Scheduling dental appointments for patients while they are at prenatal clinic visits may increase the likelihood that they receive dental care during pregnancy, according to research published in the American Journal of Public Health. The study examined an approach that integrates oral health screening and dental referrals into prenatal care. Researchers found that immediately scheduling a dental appointment before a patient left the prenatal clinic increased the likelihood of receiving subsequent dental care without requiring additional staff.
“Many of those vulnerable to oral disease enter pregnancy with dental disease, and this may worsen during pregnancy,” said study author Stefanie Russell, associate professor at Rutgers School of Dental Medicine and an adjunct associate professor at NYU College of Dentistry, who led this research while at NYU.
The research focused on the New York University/Bellevue Prenatal Oral Health Program, created by researchers and clinicians at NYU College of Dentistry and NYC Health + Hospitals/Bellevue. During weekly sessions at Bellevue's prenatal clinic, pregnant patients receive a standardized oral health screening. Patients identified as having dental needs are referred to NYU College of Dentistry for follow-up care, receive education about the importance and safety of dental care during pregnancy, and are informed that Medicaid covers dental care in New York.
From 2018 through 2020, 420 prenatal patients with Medicaid coverage were referred to NYU Dentistry for follow-up dental care. The majority were Hispanic, and roughly half spoke Spanish as their first language.
The researchers used two approaches to facilitate referrals. Some patients had dental appointments scheduled immediately before leaving the prenatal clinic. Others worked with a bilingual patient navigator who provided oral health education, reminded patients about upcoming dental appointments, and followed up afterward to identify issues.
Nearly 44% of the patients referred to NYU College of Dentistry completed a dental appointment. Both immediate appointment scheduling and working with a patient navigator increased the likelihood that patients would receive dental care. Patients whose appointments were scheduled during their prenatal visits, however, were 2.6 times more likely to see a dentist than patients who did not have appointments scheduled. They were also more likely to receive dental care than patients who worked with the navigator.
“This suggests that immediately scheduled dental appointments can be an effective way to increase dental care utilization during pregnancy, without needing to hire extra staff,” said study author Shulamite Huang, assistant professor of epidemiology and health promotion at NYU College of Dentistry.
The findings address dental care during a period when oral health needs can change. According to the release, pregnancy increases the risk of certain oral health conditions, including gingival inflammation and, in some cases, tooth decay. Current obstetric and dental guidelines state that routine and emergency dental care can be provided during pregnancy.
The researchers concluded that integrating oral health screening into a prenatal clinic is feasible and can increase engagement with dental care during pregnancy. They are continuing to study whether the resulting care improves oral health outcomes and how dental screening could be integrated with prenatal care in other settings.
“A warm hand-off is key for addressing part of the barriers to dental care during pregnancy. Our team plans to further investigate and optimize interventions addressing both patient-, provider-, and healthcare system-level barriers to dental care during pregnancy,” said Huang.
Additional study authors were Richard Heyman and Mary Kang of NYU Dentistry; Belkys Saba, formerly of NYU Dentistry; Chloe Bird of the Tufts University School of Medicine; and Chengwu Yang of the Florida Atlantic University Schmidt College of Medicine. The project was funded by the New York State Health Foundation through grant 18-06007.
