UNC dental school reaches out to pregnant women

glloyd@newsobserver.comJanuary 9, 2013 

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Pregnant dental client Kendra Jones of Chapel Hill, left, starts her clinic visit with UNC School of Dentistry fourth-year student Katelyn Henderson, 25, Thursday afternoon Oct. 4, 2012 in the Tarrson Hall student general dentistry clinic. Henderson is one of the first UNC fourth-year dental students in the new POHP (prenatal oral health program) focusing on treating and triaging pregnant women.

HARRY LYNCH — hlynch@newsobserver.com

  • Myth vs. facts Many people, including some older dentists, believe a persisting myth that dental treatment is unsafe for pregnant women and their babies. The American Dental Association recommends that all pregnant women see a dentist to assess their oral health. Studies show that most pregnant women suffer from gingivitis, spurred by higher hormone levels, and most pass bacteria from cavities on to their children. Invasive procedures should be avoided in the first trimester, medications should be watched, and some procedures might be uncomfortable for the mother during the third trimester. For comfort reasons, dentists may want to keep appointments short and not recline the pregnant woman as far back as a typical patient because of the pressure the baby puts on her stomach. Other than that, pregnant women are the same to treat as any other patient. More complicated procedures, like crowns, should wait until after the baby is born, but since women are more likely to have problems with gingivitis during pregnancy, they may even want to go to the dentist for cleanings more often than the six months usually recommended.

— The UNC School of Dentistry has started a formal rotation teaching students in their final year of dental school how to treat two patients at a time.

Fourth-year students are now treating pregnant women as part of the Prenatal Oral Health Program, a spinoff of a successful program promoting oral health in babies.

The rotation has three goals: to give students the chance to treat pregnant patients, to improve pregnant patients’ access to dental care and, most important, to encourage women to teach their future children good dental habits.

The program, funded by a grant from the Blue Cross Blue Shield of North Carolina Foundation, appears to be the first of its type in the country.

“Other schools have looked at what we’re doing here and gone, ‘That’s a great idea, wow, holy cow,’ ” professor and clinic director Scott Eidson said.

Lack of dental care in young children is a widespread problem, said professor Rocío Quiñonez, the program’s co-founder and a pediatric dentist. A study published in the American Journal of Public Health in 2011 found children with poor oral health were three times as likely as other children to be absent and to perform poorly in school.

Intervening while the child is still in the womb, when even doctor-shy women typically see a doctor, is a unique approach that doctors hope will be as successful as the school’s 7-year-old Baby Oral Health Program, which educates dentists on caring for young children.

“I think it’s a pretty cost-effective, not very time-consuming way to reach people,” said Katelyn Henderson, 26, one of the first students to treat a patient through the program. “And it’s a good experience for the students.”

Not since braces

Before coming in for a cleaning and X-rays at seven months pregnant, Kendra Jones of Chapel Hill had not seen a dentist since getting braces as a high school graduation present three years earlier, despite a nagging pain she’d had since the wires came off.

In the chair getting ready for her cleaning, Jones said she’s just never liked visiting the dentist.

“I like you, though,” she said, smiling at Henderson, her dentist for the day.

Despite cleaning teeth and filling cavities in the clinic for years, Henderson had never before seen a pregnant patient. The visit went smoothly for Jones, who had no cavities.

The clinic sees about one new pregnant patient a week, and several women with more severe dental problems have returned for follow-ups. Pregnant patients pay about $30 for a cleaning and X-rays in their initial visit.

Although students do 114,000 treatments a year and see all kinds of patients, pregnant patients have been a rarity.

That may be due to lingering misconceptions on the part of both dentists and pregnant women. Jones’ mother and several of her friends, for example, were skeptical that she needed to visit the dentist.

“She was like, ‘You don’t need to go to the dentist! Wait until after the baby,’ ” Jones said.

A close collaboration between UNC-Chapel Hill School of Medicine doctors and the dental school is the key to breaking that cycle – when Jones’ obstetrician referred her to the dental clinic and assured her that it would be safe, she was willing to go.

Unlearning old rules

A generation of dentists was taught, decades ago, that pregnant women should avoid the dentist. Better safe than sorry, went the conventional wisdom.

Some older dentists today still turn away pregnant patients, a cycle in which dentists who have never treated pregnant patients feel uncomfortable doing so even once they know it is safe, Quiñonez said.

“There’s still a lot of misinformation,” Eidson said. “I guarantee, if you polled a lot of practicing dentists, you’d get a lot of different answers.”

To educate dentists, the dental school produced a DVD and educational kit it sent to dentists around the state that it could eventually license to other schools interested in replicating the program.

Today, dental schools teach students that pregnant women can be treated safely. Regular cleanings are especially important because higher hormone levels make pregnant women more susceptible to gum disease and cysts than the average person.

If problems are not fixed proactively while a woman is still pregnant, she could easily pass bacteria from her cavities to her newborn – for example, through kissing or sharing food.

The cost savings to society from a focus on preventive dental health would be significant, Eidson said, especially problems are spotted before children end up in the emergency room.

“And that bill is a lot more than fluoride toothpaste,” Eidson said.

Lloyd: 919-932-2008

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