Communicating the Role of Oral Health on Pregnancy Outcomes in Rural Kentucky

1. Communicating the Role of Oral Health on Pregnancy Outcomes in Rural Kentucky Sharlee Shirley Burch, RDH, MPH Judy Skelton, RDH, PhD MR Mullins, DMD, MPH

2. The Value of Partnerships • Health Education through Extension Leadership – University of Kentucky College of Agriculture • Kentucky Consortium for Applied Research and Treatment – University of Kentucky College of Dentistry

3. Health Education Through Extension Leadership • Addressing the health issues of Kentuckians • Bridging people, resources, ideas and actions • Outreach, education and research • Formal collaborations with long term partnerships

4. HEEL PROGRAM GOALS • Build community capacity to improve health • Educate consumers to make informed health choices • Educate and empower individuals and families to adopt healthy behaviors and lifestyles

5. University of Kentucky College of Dentistry Division of Public Health Dentistry • Tackling the Epidemic of Oral Disease • Beyond the Dental Professional • A History of Collaboration

6. A track record for thriving partnerships • Cabinet for Health and Family Services • Tobacco Prevention Program • Ronald McDonald Charities • Fayette County Public Schools • Pikeville School of Osteopathic Medicine • College of Public Health • College of Medicine • Area Health Education Centers • Family Resource Centers • State and Local Health Department’s

7. Agriculture and Dentistry: Not so Strange Bedfellows • Health Education Through Extension Leadership Project • Chronic Disease Education – diabetes, heart disease, obesity, cancer • Oral health linkages • Economic Development

8. Oral Health Wellness and Disease Prevention Program – a HEEL Partnership • Collaborative projects • Public education • Public policy • Applied research • Service programming • Technical assistance • Instruction

9. The Outreach and Research Connection: KY-CARAT

10. KY CARATKentucky – ConsortiumforAppliedOral HealthResearch andTreatment

11. Purposes • provide an infrastructure for educating dental, medical and health professionals • provide state-of-the-art clinical care and education to patients in communities • enable the development of outreach research capabilities in rural regions of the Commonwealth.

12. Purposes (cont.) • provide an economic impact by: • decreasing expenditures for “major/heroic” oral health care of children and adults • focusing oral health dollars for regional implementation of preventive and early intervention strategies • providing an economic stimulus to the regional sites through creation of jobs • increasing oral health care access, thus broadening the participation and generating a new funding base that remains and/or flows into the regions.

13. Results and Benefitsof KY CARAT • Infrastructure development • Training • Research capacity • Healthier Kentuckians!!

14. Collaborating Sights • Center for Oral Health Research at the University of Kentucky in Lexington (Central Kentucky) • The Center for Rural Health in Hazard, KY • Mountain Comprehensive Health Corporation facility in Whitesburg, KY (Eastern Kentucky) • St. Clair Hospital in Morehead, KY (Northern Kentucky) • Trover Foundation in Madisonville, KY (Western Kentucky)

15. Areas of Focus • Preterm low birth weight babies • Early childhood caries • Diabetes and oral disease link

16. Background on Preterm Low Birth Weight Babies • The rate of preterm/low birth weight (PTLBW) infants in the U.S. has not significantly decreased during the last 3 decades • Spontaneous preterm births account for 10% of all live births in the US and is a predominant cause of perinatal morbidity and mortality • These rates tend to be highest in underserved rural populations

17. Preterm Low Birth Weight Babies • Cost to the government between $1.4 and $2.6 billion annually in Medicaid and Aid to Families with Dependent Children • It is estimated that an additional $6.4 to $12 billion dollars cost to society as a result of both short term and long term care • In Kentucky >5,000 PTLBW occur annually with an estimated acute care cost of nearly $40,000/birth

18. Oral Health and PTLBW • periodontal (gum) disease has been implicated as a contributing factor to an increased incidence of PTLBW • periodontal infection periodontal pathogens low-level, chronic bacteremia release of chemical mediators cross placenta initiate labor

19. Oral Health and PTLBW • Periodontal disease is preventable and treatable • Cost to maintain periodontal health is minimal when compared to the costs attributed to negative birthing outcomes • The potential reduction of cost to society, impact on family structure, and prevention of disease related to preterm birth validate the need to clarify the association between periodontal disease and preterm birth

20. Oral Health Wellness and Disease Prevention Program – HEEL Contribution to KY CARAT • Oral health resources for each community on pregnancy and oral wellness • Training of Extension Agents on oral health and pregnancy outcomes for spreading knowledge to at-risk mom’s in rural communities • Community based outreach and education on oral health and pregnancy

21. The Model for Outreach and Service: Centering Pregnancy Reaching Rural Women - Project site: Trover ClinicWomen’s Center Madisonville, Kentucky

22. Centering Pregnancy™ • routine, individually-based prenatal care is abolished • replaced by a system that provides complete prenatal care to groups composed of 8-10 women of similar gestational age • incorporates the three components of prenatal care – risk assessment, education, and support – in a unified format

23. Centering Pregnancy™ • encourages the women to take responsibility for their own health • at each visit, standard prenatal risk assessment is followed by an educational session using a discussion format • free exchange among the group members is encouraged

24. Centering Pregnancy™ • an atmosphere of mutual support is developed • more efficient and cost effective • additional peer-support occurring within these maternal networks

25. Centering Pregnancy™ with Smiles • Adaptation of the Centering Pregnancy model • Designed to create an integrated oral/medical health education and an intervention model

26. Centering Pregnancy™ with Smiles • Integrated educational units • Treatment to control oral infections • Self-assessment of oral diseases

27. Centering Pregnancy™ with Smiles • Oral diseases • Plaque control and disease prevention • Relationship of nutrition & oral health • Oral anatomy and eruption patterns • Maintaining baby’s oral health

28. Formative Research: The Process of Centering Pregnancy in Madisonville Kentucky

29. In the Beginning… • 2 days, possibly two groups • Slow, “ramp up” process • Hiring a Registered Dental Hygienist • Equipment and material needs • Scheduling and Billing • Will this model work???

30. Currently… • Groups every day! • Several groups a day! • RDH works full time with educating groups and serving pregnant moms! • Dental chair and equipment housed in the Center! • Scheduling and Billing in process! • Is this model working???

31. Project Completion: Goal Early 2007 • Centering Pregnancy with Smiles continues on large scale basis • Continued “tweaking” of project • Data Gathering • Continued Community Education and Outreach

32. Early Findings… • Rural Women in Kentucky will accept group prenatal care • Rural Women in Kentucky will accept dental treatment during pregnancy • Rural Women in Kentucky are engaging with each other and providers and learning more about their bodies and their babies

33. Questions/Comments?Thank you!

34. Communicating the Role of Oral Health on Pregnancy Outcomes in Rural Kentucky Sharlee Shirley Burch, RDH, MPH Judy Skelton, RDH, PhD MR Mullins, DMD, MPH