NSW Rural Allied Health Conference November 2011 Libby Baldwin & Mary-Anne Menhennitt

Acknowledgements CETI/Rural Division Rural Research Capacity Building Program, RRCBP – Emma Webster and David Schmidt NSW Health, Centre for Oral Health Strategy, COHS – Jennifer Noller Smile Mum Team – Deniliquin

Key words and acronyms Caries – tooth decay. Early childhood caries, ECC – several decayed teeth before the age of 5. GA – general anaesthetic. Low Birth Weight – LBW – babies born less than 2500g Streptococcus Mutans, S Mutans – bacteria causing tooth decay.

The background – Smile Mum Continuing high rates of Early Childhood Caries (ECC) During a 10 month period on 2007, Deniliquin Dental Clinic referred 11 children in the 0-5 age group for GA treatment of serious caries infection.

Early Childhood Caries Current early childhood programs are not preventing this decay in our risk groups because – 1. decay process has already begun 2. the most disadvantaged children do not attend these centres 3. Earlier intervention needed > pregnancy

Pregnancy/oral disease links Pregnant women have specific and heightened dental needs – gum disease.(11) Current research - adverse pregnancy outcomes – LBW, Pre- term. (12) Maternal link to development of ECC via transmission of S. Mutans.(6,7,8,9,15) Pregnancy is an optimum time for change.(15,17)

The Smile Mum Intervention Referral from pre natal health care providers Pre and post natal dental appointments Dental treatment Oral health promotion Oral care products Smoking cessation advice Data collection Ongoing managed care

Gift Pack for Mums at first Ante Natal visit and again at Post Natal visit

Smile Mum Study 2 Evaluation of ‘Smile Mum’, a program to improve the oral health of pregnant women and reduce the risk of dental disease for them and their child. Developed with the help of the CETI RRCBP. Ethics approval from the Approval for the study was obtained from Southern NSW Local Health Network Human Research Ethics Committee in July 2011.

Participants Women who had completed both the pre and post natal Smile Mum dental appointments All were holders of a government concession card Participation rate was 52% of all those invited with a total of 16 participants.

Objectives Did Smile Mum result in improved access to dental services better oral health increased knowledge of maternal/infant oral health links satisfaction with the Smile Mum program for the participants?

Methods 1.Analysis of pre and post natal comparative data from the existing Smile Mum data base. Disease risk assessment score: Knowledge quiz Smoking status Oral hygiene habits Clinical examination Lifestyle questionnaire

Methods 2.A 28 question Likert scaled survey posted home to all who had completed the Smile Mum program. Smile Mum experience Mother/baby oral health Oral hygiene Smoking status Opportunity for general feedback comments

Results: Improved access to dental services Check up in previous pregnancy? No = 11 Yes = 4 n/a = 1

Results: Improved access to dental services Smile Mum made it easier for me to attend dental appointments?

Pre –natal care health providers as referrers of pregnant women to dental service Data base – showed most were from outside regular dental networks. Midwife = 7 GP = 4 Dental clinic = 3 OHIS = 1 Poster = 1 Ante-natal class = 1

Results: Improved access to dental services “I am so glad Smile Mum was introduced to me as I probably wouldn’t have sought dental care otherwise. Now that it has I will definitely visit the dentist often as I was too scared before.”

Results: Better oral health Oral disease risk assessment score, (high, moderate, low) showing difference between score pre and post Smile Mum program

Results: Better oral health Periodontal classification score number corresponds to degree of periodontal, (gum), infection Pre natal examination total of all scores - 65 Post natal examination total of all scores - 35 Difference - 30 This difference demonstrates a reduction in the clinical signs of infection in the mouth, i.e. bleeding, inflammation etc;.

Results: Better oral health My mouth is now healthier than before Smile Mum?

Results: Better oral health Yesterday I brushed my teeth more than once …..

Results: Better oral health “I would like to say thankyou for making my mouth and teeth much healthier.” “I feel my oral hygiene has improved, particularly during pregnancy”

Results: Increased knowledge of maternal/infant oral health links The health of my mouth can affect the health of my baby

Results: Increased knowledge of maternal/infant oral health links Mothers should not share a spoon with their baby

Results: Increased knowledge of maternal/infant oral health links Bacteria from my mouth can be passed on to my baby

Results: Increased knowledge of maternal/infant oral health links It is OK to clean your baby’s dummy in your own mouth

Results: Increased knowledge of maternal/infant oral health links Quiz Pre natal total number of correct answers = 80 Post natal total number of correct answers = 106 Increased knowledge = 26 correct answers

Results: Increased knowledge of maternal/infant oral health links “Fantastic. Great advice. Makes you think about yourself more and the importance of taking care of yourself. Also makes you pass on the information to your children.” “Excellent for mums and babies.”

Results: Participant satisfaction with the Smile Mum Program. Smile Mum provided me with all the dental treatment that I needed.

Results: Participant satisfaction with the Smile Mum Program. I am happy with the treatment I received in the Smile Mum clinic.

Results: Participant satisfaction with the Smile Mum Program. The dental hygienist taught me how to brush my teeth and gums better than before Smile Mum

Results: Participant satisfaction with the Smile Mum Program. “During the pregnancy a tooth got infected and needed to be pulled out. I am still waiting for my denture plate and it is very embarrassing to smile and talk”

Results: Satisfaction with the Smile Mum program “I am very happy with the treatment I have received and am more likely to have regular checkups. The staff is friendly and made me feel comfortable”.

Smoking: risk factor for oral disease and pregnancy complications Smile Mum Study – 4 of 16 were smoking during pregnancy Of these, 2 had quit at the time of the survey. “When I first started Smile Mum I was a smoker. After attending the first session Libby’s kind advice about my teeth made me quit. Since then I have never gone back to smoking and I feel 100%better for it. Big thanks!”

Results: Summary The study showed ( that Smile Mum) increased access to dental treatment for most participants that pre natal health providers were an important referral pathway. there was a high level of satisfaction with the program most participants had increased knowledge of maternal/child oral health links. The pre and post natal comparison showed that there was an overall improvement in oral hygiene and some minor improvements in other oral disease risk assessment data.

Recommendations Strengthen and maintain the partnerships created with GP’s and other pre natal health professionals during Smile Mum. Continue the referral process to enhance access to dental services for disadvantaged pregnant women.

Recommendations Continue to develop the role of the dental professional as a smoking cessation counsellor making use of the following methods: QUIT services Motivational interviewing Brief intervention

Recommendations Continue Smile Mum: Provide an ongoing oral health managed care and recall program to Smile Mum participants Include the children in this program and monitor their caries status. Desired outcome – children caries free at age 5.

Smile Mum Study 2 Bibliography 6. Katz J, Orchard AB, Ortega J, Lamont R, Bimstein E Oral Health and Preterm Delivery Education: a New Role for the Pediatric Dentist J Pediatric Dentistry: 2006;28: Boggess KA, Edelstein BL Oral Health in Women During Preconception and Pregnancy: Implications for Birth Outcomes and Infant Oral Health Maternal Child Health J: (2006) 10:S169-S Boggess KA, Beck JD, Murtha AP, Moss K, Offenbacher S Maternal periodontal disease in early pregnancy and risk for a small-for gestational-age infant. American Journal of Obstetrics and Gynecology (2006) 194, Law V, Seow WK, Townsend G Factors influencing oral colonisation of mutans streptococci in young children Australian Dental Journal 2007;52:(2): Gaffield ML, Colley Gilbert BJ, Malvitz DM, Romaguera R Oral health during pregnancy: An analysis of information collected by the Pregnancy Risk Assessment Monitoring System. J Am Dent Assoc 2001; 132; Laine MA Effect of Pregnancy on periodontal and dental health. Acta Odontologica Scandinavica: 60(5): Chiodo T, Rosenstien L Dental treatment during pregnancy – a preventative approach JADA, Vol Thomas NJ, Middleton PF, Crowther CA Oral and Dental Health care practices in pregnant women in Australia: a postnatal survey BMC Pregnancy and Childbirth 2008, 8-13 First International Conference of Health Promotion Ottowa, Canada. 21st November 1986

Thank you From Libby & Mary-Anne