Translating prenatal oral health guidelines into obstetric practice, a practice change project

Abstract

Early childhood caries (ECC) is prevalent and burdensome to a child's quality of life and development, albeit preventable. ECC prevention strategies implemented in the prenatal period are well supported by evidence to reduce ECC incidence and dictated in numerous prenatal oral health guidelines. However, obstetric (OB) providers do not often practice this evidence. The purpose of this project was to assess, plan, implement, and evaluate the introduction of prenatal oral health practices, that coincide with current prenatal oral health guidelines, to OB providers at one OB clinic. To do so, current prenatal oral health guidelines were evaluated and coalesced to form of a prenatal oral health protocol (POHP). Two OB provider and medical assistant (MA) pairs implemented the POHP over a 90-day implementation period in one OB clinic. Lewin's Change Theory guided the practice change process. To determine if, by implementing the POHP, the prenatal oral health practices of participating OB providers were significantly improved, before and after patient's charts were reviewed and data measuring provision of oral health practices were compared using a permutation test. It was also planned to measure dental attendance. A written survey was given to participating OB providers and MAs at the end of the project to gain their perspective on the practice change process and likelihood of sustainability. The results show that significantly more patients had documentation of prenatal oral health education (p<.0002, 95% CI 0.476-0.857), oral screening questions (p<.0002, 95% CI 0.857-1), and an oral screening exam (p<.0002, 95% CI 0.619-0.952) after the POHP was implemented than before. A dental referral was not made, thus it is unknown how many patients, in receiving a dental referral, would have attended the dentist at some point during pregnancy. Four out of 17 patients, correctly screened, should have received a dental referral based on the POHP, but did not. The survey showed favorable views of the practice change process and likelihood of sustainability. In conclusion, prenatal oral health practices can be incorporated into the practice of OB providers using a POHP, an appropriate implementation period, and a practice change process guided by Lewin's Change Theory.