Ph.D. Candidates’ Research Links Maternal Gum Disease & Poor Birth Outcomes

Pregnancy, while often a joyful time, can also bring up health concerns. But the links between maternal and oral health are becoming clearer thanks to two publications and newly funded research by May Salama, a Ph.D. candidate at the Joint School of Public Health who has spent more than two years exploring the impact of gum disease during pregnancy on the health of newborns.

Salama’s recent publication in the explored possible linkages between maternal periodontitis, or gum disease, and poor birth outcomes. By systematically reviewing 62 previously published studies, Salama and her fellow researchers found strong links between maternal gum disease and issues such as low birth weight and preterm birth.

Originally from Egypt, Salama practiced as a pediatric dentist in Cairo before relocating to the U.S.

“I worked with many families who lacked access to even the most basic oral and medical care,” she said. “That experience showed me that clinical care alone isn’t enough; policy has the power to drive large-scale, lasting change.”

With that in mind, after moving to the United 91����Ƶs in 2016, Salama sought a better understanding of the U.S. healthcare system by volunteering in nonprofit dental clinics. That work sparked her interest in public health and led her to pursue a Master of Public Health degree in Epidemiology at what was then Eastern Virginia Medical School, now part of Macon & Joan Brock Virginia Health Sciences at Old Dominion 91����Ƶ.

Salama went on to complete a Dental Public Health residency in Raleigh, North Carolina, and in August 2022, began her doctoral program in Health Services Research in what is now the Joint School of Public Health, an academic partnership between Old Dominion 91����Ƶ and Norfolk 91����Ƶ 91����Ƶ.

Now nearing graduation, Salama is exploring a range of career paths, including public health policy, research, academia and work with agencies such as the Centers for Disease Control and Prevention or state health departments.

“My ultimate goal is to bridge the gap between clinical dentistry and public health,” Salama said. “Through research, education and policy, I want to make oral care an integral part of prenatal healthcare.”

There are many barriers to oral care during pregnancy—some dentists do not accept Medicaid or are hesitant to treat pregnant women, while many pregnant women are unaware of the risks. “With better education, both patients and providers can make informed decisions,” Salama explained. “Pregnancy is often a turning point—many women are motivated to adopt healthier behaviors if they have the right support.”

Building on her Oxford 91����Ƶ Press publication, Salama and her mentor, Abdullah Al-Taiar, M.D., associate professor of epidemiology in the Joint School of Public Health, were awarded a $5,000 research grant from the American Association of Public Health Dentistry. Their project uses data from the Virginia Department of Health’s Pregnancy Risk Assessment Monitoring System (PRAMS). The data, which has not been used for this purpose in Virginia before, comes from a survey distributed to new mothers. Their goal is to then expand the research to West Virginia, Kentucky, Mississippi, New Hampshire, New York, Puerto Rico and Utah, all of which include relevant dental health questions in their PRAMS surveys.

Another systematic review building off the subject has also been published in the journal by Salama and Dr. Al-Taiar, with fellow researchers, that explored the effects of professional dental cleanings and mouthwash use during pregnancy on preterm birth and low birth weight. The results showed lowered incidences of preterm birth and lower birth rates with regular dental care during pregnancy.

In service to that goal, the preliminary findings of this research were presented at the annual conference of the Society for Epidemiologic Research in Texas, the American Public Health Association conference in Minnesota, the National Oral Health Conference in Florida, the annual Old Dominion 91����Ƶ Graduate Student Government Association, and earlier this month, the American Academy of Developmental Medicine and Dentistry’s annual conference in Arizona.

“As a mother myself, this work deeply resonates with me,” Salama said.

 “When we educate mothers and healthcare providers, we empower families to achieve better health outcomes. That’s what drives me every day.”