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
Background
A tooth for every pregnancy Pregnancy & oral health
pregnancy gingivitis, pyogenic granuloma
Recent focus on pregnancy & birth outcomes transmission of mutans streptococci
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
What is PRAMS?
Pregnancy Risk Assessment Monitoring
System
Collects state-specific information on maternal attitudes and experiences
Improve the health of mothers and
infants
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
Participating States - 2003
www.cdc.gov/reproductivehealth/pramstates.htm
31 states plus New York City
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
Demographic Information
Overall response rate 73% Mothers age
< 20 years 11.4% 20-34 years 78.1% > 35 years 10.5%
Mothers race/ethnicity White 75.1% Hispanic 16.2% Other 8.6%
Demographic Information
Maternal Education < 12 years 18.1% At least 12 years 79.5% Unknown 2.4%
Marital status Unmarried/divorced/annulled 28.4% Married or separated 71.6%
Demographics & Lifestyle
Family Income < $15,000 23.7% $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%
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%
During your pregnancy...
I needed to see a dentist for a problem 72 28
I went to a dentist or dental clinic 57 43
A healthcare worker talked with me about:a. the importance of seeing a dentistb. how to care for my teeth/gums
6961
3139
Question % No % Yes
I had my teeth cleaned in the last year 53 47
30.6
44.6
51.8
0
10
20
30
40
50
60
Importance ofseeing a dentist
Physical abuseby husband
Using a seat belt
PercentYes
During your prenatal visits, did a health careworker talk with you about ...
Needed to see a dentist ...
Needed to see a dentistbecause of a problem
Did NOT goto dentist
40%
Wentto dentist
60%
11% of all women
28% ofwomen
Did NOT go to dentist ...
Income < $30,000 2.041.25 - 3.33
1.961.19-3.22
Hispanic 1.631.13-2.35
1.420.95-2.13
UnivariateOR (95% CI)
MultivariateOR (95% CI)
Among women who said they needed care, those most likely NOT to see a dentist:
PRAMS 2000 and 2001 Combined
0
10
20
30
40
50
Oregon Illinois Louisiana New Mexico
Had dental problem Went for dental care
Oregon (2000) Comparedto Other States (1998)
Gaffield ML, et al. JADA 2001;132:1009-16.
46.5
23.6
16.4
8.54.9
05
101520253035404550
< 1 Year 1-2 Years 2-5 Years 5+ Years Never
How long has it been since you had yourteeth cleaned by a dentist or hygienist?
Did NOT Have Teeth Cleaned in Last Year
WIC Enrollment
Smoked in 1st Trimester
Late/No Prenatal Care
Hispanic
1.69
1.96
1.69
1.85
1.28-2.22
1.47-2.63
1.22-2.38
1.35-2.56
Odds Ratio 95% CIMultivariate Analysis
PRAMS 2000 and 2001 Combined
Had Teeth Cleaned in Last Year
46.5
66.5 69.0
0
10
20
30
40
50
60
70
80
Oregon PRAMS Oregon BRFSS National BRFSS
Pre
cen
t o
f R
esp
on
den
ts
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