Navigating pregnancy in the United States can be expensive and confusing. Pregnant people are encouraged to take care of their health, but widespread information on how to do this isn’t always available, and accessing care can be a challenge. This is especially true for dental care, which becomes more important during pregnancy, but is often neglected. Like many aspects of maternal care, dental health is an area where gaps in knowledge and access can determine outcomes.
According to the Centers for Disease Control and Prevention (CDC), 60% to 75% of pregnant people develop gingivitis, a gum disease typically caused by a bacterial infection that can result in red and inflamed gums. Catching and treating gingivitis early is key to preventing more severe periodontal disease, which can result in bone and tooth loss. As a result of pandemic delays in care, these diseases have increased. Gingivitis is only one of several common dental health problems that can arise during pregnancy, and in some cases, dental issues can contribute to premature births, pre-eclampsia, and low birth weight babies.
As a new mom and the Chief Strategy Officer at a dental software company, I am deeply concerned about current gaps in maternal dental care. Through my work and my own pregnancy, I’ve discovered that there are many misunderstandings about whether dental procedures are dangerous for pregnant patients; some dental providers report that patients stop visiting altogether after becoming pregnant, which is unfortunate since it is an especially important time to monitor oral health.
During my own pregnancy, I encountered a dentist who told me to delay care until after I gave birth, but other providers later told me it would have been fine to visit while pregnant. I saw firsthand how difficult it can be to parse conflicting advice while juggling prenatal appointments with work and family demands — and I experience many privileges other pregnant people don’t have access to.
A 2011 study published in Public Health Nursing showed that up to 40% of women of childbearing age didn’t have dental insurance. A study focusing on Black adults in Harlem found that Black patients were more likely than white patients to have unaddressed tooth pain, and to lose teeth—which can be an outcome of advanced periodontal disease. Income and race play a part when it comes to dental care discrepancies, and—unsurprisingly—maternal health.
The United States has one of the highest maternal mortality rates in the developed world, and race is a determining factor in who is most affected. According to a study by The Commonwealth Fund, a Black woman with a college education is 60% more likely to die in childbirth than Latinx and white women with significantly less education. The situation is so dire that in 2021, Congress introduced the Black Maternal Health Momnibus Act, which will attempt to address health inequities driving Black maternal mortality rates.
Having a baby in the US is also a major medical expense, and dental care costs are a huge barrier for low-income populations. In the Harlem study, patients reported a lack of insurance, or poor insurance coverage, as a primary reason for delaying dental care. Some providers I work with have told me they have trouble retaining patients because patients often view dental care as unaffordable or extraneous. Finding ways to diminish these costs is key to encouraging preventative dental care for pregnant people across socio-economic backgrounds.
Luckily, a small group of non-profit organizations are working with dental offices to attempt to address this problem. Some, like The National Maternal and Child Oral Health Resource Center at Georgetown University, focus on educating oral health professionals on issues related to oral health in maternal and pediatric care. Others, like the Dental Lifeline Network, work to provide free and low-cost services to vulnerable populations, such as disabled and elderly people.
Technology can also help. Cloud-based dental software allows dental workers to provide mobile care more easily because they can now access patient records and administrative tools from any location. Some dental providers are utilizing this opportunity to provide mobile services to inner-city, rural, and other underserved areas. (Full disclosure: My company provides these services.)
Digitizing dental records can also help patients better access their medical history, book appointments, and coordinate across providers and care teams. This is crucial for pregnant patients who are typically seeing multiple providers, but it’s important for all patients because dentists are often the first providers to detect diseases, such as leukemia, HIV, diabetes, lupus, and even eating disorders. By streamlining patient access to records, we can help combat a siloed healthcare system that puts additional pressure on patients.
While these changes in the dental industry are exciting, we still have a long way to go. Many people remain under-educated on the importance of dental health during pregnancy, and some still see dental care as an unnecessary luxury. Significant barriers persist, including fear about dental appointments, and stigmas about poor dental health.
We need more partnerships like the ones Dental Lifeline Network and Georgetown University are facilitating, so that dentists and maternal health practitioners can stay up to date on important information, but we also need more dental offices to perform outreach through community health organizations. Our public health agencies can further help drive home the importance of dental health in maternal care, through messaging campaigns that utilize social media and community outreach to connect with high-risk and marginalized communities.
Finally, we need to understand that poor dental health during pregnancy is a system failure, not a personal failure, and remove all shame around poor dental hygiene. Instead of promoting the idea that pregnant people simply need to become better advocates for themselves, we should train providers to advocate for their patients and seek opportunities to serve new communities.
Closing racial gaps in dentistry and healthcare requires a reimagining of the system to prioritize long-term preventative care. It’s a steep climb, but by working together to address the systemic issues that make it harder for pregnant people to care for their teeth, we can close gaps that hinder overall maternal health.
