Dentists' Perceptions of Barriers to Providing Dental Care to Pregnant Women

doi:10.1016/j.whi.2010.05.007

Women's Health Issues

Volume 20, Issue 5, September–October 2010, Pages 359-365

https://doi.org/10.1016/j.whi.2010.05.007 Get rights and content

Abstract

Purpose

The purpose of the study was to understand US dentists' attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely.

Methods

In 2006 and 2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists' attitudes toward providing care to pregnant women, dentists' knowledge about the safety of dental procedures, and dentists' current practice patterns.

Results

Dentist's perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 (p = .12; n = 772; df = 52) and a Bentler-Bonett normed fit index of .98 and a comparative fit index of .993. The root mean square error of approximation is .02.

Conclusion

Findings suggest that attitudes are significant determinants of accurate knowledge and current practice. Multidimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second, and third trimesters, dentists' knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.

Section snippets

Introduction and Background

Poor maternal oral health can increase the risk of complications of pregnancy, including preterm delivery or low birth weight, gestational diabetes, preeclampsia, small for gestational age infants, and stillbirth (Vergnes & Sixou, 2007). Moreover, fetal exposure to oral pathogens may increase risk of subsequent neonatal intensive care admission (Jared et al., 2009). However, the periods before and after pregnancies are also important (D'Angelo et al., 2007). Health care goals during the

Dental Utilization Is Low for All Women

The utilization of dental care during pregnancy is reported to be low (Le et al., 2009, Lydon-Rochelle et al., 2004). Data from an ongoing population-based survey conducted by the CDC (the Pregnancy Risk Assessment Monitoring System) indicate the proportion of women who receive dental services during pregnancy varies among the US states, and ranges from 23% to 43% (Gaffield et al., 2001, Jeffcoat et al., 2001, Mangskau and Arrindell, 1996). In one study among women who reported having oral

Insurance Coverage for Dental Services Is Not Sufficient to Reduce Barriers to Care

Access to dental care is severely limited for low-income pregnant women (even those with Medicaid) and limited at all times for other women with limited social, political, and cultural resources. Pregnancy represents a time of increased risk of dental pathology and need for good care. According to a population-based study conducted in North Dakota, young women, particularly teenage mothers, women in poverty, and women with Medicaid coverage, were at increased risk of not having a dental visit

The Problem Is Multidimensional

For low-income women eligible for Medicaid, pregnancy and the post-partum period can be the only times when they have access to dental care. It is essential that low-income women and women with oral health problems before or during pregnancy seek dental care. Dental care is safe during pregnancy; the optimal period for care is during the second trimester and emergency services can be provided at any time. Barriers to receipt of dental services during pregnancy include lack of knowledge or

Participants

The sampling frame included all general dentists in Oregon in 2005. Contact information was taken from the Masterfile of the American Dental Association, which includes all licensed dentists: 1,604 general practitioners were listed for 2005; 729 (55.2%) participated in the survey. The study was conducted in 2006 and 2007.

Source of Data and Survey Procedure

The study method was a mailed survey of dentist's attitudes, practices, and knowledge regarding provision of dental care to pregnant women. We employed the tailored design

Descriptive Findings

The dentists reported seeing between 2 and 3 pregnant patients per week, on average (M = 2.55; SD = 1.09); the median was four pregnant patients per week. Table 1 presents the mean and standard deviation of each constructed scale of perceived barriers regarding provision of care. Higher scores on the barriers indicate stronger perceived resistance in terms of counseling, compensation, pressure from office staff, and pressure from peers in medicine. The highest level of perceived barriers toward

Discussion

Our paper investigates how far dental professionals have come in adopting perinatal care practices that follow recommendations of the New York State Department of Health's expert panel and the CDC. Attitudes are important and barriers clearly remain. Dentists indicated that high levels of perceived time and economic costs, and dissatisfaction with compensation by insurers, were significant barriers to provision of care for pregnant patients. Results from our analysis confirm that dentists'

Dr. Lee was a research assistant in the Department of Dental Public Health Sciences and a graduate student in the Department of Sociology and Demography, at the University of Washington.

References (29)

M.L. Gaffield et al.
Oral health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system
Journal of the American Dental Association
(2001)
R. Grol et al.
From best evidence to best practice: effective implementation of change in patients' care
Lancet
(2003)
C.E. Huebner et al.
Providing dental care to pregnant patients: a survey of Oregon general dentists
Journal of the American Dental Association
(2009)
M.K. Jeffcoat et al.
Periodontal infection and preterm birth: results of a prospective study
Journal of the American Dental Association
(2001)
M. Kobayashi et al.
The effectiveness and estimated costs of the access to baby and child dentistry program in Washington State
Journal of the American Dental Association
(2005)
P. Milgrom et al.
Medicaid reforms in Oregon and suboptimal utilization of dental care by women of childbearing age
Journal of the American Dental Association
(2010)
J.N. Vergnes et al.
Preterm low birth weight and maternal periodontal status: a meta-analysis
American Journal of Obstetrics and Gynecology
(2007)
American Academy of Pediatric Dentistry. (2008). Clinical guideline: Oral health care for the pregnant adolescent....
American Dental Association. (2000). ADA position statement on early childhood caries, 2000. Available:...
American Dental Association. (2009). State innovations to improve access to oral health: A compendium update...

K.A. Bollen

Structural equations with latent variables

(1989)

Centers for Disease Control and Prevention (CDC)

Recommendations for using fluoride to prevent and control dental caries in the United States

Morbidity and Mortality Weekly Report Recommendations and Reports

(2001)

L.S. Chavers et al.

Racial and socioeconomic disparities in oral Disadvantage, a measure of oral health-related quality of life: 24-month incidence

Journal of Public Health Dentistry

(2002)

D. D'Angelo et al.

Preconception and interconception health status of women who recently gave birth to a live-born infant–Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas 2004

Morbidity and Mortality Weekly Report Surveillance Summary

(2007)

Cited by (44)

Dentists’ knowledge of non-surgical root canal treatment, a systematic review
2024, Journal of Dentistry
Dental practice is based upon dentists’ cognitions, knowledge being foundational. Knowledge is attained through education and perception. Although knowledge is modulated by beliefs, attitudes, preferences, and behaviors, it is essential to evidence-based practice. Cross-sectional studies uniformly demonstrate that community NSRCT is of sub-optimal quality worldwide, is lack of knowledge a problem? Our purpose was to measure dentists’ knowledge of root canal treatment (NSRCT).
Quantitative and qualitative data were extracted: purpose, topics assessed, authors cited knowledge sources, number of dentists studied, number of questions, authors descriptors of knowledge level,% correct answers by question, authors recommendations.
OVID Medline, EMBASE, Web of Science, and hand-searching.
Studies which had measured dentists’ knowledge of non-surgical root canal treatment that was valuable, reliable, and had practical implications which could be implemented. A total of 51 papers from 19 countries measured the knowledge of 15,580 dentists using 445 questions on 29 root canal treatment topics.
‘Gold standards’ were from literature, external bodies, or expert consensus in 47, 31, and 2 papers respectively. Levels of knowledge by percentage correct answers among studies were poor to moderate and varied considerably. The mean, for the 50 studies where overall study percentages could be calculated, was 57 %, standard deviation 17 %, and a range of 16 % to 82 %. Authors’ adjectives describing knowledge levels were generally negative. Additional education was advised in 49 papers, but without evidence that education was inadequate; 6 papers recommended increased use of protocols; only 5 papers advocated research on the cause of lack of knowledge.
Dentists’ root canal treatment knowledge was found to be poor to moderate, as well variable. This may constrain quality of care. However, provision of information without attention to dentists’ cognitions and motivations may not be successful. Educational strategies and goals should be re-evaluated. Evidence-based practice faces many barriers.
Dental Anxiety Amongst Pregnant Women: Relationship With Dental Attendance and Sociodemographic Factors
2022, International Dental Journal
Citation Excerpt :
Seeking dental treatment is not only for the maintenance of the mother's oral health but also for the infant's, because if a pregnant woman has dental caries, then the cariogenic bacteria can be transmitted to her infant.4 Many factors have been associated with the neglect of oral health amongst pregnant women, including patient's low oral health knowledge, negative dental experience, or the dentist's misconception of not providing dental treatment during pregnancy.1,5 Poor access to oral care amongst pregnant women is also related to low socioeconomic status and distant geographic locations.3
: Access to oral care during pregnancy is important for the maintenance of optimal oral health.
: The aim of this study was to estimate dental anxiety (DA) and its association with previous dental visits and sociodemographic factors amongst pregnant women.
: A cross-sectional study was conducted (June through August 2019) amongst pregnant women (N = 825) attending hospitals and health centres in Dhahran, Khobar, and Dammam cities in the Eastern province of Saudi Arabia. The Modified Dental Anxiety Scale (MDAS) was used to assess DA and the World Health Organization Oral Health Survey for Adults was administered to evaluate patterns of dental attendance.
: DA was found in 90.9% of the pregnant women. The mean DA score of the sample was 12.53 ± 5.33 (range, 5 to 25) and it was significantly higher amongst non-Saudi (13.21 ± 5.24) vs Saudi women (12.15 ± 5.34) (P = .006), those who had negative dental experience (13.99 ± 5.62) vs those without such experience (12.2 ± 5.21) (P < .001), and those with dental pain or discomfort (13.18 ± 5.46) vs without pain or discomfort (11.94 ± 5.14) (P = .001). The study found a significant relationship between DA and reasons for dental attendance before pregnancy (P = .002) and time since the last dental visit (P = .009). Multiple logistic regression analysis showed significantly increased odds (OR, 1.69; 95% CI, 1.25 to 2.27) of experiencing moderate to extreme DA amongst pregnant women who visited the dentist after a year/never visited compared to those who visited in less than a year. Similarly, participants with negative dental experience were significantly more likely to have moderate to extreme DA (OR, 1.49; 95% CI, 1.02 to 2.20) than those without negative experience after adjusting for sociodemographic factors.
: DA was highly prevalent amongst pregnant women, which was significantly associated with negative dental experience, dental pain or discomfort, and reasons for and time since the last dental visit.
Characterizing the Subgingival Microbiome of Pregnant African American Women
2019, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Citation Excerpt :
Socioeconomic disparities related to prenatal oral hygiene practices and dental service use during pregnancy also exist (Boggess et al., 2010; Eke, Dye, Wei, Thornton-Evans, & Genco, 2012) and are major public health concerns. Several structural and behavioral factors may be at work, including limited health care resources (Lee, Milgrom, Huebner, & Conrad, 2010), lack of understanding about the importance of prenatal preventive oral health practices (Marchi, Fisher-Owens, Weintraub, Yu, & Braveman, 2010), and poor adherence to recommendations from dentists and maternal health care providers regarding oral health care (Lee et al., 2010; George et al., 2012). To investigate the high rate of preterm birth in African American women and prevent confounding that may result from comparisons across racial groups, studies that are focused on risk within a racial subgroup are needed.
To generate preliminary data about the subgingival microbiome of pregnant African American women to calculate power for a future larger study and to explore associations among the microbiome, periodontal inflammation, and preterm birth.
Comparative descriptive pilot study design.
Urban area in the southeastern United States.
Thirty-four African American women in the third trimester of pregnancy.
Based on visual assessment, participants were placed in two groups: healthy gingiva and gingivitis. Saliva samples were analyzed for interleukin-1β (IL-1β), matrix metalloproteinase–8 (MMP-8), and C-reactive protein (CRP). DNA was extracted from subgingival plaque samples, and amplicons of the fourth hypervariable region were sequenced.
We found no differences in overall microbiome diversity between the healthy gingiva (n = 22) and the gingivitis (n = 12) groups although significant differences were found among the bacterial taxa present. The gingivitis group had greater levels of salivary IL-1β and MMP-8, whereas CRP was not different between groups. Overall microbiome diversity was positively associated with the CRP level. We found no significant relationships among the subgingival microbiome, periodontal inflammation, and preterm birth.
Gingivitis in pregnancy did not appear to shift the overall composition or diversity of the subgingival microbiome although differences in several bacterial taxa suggest that inflamed gingiva in pregnant women are associated with a disruption in the stability of the subgingival microbiome. A correlation between the abundance of bacteria and CRP also suggests an association between the microbiome and systemic inflammation. These findings provide support for future research about how the oral microbiome and progression of periodontal disease in pregnant women link with adverse pregnancy outcomes.
Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned
2023, Health Promotion Practice
Physiology of pregnancy and oral local anesthesia considerations
2023, PeerJ
Pain Relief Effects and Safety of Transitional Therapy in the Treatment of Posterior Teeth of Pregnant Women with Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis
2022, International Journal of Women's Health

View all citing articles on Scopus

Dr. Lee was a research assistant in the Department of Dental Public Health Sciences and a graduate student in the Department of Sociology and Demography, at the University of Washington.

Dr. Milgrom is Professor of Dental Public Health Sciences in the School of Dentistry and Director of the Northwest Center to Reduce Oral Health Disparities at the University of Washington.

Dr. Huebner is Associate Professor in the Department of Health Services and Director of the Maternal and Child Health Program, School of Public Health at the University of Washington.

Dr. Conrad is Professor of Health Services, School of Public Health at the University of Washington.

: Supported by Grant No. R40MC03622 from the Maternal and Child Health Bureau, HRSA, and Grant No. No. U54DE019346 from the National Institute of Dental and Craniofacial Research, NIH.

View full text

Original articleDentists' Perceptions of Barriers to Providing Dental Care to Pregnant Women

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Introduction and Background

Dental Utilization Is Low for All Women

Insurance Coverage for Dental Services Is Not Sufficient to Reduce Barriers to Care

The Problem Is Multidimensional

Participants

Source of Data and Survey Procedure

Descriptive Findings

Discussion

Journal of the American Dental Association

Lancet

Journal of the American Dental Association

Journal of the American Dental Association

Journal of the American Dental Association

Journal of the American Dental Association

American Journal of Obstetrics and Gynecology

Structural equations with latent variables

Recommendations for using fluoride to prevent and control dental caries in the United States

Morbidity and Mortality Weekly Report Recommendations and Reports

Racial and socioeconomic disparities in oral Disadvantage, a measure of oral health-related quality of life: 24-month incidence

Journal of Public Health Dentistry

Preconception and interconception health status of women who recently gave birth to a live-born infant–Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas 2004

Morbidity and Mortality Weekly Report Surveillance Summary

Original article
Dentists' Perceptions of Barriers to Providing Dental Care to Pregnant Women