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Educator Spotlight: Dr. Stefanie Russell

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By Janet Hulstrand

“It’s pretty common in a lot of cultures to say that every time a woman has a baby she loses a tooth,” says Stefanie Russell, D.D.S., M.P.H., Ph.D. This traditional belief piqued her interest and became one of the things the Clinical Associate Professor in the Department of Epidemiology and Health Promotion at New York University College of Dentistry investigated in the course of working on her dissertation. Stephanie Russell 200 x 291

“I used an existing database from the Centers for Disease Control and Prevention, and I found that it was indeed true that for every additional child, women did end up having worse oral health.” She adds, “Not only did they wind up having fewer teeth, they wound up having more untreated decay and more periodontal disease. The question is, why?” 

Early in her career, Dr. Russell realized she wanted to be able to effect population change through public health research. She pursued an M.P.H., and ultimately a Ph.D. in epidemiology. 

“My primary interest is in disparities in oral health,” she says. Dr. Russell has focused her research on women because, in many cultures, women are the key to improving the health, hygiene and home life of the family. Her decision to focus on oral health during pregnancy came about because, she says, pregnancy provides a window of opportunity. 

“It’s a time when women tend to take care of themselves,” Dr. Russell observes, “and change their behavior to make things better for their children, and hopefully for themselves.” It’s also a time, she points out, when women may have a better opportunity to maintain their oral health, thanks to public assistance programs. 

There is a biological mechanism that accounts for an increased need for calcium during pregnancy, Dr. Russell says, but that calcium is being drawn from the skeleton, not from the teeth, as some folk beliefs hold. Through her research she is trying to determine what other factors could explain the impact of pregnancy on oral health. 

“I thought about how when you have a child, all of a sudden your whole life changes,” she explains. “You may be less likely to have insurance. You might have less money available to go to the dentist when you need to. You may have less time to do so.” She is currently working on designing a study that will allow her to tease out the effects of pregnancy on long-term oral health.  

“I think this is where we need to really put our efforts at addressing the issue of untreated decay, because I believe that if you can improve the oral health of the mother, you can also have a very big impact on the oral health of her children. The idea that women should forgo dental treatment during pregnancy is obsolete,” Dr. Russell says. “Those beliefs need to die out.” 

Over the past 15 years, things have changed, and those changes have been made clear in national guidelines published in 2012. “The evidence shows that we’re not going to do any harm if we properly treat pregnant women. In fact, by denying them care during pregnancy, we’re missing a great opportunity to positively impact oral health,” Dr. Russell says.

She and her colleagues have recently completed a study of pregnant women referred for dental care through their prenatal clinic at Long Island Jewish Hospital. The study found that when referred for dental care by their prenatal providers, low-income women—who traditionally have low rates of dental care utilization but high, unmet treatment needs—will indeed use dental care if it is offered. “I’m hoping this program may serve as a model for improving access to, and utilization of, dental care during pregnancy,” Dr. Russell says, and she believes dental schools are central to achieving this goal. 

“A study to see exactly what dental schools are teaching would be helpful. The people who are giving the lectures on pregnancy are probably giving good, and current, information. I know at NYU we are, but I’ve still seen as recently as last spring that pregnant women were being denied dental treatment in our clinic by dentists who didn’t know about the new guidelines.” She adds, “There’s often a disconnect between guidelines and practice. Doing something to bridge that gap is really important, but I don’t know of any specific programs geared toward changing practitioner’s attitudes. I think that’s always been very hard to do.”

One positive trend, Dr. Russell says, is an emphasis on interprofessional collaboration between obstetricians and dentists who are following the new guidelines. “Obstetricians who are forward-thinking are asking about oral health, and are actually setting up programs where they refer patients for preventive and restorative dental care. We need to see more of that kind of thing.”

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