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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. Dental Prevention Programs

Approach. Integrate oral health screening and dental care referral into standard prenatal care protocols

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Overview. Maintaining oral health is essential during pregnancy, as complex physiological changes increase the risk for periodontal disease and dental caries, which are associated with poor birth outcomes, including preterm births and low birthweight infants. [1] Evidence-based professional guidelines recommend integrating oral health screening into the first prenatal visit to identify pregnant patients with oral health needs and provide subsequent referrals to a dentist. [1] This quality improvement strategy involves utilizing a valid and reliable screening tool during prenatal care to streamline the referral process. [1] Successful implementation ensures that pregnant women at risk are identified early, allowing time for necessary dental care prior to birth. [1] Evidence demonstrates the efficacy of this strategy: one project screened 826 pregnant women, finding that over 30% reported a dental problem and 74.6% received dental referrals. [1] Furthermore, among low-income and minority women who are eligible for referral, those who reported receiving a dental referral were 4.6 times more likely to report having a dental visit during pregnancy compared to those who did not (67.3% vs. 35.1%), indicating that referral from a prenatal care provider is a significant predictor of dental care utilization among at-risk populations.[2]

Evidence. Moderate Evidence. Strategies based on moderate evidence show a clear trend toward positive results. While these approaches are likely to be effective, further research is needed to confirm their impact. Implement with evaluation to better understand specific local effects.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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.
  • Morbidity Reduction. This strategy addresses factors that can decrease the incidence or prevalence of diseases and illnesses.

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. Referral and Follow-Up (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of prenatal care clinics that adopt the standardized oral health screening and referral algorithm into their first prenatal visit protocol. (Measures the institutional adoption of the integrated protocol)
  • Number of pregnant women who are administered the oral health screening tool during their first or initial prenatal visit. (Measures the volume and reach of the screening component across the target population)
  • Number of community dental providers who formally partner with prenatal clinics to accept referrals from the integrated program. (Measures the development of the external network capacity)

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

  • Percent of prenatal care providers (e.g., Ob-Gyns, Midwives, Nurses) trained and certified on the validated oral health screening tool and corresponding referral pathway protocols. (Measures the workforce readiness and capacity for implementation)
  • Percent of eligible pregnant women identified with an oral health need who receive a specific, actionable referral or offered an appointment opportunity with a dental provider. (Measures the quality and fidelity of the referral component of the service delivery)

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

  • Number of pregnant women who report or confirm seeing a dentist during their pregnancy following a prenatal care referral. (Measures the critical increase in health service utilization attributable to the referral system)
  • Number of pregnant women identified as high risk for dental disease who receive definitive treatment (e.g., filling, extraction, scaling/root planing) during their pregnancy. (Measures the attainment of necessary therapeutic care)
  • Number of formal agreements established between medical (prenatal) and dental systems to create joint accountability for tracking referral completion. (Measures the creation of a supportive system for referral completion)
  • Number of low-income pregnant women who transition from having untreated dental caries or periodontal disease at the start of pregnancy to receiving treatment by delivery. (Measures the impact on reducing unmet oral health needs)

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

  • Percent increase in the standardized dental care utilization rate among pregnant women in participating clinics compared to non-participating clinics. (Measures the overall impact of the integrated program on utilization)
  • Percent of women identified with an oral health need during the first trimester who complete a dental visit within the recommended public health timeframe (e.g., 90 days). (Measures the timeliness of access to treatment during pregnancy)
  • Percent of referred pregnant women who report high satisfaction with the ease of the referral process and the timeliness of their dental visit. (Measures the quality of the patient experience regarding care coordination)
  • Percent of low-income pregnant women who demonstrate a documented improvement in oral health status (e.g., reduction in reported dental pain or untreated disease) by the third trimester. (Measures the impact on clinical health outcomes in a priority population)

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] Spencer, M., & Idzik, S. K. (2023). Dental screening and referral during prenatal care. MCN: The American Journal of Maternal/Child Nursing, 48(6), 320-325. [2] Russell, S. L., Kerpen, S. J., Rabin, J. M., Burakoff, R. P., Yang, C., & Huang, S. S. (2021). A Successful Dental Care Referral Program for Low-Income Pregnant Women in New York. International Journal of Environmental Research and Public Health, 18(23), 12724.

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.