Table 1 Illustrative quotations from study informants: barriers and facilitators to prenatal oral health care utilization
Barriers | Informants | Illustrative quotations |
|---|---|---|
Socioeconomic hardships and competing interests | Parenting woman | “I'm not so pressured to figure out dental care for myself, at least not when I have other things going on that's more important than dental care” |
Lack of awareness of benefits and importance | Parenting woman | “I wish I knew more about that my dental health has something to do with my baby’s health” |
Lack of awareness of dental coverage from medical insurance | Social worker | “The population we serve has Medicaid insurance which is comprehensive. But I'm not sure that it's clear to the patients that it includes dental coverage” |
Inadequate inter-professional collaboration | Parenting woman | “My provider never told me that was a problem. I started having bleeding gums and then I looked it up online. That's how I know about it” |
Parenting woman | “It would be good if the OB would address this. Have you seen your dentist? That would be one way to make pregnant women go see the dentist” | |
Lack of awareness of prenatal oral health guidelines | DDS/DMD | “Some patients worry about dental treatment during pregnancy. Currently, we just give patient verbal education, no handouts, we just tell patient due to the hormone change, you need to have better oral hygiene. If there is a guideline that we can show them, it is better” |
OBGYN | “In medical school, we didn’t have classes for oral health. None” | |
Insufficient dentists providing treatment to underserved pregnant women | Parenting woman | “The worst thing of being pregnant is you have toothache. So I'm just going to be honest with you. I had a bad tooth, I was in a lot of pain, but they (dentists) would not pull it because I was pregnant. I had to go to another doctor, acted like I wasn't pregnant and they pulled the tooth out” |
OBGYN | “Oftentimes what comes into play is no one (dentists) will see them (pregnant women). They (patients) told me, they are in too much pain, but the dentists won't do anything, they will ask me can you do something?” | |
Facilitators | Informants | Illustrative quotations |
Constant reminders | Parenting woman | “I need constant reminders by my OB. When I find out I'm pregnant, that could be a good time to be asked, hey, do you know this will cause problem to your baby? Then, when I go to my next appointment, they ask me, hey, here's some more information about this, the germs in your mouth could be passed to your baby. When I go to my next appointment, I will be asked again, hey, I don't know if you took a look at that paperwork? A constant reminder goes a long way” |
Raise community awareness via mass media | Parenting woman | “It (prenatal oral health education) has to be interesting, I would say more of a commercial on TV. Whether I'm eating, or I'm talking on the phone, my eyes are still on TV. I can read what's on the TV, that's going to be in my mind. Even if I don't hear nothing about what they're saying, I'm, at least, going to remember something from that commercial” |
Strengthen interprofessional collaboration | OBGYN | “Adding an additional task to an already packed prenatal schedule for medical providers can be challenging. But I think our midwifery colleagues are a bit flexible and they often do some more holistic family care. For example, they make home visits in the neonatal period. Introducing the idea of oral health in that community might be reinforcing” |
PCP | “The system for EPIC, I do not think is yet to set up having special health maintenance tabs for pregnancy. But if there was, you could have a health maintenance checklist that says, dental care is overdue or is unsatisfied at this time. That would be a reasonable thing to consider for all pregnant patients” | |
OBGYN | “OBGYN, family doctors or pediatricians giving oral health education, potentially, depends on what is involved to satisfy that billing code” | |
DDS/DMD | “The social workers are also very important for spreading correct oral health knowledge for pregnant women. They can work as a bridge to help mothers getting sufficient dental education and dental care in community” | |
OBGYN | “There is a push currently to offer doula services to a broader range of patients. I think expand Medicaid coverage to cover doulas for lower income populations, who are oftentimes going out to the community to support. So that would be another place to introduce oral health education during pregnancy” |