Improving Oral Health For Underinsured Women At First Prenatal Visit

BACKGROUND: Periodontal disease contributes to gestational diabetes, preeclampsia, preterm labor, and low birth weight in pregnancy. Women with low socioeconomic status often lack access to dental services and have low dental health literacy and practice. Dental treatment is safe during pregnancy and can reduce periodontal disease for some women. Prenatal and dental providers are aware of the possible adverse outcomes associated with poor oral health and the importance of oral health evaluation and treatment in pregnancy but may lack application of this knowledge in the clinical setting. PURPOSE: The project aimed to improve prenatal provider oral health knowledge and to increase provider activities of oral health education, assessment, and referral for underserved prenatal patients to dentists. METHODS: The project took place in two clinics in urban Salt Lake City that provide prenatal services to underinsured women. Prenatal providers from both clinics (4 Physicians, 3 NPs and 4 PAs) evaluate an estimated 30 new prenatal patients per month. The baseline frequency of provider-initiated oral health education, assessment, and referral to dentists was measured by a one-month chart review of all initial prenatal patients. Prenatal providers completed a pretest to assess their oral health knowledge and an 8-question survey about oral health prenatal screening practices. Providers had the option to engage in an on-line oral health refresher course for one Continuing Education Unit (CEU), followed by a post-survey to assess change in knowledge. Practice change after the educational intervention was measured by comparing pre and post-intervention data from a chart review that quantified the frequency of provider-initiated oral health education, assessment, and referral to dentists. No cases of documented provider-initiated oral health education, assessment, or dentist referrals were found in the baseline chart review. After completing the education module, post-test provider knowledge increased by an average of 24%. On 4 of 8 criteria for oral health assessment, provider intent to change increased > 1 point on a 5-point Likert-type scale. The post intervention chart review showed an increase in prenatal provider initiated oral health education by 10% (n = 3), assessment by 45 % (n = 13), and dentist referrals by 59% (n = 17). KEY FINDINGS: Prenatal provider engagement in oral health refresher training increased provider-initiated oral health education, assessment, and dentist referrals for underinsured women. CONCLUSION: Prenatal providers have gaps in oral health knowledge which can be addressed by on-line training. Low provider participation in an on-line module for CMEs could be addressed by finding the optimum time for training or by including the content in a larger educational venue. Oral health care for women with low socioeconomic status may improve through similar provider training by increasing provider oral health knowledge, oral assessments and patient dental referral. Other clinic processes may improve when addressed in a similar educational project.