“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.
“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
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
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
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.”