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Dental Public Health Activities: Descriptive Summaries

Integration of Oral Health Assessment, Education and Dental Referrals into Perinatal Care

Practice Number: 22002
Submitted By: MaineHealth
Submission Date: April 2019
Last Reviewed: April 2019
Last Updated: April 2019
Best Practice Approach Example Integration of Oral Health Assessment, Education and Dental Referrals into Perinatal Care

The Before the First Tooth (BTFT) initiative works to integrate oral health into prenatal care by providing oral health education for health providers and expectant mothers and will refer patients to dental services. This initiative was part of the PIOHQI grant supported by HRSA and is housed at Maine Health. Numerous Maine reports have documented barriers in access to care, workforce shortages and a lack of reimbursement for dental services.

This initiative has worked on a state-wide clinical prenatal oral health integration pilot program encompassing the integration of oral health screenings, assessments and dental referrals during OB/medical prenatal visits and collecting data from each pilot site to assess impact, challenges and successes. Each pilot site received a one-hour clinical training and guide to implementation prior to the pilot launch. The initiative established goals, objectives and requirements for data reporting, and how initiative staff would provide support.

The initiative has received positive acceptance of oral health assessments and referrals during prenatal care by the healthcare providers.  Preliminary data found that 28% of pregnant women reported seeing a dentist in the previous six months. At the completion of the six-month pilot, sites reported 90% of new prenatal patients received an oral health assessment during a prenatal appointment with 8%, 50% and 48% receiving immediate, early and routine dental referrals. Each pregnant patient receives oral health education materials, recommendations about oral health care during pregnancy and a dental referral if needed from the OB/medical practice. Pilot sites range from FQHCs, co-located dental clinics, and Ambulatory Clinics.

Lessons learned from these sites will instruct other practices that are considering implementing similar activities. Associated costs include staffing, travel, supplies, contractual/consulting work, and support services.

Lessons Learned:

  • Many of the pilot sites found patients were uninsured/underinsured and unable to afford dental care. When faced with an immediate or urgent dental need, these patients experienced delayed care or had to be seen at the emergency room due to restricted access to care. 
  • Clinical test sites varied from practice to practice.
  • Do not launch a clinic test pilot in middle of an EHR change or any other large systems change.
  • Due to gaps in the referral process, case management is essential.
  • The pilot phase provides an opportunity to identify issues that need to be addressed and determine action steps to full implementation, to assure the least possible disruption when full implementation occurs.
  • A best practice goal is to embed the OHA into an EHR system, however incorporating assessments into an EHR as a discoverable field (reportable data) is typically a lengthy and challenging process within many health systems.
  • Staff turnover was experienced throughout the project. Therefore, orientation about the project is a key component of onboarding.

The most challenging cases were patients who were in need of immediate care that were uninsured or underinsured. The goal was to link patients to local dental offices instead of accessing the emergency department due to dental pain, abscess or infection.  This became challenging due to limited access and lack of Medicaid coverage for pregnant women over the age of 21

Contact Person(s) for Inquiries:

Laura Robbins, CHES, Director, Before and From the First Tooth, MaineHealth, 110 Free Street, Portland, Maine, 04101, Phone: 207-661-7568 

Audrey Patin, RDH, CHES & Cori Holt, MBA, Pediatric and Prenatal Oral Health Managers, MaineHealth, 110 Free Street, Portland, Maine, 04101, Phone:207-662-6296, Email: