How a Prenatal Oral Health Program Changed the Culture of a University

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As a refugee from the war torn country of Bosnia and Herzegovina, Ljiljana Karan and her family had very little access to health care and were often on the receiving end of public health service. “I felt first-hand the uplifting impact that service can have on an individual,” said Karan. “This inspired me to instill in others the education and empowerment that my family and I had felt.”

Later, as a student at UNC Chapel Hill Gillings School of Global Public Health, Karan took a special interest in her maternal and child health classes, where she learned about the prominent role that women—mothers especially—have in shaping the health behaviors of their family. She is now a student at East Carolina University School of Dental Medicine (ECU SoDM) where she has teamed up with classmate Alexandra Davis to harness the power of maternal health as it relates to the rest of the family.

Like Karan, Davis understands the impact that women have on family health through her mother, a nurse whose career focused on obstetrics and women’s health. When the opportunity arose for Karan and Davis to expand the Prenatal Oral Health Program (pOHP) at the ECU School of Dentistry Clinic, they applied for a NC Albert Schweitzer Fellowship.

The program was started last year by Schweitzer Fellows for Life Mary Bec Keith and Kaitlyn Anderson Spencer. Keith and Spencer trained medical students and residents of ECU Brody School of Medicine Obstetrics and Gynecology (OB/GYN) Clinic to incorporate oral health messaging into the prenatal exam, and to refer patients to the ECU School of Dentistry Clinic for oral health services. As a result of their efforts, 47 pregnant women received oral health care and education. Before their program launch, only three pregnant patients had been served at the dental school clinic.

As Blue Cross Blue Shield North Carolina Foundation Schweitzer Fellows, Karan and Davis have expanded the program to provide pOHP training to the Pitt County Health Department. Their goal of the expansion was to educate the broader medical community about the need for prenatal oral health and to further expand the number of pregnant women from the Greenville area that access care at ECU SoDM.

Karan is pleased with the impact the program has had on patients, many of whom are low-income women who did not even know they were eligible for dental coverage under Medicaid. In conducting trainings for local OB/GYN practitioners, Karan and Davis saw a similar lack of knowledge about how pregnant women should access dental care, which they attribute in part to scientifically outdated beliefs that pregnant women shouldn’t receive dental treatment and risk being exposed to x-ray imaging during pregnancy. They were happy to dispel the myths and fill gaps in knowledge.

Karan and Davis also focused on creating formal education materials providers can use when educating pregnant patients. They were so successful that they were asked by an ECU SoDM faculty member to develop university protocols when educating and treating pregnant patients. They welcomed the opportunity to shape their extensive review of the literature on the provision of safe dental treatment during pregnancy into Clinic Protocol Guidelines to guide ECU SoDM faculty, staff, and students in ensuring that pregnant patients receive the consistent, quality care that they need.

“Now that the official procedures has been approved and published,” says Davis, “there should be no question in regard to the treatment of pregnant women thus all faculty members, part time and full time, should be aware of the protocols at the school regardless of what they practice in their private offices.”

Though it was completely unexpected, Davis says the chance to create the protocols which required vetting and approval by three separate committees was her proudest accomplishment as a Fellow.

“Experiencing the approval process firsthand was invaluable,” Davis says. “I truly believe I will draw upon it again when instituting changes in my community post-graduation.”

Karan is thrilled about the potential lasting impact of the Clinic Protocol Guidelines. “It’s exciting to know that what we have done will remain at ECU SoDM and provide students university standards so that they can treat pregnant patients with the utmost confidence and skill while in school and in their future careers as well,” she says.

The Fellows credit much of their success from the support they have received from their mentors: Dr. Geri Crain, Dr. Kimberley Gise, Dr. Renee Spain and Dr. Sarah Smith. “Our mentors opened doors for us and paved the way to help us ensure pOHP will be incorporated in to the dental school and the clinic,” says Davis.

They are also grateful also for the lasting impact of the Fellowship on their own professional development. “I’ve seen tremendous development in myself professionally throughout this project,” says Karan. “I feel more comfortable communicating with my patients and with public speaking, too, since we did many presentations to spread the message of our project.

“Being a Fellow for Life will serve as a constant reminder, on those days when I feel burnt out or caught up in the technicalities of my career, of how I can use my position as a dental professional to help others meet their health needs, whether it’s access to care, access to education, or access to a healthy meal,” she adds.

Likewise, Davis says she has grown to become more of patient needs and their unique circumstances. “I want to use my knowledge about patient barriers to better serve my community as a practicing dentist,” she says.

“Additionally, the Schweitzer Fellowship has given me a great opportunity to learn how instituting projects in my community will be,” Davis says. “I hope that pOHP won’t be the last project I implement to serve the needs of my community. I’ve learned a lot about communication, professionalism, and administration to assist me in future projects.”