Barriers to Preventive Oral Health Care during Pregnancy Among New Mothers-Florida PRAMS 2012-2013

BACKGROUND:  Regular preventive dental care is important for overall health, and should be maintained during pregnancy as the physiologic changes associated with pregnancy may result in noticeable oral health changes. However, many pregnant women do not visit the dental office. Research has identified several barriers to obtaining dental care during pregnancy including lack of dental insurance and misconceptions about the safety and appropriateness of dental care during pregnancy. The purpose of this analysis is to identify characteristics and barriers associated with a preventive dental visit during pregnancy among new mothers in Florida. 

METHODS:  We used weighted data from the 2012 and 2013 Florida Pregnancy Risk Assessment Monitoring System (PRAMS) matched to birth certificates. Chi-square statistics were calculated for the outcome of interest (preventive dental visit). Unadjusted and adjusted risk ratios (aRR) and 95% confidence intervals were calculated using Poisson Regression. Demographic characteristics of interest included race/ethnicity, age, education, household income, and marital status. The following behaviors, experiences, and characteristics were included in our analysis, hereby referred to as “barriers to care”: preconception teeth cleaning behavior, receiving preconception and prenatal education about the importance of visiting the dentist, patient knowledge, and having dental insurance during pregnancy. 

RESULTS:  Overall, 36.5% of new mothers in Florida had a preventive dental visit during pregnancy. Chi-square statistics revealed significant differences in receipt of a preventive dental visit by all the demographic variables of interest. Household income less than $44,000 was significantly associated with not receiving a preventive dental visit during pregnancy (aRR=1.72, 95% CI: 1.52, 1.95). All of the identified barriers to care were significantly associated with not receiving a preventive dental visit in adjusted analyses. In particular, relative to new mothers who received a preventive dental visit, the following women were more likely to not receive a preventive dental visit: women with no preconception teeth cleaning (aRR=2.61, 95% CI: 2.31, 2.93), women without prenatal education (aRR=2.46, 95% CI: 2.19, 2.76) and women without dental insurance during pregnancy (aRR=1.58, 95% CI: 1.45, 1.72). 

CONCLUSIONS:  The majority of new mothers in Florida are not receiving preventive dental care during pregnancy. Preconception maternal behavior, discussions with providers during pregnancy, and insurance coverage are particularly impactful. Programmatic efforts should focus on promoting preconception health for all women, reinforcing the safety and appropriateness of dental care during pregnancy to both expectant mothers and providers, and expanding accessibility and coverage of dental services during pregnancy.