Ask A Researcher

May 2021

NEW! PRAMS Points – A Brief Infographic using North Dakota PRAMS Survey Data

The North Dakota Department of Health and the Center for Social Research (CSR) at North Dakota State University (NDSU) continue their collaboration with the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS), a project that focuses on gathering state-specific data on maternal attitudes and experiences before, during, and shortly after pregnancy to improve the health of mothers and infants. Chelsey Hukriede is a research specialist at the CSR and serves as the Project Coordinator for two statewide surveillance projects, PRAMS and North Dakota Study of Associated Risks of Stillbirth (SOARS). Chelsey earned her master’s degree in Sociology from the University of North Dakota. Kendra Erickson-Dockter is a research specialist with the CSR and provides support for projects, such as PRAMS, SOARS, and North Dakota Compass. Kendra received her master’s degree in Sociology and is a doctoral student in Human Development at NDSU. 

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a collaborative surveillance project of the Centers for Disease Control and Prevention (CDC), the North Dakota Department of Health, and the Center for Social Research (CSR) at North Dakota State University. PRAMS collects state-specific data on maternal attitudes and experiences before, during, and shortly after pregnancy, with the overall goal of reducing infant morbidity and mortality.

To help disseminate study results, a series of PRAMS analysis documents will be released on a variety of topics such as oral health, prenatal care, chronic disease, and substance use. First to be released in this series is PRAMS Points: Pregnancy and Oral Health, a brief infographic looking at oral health care among pregnant women in North Dakota. The document was produced with North Dakota PRAMS survey data collected in 2017 and 2018.

This article overviews the data points regarding pregnant women’s oral health in North Dakota that appear in the first PRAMS Points.

Oral Health Background

Oral health care and education during pregnancy is important, not only for the oral health of pregnant women, but also for their babies' health. Pregnant women may be more at risk for oral health problems like cavities or gingivitis due to things such as changing hormones and eating habits. If left untreated, poor oral health during pregnancy can lead to poor pregnancy outcomes such as preterm birth and low birth rate, in addition to poor outcomes for mothers’ and babies’ oral health after pregnancy (2).

Nearly half of all pregnant women in North Dakota had their teeth cleaned by a dentist or dental hygienist during their last pregnancy (46%). Yet, almost all pregnant women in North Dakota visited a doctor, nurse, or other health care worker for prenatal care to get checkups and advice about pregnancy before their baby was born (99%).

Brushing for Two: Knowledge vs Action

A large majority of pregnant women in North Dakota were aware of the importance of good oral hygiene (89%) and thought it was safe to go to the dentist during pregnancy (86%). However, this knowledge is not translating into action, as less than half of pregnant women in North Dakota had their teeth cleaned during this time (46%).

Barriers to Oral Health Care

Pregnant women in North Dakota had few barriers (e.g., could not afford, lack of transportation or insurance) that made it hard for them to go to a dentist or dental clinic. The largest barrier for women to go to a dentist or dental clinic during their most recent pregnancy was lack of dental insurance (28%), followed by affordability (15%).

Room for Improvement

Sizeable health care gaps stand out when examining data associated with oral health care while pregnant in North Dakota by race/ethnicity, age, education, and income.

  • Twice the percentage of white women compared to that of minority women had their teeth cleaned by a dentist or dental hygienist during their pregnancy (52% compared to 23-27%, respectively).

In North Dakota as age, educational attainment, and income levels increase, so does the likelihood of pregnant women going to the dentist or dental hygienist to have their teeth cleaned during their pregnancy.

  • Twice as many women who are 40 and older compared to teenage women got their teeth cleaned while pregnant (61% compared to 31%, respectively).
  • Nearly 4 times the percentage of women with education higher than a bachelor's degree compared to those without a high school diploma got their teeth cleaned while pregnant (75% compared to 19%, respectively).
  • Nearly 3 times the percentage of women with incomes greater than $85,000 compared to those with incomes of $24,000 or less got their teeth cleaned while pregnant (68% compared to 25%, res pectively).


Routine dental checkups and teeth cleanings during pregnancy are safe and important to women's oral health, which contributes to their and their babies' overall health during and after pregnancy (1). Other types of dental procedures, such as x-rays and cavity fillings, are safe to have done during pregnancy when necessary. Although North Dakota PRAMS survey results indicate that most women knew of the importance of good oral care during pregnancy, there appears to be a disconnect between knowledge and action.

This analysis does not offer insight into why pregnant women are not going to their dental providers for routine care, but these data illustrate that many pregnant women in fact are not seeking care even when there appears to limited knowledge or financial barriers. Pregnant women may be avoiding the dentist for a number of reasons: visit is unnecessary or oral health problems were not that serious, no time to go, transportation, inconvenient clinic hours, cost, poor quality of care, wait times, or belief they have a 'healthy mouth' (3).


Analysis of the PRAMS 2017 and 2018 data set indicates that substantial health care disparities exist. There is a need for ongoing programming and outreach activities to address oral health care disparities.

Further discussion and educational campaigns on the importance of good oral hygiene practices and going to the dentist for regular and emergency care should be performed to encourage and remind women to seek dental care during pregnancy, in addition to education regarding potential risks of not maintaining good oral health during and after pregnancy.

Oral health education cannot solely fall on the shoulders of dental professionals. According to these data, women before and during pregnancy are more likely to see other types of health care providers, which may suggest a more collaborative partnership approach across health care professions to support better oral health care education.

PRAMS Information

In addition to more information about the PRAMS project and PRAMS data, these NEW PRAMS Points will be available at

PRAMS Points Contributors

PRAMS Points and this article were prepared by the Center for Social Research at North Dakota State University for the North Dakota Department of Health. Contributors of the PRAMS Points are Nancy Hodur, Center Director; Kendra Erickson-Dockter, Research Specialist; Chelsey Hukriede, PRAMS Coordinator; and Elvis Ndembe, Research Specialist.


(1) American Dental Association. Is It Safe To Go To the Dentist During Pregnancy? Retrieved from:

(2) Pregnancy and oral health. (2019, February 19). Retrieved February 2021, from:

(3) Taber, Leyva, Persoskie (2014). Why do people avoid medical care? A qualitative study using national data. National Cancer Institute, National Institutes of Health, MD, USA


Ask a researcher archive

Nicholas Bauroth. City Governance: Commission or Council for Fargo, North Dakota?
February 2024

Ina Cernusca. 2024 Brings a NEW Visualization Tool and Data Updates to the North Dakota State Legislative District Profiles.
January 2024

Samuel Faraday Saidu and Chelsey Hukriede. Strapped for Safety: Exploring Insights into Car Seat Knowledge Among North Dakota Mothers.
December 2023

Debarati Kole and Kendra Erickson-Dockter. A Comprehensive Look at the Multifaceted Risk Factors of Postpartum Depression
October 2023

Valquiria F. Quirino and Avram Slone. COVID-19 pandemic in North Dakota: Significance, progression, and government response.
September 2023

Karen Olson. The Lasting Impact of Maternal Childhood Trauma
August 2023

Avram Slone. The Social Variability of COVID-19 Mortality in North Dakota between March 11th, 2020 and February 13th, 2022
July 2023

Nancy Hodur and Dean Bangsund. Agriculture a Key Driver in the North Dakota economy
June 2023

Karen Olson. Health and Well-Being in North Dakota. Understanding how the five social determinants of health are impacting the ability of North Dakotans to thrive
May 2023

Kendra Erickson-Dockter. North Dakota Compass: 10 years of Measuring Progress and Inspiring Action.
April 2023

Hannah Hanson & Grace Njau. Every Dad Counts: North Dakota Fatherhood Experiences Survey
March 2023

Nancy Hodur. Housing Market Conditions and Declining Homeownership Rates
February 2023

North Dakota Compass. 2022 Recap: Data highlighted throughout the year
January 2023

Kendra Erickson-Dockter. A Look into a Chronic Condition and Pregnancy: Preexisting Diabetes PRAMS Points 2022
December 2022

Nancy Hodur and Karen Olson. Lower-income households and baby boomers, main drivers for North Dakota housing needs in the near term
November 2022

Avram Slone. The Impact of COVID-19 on Group Quarters in North Dakota
October 2022

Chelsey Hukriede. Safe Sleep PRAMS Points 
September 2022

Kendra Erickson-Dockter. Gestational Diabetes PRAMS Points – A NEW Dashboard Format!
August 2022

Aastha Bhandari, Debarati Kole, Dr. Nancy Hodur. Mission Of Mercy: Giving hope through a smile.
July 2022

Ina Cernusca.Households with children have been disproportionately affected by the COVID-19 pandemic, especially in the first year of the pandemic.
May 2022

Andy Wiese and Karen Olson. One Health System’s Approach to Improving Community Health. Understanding what the 2021 Community Health Needs Assessment Conducted by Sanford Health means for population health
April 2022

Mariel Lopez-Valentin and Grace Njau. North Dakota Title X, Family Planning Needs Assessment
January 2022

Nancy Hodur and Dean Bangsund. North Dakota Lignite Energy Industry Workforce
December 2021

Ina Cernusca. Vaccine Acceptance and Hesitancy in North Dakota
October 2021

Nancy Hodur and Karen Olson. Rural Communities Will Benefit from a New Cooperative in Walsh County
September 2021

Matt Schmidt and Grace Njau. COVID-19 Trends Among North Dakota Children, March 2020 – March 2021
August 2021

Kendra Erickson-Dockter and Ina Cernusca. COVID Hardship on North Dakota Households: New study on the impacts on North Dakota households that lost employment income during the pandemic
July 2021

Chelsey Hukriede and Kendra Erickson-Dockter. NEW! PRAMS Points – A Brief Infographic using North Dakota PRAMS Survey Data
May 2021

North Dakota Compass: A look inside the 2021 Compass Points
April 2021

Ina Cernusca: Households with children are disproportionately affected by the COVID-19 pandemic
March 2021

Ina Cernusca: Differences in COVID-19 Risk Factors at District Level
February 2021

Kendra Erickson-Dockter, Chelsey Hukriede, and Grace Njau: An Introduction to the North Dakota Study of Associated Risks of Stillbirth (SOARS)
October 2020

Karen Ehrens: North Dakota Families are Facing Food and Other Hardships in the Wake of COVID-19 Pandemic, and Helpers Respond
September 2020

Ina Cernusca: Taking the pulse of North Dakota households during the COVID-19 pandemic.
July 2020

Nancy Hodur:Challenges of Grocery Stores in Rural North Dakota
May 2020

North Dakota Compass:2020 Compass Points: Measuring progress. Inspiring action.
March 2020

Amy Tichy:Student Veterans in the College Classroom.
February 2020

North Dakota Compass:North Dakota Compass launches the 2020 State Legislative District Profiles
January 2020

Grace Njau, Nancy Hodur:&Chelsey Hukriede: Risk Behaviors among Women with a Recent Live Birth in North Dakota: Findings from the 2017 North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
November 2019

Ina Cernusca:& Karen Olson: Behind the scenes – The story of the North Dakota State Legislative District Profiles
October 2019

Ina Cernusca: Key demographic trends in North Dakota.
August 2019

Karen Olson: The 30th edition of the Annie E. Casey Foundation’s KIDS COUNT® Data Book finds that 175,772 children will shape the future of a more diverse North Dakota.
July 2019

Shweta Arpit Srivastava & Dr. Ann Burnett: “Giving rope and pulling it back”: Parental dilemmas to prevent adolescent substance use
June 2019

Ina Cernusca: 2019 Compass Points: Setting direction for improving the quality of life in North Dakota
May 2019

Joshua Marineau and Onnolee Nordstrom: Learning from Fargo -- An Exploration of the Fargo-Moorhead Entrepreneurial Ecosystem
March 2019

Nancy Hodur: Improving Oral Health for Older Adults in North Dakota
November 2018

Rachelle Vettern: Engaging Volunteers across Generations
October 2018

Karen Olson: The 2018 KIDS COUNT® Data Book reveals strengths and challenges for children in North Dakota – and emphasizes that an inaccurate census in 2020 threatens to worsen existing challenges for North Dakota youth
July 2018

Lori Capouch: Is food access a concern in rural North Dakota?
May 2018

Deb Nelson: Williston Basin 2016: Employment, Population, and Housing Forecasts – An Overview
January 2018

Karen Olson: North Dakota among Top 10 States in Country for Child Well-Being
July 2017

Nancy Hodur: SEAL!North Dakota: A School Dental Sealant Program
June 2017

Grace Njau: A Brief Introduction to the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
April 2017

Ina Cernusca: North Dakota’s Women study: A brief overview
March 2017

Dean Bangsund: Effects of Fargo-Moorhead Area Diversion on Spring Planting for Producers
February 2017

Deb Nelson: Vision West: Leading, Educating, and Collaborating to Mobilize the 19 Western North Dakota Counties Towards Resilience and Prosperity
December 2016

Nancy Hodur: North Dakota Statewide Housing Needs Assessment: A Brief Overview of the Population and Housing Forecast component
November 2016

Social Isolation: Experiential Narratives of African Refugee Women in the Fargo-Moorhead Community
September 2016

Sean Brotherson: Father Involvement and the Future of Children and Families
July 2016

Carol Cwiak: Bakken Oil: What Have We Learned and What Will We Do Differently Next Time
June 2016

Jessica Creuzer: The Changing Face of Western North Dakota: What are the Effects of Increased Travel from Energy Development
April 2016

ND Compass: City Profiles
February 2016

ND Department of Health: Making Change Happen
January 2016

Jennifer Weber: A Bold New Direction for the North Dakota University System - The NDUS Edge Dashboards
December 2015

Wendy Troop-Gordon: What Has Science Taught Us About Bullying?
November 2015

ND Compass: A Look at the Youngest North Dakotans
October 2015

Kendra Erickson-Dockter: Growing Older in North Dakota
September 2015

Michael Ziesch: Data You Can Trust: The Labor Market Information Center
August 2015

Malini Srivastava and Troy Raisanen: efargo: City Scale Sustainability
July 2015

Kevin Iverson: The State Repository of Census Information- The North Dakota Census
June 2015

Wonwoo Byun: Reducing Sedentary Behavior is a Key for Obesity Prevention in Children
May 2015

Kathryn Gordon: The Science of Suicide Prevention
April 2015

ND Compass: Tell a Story with Data! The Importance of Crade-to-Career Success
March 2015

Abby Gold: Community Food Systems: Food Charters and More
February 2015

Heather Fuller-Iglesias: The Importance of Recognizing the Role of Social Support in Human Development Across the Lifespan
January 2015

Michael Carbone: Using Data to End Homelessness
December 2014

Randal Coon: Tribal Colleges Contribute to the State's Economy
November 2014

Deb White: Women's Representation in Elected Office
October 2014

Randal Coon: Pull Factors Measure Retail Trade Performance
September 2014

Karen Olson: North Dakota ranks Well Nationally with Regard to Overall Child Well-Being; However, Substantial Opportunities for Improvement Exist
August 2014

Julie Garden-Robinson: Guard Against Grilling Gaffes: Healthy Grilling and Food Safety Tips
July 2014

Michael Noone: Extreme Weather Patterns- North Dakota Has It All
June 2014

Kathleen Tweeten: Why All Community Development Decisions Should Use the Community Capitals Framework
May 2014

Clayton Hilmert: Stress effects on pregnancy: The impact of the 2009 Red River flood on birth weight
April 2014

Karen Ehrens: Food Deserts and how they impact North Dakota
March 2014

Gretchen Dobervich and Kendra Erickson-Dockter: New Geographic Profiles: How they can work for you
February 2014

Compass Staff: "New Compass Team Brings Changes in 2014"
January 2014

Donna Grandbois: "Fargo-Moorhead American Indian Community-Sponsored Health Needs Assessment"
November 2013

Karen Olson: "North Dakota KIDS COUNT - why it counts for you
October 2013

Nancy Hodur: "Western North Dakota School Administrators Face Challenges"
August 2013

Megan Chmielewski: "Annual population estimates tell interesting stories about North Dakota's growth patterns"
July 2013

Ramona Danielson: "Learn how to make the ND Compass website work for you"
May 2013

Karen Olson: "About the American Community Survey (ACS)"
February 2013

North Dakota Compass

Center for Social Research
North Dakota State University

Compass created by:
Wilder Research

© 2024. All rights reserved.