NSW Rural Allied Health Conference November 2011 Libby Baldwin
& Mary-Anne Menhennitt Slide 2 Acknowledgements CETI/Rural
Division Rural Research Capacity Building Program, RRCBP Emma
Webster and David Schmidt NSW Health, Centre for Oral Health
Strategy, COHS Jennifer Noller Smile Mum Team Deniliquin Slide 3
Key words and acronyms Caries tooth decay. Early childhood caries,
ECC several decayed teeth before the age of 5. GA general
anaesthetic. Low Birth Weight LBW babies born less than 2500g
Streptococcus Mutans, S Mutans bacteria causing tooth decay. Slide
4 The background Smile Mum Continuing high rates of Early Childhood
Caries (ECC) During a 10 month period on 2007, Deniliquin Dental
Clinic referred 11 children in the 0-5 age group for GA treatment
of serious caries infection. Slide 5 Early Childhood Caries Current
early childhood programs are not preventing this decay in our risk
groups because 1. decay process has already begun 2. the most
disadvantaged children do not attend these centres 3. Earlier
intervention needed > pregnancy Slide 6 Pregnancy/oral disease
links Pregnant women have specific and heightened dental needs gum
disease.(11) Current research - adverse pregnancy outcomes LBW,
Pre- term. (12) Maternal link to development of ECC via
transmission of S. Mutans.(6,7,8,9,15) Pregnancy is an optimum time
for change.(15,17) Slide 7 The Smile Mum Intervention Referral from
pre natal health care providers Pre and post natal dental
appointments Dental treatment Oral health promotion Oral care
products Smoking cessation advice Data collection Ongoing managed
care Slide 8 Gift Pack for Mums at first Ante Natal visit and again
at Post Natal visit Slide 9 Smile Mum Study 2 Evaluation of Smile
Mum, a program to improve the oral health of pregnant women and
reduce the risk of dental disease for them and their child.
Developed with the help of the CETI RRCBP. Ethics approval from the
Approval for the study was obtained from Southern NSW Local Health
Network Human Research Ethics Committee in July 2011. Slide 10
Participants Women who had completed both the pre and post natal
Smile Mum dental appointments All were holders of a government
concession card Participation rate was 52% of all those invited
with a total of 16 participants. Slide 11 Objectives Did Smile Mum
result in improved access to dental services better oral health
increased knowledge of maternal/infant oral health links
satisfaction with the Smile Mum program for the participants? Slide
12 Methods 1.Analysis of pre and post natal comparative data from
the existing Smile Mum data base. Disease risk assessment score:
Knowledge quiz Smoking status Oral hygiene habits Clinical
examination Lifestyle questionnaire Slide 13 Methods 2.A 28
question Likert scaled survey posted home to all who had completed
the Smile Mum program. Smile Mum experience Mother/baby oral health
Oral hygiene Smoking status Opportunity for general feedback
comments Slide 14 Results: Improved access to dental services Check
up in previous pregnancy? No = 11 Yes = 4 n/a = 1 Slide 15 Results:
Improved access to dental services Smile Mum made it easier for me
to attend dental appointments? Slide 16 Pre natal care health
providers as referrers of pregnant women to dental service Data
base showed most were from outside regular dental networks. Midwife
= 7 GP = 4 Dental clinic = 3 OHIS = 1 Poster = 1 Ante-natal class =
1 Slide 17 Results: Improved access to dental services I am so glad
Smile Mum was introduced to me as I probably wouldnt have sought
dental care otherwise. Now that it has I will definitely visit the
dentist often as I was too scared before. Slide 18 Results: Better
oral health Oral disease risk assessment score, (high, moderate,
low) showing difference between score pre and post Smile Mum
program Slide 19 Results: Better oral health Periodontal
classification score number corresponds to degree of periodontal,
(gum), infection Pre natal examination total of all scores - 65
Post natal examination total of all scores - 35 Difference - 30
This difference demonstrates a reduction in the clinical signs of
infection in the mouth, i.e. bleeding, inflammation etc;. Slide 20
Results: Better oral health My mouth is now healthier than before
Smile Mum? Slide 21 Results: Better oral health Yesterday I brushed
my teeth more than once .. Slide 22 Results: Better oral health I
would like to say thankyou for making my mouth and teeth much
healthier. I feel my oral hygiene has improved, particularly during
pregnancy Slide 23 Results: Increased knowledge of maternal/infant
oral health links The health of my mouth can affect the health of
my baby Slide 24 Results: Increased knowledge of maternal/infant
oral health links Mothers should not share a spoon with their baby
Slide 25 Results: Increased knowledge of maternal/infant oral
health links Bacteria from my mouth can be passed on to my baby
Slide 26 Results: Increased knowledge of maternal/infant oral
health links It is OK to clean your babys dummy in your own mouth
Slide 27 Results: Increased knowledge of maternal/infant oral
health links Quiz Pre natal total number of correct answers = 80
Post natal total number of correct answers = 106 Increased
knowledge = 26 correct answers Slide 28 Results: Increased
knowledge of maternal/infant oral health links Fantastic. Great
advice. Makes you think about yourself more and the importance of
taking care of yourself. Also makes you pass on the information to
your children. Excellent for mums and babies. Slide 29 Results:
Participant satisfaction with the Smile Mum Program. Smile Mum
provided me with all the dental treatment that I needed. Slide 30
Results: Participant satisfaction with the Smile Mum Program. I am
happy with the treatment I received in the Smile Mum clinic. Slide
31 Results: Participant satisfaction with the Smile Mum Program.
The dental hygienist taught me how to brush my teeth and gums
better than before Smile Mum Slide 32 Results: Participant
satisfaction with the Smile Mum Program. During the pregnancy a
tooth got infected and needed to be pulled out. I am still waiting
for my denture plate and it is very embarrassing to smile and talk
Slide 33 Results: Satisfaction with the Smile Mum program I am very
happy with the treatment I have received and am more likely to have
regular checkups. The staff is friendly and made me feel
comfortable. Slide 34 Smoking: risk factor for oral disease and
pregnancy complications Smile Mum Study 4 of 16 were smoking during
pregnancy Of these, 2 had quit at the time of the survey. When I
first started Smile Mum I was a smoker. After attending the first
session Libbys kind advice about my teeth made me quit. Since then
I have never gone back to smoking and I feel 100%better for it. Big
thanks! Slide 35 Results: Summary The study showed ( that Smile
Mum) increased access to dental treatment for most participants
that pre natal health providers were an important referral pathway.
there was a high level of satisfaction with the program most
participants had increased knowledge of maternal/child oral health
links. The pre and post natal comparison showed that there was an
overall improvement in oral hygiene and some minor improvements in
other oral disease risk assessment data. Slide 36 Recommendations
Strengthen and maintain the partnerships created with GPs and other
pre natal health professionals during Smile Mum. Continue the
referral process to enhance access to dental services for
disadvantaged pregnant women. Slide 37 Recommendations Continue to
develop the role of the dental professional as a smoking cessation
counsellor making use of the following methods: QUIT services
Motivational interviewing Brief intervention Slide 38
Recommendations Continue Smile Mum: Provide an ongoing oral health
managed care and recall program to Smile Mum participants Include
the children in this program and monitor their caries status.
Desired outcome children caries free at age 5. Slide 39 Smile Mum
Study 2 Bibliography 6. Katz J, Orchard AB, Ortega J, Lamont R,
Bimstein E Oral Health and Preterm Delivery Education: a New Role
for the Pediatric Dentist J Pediatric Dentistry: 2006;28:494-498 7.
Boggess KA, Edelstein BL Oral Health in Women During Preconception
and Pregnancy: Implications for Birth Outcomes and Infant Oral
Health Maternal Child Health J: (2006) 10:S169-S174 8. Boggess KA,
Beck JD, Murtha AP, Moss K, Offenbacher S Maternal periodontal
disease in early pregnancy and risk for a small-for gestational-age
infant. American Journal of Obstetrics and Gynecology (2006) 194,
1316-22 9. Law V, Seow WK, Townsend G Factors influencing oral
colonisation of mutans streptococci in young children Australian
Dental Journal 2007;52:(2):93-100 11. Gaffield ML, Colley Gilbert
BJ, Malvitz DM, Romaguera R Oral health during pregnancy: An
analysis of information collected by the Pregnancy Risk Assessment
Monitoring System. J Am Dent Assoc 2001; 132; 1009-1016 12. Laine
MA. 2002 Effect of Pregnancy on periodontal and dental health. Acta
Odontologica Scandinavica: 60(5):257-264 15. Chiodo T, Rosenstien L
Dental treatment during pregnancy a preventative approach JADA,
Vol. 110 1985 17. Thomas NJ, Middleton PF, Crowther CA Oral and
Dental Health care practices in pregnant women in Australia: a
postnatal survey BMC Pregnancy and Childbirth 2008, 8-13 First
International Conference of Health Promotion Ottowa, Canada. 21st
November 1986 Slide 40 Thank you From Libby & Mary-Anne
