Long-term effectiveness of the midwifery initiated oral health-dental service program on maternal oral health knowledge, preventative dental behaviours and the oral health status of children in Australia

Background: Early childhood caries remains a public health challenge and many interventions to manage this disease have focused on prevention during early infancy. Promoting oral health during pregnancy may also improve the oral health of children, however, there is limited evidence in Australia. The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) was developed to train midwives to promote maternal oral health and a large trial showed the program substantially improved the oral health status, knowledge and behaviours of pregnant women. This study evaluated the long-term effectiveness of the program (post trial) on maternal oral health knowledge, preventative dental behaviours, and early childhood caries in offspring.Methods: A prospective cohort study was conducted in three large metropolitan health services in Sydney, Australia. The study followed 204 women and their children three to four years after participating in the original MIOH-DS trial (intervention and control groups). The outcome measures included child dental decay (cariogenic bacteria), and a maternal oral health knowledge and behaviours questionnaire. Descriptive statistics were used to analyse the main outcomes and a regression model was constructed to explore predictors of dental decay among children.Results: There were no significant differences across the outcome measures between the MIOH-DS participants (mother/child) and control groups except for a small difference in maternal oral health knowledge. Most mothers across both groups demonstrated high oral health knowledge and positive oral health practices, and the regression model found that these outcomes provided a protective effect (low levels of bacteria and dental caries) among children. Some aspects of oral health remained poorly understood by mothers across both groups―the oral health impact of sugary foods and drinks, at-risk feeding practices, and the recommended age for first dental visits.Conclusions: The long-term impact of the program demonstrates the effectiveness of improving maternal oral health knowledge and preventative behaviours to reduce the risk of early childhood caries, although the specific effect of the MIOH-DS program was not found. Although oral health knowledge was high across participants the findings suggest the need for reinforced education around feeding, diet and dental visiting through postnatal early childhood services to show sustained improvements.