Is a public dental program for high-risk pregnant women effective?

Objectives: An existing publicly-funded clinical dental prenatal program for low income, high-risk women in Vancouver, Canada was evaluated using a qualitative and quantitative approach with mixed methods. The results of the program's outcome evaluation (oral health status, behaviors, knowledge, program experience) will be described. Methods: Women referred to the program by community health staff received two clinical dental hygiene visits for periodontal debridement, oral hygiene instruction and counseling. A third post-natal visit was added to permit longer-term data collection. Data collected at all 3 visits included measurement of clinical indices, evaluation of toothbrushing, and assessment of knowledge by questionnaires, chart reviews, and interviews. Data was analyzed by univariate analysis, t-test, ANOVA, and Wilcoxon-Signed Rank Test. Results: Data collected from 61 women at baseline revealed age (mean±SD) of 27±5.0 years; 30% Canadian-born; 49% had other children; 90% were concerned about bleeding gums; and 69% had visible dental caries. Fifty women attended a second visit at 4.1±2.3 weeks and 39 attended the third visit at 45.9±7.8 weeks. Significant improvements (P<0.05) over time were demonstrated in oral health knowledge (e.g. bleeding gums abnormal, sleeping with bottle unhealthy, mother's oral health affects baby); toothbrushing skills; clinical indices (gingivitis, plaque, calculus, probing depth, and bleeding) and dental attendance by client's other children. 93% of women reported performing infant oral care; 80% admitted that oral care was more important since attending program; 92% reported a positive program experience. However, 71% of clients at 2nd visit and 55% by 3rd visit never obtained the recommended urgent dental treatment. Conclusions: Outcomes evaluation revealed positive changes, extending into the post-natal period, in knowledge, behaviors and clinical outcomes despite language barriers, insufficient resources and limited involvement of dental community. Identified program limitations need to be addressed to further improve outcomes of this promising intervention. Research partially supported by BCDHA.