Racial/ethnic Disparity in Perceiving Oral Health Benefits Among Pregnant Teen Enrolled in Medicaid : An Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS), 2012-2015

Background: Previous studies have shown that racial/ethnic minority women have poorer oral health and less likely to visit dentists during pregnancy. Possible causes were shown to be a lack of dental coverage or perceived benefits. Medicaid for children provides the comprehensive dental treatment. This study examined if such racial and ethnic disparities persist among pregnant teens enrolled in Medicaid in accessing dental care and perceiving oral health benefits during pregnancy.

Methods: Study

Design: This retrospective secondary data analysis examined dental visits and coverage, perceived benefits of oral health, and oral health counseling during pregnancy using the Pregnancy Risk Assessment Monitoring System datasets between 2012 to 2015. Demographic variables and prenatal visit scores from birth certificate data and survey responses on dental variables were included in the analysis.

Population Studied: 5,157 women with a recent birth history, a weighted number of 270,022 teens, were included in the study from 36 states and New York City. Women who were 20 or older at the time of delivery were excluded. Race/ethnicity was categorized into non-Hispanic white (white), non-Hispanic black (black), and Hispanic. Teens with other races/ethnicity and other medical insurance were excluded from this study.

Results: Less than half of the teens (43.7%) reported that they had dental visits for cleaning. Prior to pregnancy, 55.4% of teens reported they had dental visits for cleaning. Most teens (82.3%) reported that they knew it was important to care for their teeth and gums during pregnancy (perceived oral health benefits). When adjusted for age, marital status, maternal education, the timing of the first prenatal visit, previous live birth, and pre-pregnancy dental visit, there was no difference in visiting dentists for cleaning during pregnancy by race/ethnicity. However, there was a significant difference in perceived oral health benefits during pregnancy in black teens (aPR=0.95[0.91-0.99], p=0.009) and Hispanic teens (aPR=0.92 [0.87-0.96], p<0.001) compared to White teens.

Conclusion:

Conclusion: There was a significant racial/ethnic difference in perceiving the importance of oral health during pregnancy. Future study needs to examine meaningful oral health education for Black and Hispanic pregnant teens, which can modify health beliefs and health behavior to maintain oral health during pregnancy and after delivery.

Implications for Policy or Practice: Pregnancy is a critical time to secure the oral health of mothers and their children. The mother's perceived benefits of oral health can change home oral hygiene practice for herself and her baby. It was alarming that teens of color were significantly less likely to perceive oral health benefits during pregnancy than White teens adjusting for other demographic variables and prenatal care timing. Policymakers and practitioners should find ways to change the perceived oral health benefits among pregnant teens, empowering them to understand the importance of oral health during pregnancy and after delivery.