Maternal and Child Oral Health – Systematic Review and Analysis

A report prepared by the Murdoch Children’s Research Institute for the Ministry of Health, September 2008

Background – why was the report commissioned?

The Government is investing a significantamount of additionalfunding to improve child and adolescent oral health services, and the facilities they are provided in. This investment is a key part of implementing the oral health strategic vision Good Oral Health for All, for Life and the government’s commitment to better, sooner and more convenient access to health services.

A key part of the strategic vision is a move to increase prevention and early intervention activities to reduce both the level and severity of dental disease among children.

The Ministry of Health commissioned this report in 2008 to contribute to the body of knowledge around prevention and early intervention opportunities at the preand post natal phase. Lack of information was identified as hindering policy and programme development, for example, in preparing guidance on effective programmes to reduce early childhood caries. The Ministry of Health is grateful to the Murdoch Children’s Research Institute for the report.

What is in the report?

The report provides a structured analysis and review of the literature and evidence around the impact of maternal oral health on child oral health. It sets out:

  • where there is evidence and data at a national or international level
  • the strength of the evidence
  • the gaps in the epidemiology
  • suggestions for options to be explored.

Key findings

The report advocates for early interventions focusing on primary prevention among pre and post-natal women, and where possible, targeting these to disadvantaged groups. In particular it notes:

  • early childhood caries (ECC) appears to be an ongoing and significant problem for children in New Zealand
  • little information is available on the disease levels of children under the age of five and even less about the impact of dental disease on the functioning of families and the quality of life of children and families
  • in relation to periodontal disease (PD) there appears to be some evidence of a relationship between PD and poor birth outcomes
  • there is little strong evidence to link poor maternal health during pregnancy directly with ECC in their offspring
  • improvements of maternal oral health are associated with some reductions in dental caries experience in their children, however, the quality of primary studies is not high
  • the role of fluoride in maternal and child oral health remains important.

A summary of the recommendations and the Ministry’s response is in the table below.

Summary of the key recommendations and the Ministry’s response

Recommendation / Key points / Ministry of Health response
1. Evidence / More research is needed. / The Ministry is organising workshops around the country during 2009 to disseminate the report findings and to stimulate discussion and further research. The Ministry has an annual contestable research round to support research and contestable funds are available through sources such as the New Zealand Dental Association, Dental Research Foundation and the Health Research Council.
2. Routine surveillance / Establishing baseline data for the pre-school population would be useful. / Agree. District health boards are now required to report on the number of pre-school children enrolled in the oral health service. Information is also beginning to be collected through the B4 School Check programme being rolled out in all DHBs. The progressive introduction of electronic dental record systems in DHBs will provide access to dental status data at pre-school ages. A pre-school caries risk assessment tool is being developed to assist providers identify children at risk. This could contribute to the establishment of baseline data.
3.Addressing inequalities / All pregnant women should be targeted for oral health promotion, with additional resources to develop programmes for socially disadvantaged women and those from high risk populations. / DHBs and service providers are best-placed to determine the needs of their communities and the best service-mix and delivery options to address them within available resources. The Ministry of Health plays a role in advocating for the inclusion of oral health promotion across the wider health sector.
4. Health promotion / Oral health promotion should be integrated with existing services already accessed by women from disadvantaged groups, such as Well Child or primary care services. / Agree. This is increasingly occurring. Oral health promotion has been included as a stronger feature in the Well Child schedule of visits. Stronger linkages with primary care and other allied health providers are encouraged. Family Start services provided through the Ministry of Social Development also include dental health check-ups.
5. Evaluation / Oral health promotion programmes should include evaluation plans. / The Ministry of Heath document Promoting Oral Health: A toolkit to assist the development, planning, implementation and evaluation of oral health promotion in New Zealandpublished in February 2008 includes a structured approach to oral health promotion programme design and evaluation.
6. Cultural competency / Oral health interventions should be preceded by careful and comprehensive needs assessment using techniques that engage community groups. / As noted above, DHBs are expected to identify community needs and to fund or deliver appropriate services. A structured approach is also discussed in Promoting Oral Health: A toolkit to assist the development, planning, implementation and evaluation of oral health promotion in New Zealand.
7. Content / Primary level approaches should include low technology strategies such as tooth brushing with fluoride toothpaste, and be integrated with comprehensive prevention and health promotion approaches. / Agree. Simple, manageable self-care strategies need to be supported. Key messages need to be consistent across the sector.