Qualitative exploration of barriers and facilitators of dental service utilization of pregnant women: A triangulation approach.

BACKGROUND: Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women's dental service utilization. METHODS: Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software. RESULTS: Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists' unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies. CONCLUSIONS: Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.

Follow-up preventive dental visits for Medicaid-enrolled children in the medical office.

OBJECTIVE: To describe the frequency and determinants of follow-up preventive oral health visits at medical offices among children screened for dental disease, receiving fluoride varnish and counseling. METHODS: Parents of Medicaid children enrolled in a clinical trial completed a baseline questionnaire before their child's medical visit. The providers completed patient dental encounter forms at each visit, documenting dental services, caries risk, and dental disease. Questionnaires, encounter forms, and Medicaid claims were linked to create a database with information on visits, child and caregiver characteristics, and oral health practices. Descriptive and multivariate analyses assessed associations of variables with likelihood of follow-up visits. RESULTS: A total of 744 children with mean age of 15 months at enrollment had 1,415 oral health visits. Children averaged 0.9 follow-up oral health visits and 1.3 follow-up well-child visits. Fewer children had follow-up oral health visits (55 percent) than well-child visits (70 percent), but children with a baseline preventive dental visit at a younger age had more visits with shorter intervals. Caregivers reporting greater numbers of children and putting the child to bed with the bottle had more subsequent visits. Older age of child, male child, and caregiver education < or = 12 years were associated with fewer follow-up visits. CONCLUSIONS: Children with preventive dental services in medical offices have similar numbers of oral health and well-child visits, with both below recommended numbers. Strategies to increase these services may need to be tied to those aimed at increasing compliance with well-child visits, taking advantage of nonwell-child visits, and implementing Medicaid policies that allow for optimal timing of visits.