Smart Connected Oral Health Community (SMARTeeth)

Objectives: Limited access to and underutilization of dental care during pregnancy is a public health issue worldwide. This study aims to assess an innovative “SMARTeeth” program that provides a digital tool-enabled oral health screening for underserved pregnant women at an obstetric office facilitated by community health workers (CHWs).
Methods: In this SMARTeeth clinical program, as an innovative clinical service, CHWs use an intraoral camera to take a full set of intraoral photos for pregnant women when they visit their prenatal care providers during pregnancy. Afterward, a virtual dental consultation with a dentist assesses screening findings and treatment plans. Subsequently, patients are triaged for in-person visits. Training for CHWs includes utilizing electronic medical and dental records for patient registration and documentation as well as developing capability of taking diagnostic intraoral photos.
Results: From April to September 2023, 150 underserved pregnant women (average age: 29±6 years) participated, representing diverse racial backgrounds: 53.1% Black, 36.4% White, 6.3% Asian, and 4.2% other races, with 13.8% identifying as Hispanic. Among screened pregnant women, 72% had urgent dental issues, including toothache, broken teeth, and severe gum bleeding with average decayed teeth (2.4±2.5). The competency of CHWs was evaluated by a dentist who found that 73% of total photos, 84% of front teeth photos, and 91% of occlusal arch photos were diagnostically useful. CHWs faced challenges in capturing photos of posterior teeth, with diagnostic rates of 80% for the buccal side of premolars and molars, and 73% for occlusal surfaces. Additionally, diagnostic rates were 84% for buccal sides and 64% for occlusal surfaces. Conducting virtual dental visit triage effectively facilitated in-office treatment delivery, including extraction, pulpectomy, scaling and root planning, and restorations during the first office visit.
Conclusions: Oral health screening outside of the dental office by CHWs holds promise for improving access and utilization of prenatal dental care among underserved population.