Implications of motivational interviewing and oral hygiene instruction for the reduction of oral health disparities among pregnant women

Pregnancy is a “teachable moment” during which women may be particularly amenable to making health behavior changes that can have significant impact, not only on themselves, but also on their offspring. Dental complications during pregnancy, such as periodontal disease, have been linked to low birth weight and premature birth. Additionally, mothers' oral health status has been related to childhood caries, through the direct transmission of oral pathogens. Motivational Interviewing (MI) is a promising intervention in the oral health care arena. MI has been empirically supported as a treatment for substance abuse, as well as other health issues including, diabetes, HIV, hypertension, and smoking. This study sought to understand the effectiveness of motivational interviewing and oral hygiene instruction (OHI) to increase motivation to engage in positive oral health behaviors (e.g., proper oral hygiene and needed treatment). The hypotheses of this study were addressed by assessing oral health care behaviors, oral health values, and issues related to dental care utilization in 85 pregnant women using a 2 (intervention group: motivational interviewing or oral hygiene instruction) X 2 (time of measurement: pre-test vs. follow-up) mixed design with random assignment. It was hypothesized that level of Streptococcus mutans would significantly decrease and that tooth brushing, flossing, and dental visit frequency, and dental knowledge would significantly increase after the interventions. It was hypothesized that oral health values would significantly improve after MI and OHI. MI was predicted to contribute to greater change in the dependent variables compared to OHI. There were four variables that were included for exploratory purposes: dental fear, oral health quality of life, toothpaste use, and floss use. Participants were asked to provide a saliva sample to estimate the number of Streptococcus mutans using the Dentocult strip-test, and to complete the Dental Neglect Survey (DNS), the Dental Fear Survey (DFS), the Oral Health Impact Profile-14 (OHIP-14), and the Dental Knowledge Inventory. Two follow-up phone calls were conducted, at two weeks and one month after the initial assessment, during which motivation and oral health behavior was assessed. Participants provided another saliva sample, and completed the DNS, DFS, and OHIP-14 at follow-up six weeks later. Data analysis was conducted in six phases: (a) preliminary examination of data, (b) exploration of the psychometric properties of the primary dependent variable instruments, (c) examination of groups at baseline, (d) group comparisons, (e) exploratory analyses, and (f) correlational analyses. The present study examined six primary dependent measures: (a) tooth brushing frequency, (b) flossing frequency, (c) dental visit frequency, (d) oral health values, (e) dental knowledge, and (f) level of Streptococcus mutans. Tooth brushing frequency, flossing frequency, oral health values, and dental knowledge were significantly higher at follow-up among participants. Amount of toothpaste and floss returned were significantly lower at follow-up among participants. OHI was found to significantly increase dental knowledge among women. No significant differences in level of Streptococcus mutans, dental fear, dental visit frequency, or oral health quality of life were noted at follow-up; MI and OHI interventions generally were found to similarly affect the dependent variables. Several study limitations were noted and future research in this area is encouraged. Effective interventions with this group may have preventive implications related to oral health care, such as increased utilization of dental care services and the reduction of treatment barriers, for a group that is in need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)