Ask any expecting mom what is on her mind, and the list is endless. I think about the things I did to prepare for my pregnancies, especially when my healthy boys call on Mother's Day. Each time I was pregnant, I devoured articles on every topic, from what to eat (and what not to eat) to how to plan for delivery. As a soon-to-be new mom, I worried about every little thing because I wanted to maintain the best health for my newborn and myself. I confess that I wasn't really thinking about my teeth, but I should have been.
Oral health has a marked impact on maternal health and fetal development. Oral diseases are among the most prevalent and preventable conditions affecting all American women. Pregnant women are particularly susceptible to dental problems due to hormone changes, vomiting from morning sickness and other pregnancy-related issues. And dental problems can have a profound impact on the child. Take tooth decay. Left untreated, it can develop into a serious oral infection or abscess, and even a bacterial skin infection. Untreated gum infections - gingivitis or periodontitis - in pregnant women can lead to low birth weight, premature delivery and lower placental blood flow. In addition, bacterial diseases of the mouth that cause cavities can spread from mother to infant.
That is why the standard of care for prenatal care includes a referral to a dentist. Yet, for low-income pregnant women struggling to get by, dental care may be out of reach. Dental care can be expensive for anyone, but for women relying on public health insurance, the coverage landscape has many roadblocks.
Medicaid is the nation's major insurer for women of reproductive age who need prenatal, maternal and post-partum services. Women relying on Medicaid have access to a benefits package that includes a number of critical health services, including prenatal check-ups and screenings to keep both mother and fetus healthy. Inexcusably, dental care is not a mandatory service, and thus not always covered by Medicaid. In years of tight state budgets, dental coverage may be one of the first things to go. As a result, access to dental care may depend on where you live. Some states, like Oregon, provide dental coverage to the majority of its Medicaid enrollees. Others, like Georgia and Idaho, only offer dental coverage to pregnant women, but not to other adults. Even in states that provide dental coverage, pregnant women may have difficulty finding a dentist who participates in Medicaid.
The good news for low-income pregnant women is that Medicaid requires states, at a minimum, to cover dental services if a woman's pregnancy could be impacted, such as with periodontitis. Pregnant adolescents under age 21 can also count on Medicaid to help alleviate dental pain, restore damaged teeth and maintain good dental health.
States can also cover pregnant women in need via the Children's Health Insurance Program (CHIP). Depending on how the state structures its program, a pregnant women may, at a minimum, have limited scope dental care covering at least the dental services that could impact her pregnancy, or full-scope dental care including cleanings and restorative treatments.
For low-income pregnant women getting coverage through a Marketplace created under the Affordable Care Act (ACA), dental coverage may not be provided, as the ACA does not require dental coverage as part of comprehensive pregnancy care. Insurers, however, may offer separate dental plans in the health insurance Marketplaces. There is interest in these plans, as many people have already taken advantage of them.
Health advocates and policy makers at the state and federal levels have a number of tools they can use to improve dental care. States should recognize that providing comprehensive dental care is in the best interests of both mother and infant, and advocates should work to educate people about their coverage options. On this Mother's Day, let us acknowledge that the life of a healthy child starts with a healthy mother. Let's give mothers and children a Mother's Day gift of health, including healthy teeth.