An ongoing public health challenge: Family oral heatlh: The Philadelphia Nurse-Family Partnership "Smiles" Initiative Update

In 2007, a homeless Maryland twelve year old boy, Diamonte Driver died from an abscessed tooth. In 2008, a California woman's first pregnancy ended with a stillbirth. She had untreated gingivitis that allowed bacteria to enter the bloodstream. Her baby died from a septic infection caused by Fusobacterium nucleatum. Public health initiatives that educate pregnant and parenting families about good oral and preventive health practices are critical. This paper updates the “Smiles” initiative of the Philadelphia Nurse-Family Partnership (NFP) initially presented at the 2007 annual meeting. Yearly, the Philadelphia NFP serves 400 low-income, eligible pregnant and parenting first-time mothers and concomitant number of offspring. The 2006 - 2007 dental health teaching tool documented that the majority of women (N=123) had significant oral health needs. They self reported inadequate oral hygiene and shared that scheduling and keeping preventive or restorative dental health appointments “scary”. In addition, more than half did not recall any primary care provider addressing their oral health needs during pregnancy. Based on these data, the educational tool was revised. A NFP Nurse Intervention section was added to document in home education (thirty-six weeks gestation and four months post-partum), referrals made, and essential provider follow-up. This paper presents findings based on extrapolated data of NFP women (N=300) enrolled in the program since 2007. This cohort self reported that seventy-two percent of prenatal or primary care providers did not discuss 1) oral health during pregnancy, 2) care of infants' gums and erupting teeth during the first year of life, 3) the need for routine or emergency dental care during pregnancy. The role of public health nurses and like minded professionals to improve the dental health of low-income urban mothers and their offspring is emphasized. In the 21st century, there is no reason that anyone should lose their teeth prematurely; die from an abscessed tooth; have untreated gum disease that contributes to prematurity and/or fetal demise. Discussion regarding the replication of the Philadelphia “Smiles” initiative with other low income, at risk populations concludes the presentation.