A foundation in Seattle that focuses on oral health has been working to go where their partners in health have long focused: on addressing the health of children before they are born.

The mission of the Washington Dental Service Foundation is to prevent dental disease and improve overall health for residents of the state of Washington. We focus on prevention and target the majority of our efforts toward young children ages 0-6 and seniors; however, we are now taking our prevention efforts to children even farther upstream by addressing the dental health of pregnant women.

Why? Mothers who have cavities are likely to pass along cavity-causing bacteria to their babies, increasing the chances of their babies getting cavities. Conversely, mothers with good oral health and knowledge are in the best position to protect their children from cavities.

With this in mind, the Washington Dental Service Foundation launched its Prenatal Initiative in 2010, and we are rolling it out in three phases: (1) teaching dentists to manage the care of and treat their pregnant patients; (2) partnering with community organizations to deliver oral health information and messages to pregnant women that motivate them to get dental care; and (3) teaching prenatal health providers to provide oral health education, screenings, and referrals.

In Phase One, we started with dentists because they are critical to ensuring that pregnant women have good oral health. If dentists do not treat pregnant women, it is nearly impossible for many women to achieve good oral health before their babies are born. To our advantage, Medicaid coverage in Washington State includes dental benefits for pregnant women both during pregnancy and for two months after the birth of a child.

To understand what it would take for dentists to treat pregnant women, we conducted focus groups with dentists. Through these groups, we learned that many dentists were hesitant to treat pregnant women because they were concerned about liability, were not taught in dental school about the timing and safety of providing dental treatment during pregnancy, and wanted guidance about which medications were safe to use with pregnant women. The dentists suggested that the Washington Dental Service Foundation develop a training for dentists.

The Washington Dental Service Foundation, in collaboration with the University of Washington Schools of Dentistry, Pharmacy, and Medicine developed a course, Oral Health from Birth: Using Evidence Based Care to Manage and Treat Your Pregnant Patients, which teaches dentists to treat their pregnant patients. The course includes the information that dentists identified as most important, and it follows evidence-based guidelines developed by the New York State Department of Health (supported by the Maternal and Child Health Services Block Grant Program, the Centers for Disease Control and Prevention, and Health Resources and Services Administration grants) and the California Dental Association Foundation (which received funding for this effort from the California HealthCare Foundation, as well as First 5 California, Sierra Health Foundation, and Anthem Blue Cross Foundation).

The course also follows the 2012 National Consensus Statement (published by the National Maternal and Child Oral Health Resource Center, at Georgetown University) on treating pregnant women. The course has been incorporated into the University of Washington School of Dentistry’s curriculum and, since 2011, has been delivered in community settings to more than 600 dental professionals.

Phase two is focused on getting information, messages, and referrals to pregnant women so they will understand the importance of good oral health during pregnancy and will visit the dentist. We asked the question: With treatment more readily available, what would it take for pregnant women to seek dental care? In the spring of 2012 we invited pregnant women to a series of focus groups to answer this question. These women told us that they needed: (1) understanding of why oral health is important during pregnancy and the connection between a mother’s oral health and her child’s; (2) assurance that dental care during pregnancy—including medications and x-rays—is safe for mother and baby; and (3) their prenatal health provider and dentist to provide this information. We are using these results to develop messages and educational materials. We are also developing strategic partnerships with community organizations, the federal Women, Infants, and Children (WIC) program, and home visiting programs to deliver those messages and materials and to provide dental care to pregnant women.

Phase three of the project is just now unfolding. The plan is to work directly with prenatal providers (doctors, nurses, and midwives) to ensure that they refer women to dental care during pregnancy. Similar to previous outreach efforts, we will initiate a focus group, develop outreach tools, and work with partners to provide trainings to appropriate providers.

The Washington Dental Service Foundation includes policy as part of each of its initiatives; we address policy issues when opportunities or threats present themselves. One such threat arose in 2011 when the Washington legislature proposed eliminating dental benefits for pregnant women on Medicaid. This was a serious challenge to the success of the program, which was surmounted through the advocacy efforts of the foundation along with those of numerous community partners.

Another challenge has been to scale the project to reach dentists in all parts of the state. We continue to investigate new venues and options for dissemination, because despite the course for dentists (Phase One) being free, logistical limitations constrain the number of in-person trainings that may be provided annually.

In the coming years, we will look to Medicaid data to evaluate our progress toward encouraging more women to receive oral health care during pregnancy. We are excited to now be going where many of our partners in health have long focused–farther upstream–protecting the health of children before they are born.

Read an article about another Washington Dental Service Foundation effort in the GrantWatch section of the November 2008 issue of Health Affairs.