Implementation of a Perinatal Dental Screening Tool in an Obstetric Practice

Abstract

Background Oral health is an important aspect of overall health and should be maintained during pregnancy. Due to complex physiological changes during pregnancy, the pregnant woman is at risk for developing periodontal disease and dental caries. This is associated with poor birth outcomes including pre-term births and low birth weight infants. Evidence-based guidelines developed by several professional organizations indicate that oral screening should be included in the first prenatal visit.

Local Problem Pregnant women enrolled in Medicaid have dental coverage during pregnancy. Despite this, only 27% of these women utilized their dental benefits. The purpose of this quality improvement project was to implement a dental screening tool at an obstetrical practice. The screening tool was used to identify pregnant women with oral health needs and provide subsequent referral to a dentist.

Interventions Implementation occurred over fourteen weeks. The screening tool included three maternal oral screening (MOS) questions. The first question was to determine if the patient had a dental cleaning in past twelve months and the other two questions were about dental concerns, pain and bleeding gums. The purpose of the screening was to identify oral health needs and refer to dental provider as appropriate. Patients from all practice locations were screened and received a referral to an existing dental home or one covered by their insurance. Results A total of 826 pregnant women were screened. Of all the pregnant women screened 36.3% (n= 300) had not had their teeth cleaned in the past twelve months. Greater than 30% of pregnant women (n=316) reported some type of dental problem, 244 (29.5%) were screened during the first prenatal visit, and 36.7% (n=303) were enrolled in Medicaid. At the completion of the implementation, the number of dental referrals issued was 616 (74.6%). Conclusion Conducting oral health screenings during the prenatal visit is important for identifying pregnant women at risk for oral health problems and improving birth outcomes. Performing the screening at the first prenatal visit allows the woman time to visit the dentist prior to delivery. Integration of an oral health screening and referral process can be successfully implemented to meet the needs of the pregnant population.