MCHbest. NPM 13.1: Preventive Dental Visit: Pregnancy
Strategy. Provider Education
Approach. Collaborate with obstetrical and/or nurse midwifery associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and make referrals.
Overview. Provider education is an evidence-based strategy that has shown utility in increasing use of professional services other than oral health by MCH population groups. While limited research has been conducted to verify results with populations in need of oral health services, this research can serve as a proxy to gauge effect. However, more research is needed for conclusive results.1 Prenatal care associations include obstetric, nurse midwifery, and family practice groups; partneships provide an opportunity to train their members to conduct oral health risk assessments, provide preventive oral health care, and refer pregnant women to oral health professionals for dental visits. Examples of preventive oral health care include education and anticipatory guidance and fluoride varnish applications.2
Evidence. Expert opinion. Strategies with this rating are recommended by credible, impartial experts and are consistent with accepted theoretical frameworks. However, the strategies have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects. This strategy was drawn from Holt K, Louie R. 2019. Strengthening State and Jurisdiction Efforts Related to Title V Maternal and Child Health National Performance Measure 13 (Oral Health). Washington, DC: National Maternal and Child Oral Health Resource Center. This expert opinion is based on multiple resources.3 (Read more about understanding evidence ratings).
Target Audience. Providers.
Outcome. Proportion of pregnant women with a dental claim.
Examples from the Field. There are currently 6 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Collaborate with obstetrical and/or nurse midwifery associations to train their members to provide preventive oral health care to pregnant women and referrals to oral health professionals for dental visits,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):
Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).
Possible Data Sources for ESMs:
- Training event data
- Medical clinic/office surveys
- Medical clinic/office referral data
- Dental clinic/office data
1 Perkins, R. B., Zisblatt, L., Legler, A., Trucks, E., Hanchate, A., & Gorin, S. S. (2015). Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine, 33(9), 1223-1229.
2 Holt K, Kolo S, Louie R. 2020. Title V National Performance Measure 13 (Oral Health): Strategies for Success (2nd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center.
3 Resources used to establish expert opinion:
- American College of Obstetricians and Gynecologists Women’s Health Care Physicians; Committee on Health Care for Underserved Women. 2013. Oral health care during pregnancy and through the lifespan. Obstetrics and Gynecology 122(2 Pt 1):417–422.
- Association of State and Territorial Dental Directors, Best Practice Committee. 2019. Best Practice Approach: Perinatal Oral Health. Reno, NV: Association of State and Territorial Dental Directors.
- Casamassimo P, Holt K, eds. 2016. Bright Futures in Practice: Oral Health—Pocket Guide(3rd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center.
- Clark MB, Douglass AB, Maier R, Deutchman M, Gonsalves W, Silk H, Wrightson AS, Quinonez R, Dolce M, Dalal M, Rizzolo D. 2010. Smiles for Life: A National Oral Health Curriculum(3rd ed.).Leawood, KS: Society of Teachers of Family Medicine.
- Lorenzo S, Goodman H, Stemmler P, Holt K, Barzel R, eds. 2019.The Maternal and Child Health Bureau–Funded Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Initiative 2013–2019: Final Report. Washington, DC: National Maternal and Child Oral Health Resource Center.
- Oral Health Care During Pregnancy Expert Workgroup. 2012. Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal and Child Oral Health Resource Center.