Midwives and oral health recommendations

Background

There has been a growing awareness of the role and impact of oral health during pregnancy on children. Studies have suggested that poor oral health can lead to perinatal complications such as low birth weight, preterm delivery and poor oral health in children. Good oral health is vital to overall health and well-being but is nevertheless often neglected during pregnancy, especially among women of lower socioeconomic status. A major global health issue, early childhood caries (ECC) is the most common chronic disease among children, affecting up to 94% of children aged 1 to 5 years worldwide. In Germany there are different oral care recommendations from different professional organisations (pediatric and dental). As midwives are often the first health professionals that pregnant women encounter, they can have a pivotal role in influencing the oral health of expecting mothers and their children. With this nationwide survey, the authors assess the current state of knowledge and recommendations of active, practizing midwives in Germany. Furthermore they evaluate, which guidelines (Pediatrics Society or Dentistry Society) they follow.

Methodology

The nationwide survey was conducted online using a self-developed, pretested and validated standardised questionnaire. Members of the German Association of Midwives (7,500) were informed of the survey via email, newsletter, the association’s website and journal. Survey participants were midwives currently practizing in Germany. The survey began on the 1st of February, 2015 and ended on April 30th, 2015. The survey consisted of a 16 item standardised questionnaire with both closed questions and open-ended questions. No incentives were offered for participation and the survey was approved by the Ethics Committee of the Jena University Hospital.

Results

• The survey response rate was 12.6% (947 participants).
• A vast majority of midwives (78.6%) advised pregnant women about periodontal diseases.
• Just over half of the midwives (53.5%) recommended a dental visit during pregnancy.
• “A total of 65.5% of midwives advised parents about early childhood caries.”
• Just over 60% recommended that oral hygiene starts with eruption of the first tooth.
• Most midwives recommended vitamin D, vitamin D combined with fluoride and fluoride supplements.
• “The recommendation of fluoride supplements was rejected by 18.3% of midwives.”
• 43% of midwives recommended the use of fluoride toothpaste.
• Most midwives recommended a child’s first dental visit to be at age 2 or 3 years while one-third gave no recommendation.
• Advice about ECC included consequences of prolonged bottle use and sweetened drinks.
• “The preventive recommendations were given regardless of age, professional experience or working conditions of the midwives.”
• “The preventive recommendations of midwives who had already received advanced training in oral health were significantly different from their colleagues. Trained midwives were aware of the role of maternal health and its potential impact on the child.”
• More than half of the midwives used a mix of pediatric and dentistry guidelines.
• “The results revealed that there is a strong need for the development of uniform guidelines that are based on agreement between the societies of pediatricians and the societies of pediatric dentists in Germany.”

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