Original articleDentists' Perceptions of Barriers to Providing Dental Care to Pregnant Women
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.
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2019, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation 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.
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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.