Oral Health and Group Prenatal Care
The 2000 Surgeon General’s report calls oral diseases a “silent epidemic.” The report states that oral health is associated with general health and that poor oral health is associated with increased incidence of heart disease, diabetes, and preterm birth and low birth weight infants.
Kentucky ranks first in the nation for residents who have lost all their teeth, 29th for dentist-patient ratio (even lower in Appalachian and rural counties), 49th in the number of low-income adults who made a dental visit in the preceding year, and fifth for cardiovascular disease mortality rate. Kentucky has some of the nation’s highest rates of poor oral health and negative birthing outcomes. Approximately 5,000 premature, low birth weight babies are born in Kentucky annually, and Kentucky’s rates of preterm babies and low birth weight babies have increased by nearly 20 percent over the last 10 years. These babies are likely to experience higher than average health problems throughout their lifetimes. Their families and the Commonwealth will face significant costs associated with their prematurity and low birth weight. Medical procedures at time of birth average $40,000, making the annual cost in Kentucky approximately $20 million.
Responding to this Kentucky priority problem, the initiative for Oral Health and Group Prenatal Care, or “Centering with Smiles,” is working to reduce the cycle of preterm birth, low birth weight, and poor oral health in Kentucky. The UK team works with local healthcare providers to offer group prenatal care at UK and rural clinics combined with treatment for persistent infection in the mouths of pregnant women. The team hopes to reduce the number of preterm, low birth weight children born in Kentucky, improve overall health, and reduce healthcare costs.
Centering with Smiles
The UK team, including Jeff Ebersole, Robert E. Kovarik, M. John Novak, M. Raynor Mullins, and Judy Skelton from the College of Dentistry and James E. Ferguson, II from the College of Medicine, is targeting oral diseases as a possible cause of low birth weight babies in the Commonwealth. By increasing the availability of dental care in rural clinics, the project seeks a reduction in the number of low birth weight babies, as well as a 40 percent reduction in the number of children suffering from early childhood caries. A one-in-ten reduction in Kentucky preterm births alone could save over $2 million annually. Together, they could save $17 million annually. The program targets populations in UK clinics and rural sites in Hazard, Whitesburg, Madisonville and Morehead.
Actions and Outcomes to Date
Working with the Women’s Center at the Trover Foundation, the Hopkins County Health Department, and the Bluegrass High Risk Obstetrics at the Chandler Medical Center in Lexington, the project has produced significant advances. At the Women’s Health Center in Madisonville, overall preterm birth rates have been reduced from 18% to 6%, and rates of low birth weight deliveries from 11% to 3%. The rates for preterm birth of women who completed more than 50% of the Centering visits and received dental care were reduced from 18% to 4%; their rates for low birth weight were reduced from 8% to 4%. Women who did not attend at least 50% of the Centering visits and did not receive dental care had dramatically higher rates than Hopkins County’s historical norm of 28% for preterm and/or low birth weight infants; for these women the rate was 42% as opposed to 5% on the Centering with Smiles program.
These data suggest that oral infections are an important risk factor for the delivery of pre-term infants. The March of Dimes has included the Centering with Smiles project in its New Kentucky Initiative, aimed at improving the rates of preterm birth and low birth weight babies.
More regional health centers are being identified for starting the Centering with Smiles program. A self-sustaining program is sought. Expansion of the program throughout Kentucky will have a significant impact on the health and welfare of our children as well as in lowering healthcare costs in the Commonwealth. Applications have been submitted for federal and state research support to continue the initiative.