Oral Health Policy and Practice Guidelines for Prenatal Providers

Oral health is an essential component of overall health. Providing anticipatory guidance, education, and risk-based referral is within the health care framework of the prenatal and primary care provider. All patients benefit from having their health care issues assessed and receiving prevention and health promotion information that limits unnecessary complications, pain, and burden of disease. For success, those effort should fit with patient and clinic flow and deliver targeted education and referral. With this patient-centered approach, prenatal and primary health care providers can easily implement the field-tested oral health integration concepts.

During the first prenatal visit, take a simple oral health history, including recent dental problems and dental care received. A sample Oral Health Assessment, Integration and Referral Form is available in the Education and Fast Facts section of this resource guide. Consider implementing such a tool into the electronic health record to document assessment of risk, services or guidance provided, and clinical findings. The immediacy of referral should be indicated on the form, which allows care coordinators to assist in obtaining timely professional care. It is important to follow up on any oral health problems or referrals to ensure that the patient was connected to corrective dental care.

Once oral health screening is incorporated in the clinic flow, it only takes a few minutes to provide a brief oral examination to check the general appearance of teeth and gums. Smiles for Life: A National Oral Health Curriculum is a comprehensive module-based oral health curriculum targeted to medical practices and health care teams. Relevant modules for the prenatal provider are Smiles for Life Course 5 – Oral Health for Women: Pregnancy and Across the Life Span, Course 6 – Caries Risk Assessment, Fluoride Varnish and Counseling, and Course 7 – The Oral Examination training materials.

Document in the prenatal care record any oral health issues identified and services or education provided. These may include anticipatory nutritional counseling, care for nausea/vomiting, or assisting patients with quitting their use of tobacco, alcohol, or marijuana. Reassure patients that community water fluoridation is safe and effective for all ages, including very young children. Based on risk assessment, consider providing fluoride varnish treatment for pregnant women. Specific additional topic areas to cover at subsequent prenatal and post-partum visits:

• Importance of oral health during pregnancy, including professional assessment and prevention visits at least every six months to control gum disease
• Importance of adhering to the oral health providers’ recommendations
• Reassurance that dental care is safe throughout pregnancy, including X-rays, dental restorations/extractions, pain medication, and local anesthesia

Special consideration to prevent tooth decay in pregnant individuals experiencing frequent nausea and vomiting:

• Eat small amounts of nutritious foods throughout the day
• Use a teaspoon of baking soda (sodium bicarbonate) in a cup of water as a rinse after vomiting to neutralize the acid
• Do not brush for one hour after vomiting because stomach acid can weaken the enamel and cause tooth hypersensitivity
• Chew sugarless or xylitol-containing gum after eating, which prevents transmission of bacteria (Streptococcus mutans) to their children and reduces children’s risk for tooth decay
• Use gentle brushing with a soft toothbrush and fluoride toothpaste to prevent damage to demineralized tooth surfaces
• Include oral health in prenatal care classes

Consider providing in-office fluoride varnish applications for women who are at high risk for or currently have active dental caries. See Smiles for Life Caries Module 6 – Caries Risk Assessment, and Fluoride Varnish and Counseling for an online tutorial.

Print/copy the Oral Health Assessment, Integration and Referral Form and send it with referral to the oral health provider. Include pertinent health information on the oral health referral form. Encourage women who have not seen a dentist within the last six months to schedule an appointment with their regular dentist.

Consider developing a list of dental care resources such as area Federally Qualified Health Centers (FQHCs) and private dental offices, and a map of dental care providers in relation to the medical practice. Develop a referral list by calling area dental offices or using the Find a Dentist function on insurekidsnow.gov. Be sure to determine whether the dental facilities accept adult Medicaid or other insurance plans and whether they have sliding fee schedules for uninsured patients. Refer patients to providers who participate in their dental plans and are comfortable caring for pregnant women. Illinois Medicaid benefits for adults include comprehensive examination, dental cleanings, treatments for periodontal disease, dental restorations (fillings), extraction of teeth, and additional services with prior authorization. A description of dental coverage and help for managed care adults and children members enrolled in Medicaid can be found on the Illinois Department of Healthcare and Family Services Dental Program webpage.