Oral Health in Illinois: A Focus on Pregnancy and Early Childhood

Oral health is a key component of overall health, and optimal health can be maintained or improved during the prenatal period. Pregnancy is an opportune time for health interventions and serves as a “teachable” moment when women may be motivated to adopt more healthy behaviors. Studies show that oral health services are extremely important and can be provided safely during pregnancy. However, the use of dental services among pregnant women is far below that of the rest of the population. Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) indicate that in 2018, 84% of women had dental insurance during pregnancy, but only 43% had their mouth examined and teeth cleaned. The 2018 PRAMS data also show that women enrolled in Medicaid or who belonged to a racial or ethnic minority were much less likely to obtain oral health care when pregnant compared with women from families with higher incomes, those who were privately insured, or who were non-Hispanic White.

The perinatal period begins at conception and ends two months after delivery. It is a unique time during a woman’s life and is characterized by complex physiological changes that may adversely affect oral health. Several factors play a part in the oral health of women during this period, including the ability to access and utilize care; financing; knowledge, attitudes, and behaviors; and workforce preparedness and willingness to serve this population.

Physiological and behavioral changes during pregnancy may adversely affect oral health. In addition, studies report that the quality and amount of saliva declines and the levels of cariogenic oral bacteria increases during pregnancy, which elevates the risk for development and progression of tooth decay. Tooth decay during pregnancy can cause pain, nutritional deficiencies, lost workdays, and reduced employability, all of which adversely affect a woman’s quality of life. Additionally, children born to mothers with poor oral health and high levels of cavity-causing bacteria are at higher risk for developing tooth decay, the most prevalent preventable chronic disease of children in the United States. In one study, fluoride varnish application on women’s teeth reduced the transfer of cariogenic (caries-causing) bacteria to their children. These bacteria primarily pass from mother to child soon after birth and reducing the concentration of these bacteria in the mother’s mouth before birth leads to less bacteria being transferred and a reduced potential for the development of cavities in their children.

Pregnancy and motherhood are promising times for oral health promotion, better home care practices, and professional interventions by all health care providers. These activities include education on dental disease processes (primarily dental caries and periodontal diseases); self-care for prevention; professional services, such as fluoride varnish application (dental caries prevention); and teeth cleaning (promote health and treat inflammation of the supporting structures).

Improving access to dental care for maternal and preschool child populations is a considerable task, and one that requires an interdisciplinary approach. Medical care providers see both populations frequently, so they are in a unique position to support the dentist’s efforts to educate and to intervene when oral health problems are detected.

The focus of Oral Health During Pregnancy and Early Childhood in Illinois is to improve the health of women of childbearing age and young children. Receipt of preventive oral health care, education of the importance of effective self-care practices, and timely access to corrective treatments that address dental diseases are good for both the health of the woman and for the future oral health of their child. Access to information for primary prevention, funds for secondary prevention in the school setting, and for dental treatment has been a priority for the Illinois Title V Maternal and Child Health (MCH) Program. This has led to several prior initiatives to improve oral health among pregnant individuals and young children.

The American Congress of Obstetricians and Gynecologists states that dental treatment is safe and desirable during pregnancy. Unfortunately, 2018 Illinois data show that only 42.8% of new mothers had their teeth cleaned during their pregnancy. The use of dental services in children is similarly low, with only about 47.4% of Medicaid-eligible children in Illinois under the age of 21 receiving even one dental service in 2019.

An early Illinois Department of Public Health (IDPH) initiative, still relevant in today's arsenal, is education directed toward pregnant women and parents of young children, the Special Supplemental Nutrition Program for Women Infants, and Children (WIC) program providers, health center primary care workers, and oral health staff. Improving Women's and Children’s Oral Health, an in-office flip chart, was developed in response to the needs identified for bilingual oral health education materials. This tool continues to deliver appropriate preventive education to at-risk populations using a systematic approach that integrates oral health into existing state services to help reduce the burden of oral disease.

In 2017, a collaboration between Illinois’ Title V program and the Division of Division of Oral Health, housed in the IDPH Office of Health Promotion, allowed for the continuation of previous improvement strategies that focused on the oral health status of pregnant women and young children. This effort included an updated literature search, review of Illinois PRAMS data, hosting informational webinars, and two statewide stakeholder meetings. Illinois’ oral health disease burden information and utilization data were presented, and conversations ensued with stakeholders about the challenges experienced by MCH populations in obtaining timely access to preventive and to corrective care. Subsequently, an ad-hoc Oral Health Workgroup led by IDPH was formed to further develop opportunities for systems change, project planning, and follow-up activities.

An updated compilation of Illinois resources was identified as one such outcome. It is apparent that Illinois stakeholders are committed and ready to increase their activity so that more women, children, and families gain good health and can maintain it.

The Oral Health in Illinois: A Focus on Pregnancy and Early Childhood - A Resource Guide and Toolkit presented here contains information from national and state sources with the addition of several resources developed by IDPH specifically for this project. The Massachusetts Department of Public Health’s (MDPH) Oral Health Practice Guidelines for Pregnancy and Early Childhood also was extensively used with permission in development of this guide and toolkit.

Oral Health in Illinois: A Focus on Pregnancy and Early Childhood contains information, resources, and tools that support opportunities for individuals and systems to change in ways that improve oral health status through collaboration, timely referral, and integration of health promotion and services. To achieve this goal, it is important to understand and address major factors contributing to poor oral health status by increasing health literacy, enhancing health promotion, stressing the importance of routine self-care practices, and increasing access to prevention and treatment services.

In addition to periodic professional assessment and care, continuous and effective self-care practices are crucial in maintaining health. Together, assessment and preventive oral health care have the power to decrease the risk and burden of oral and other chronic health conditions for all age groups and populations. Improving women’s periodontal and dental health will improve the health of their children and other family members by decreasing the transmission of bacteria and adverse birth outcomes.

Effective field-tested systems change efforts increase interdisciplinary collaboration and contribute to improved health outcomes that can put the maternal-child health population on a path to a lifetime of good health. One simple strategy is to expand bi-directional initiatives that encourage health care providers to cross-refer pregnant individuals to timely and appropriate health care services to improve birth and postpartum outcomes. Integrating oral health within prenatal care supports the importance of professional oral health care during the perinatal period. Oral health care providers have the professional responsibility to accept referrals of pregnant women and to provide preventive and corrective care, relying on the best available evidence that indicates that it is safe and desirable to do so at any age, pregnancy stage, and life cycle.

Differences in oral health status exist and are a result of unequal access to knowledge, to resources, and to access to corrective treatments. Therefore, Oral Health in Illinois: A Focus on Pregnancy and Early Childhood seeks to inform professionals, the public, and policy makers on these topics. The intent is for these groups to take action as individuals, as families, and as communities in ways that improve overall health status with a focus on oral health.

Oral Health in Illinois: A Focus on Pregnancy and Early Childhood builds on local, state, and national efforts and summarizes information in sections to improve health outcomes by focusing on self- care, prevention, and treatment of disease. For ease of navigation and taking action, it is divided into sections:

• Policy, Practice Guidelines, and Recommendations
• Illinois Oral Health Toolkit

The Policy, Practice Guidelines, and Recommendations is intended for prenatal, pediatric, primary care, and oral health care providers, and for caregivers. This section is subdivided into information on each of these provider types by specific activities:

• assessment
• advise and educate
• provide care and management
• refer and collaborate

The Illinois Oral Health Toolkit is for providers, individuals, families, and organizations that work to improve the oral health status of Illinoisans. The Toolkit gathers accessible training topics developed by national, state, and local experts including anticipatory oral health guidance, risk factor assessment, flipchart, and PowerPoint presentation.  The Toolkit includes information on accessing oral health care in Illinois with a special section on the Illinois Medicaid Dental Program for children and adults and transportation assistance to attend health care appointments.