maternal and child oral health ～ during pregnancy and early childhood

1. maternal and child oral health～during pregnancy and early childhood January 19, 2006 Hiroko Iida, D.D.S., M.P.H. Assistant Professor Division of Pediatric Dentistry Eastman Department of Dentistry University of Rochester

2. Why maternal and child oral health? • Poor maternal periodontal health may contributes to the incidence of preterm and low birth weight • Poor maternal oral health may increase the risk of early childhood caries • The consequences of poor oral health can have a lifelong impact

3. Periodontal health during pregnancy • Pregnancy gingivitis • in over 30% of pregnant women • Periodontal disease • in 37-46% of women of reproductive age • in up to 30% of pregnant women Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

4. Periodontal health during pregnancy • Potential associations between severe periodontitis and poor pregnancy outcomes (low birth weight and/ or preterm birth). • Early periodontal intervention during pregnancy might reduce the adverse birth outcomes. Graffield ML et al. Oral health during pregnancy: An analysis of information collected by the Pregnancy Risk Assessment Monitoring System. JADA 2001; 132 (7): 1009-16 Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

5. Dental caries among children and adolescents in the U.S. • Dental caries is one of the most common chronic diseases among 5-to 17- year-olds NCHS 1996 Oral Health in America: A report of the Surgeon General

6. Dental caries: decline and epidemic • Fluoride • Water fluoridation • Fluoride dentifrices • Improved awareness on oral health • Disproportional distribution among younger age and disadvantaged population

7. Dental caries among children and adolescents in the U.S. • 25% of the nation’s most vulnerable children account for 80% of the cases of dental caries. • Poor children have 4 times the prevalence of severe dental decay as non-poor children and 2.4 times their unmet need for dental treatment. Healthy People 2010 Progress Review Oral Health. U.S. Department of Health and Human Services. March 17, 2004

8. Definition of Early Childhood Caries (ECC) • “The presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth in a child 71 months of age or younger” • "Severe Early Childhood Caries" refers to "atypical" or "progressive" or "acute" or "rampant" patterns of dental caries. AAPD & ADA Position and Statement on Early Childhood Caries 2000.

9. Prevalence of ECC • Overall 27.5% • 10.9% of 2-year-olds and 44.3% of children of 5-year-olds. • As high as 70% within disadvantaged populations: low SES, ethnic minorities, immigrants. Iida H, Auinger P, Weitzman M, Billings RJ. No Association between infant breastfeeding and early childhood caries.NHANES 1999-2002 Weinstein P. Public health issues in early childhood caries. Community Dent Oral Epidemiol 1998; 26(supplement 1): 84-90

10. ECC and Impact on Public Health • Cost of treatment can range from $1,500 to 2,000. • Poor outcome of the treatment. • Impact on general health and future caries risk.

11. ECC and treatment outcomes • Poor compliance for recalls and high rate of relapse • 39% of those who returned in 6 months after treated under G.A. (72%) had new caries lesions • 45% relapsed by the end of 12 months post tx • 31% returned in 6 months and 38% of them had new caries lesions Chase I, Berkowitz R et al. Clinical Outcomes for ECC; the Influence of Salivary MS levels. Eur J Pediatr Dent. 2004 Sept; 5(3): 143-6 Almeda AG, Roseman MM et al. Future caries susceptiblity in children with ECC following treatment under GA. Pediatr Dent 2000: 22(1); 33-37 Primosch RE, Balsewich CM et al. Outcomes assessment an intervention strategy to improve parental compliance to follow-up evaluations after treatment of ECC using GA in a Medicaid population. ASDC J Dent Child 2001; 68(2):102-8

12. Child’s oral health behaviors • Child’s oral health behaviors are dependent, in part, on parental oral health beliefs and behaviors

13. The factors that influence child’s oral health behaviors • Parental dental behaviors • More parents who brought their children for emergent care had more emergency visits themselves in the past 2 years than parents in the counter group. • More parents who brought their children for regular care had more hygiene visits themselves in the past 2 years than parents in the counter group.

14. The factors that influence child’s oral health behaviors • Previous pain that parents experienced in the last dental visit. (p=0.0001) • Perceived problems of access dental care for themselves and for their children. (p=0.0001) • Parental dental problems (toothaches, sensitivity, bleeding). (p=0.0001) N. Nauman, H. Iida, C. Feng. Determination of factors that impact utilization of dental services among parents of pediatric patients who seek episodic dental care. Eastman Dental Center, University of Rochester. Rochester, NY

15. Findings from other studies • Mothers that report good oral health and believe in care for their children are five times as likely to have a usual source of care for themselves than mothers who report both poor oral health and more negative attitudes about dental care for children. • Interventions aimed at child health that ignore the welfare of the mother are likely to be less successful than those that also address the mothers' needs. Skaret E, Milgrom P, Raadal M, Grembowski D. Factors influencing whether low-income mothers have a usual source of dental care. J Dent Child, Vol. 68(2), 136-9, 2001

16. Vertical (from mother to child) transmission of mutans streptococci (MS) • Most children appear to acquire MS (cariogenic bacteria) from their mothers. • Mothers who have untreated dental caries appear to be at greater risk to pass on Streptococcus species than mothers without caries. • DNA fingerprinting studies show genotype matches between mothers and infants in over 70% of cases. Berkowitz RJ, Jones P. Mouth-to-mouth transmission of the bacterium Streptococcus mutans between mother and child. Arch Oral Biol. 1985; 30: 377-379 Caufield PW, Grifen AL. Dental Caries: An infectious and transmissible disease. Pediatric Clinics of North America. 2005

17. Colonization of mutans streptococci (MS) • Primary oral infection by mutans streptococci may occur in predentate infants. • Children whose teeth are colonized by MS at an early age show higher caries experience than those colonized later or not at all. Berkowitz RJ. Acquisition and transmission of Mutans Streptococci. CDA Journal. 2003; 31(2): 135-8

18. Oral health promotion during pregnancy and early childhood • Expectant or new mothers heightened readiness to learn and to be motivated to care for her own health and that of her baby. • Women and children have multiple health care visits during pregnancy and the first year of life

19. Access to oral health care during early childhood • AAPD, ADA and AAP recommend the first dental visit within 6 months after the eruption of the first tooth and no later than the first birthday… Estimate for number of children/ 1000 participating in Health Care in a Typical Month, by age (Standard Error of Mean) Age N Visiting a Physician’s office N visiting a dentist < 2 y 362.6 (13.9) 1.8 (1.1) 2-5 y 193.5 (6.1) 37.8 (2.0) 6-12 y 141.7 (4.6) 96.6 (4.3) 13-17 y 141.7 (4.8) 133.4 (7.2) S. Dovey, M. Weitzman et al. The Ecology of Medical Care for Children in the United States. Pediatrics 2003; 111(5): 1024-1029

20. Oral health promotion during pregnancy • For many women, pregnancy is the only time that they have medical and dental insurance. • Periodic dental exam and hygiene every 6 months is a standard of care today. Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

21. Access to oral health care during pregnancy • 34% of Medicaid insured pregnant women saw a dentist compared to 55% of pregnant women with private insurance carriers (2002 New York State Pregnancy Risk Assessment Monitoring System) Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

22. Barriers for access to dental care during pregnancy and early childhood • Barriers that exist in the patient side: • Low priority in oral health • Lack of awareness for dental care during pregnancy and early childhood • Misconceptions • x-rays and dental treatment during pregnancy are harmful • It is too early to bring children younger than 3 years of age for a dental check-ups

23. Barriers for access to dental care during pregnancy and early childhood • Barriers that exist in provider side: • Limited number of providers who treat pregnant women and young children under 3 years of age • Lack of recognition about maternal and child oral health issues • Anecdotal fear about risk for pregnancy and pregnancy outcomes

24. The guidelines “oral health care during pregnancy and early childhood” • Bureau of Dental Health, New York State Department of Health • Recommendations for prenatal, oral health and child health professionals • Will be available electronically in the spring 2006

25. Integration of oral health into perinatal care systems • Perinatal Care Providers • Assess risks and needs • Referral to dental care providers • Oral health education Pregnant women/ Mothers Oral Health Care Providers • Child Care Providers • Assess risks and needs • Referral to dental care providers • Anticipatory guidance • Oral health education Children

26. Key questions at the prenatal visit • Do you have bleeding gums, toothache, cavities, loose teeth, or other problems in your mouth? • Have you had a dental visit in the last 6 months? Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

27. Oral health education at prenatal visit • Dental care is safe and effective during pregnancy. • Delay in obtaining necessary treatment could result in significant risk to mother and unborn child. • Importance of regular dental visit • Brushing, flossing, eating healthy by limiting the intake of fermentable carbohydrates Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

28. Lift the lip/ open wide at child health visit • Check for: • Oral hygiene • White spots (chalky white area on smooth surface) on baby’s upper front teeth and dental decays on the chewing surface of back teeth

29. Key questions at child health visit • Ask mother: • If the child has any special health care needs • If there is a family dentist • If the child has been to a dentist (if >1 y/o) within 6 mos • If the mother has been to a dentist within a year • If the child’s siblings or parent have any dental problems • If the mother gives her child age-appropriate oral hygiene • If the child goes to bed with a bottle containing a sugary liquid • If child has an access to fluoridated drinking water, supplements, or toothpaste Bureau of Dental Health, New York State Department of Health. Oral Health Care During Pregnancy and Early Childhood

30. Oral health intervention at child health visit • Educate mother: • Age appropriate oral hygiene • The first dental visit should occur within 6 months after the eruption of the first tooth and no later than the first birthday • Prevention is more effective than treatment • Avoid saliva-sharing behaviors between family • Avoid putting the child to bed with a nursing bottle or sippy cup containing sugary liquids • Referrals to a dentist and assist in establishing a dental home for the child and mother

31. Useful oral health resources at perinatal care settings • Colgate Bright Futures Bright Smiles brochures • http://www.colgate.com/app/BrightSmilesBrightFutures/US/EN/OHE/Online_Articles/PregnancyThroughToddlerYears.cvsp • For pregnant mothers and new parents • prenatal, 0-6 months, 6-18 months, 18-24 months • Bright Futures in practice: Oral Health • http://www.brightfutures.org/oralhealth • Prenatal, infancy, early childhood

32. Eastman Dental Center 625 Elmwood Avenue 14620 585-275-5051 Strong Memorial Hospital 601 Elmwood Ave 14642 585-275-5531 Rochester General Hospital 1425 Portland Avenue 14621 585-338-4000 Highland Hospital 1000 South Ave 585-271-4636 Downtown Dental Center 228 E. Main St 14604 585-423-1880 Orchard St Community Health Center 158 Orchard 14611 585-436-8123 Anthony Jordan Health Center 82 Holland Street 14605 585-423-5800 Unity Dental Group 89 Genesee Street 14611 585-368-3800 2440 Ridgeway Avenue 14626 585-295-1890 2060 Fairport Nine Mile Point Rd 14526 585-377-5810 Dental clinics that accept Medicaid in Finger Lakes Region

33. Dental clinics that accept Medicaid in Finger Lakes Region cont. • Westside Health Services • Woodward Health Center 480 Genesee 14611 585-436-3040 • Brown Square Center 322 Lake Ave 14608 585-254-6480 • Small Smile Dentistry 720 E Ridge Rd 14621 585-663-1624 * Dental clinics with underline see young children

34. To develop oral health component in your perinatal program • Organize workshops or study group meeting to learn about NYSDH oral health guidelines! • invite a dental professional (who would accept referrals) • discuss about dental referral system • referral forms, appointment making, medical clearance • develop materials to educate pregnant women or mothers about oral health • organize periodic meetings to evaluate effectiveness of the processes and materials

35. Thank you! Email: Hiroko_Iida@urmc.rochester.edu Phone: 585-275-5540