The American Academy of Pediatric Dentistry (AAPD) and the Children's Dental Health Project (CDHP) are collaborating on a five-year HRSA-funded project to improve the oral health of pregnant women, new mothers, infants and toddlers. The project, entitled "Improving Perinatal and Infant Oral Health" (part of the HRSA/MCHB grant project titled Partnerships to Promote Maternal and Child Health, or PPMCH) is an initiative designed to reduce oral health disparities among these groups and increase access to oral health care services. The three main goals of the project are to: 1) expand availability of prenatal oral health care; 2) expand availability of infant oral health care; and 3) raise public awareness regarding dental care for pregnant women and infants.

The Problem
The consequential and high prevalence of oral disease among low-income and special needs Maternal and Child Health (MCH) populations has not been well addressed through primary prevention and health promotion. As dentistry has sought to reduce disease burden and health disparities, it has turned its attention to younger and younger age groups and has now gained a science-based appreciation for interventions targeting pregnant women, new mothers, and infants. As early as 1989, AAPD promulgated policy calling for care "that begins ideally with prenatal counseling" and continues with "an initial visit no later than 12 months of age" yet less than a fourth of dentists act on this policy and the public is generally unaware of the issue. The US Surgeon General in 2000 promoted attention to oral care and guidance during pregnancy as a key strategy to improve maternal health, fetal development, infant health, and birth outcomes. Yet Healthy People 2010 targets for improved oral health and improved pregnancy outcomes remain elusive in part because dental providers have not yet engaged meaningfully in promoting the oral and general health of perinatal populations.

Project Goals and Objectives
Goal I: Expand availability of prenatal oral health care
Objective 1: Disseminate resources on dental care for pregnant women to clinicians, health educators, and patients.
Objective 2: Promote policymakers' action to expand access to perinatal dental services.
Goal II: Expand availability of infant oral health care
Objective 1: Expand adoption of the age-one dental visit and dental home policies by pediatric and general dentists.
Objective 2: Expand dental care for infants at greatest risk for early oral disease.
Goal III: Raise public awareness regarding dental care for pregnant women and infants
Objective 1: Target AAPD's public awareness campaign (Good Health Starts Here) to pregnant women.
Objective 2: Promote inclusion of perinatal oral health components in public health campaigns

Methodology
The American Academy Pediatric Dentistry (AAPD) is the national dental membership organization that focuses on maternal and child health issues within the larger umbrella of the American Dental Association (ADA). AAPD members include over 90% of the nations pediatric dentists as well as general dentists affiliated through the American Society of Dentistry for Children. AAPD's mission is "to advocate policies, guidelines, and programs that promote optimal oral health and oral health care for children" within the context of families. Through a contractual affiliation, Children's Dental Health Project, a DC-based non-profit policy agency will function as the Program Office for this Project.

The Project employs a six-step approach to address identified needs for information communication, clinical protocols and tools, patient education materials, interdisciplinary coordination, policy activism, and public education. These six steps are: collect, review, and report on available information; then identify gaps; and finally address gaps through development and dissemination of novel products. The Work Plan details 12 planned tasks that, taken together, will prepare dentists to engage a wide variety of MCH organizations and providers at local, state, and national levels to:

promote appropriate oral health care for pregnant women;
actively participate in prenatal oral health counseling;
engage policymakers in taking effective action to improve dental access for socially-vulnerable pregnant women;
increase their adoption and capabilities in providing infant oral health care;
increase their adoption and capabilities in identifying and targeting care to children at highest risk because of social, medical, or dental predisposing factors;
increase the volume of early care available to children with special healthcare needs and those in Medicaid; and
articulate prenatal, neonatal, and infant oral health concerns to the public at large.

Innovative activities and products that prepare dentists to act effectively and partner widely include primary and continuing education and training programs and curriculum guides; refined clinical policies for oral care of pregnant women and infants; communications tools including policy briefs, news articles, and journal articles; patient education tools including a "new mother kit" and educational resources; a national symposium on care of young children with special healthcare needs; meetings with policymaker organizations; and products for public information campaigns.

Coordination
While this Project is national in scope and targeted primarily to improving dentists' capacities to address an identified need, it specifically prepares dentists in their various local, state, and regional capacities to coordinate activities with MCH officials, MCH programs, and prenatal care providers. At the national level, member agencies that will be engaged to coordinate effective action include but are not limited to the Association of Maternal and Child Health Programs, the National Conference of State Legislatures, the American College of Obstetrics and Gynecology, Healthy Mothers Healthy Babies, and the American Dental Association. At the state level, dentists' involvement in issues related to pregnant women and infants will engage them with State MCH programs and state-level policymaker and provider groups. At the local level, their involvement will engage them in coordinating direct services through programs that target low-income women and new mothers of children with special needs.

Evaluation
Time-framed measurable objectives with specific targets have been developed for each Project objective. These measures are consistent with Healthy People 2010 Objectives and action steps articulated by the Surgeon General's Call to Action to Promote Oral Health. They involve both process and outcome measures that demonstrate impact. They rely upon quantitative data collected through an annual AAPD member survey, a survey of dental educators, and through available federal sources.