Date of Award

Fall 2020

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Sudha Xirasagar


ABSTRACTThe purpose of this study is to examine maternal preventive dental services utilization by analyzing the role of preconception oral health counseling in utilization of dental cleaning services before or during pregnancy and the association of utilization with preterm birth (<37 weeks) and small for gestational age (SGA) (same sex newborns having birth weight for gestational age below the 10th percentile of the reference population as defined by the World Health Organization (WHO)). Studies suggest that unfavorable maternal oral conditions have significance in birth outcomes, specifically periodontal disease (periodontitis), an oral inflammatory condition which is shown to be a risk factor for preterm birth and low birth weight (Dortbudak et al., 2005; Guimarães et al., 2012; Tejada et al., 2012). Dental cleaning before and during pregnancy is effective in the prevention of oral disease including gingivitis and periodontitis (Johnson et al., 2006; Kurien et al., 2013; Steinberg et al., 2013).

Cross-sectional 2012-2015 data from the South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) survey, a population-based surveillance system on prenatal, perinatal and postpartum experiences of resident mothers who recently delivered a live-born infant, were analyzed using weighted analyses in SAS. Analyses included demographic univariate analyses, Rao-Scott Chi-squared tests of significance to study differences between groups, and multivariate logistic regression models to estimate adjusted odds ratios (AOR). This study controlled for socio-demographic characteristics and prenatal maternal morbidities that are known to be associated with health services utilization and birth outcomes. Among the 2,870 surveyed mothers, 8% had received preconception oral health counseling and 59% had received dental cleaning before or during pregnancy. Preconception oral health counseling by a medical provider was associated with five-fold higher odds of having had dental cleaning relative to no counseling in both univariable and adjusted multivariable logistic regression analyses (OR 5.668; 95% CI [2.760, 11.639]; p <.0001) and (AOR 4.994; 95% CI [1.972, 12.649]; p < 0.0007) respectively.

The study showed that dental cleaning was associated with lower risks of both preterm birth and SGA outcomes. The beneficial effect of dental cleaning before or during pregnancy on preterm birth varied by smoking status and traumatic stress experiences. Among nonsmoking mothers, those who reported dental cleaning were 62% less likely to experience preterm birth than non-smoking mothers who did not have dental cleaning (AOR 0.377; CI [0.201, 0.706]; p=0.0023). Among smoking mothers, dental cleaning was not associated with a reduction in preterm birth risk; the risk was similar regardless of dental cleaning status. Among mothers who experienced any traumatic stress during pregnancy, dental cleaning was associated with reduced likelihood of preterm birth compared to mothers who did not have dental cleaning (AOR 0.241; CI [0.098, 0.594]; p=0.0020). With respect to SGA, mothers who smoked during pregnancy but completed a dental cleaning had 70% lower odds of SGA than smoking mothers who did not get dental cleaning (AOR 0.302; CI [0.097, 0.945]; p=0.04).

Overall, this study suggests that provision of oral health counseling by a medical provider before pregnancy is an effective low-cost intervention which impacts maternal preventive dental services utilization. Furthermore, dental cleaning is associated with mitigation of preterm birth and SGA risks among sub-groups of mothers with other risk factors for these adverse outcomes. Regarding preterm birth, dental cleaning provides a protective effect among non-smoking mothers and mothers with traumatic stress. Regarding SGA, dental cleaning showed a protective effect among smoking mothers. This study provides positive evidence that obstetric care guideline changes to include oral health promotion among women of reproductive age may diminish the current underutilization patterns in preventive dental services and improve birth outcomes.