Ensuring Access to Dental Care for Pregnant Women in Vermont

Introduction. In Vermont, $2.7 million is spent annually caring for children ages 0-5 with early childhood caries (ECC) who require hospitalization for treatment. Nationwide, obstetricians are often not familiar with published prenatal oral health guidelines. It is unclear how providers in Vermont address prenatal oral health. Recently, the $495 Medicaid cap on reimbursement for perinatal dental care was lifted and now extends coverage 60 days after delivery, making the prenatal period an ideal time to intervene.

Objective. To identify barriers to prenatal oral health care.

Methods. A survey was emailed to 148 obstetric providers in Vermont, including obstetricians, family physicians, midwives, and nurse practitioners. The same survey was distributed at OB/GYN grand rounds. 39 completed surveys were received. The survey assessed patient demographics, knowledge, and methods used to address prenatal oral health. A patient focus group was conducted at a local residential health care facility.

Results. 74% of survey respondents were not aware of the Medicaid cap change. Time constraints during visits, lack of formal training, and scarcity of dental providers were identified as barriers to addressing prenatal oral health. Only 18% of respondents currently use oral health guidelines. The focus group thematic analysis reported challenges with the scarcity of dentists accepting Medicaid and long wait times to schedule appointments.

Conclusions. There is a need for improving central organization membership (such as OB/GYN participation in ACOG) and continuing medical education pertaining to recommended guidelines.  Moreover, the oral health needs of Vermonters could be better served if more dentists accepted Medicaid.