral health
• Low-income and Hispanic women are less likely to
  seek dental care

21
Potential Recommendations

• Educate health care workers
• Educate pregnant women
• Target high risk women
• Develop a referral network
• Medicaid dental for pregnant women
• Oral health questions in PRAMS

THE END