Implementation of an Oral Health Program in a Prenatal Practice Setting

Abstract

Background Untreated periodontal disease during pregnancy can contribute to adverse health outcomes involving both oral health and pregnancy. Medicaid has offered full dental benefits in its coverage to pregnant women, but there has been a steady decrease in usage with only 26.8% of women enrolled utilizing this benefit. An oral health program that includes screening and referrals, and partnering with a Medicaid accepting dental provider addresses the barriers that pregnant women with Medicaid benefits encounter.

Local Problem Prenatal practices have expressed difficulty addressing the oral health care needs of their Medicaid patients. The purpose of this quality improvement project was to implement a dental screening and referral program that would link Medicaid recipients within a prenatal practice to a clinic for oral health care.

Interventions The structure of the program was based on the Oral Health Delivery Framework, and implementation occurred over fourteen weeks. The screenings consisted of a three-question selfassessment of dental concerns and one question determining if the patient had seen a dentist within the past twelve months. The purpose of the screenings was to assess the acuity of the dental needs and the level of urgency needed for the referral. All patients screened were then referred for dental care to a local Medicaid dental clinic. A pre-printed dental referral form was used to specify safe medical and dental treatments during pregnancy.

Results All patients screened were referred to the clinic resulting in a 100% referral rate. The goals of having a patient’s first appointments scheduled within three weeks of the date of referral (mean time was 3.2 weeks) and subsequently, having treatment plans established within three weeks were not met. Only 7.5% of the women screened had seen a dentist within the past twelve months. The disease burden was found to be high when 70% of those screened had at least one dental concern, and 88.9% of the patients required more than just oral prophylaxis at their dental visit as a treatment plan needed to be established.

Conclusion Prenatal practices are an optimal location for assisting women with Medicaid benefits to access dental care early in pregnancy. Prior identification of a Medicaid dental clinic was a critical component to the program’s success. The screenings provided the opportunity to determine the urgency of the referral. Using a dental referral form was beneficial to communicate safe treatments to the dental provider. Establishing the first scheduled appointment within three weeks of being referred to the dental clinic was the most significant barrier encountered. Expanding this program to include additional providers would potentially address this barrier and assist with increasing access to dental care for this population.