Oral health in pregnant rural women

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oral health in pregnant rural women
Dr Anjali Ragade (left front) and her team at the Echuca Regional Health public dental clinic posing with one of their first expectant mums making use of the services provided.

An innovative oral health initiative in rural Victoria has led to improved outcomes for pregnant women—and their children. Lynne Testoni reports

Sometimes public health campaigns are all about asking the right questions and seeing the right people when you want to make a difference. 

This was the experience of dentist Dr Anjali Ragade, based in Echuca, on the Victorian/NSW border, when she was asked to prepare an oral healthcare project as part of a leadership course through Dental Health Services Victoria (DHSV).

While completing the course and analysing the clinical work in the community, she realised that her clinic was missing a critical group of patients—economically disadvantaged new mothers.

“I just suddenly realised that we didn’t really get many pregnant women into the clinic and because they are priority patients, we should be actually seeing lots of them,” she explained.

“And if we did see them at all, we usually only saw them during the last weeks of their pregnancy when they had an emergency.” 

This realisation prompted Dr Ragade to consider why they weren’t accessing many pregnant women through their clinic. A believer in value-based health care, she decided that the area of oral health in pregnant rural women needed further investigation, resulting in a comprehensive project, with findings presented to the recent World Dental Congress, held virtually between 26-29 September, 2021. 

Working with local midwives and general practitioners, the Echuca Regional Health public dental clinic utilised the training of antenatal teams (sponsored by DHSV) to help them promote oral health, complete initial assessments, and refer expectant women to DHSV as part of the pregnancy booking visit. The women targeted were holders of pension or healthcare cards, so many were from disadvantaged backgrounds and a significant number were Indigenous.

Dr Ragade then followed up the expectant mothers to encourage them to visit the dental clinic, where they were treated for urgent dental problems and educated about oral health care.

I feel that the mother is the central unit of the family. If you are able to motivate the mother, you will motivate the family to change their habits. Change will begin from there, basically. 

Dr Anjali Ragade, Echuca Regional Health public dental clinic

“If they were in pain, at least we got them some relief, but for patients with lots of problems, we try to hold an education session and teach them how to look after their teeth,” she explains. 

“We get their mouth clean, so they can look after it. And then we do some fluoride application—so it’s about preventative care if we don’t have enough time to fix all the problems.

“It’s all about trying to identify problems and let them know how to manage them. And hopefully they will continue even after the delivery.”

Targeting expectant mothers is the ultimate in early intervention for at-risk families, says Dr Ragade.

“That’s why I chose pregnant women. Because I feel that the mother is the central unit of the family. If you are able to motivate the mother, you will motivate the family to change their habits. Change will begin from there, basically.” 

It’s still early days, but the results of the project have been promising, showing a significant increase—of 168 per cent—in the number of antenatal engagements in oral healthcare in the intervention period as compared to the baseline.

Dr Ragade says she is now seeing improvements in oral health and even seeing patients now expecting subsequent babies, who are coming to the clinic voluntarily, beyond the scope of the project.

“It’s difficult,” she admits. “We come from an area that includes a lot of people from lower socio-economic status and education, especially the patients I see. So we see a lot of challenges, which we still have to work on.

If they were in pain, at least we got them some relief, but for patients with lots of problems, we try to hold an education session and teach them how to look after their teeth.

Dr Anjali Ragade, Echuca Regional Health public dental clinic

“I think it’s still baby steps. However, in these two years [since the beginning of the program], I can see a lot of difference. When we started, the referrals that were coming to me were mostly of pregnant women who were going to deliver in the next four or six weeks. I didn’t have much time to work with them before the baby was born.

“However, the referrals that I’m seeing today are patients who are going to deliver in four months. So I can see the change.

“Because it’s a small community, it’s now reached the stage where we actually can see that they’re coming back. And I’ve seen some people whom I missed the first time, that I wanted to get in, but couldn’t, and now the second time around, they’ve come in to book.”

Dr Ragade has been working in Echuca for more than eight years, commuting from Shepparton (an hour’s drive) four days a week. During her time at the clinic, she has built up strong relationships within the local health community, which helped her with the project, because it relied so much on her allied health partners.

“If you have worked in a hospital for a while, you know the people and the contacts that you need to run a project like this,” she says.

Dr Ragade credits her mentors, A/Prof Werner Bischof and Cynthia Opie with helping her get the project off the ground, as well as the Echuca Regional Health dental health team, including practice manager Carmel Beck, and dentist Anil Ragade (Anjali’s husband).

“If I needed time away from the clinic to do any of this, such as to teach people or communicate with doctors and midwives, I did get a lot of support from the hospital,” she says. “I’m quite thankful for that.” 

And, of course, this project is only the beginning of the plan to improve the oral health in disadvantaged communities, she says. 

“I want to follow this up with a project called Toward Zero, where we target the babies from zero to five years of age.”  

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