Periodontal disease is associated with adverse pregnancy outcomes, including preterm birth, low birthweight, and pre-eclampsia. Guidance from practitioners that provide care during pregnancy and delivery should include knowledge of the association between periodontal health and adverse pregnancy outcomes. In a study published in March 2020 in the International Journal of Environmental Research and Public Health the authors aimed to “evaluate the knowledge, attitudes and practice behavior of Australian midwives regarding the periodontal health of pregnant women to inform interprofessional antenatal care.” 1
Women are at an increased risk of developing periodontal disease and dental caries during pregnancy. This is associated with hormonal changes as well as increased level of systemic inflammation. Though previous studies have shown that obstetricians and gynecologists are aware of the association between oral health and adverse pregnancy outcomes, pregnant women are not referred to dentists for routine dental care as needed.
Though most pregnant women will access care from a midwife or OB/GYN, many will not seek routine dental care. Having trained and educated midwives that can promote oral health and the importance of dental care during pregnancy would be a benefit for patients. Ignoring the association and importance of dental care during pregnancy is a missed opportunity by the midwife to ensure the best outcome for the mother and baby.
Midwives included in this study were primarily female and on average 43 years old. This meets the national average of midwives in Australia as 99% are female and the average age is 44. The midwives in this study understood basic signs of periodontal disease but were not clear on the definition and etiology of the disease. Nor did they understand the difference between periodontal disease and dental caries.
The results showed 63% understood that periodontal disease is an inflammatory bacterial infection, however 31.8% incorrectly defined periodontal disease as a degenerative disease. Additionally, 28.9% identified gingival bleeding and 21.6% identified tooth mobility as clinical signs of periodontal disease, while 16% misidentified dental caries as a clinical sign of periodontal disease.
Unfortunately, 24.2% of midwives in this study felt that inquiring about their patient’s oral health was “beyond the routine practice of midwife.” Additionally, 21% of the midwives in this study never referred their patients for a dental consult. Barriers that were postulated included unclear referral pathways, the midwife’s knowledge of oral health, and lack of time during appointments. However, overall, the midwives in this study presented a positive attitude towards the importance of oral health as it applies to reducing risks of adverse pregnancy outcomes.
The authors conclude by stating, “The findings of this study show that further development of the Australian midwifery curricula is needed to support midwives in developing basic competencies to understand the fundamental signs and causes of oral disease, provide basic oral health information, and refer patients for further dental care. Midwives can play a key role in educating pregnant patients about oral health and connecting these patients at risk of gum disease with access to needed dental care. Interprofessional collaboration is critical for achieving optimal oral health and improving pregnancy outcomes.”
Does this study highlight the importance of interprofessional collaboration? Would you be willing to work with other healthcare professionals to improve dental care, especially for pregnant women? What suggestions do you have to achieve more interprofessional collaboration?
- Nguyen JG, Nanayakkara S, Holden ACL. Knowledge, Attitudes and Practice Behaviour of Midwives Concerning Periodontal Health of Pregnant Patients. Int J Environ Res Public Health. 2020;17(7):2246. Published 2020 Mar 27. doi:10.3390/ijerph17072246