Evidence Tools
MCHbest. NPM 13.1: Preventive Dental Visit: Pregnancy
Strategy. Teledentistry
Approach. Develop and provide training (or professional development) for oral health professionals at the state and/or local level about teledentistry (including state practice acts and reimbursement policies), and provide teledentistry services for pregnant people.
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Overview. Telemedicine, sometimes called telehealth, uses telcommunications technology to deliver consultative, diagnostic, and health care treatment services.1 Teledentistry is the remote facilitating of dental treatment, guidance, and education via the use of information technology instead of direct face-to-face contact with patients.2 Teledentistry offered an innovative solution to resume dental practice during the COVID-19 pandemic, and may be especially important for pregnant people who need to receive dental care, especially during the second trimester.3
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.4,5 As an incentive for oral health professionals to complete training, offer continuing education credits. Examples of preventive oral health care include risk assessment, education and anticipatory guidance (eating practices, oral hygiene practices, smoking prevention/cessation), and fluoride varnish applications. See 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).
Evidence. Scientifically rigorous. Telemedicine has been shown by the Robert Wood Johnson Foundation to be scientifically supported. In addition, systematic reviews have established teledentistry as an equally effective practice.6 Programs based on this strategy are likely to work. This strategy has been tested more than once and results trend positive overall.
Target Audience. Providers.
Outcome. Increased understanding and uptake of teledentistry; proportion of people with a dental claim. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.
Examples from the Field. Access descriptions of current ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Develop and provide training for oral health professionals at the state and/or local level about teledentistry, and provide teledentistry services for pregnant women,” 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):
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Quadrant 1:
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Quadrant 2:
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Quadrant 3:
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Quadrant 4:
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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:
- Professional development/training event data
- Dental clinic/office data
- State Medicaid program data in states with a Medicaid dental benefit for pregnant women
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
References:
1 Ghai S. Teledentistry during COVID-19 pandemic. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020 Sep 1;14(5):933-5.
2 Shaygani F, Marzaleh MA. COVID-19 Pandemic: An Opportunity for Using Tele-Dentistry for a Better Dental Care. Prehospital and Disaster Medicine. 2022 Sep 15:1-3.3 Lipper J. Advancing Oral Health through the Women, Infants, and Children Program: A New Hampshire Pilot Project. (2016). Center for Health Care Strategies.
4 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.
5 Additional Resources:
- 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.
- Maternal and Child Oral Health Resource Center. 2010. Open Wide: Oral Health Training for Health Professionals. Washington, DC: National Maternal and Child Oral Health Resource Center.
- Wells J. 2019. Improving Oral Health Outcomes for Pregnant Women and Infants by Educating Home Visitors. Washington, DC: Association of Maternal and Child Health Programs.
6 Systematic reviews of teledentistry:
- Alabdullah JH, Daniel SJ. A Systematic Review on the Validity of Teledentistry. Telemed J E Health. 2018;24(8):639‐648. doi:10.1089/tmj.2017.0132
- Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the benefits of teledentistry. J Telemed Telecare. 2018;24(3):147‐156.