Literature Review on Dental Care

The health, well-being and quality of life of human beings depend on good oral health throughout a lifetime, from infancy to adulthood. According to the World Health Organization (2018), oral health diseases such as dental caries (cavities) and periodontal disease, affect many people around the world and they are, for the most part, entirely preventable. Populations most vulnerable to these preventable diseases are youth, older adults, racial and ethnic minorities, individuals with intellectual and developmental disabilities (IDDs) and pregnant women, to name a few. It is important to understand why pregnant women of lower socio-economic status do not receive dental care throughout the entirety of their pregnancy to help develop appropriate interventions.

Oral Health Diseases

During pregnancy, physiological changes and fluctuating hormone levels can negatively affect the oral health of women (Steinberg, Hilton, Iida, & Samelson, 2013). These fluctuations in hormones can lead to an oral health disease called periodontal disease. Periodontal disease is a disease that affects the gums surrounding the teeth. Progression of periodontal disease can oftentimes lead to tooth loss among those affected. Poor pregnancy outcomes associated with periodontal disease are low birth weight, preeclampsia and gestational diabetes mellitus (Corbella et al., 2016; Hartnett et al., 2016; Wu, Chen, & Jiang, 2015).

In addition, the increased risk in periodontal disease is not the only poor oral health outcome pregnant women need to worry about. Tooth decay, due to dental caries, is a common disease that women may experience due to changes that occur during pregnancy. Considered a non-communicable disease by the World Health Organization (2018), tooth decay caused by dental caries is the most common disease affecting people worldwide. It is considered the most common chronic disease in children around the world (Pitts, et al., 2017; U.S. Department of Health and Human Services, 2000). Dental caries are the breakdown of tooth enamel due to bacteria-created acid (Pitts et al., 2017). Enamel is the white part of the tooth that protects against caries. Once the enamel is eaten away by the acid produced by bacteria in the mouth, holes form on the surface of teeth and can be very painful. If caries are left untreated, the infection can occur (Pitts et al., 2017).

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Barriers to Accessing Dental Care

Many vulnerable populations may experience barriers to accessing quality and timely dental services due to a lack of insurance, education or being underinsured leading to unaffordable dental procedures. In addition to accessing dental services, vulnerable populations may also experience health disparities. Pregnant women are an example of a vulnerable population that may experience worse health outcomes due to being pregnant or based on their socio-economic status. According to the U.S. Surgeon General, preventative care for oral health during pregnancy should be considered a priority for improved health outcomes for both mother and child. (U.S. Department of Health and Human Services, 2000). Preventative care includes visiting the dentist at least twice a year and continuing regularly scheduled dental procedures as they are safe to perform (The American College of Obstetricians and Gynecologists, 2013). Regular dental procedures can include fillings, crowns and root canals. X-rays are also safe during pregnancy with proper use of equipment.

A study conducted by Azofeifa, Yeung, Alverson, and Beltran-Aguilar (2016), pregnant women experience a higher rate of dental caries than women who were not currently pregnant. This may be due to some dentists not wanting to treat pregnant women due to liability issues or obstetrician-gynecologists not stressing the importance of or educating about oral health during pregnancy, however, further research would be needed (Hartnett et al., 2016; National Maternal and Child Oral Health Policy Center, 2012). A study done by Marchi, Fisher-Owens, Weintraub, Yu, and Braveman (2010) found that a lack of a perceived need of dental care was also a barrier for pregnant women, specifically, accessing dental care. In addition to a lack of a perceived need of dental care during pregnancy, cultural beliefs might also limit a woman’s ability to receive dental care (Abiola et al., 2011; Ibrahim, Mudawi, & Ghandour, 2017). Another barrier to receiving dental care during pregnancy is the belief that procedures are unsafe (Marchi et al., 2010).

Tooth decay may not only cause someone physical pain, it may also lower the quality of life, especially of individuals of vulnerable populations like pregnant women. During pregnancy, women’s perceptions of themselves are lower compared to before they got pregnant (Geevarghese, Baskaradoss, & Sarma, 2017; Haas et al., 2005; McKee, Cunningham, Jankowski, & Zayas, 2001).

Health Belief Model

In order to understand why pregnant women do not seek dental care during pregnancy, the health belief model can be used to explain why. The health belief model (HBM) is a theory that can be used to help public health practitioners in explaining why or why not individuals choose to use health services (McKenzie, Neiger, & Thackeray, 2009, p. 173; Rosenstock, 1966). This theory can help explain why some women do not visit the dentist during pregnancy. For pregnant women, the HBM theorizes that if women feel susceptible to periodontal disease, they will seek dental care. Oral health education during pregnancy by obstetrician-gynecologists or dentists is a way to increase awareness of the importance of visiting the dentist during pregnancy. By a lack of information about the importance or oral health during pregnancy and how it may harm the child, the perception of the seriousness of oral health diseases is decreased. They will also seek care if they understand the severity of periodontal disease and its effects on their child. Education on the importance of visiting the dentist during pregnancy may increase a mother’s perceived severity. If pregnant women are aware that oral health diseases are entirely preventable, they might realize the benefits of receiving dental care during pregnancy. However, going to the dentist can be costly if an individual does not have dental insurance or if the dentist feels uncomfortable treating pregnant women. If a pregnant woman feels that the benefits outweigh the barriers to receiving dental care, this might increase the likelihood of taking action to prevent poor health outcomes for the mother and baby. Through creating awareness and removal of barriers, pregnant women can seek dental services and prevent adverse health outcomes due to oral health diseases.