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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Provider Education. (Early Head Start, Home Visiting, WIC). (13.1)

Approach. Collaborate with Early Head Start programs, home visiting programs, and/for Special Supplemental Nutrition Program for Women, Infants, and Children. (WIC) clinics to train staff to conduct oral health risk assessments, provide preventive oral health care, and refer pregnant women for dental visits

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Overview. Provider education is an evidence-based strategy that has shown utility in increasing access to oral health care by MCH population groups.[1] It is important that providers conduct oral health risk assessments and screenings and provide education to pregnant women. Examples of education topics include the safety and importance of oral health care during pregnancy, overcoming fears about receiving oral health care, how and where to access timely oral health care, eating healthy foods, the importance of consuming fluoridated water, and counseling about good preventive oral health behaviors to improve women’s, infants’, and children’s oral health. Preventive oral health care also includes providing anticipatory guidance on feedback practices, providing tooth brushing instruction, using topical fluorides, and conducting lift the lip screenings. [2, 3]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Collaboration (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of 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. Here are sample ESMs to use as models 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).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of Early Head Start, home visiting, and WIC programs engaged in oral health integration partnerships. (Measures breadth of collaborations across maternal and child health support programs)
  • Number of program staff who complete training and demonstrate proficiency in oral health core competencies. (Measures reach of program staff capacity building for oral health trainings)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of oral health training sessions for program staff that are tailored to literacy levels of clients served. (Measures responsiveness of oral health training programs)
  • Percent of programs that incorporate oral health content into standard client education and service delivery protocols. (Measures integration and systematization of oral health education into existing workflows)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of program sites that have a designated oral health champion for coordinator. (Measures existing infrastructure for sustained activity focussed on oral health programming)
  • Number of programs that integrate oral health status and services into client data tracking and reporting. (Measures level of integration of tracking oral health status into existing data systems)

OUTCOME MEASURES:

  • Number of pregnant women referred by programs who complete a dental visit. (Measures effectiveness of referral process between programs and oral health clinics)
  • Number of pregnant women who receive at least two preventive oral health services in programs during pregnancy. (Measures level of continuity of integrated oral health care with perinatal care)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of program resources and staff time dedicated to oral health integration in sites serving populations of focus. (Measures tailoring of efforts to integrate oral health services into existing healthcare infrastructure)
  • Percent of programs that integrate oral health status and services into client data tracking and reporting. (Measures level of integration of tracking oral health status into existing data systems)

OUTCOME MEASURES:

  • Percent of pregnant women who receive at least two preventive oral health services in programs during pregnancy. (Measures level of continuity of integrated oral health care with perinatal care)
  • Percent of children born to program participants who receive recommended oral health services by age one. (Measures impact of oral health programming on intergenerational transmission of positive practices)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Lipper J. 2016. Advancing Oral Health Through the Women, Infants, and Children Program: A New Hampshire Pilot Project. Hamilton, NJ: Center for Health Care Strategies.

2 American Public Health Association. 2020. Improving Access to Dental Care for Pregnant Women Through Education, Integration of Health Services, Insurance Coverage, an Appropriate Dental Workforce, and Research.Washington, DC: American Public Health Association.

3 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.

4 Additional Background Resources:

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.
Byrd MG, Quinonez RB, Rozier RG, Phillips C, Megegan M, Martinez L, Divaris K. 2018. Prenatal oral health counseling by primary care physicians: Results of a national survey. Maternal and Child Health Journal 22(7):1033–1041. Journal of Dental Education 81(2):1405–1412.
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.
Leone SM, Quinonez RB, Chuang A, Begue A, Kerns A, Jackson J, Phillips C. 2017. Introduction of prenatal oral health into medical students’ obstetrics training. Journal of Dental Education 81(12):1405–1412.
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.
Naavaal S, Brickhouse TH, Hafidh S, Smith K. 2019. Factors associated with preventive dental visits before and during pregnancy. Journal of Women’s Health 28(12):1670–1678.
National 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.
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.
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.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.