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School-based dental care lauded, but still lacks teeth

WESTMINSTER – Eight-year-old Maria Moline Talamantes slipped off the bright pink sunglasses that had been shielding her eyes, hopped out of Genevieve Valdez’s portable dental chair, and pronounced the entire procedure as painless as advertised.

“Yes, I’d do it again,” she said, before hurrying back to rejoin her second-grade classmates at Rocky Mountain Elementary School. Wednesday marked Maria’s first-ever dental exam, and it happened in a classroom right at her school.

Valdez, a dental hygienist with the non-profit Kids in Need of Dentistry (KIND), is at the school this week putting sealant on children’s molars, as part of the organization’s successful Chopper Topper Program. Next week, she’ll be elsewhere, at another school whose students are also unlikely to have experienced much in the way of dental care.

If it weren’t for a successful collaboration among schools, dental care providers and the Colorado Department of Public Health and Education, Maria and thousands of other children like her would still be waiting to see a dentist, with the delay sometimes causing dreadful results. Two years ago, a 12-year-old Maryland boy, Deamonte Driver, died from a brain abscess caused by untreated oral disease.

Ten years after a landmark Surgeon General’s report first called attention to the problems stemming from a lack of oral care among America’s children, Colorado is actually now doing better than most states at getting poor children the dental care they need.

“The Cost of Delay,” a report released last month by the Pew Center on the States, found that an estimated one in five American children go without dental care each year, but some states are much better than others at employing a variety of proven strategies for helping disadvantaged children obtain oral care. Among those strategies highlighted in the report: sealants, community water fluoridation, Medicaid improvements, and recruiting more dental providers.

Colorado garnered a B in the study, and drew special praise for the state’s aggressive program of going into schools to apply sealant. Colorado also does a better-than-average job of getting its Medicaid-enrolled children into some kind of dental program, and is approaching the national average for the number of communities with fluoridated water.

Only six states – Connecticut, Iowa, Maryland, New Mexico, Rhode Island and south Carolina – earned an A in the report, while 33 states and the District of Columbia got just a C or below. Nine states – including Wyoming – got an F.

“We have made a concerted effort to prioritize children’s health,” says Theresa Anselmo, director of the CDPHE’s Oral Health unit. “We need to be proud of ourselves but not rest on our laurels. This is just the beginning.”

The Health Department works with a number of contractors – including KIND – to provide dental services in low-income schools. They target those schools in which half or more of the students are eligible for free or reduced-price lunch. But all students who attend the eligible schools – regardless of family income – may participate in the program.

By that measure, 398 schools in Colorado – enrolling about 24,000 children – are eligible for the sealant program. But only 99 schools participated last year, and just under 7,000 youngsters received free school-based dental care. Nationally, 25 percent of schools with a large percentage of high-risk students offer sealant programs.

“It’s purely economic,” says Anselmo. “We didn’t have the funding to go into more schools.”

But there’s more than economics at play. Fear prevents a number of families from participating, even when the free dental services are available at their child’s school.

The children can’t be seen by hygienists unless the parents sign a release. And many undocumented workers are reluctant to sign anything, lest they call attention to themselves. Unfortunately, children of transient workers are the most likely to have tooth decay, because they’re more likely to have lived in places that lack fluoridated water.

“There’s also just a lack of education,” says Valdez, who spent 20 years working in conventional dental offices before deciding that helping poor children was more rewarding. “A lot of these kids ask me if I’m going to pull all their teeth.”

KIND, which has been around since 1912, will be taking its sealant program into 60 schools in eight school districts this year, but has received a grant to add another 25 to 30 schools next year.

The sealant program – which involves putting a protective coating over teeth as well as providing a full dental exam – is geared to second graders. “The reason we target second grade is because there’s a very narrow window of opportunity when their six-year molars emerge,” says Anselmo. “If we waited until the third grade, if they’re at higher risk of getting cavities, then those teeth would mostly likely already be decayed. So we have this window of opportunity to seal off the teeth with a coating so bacteria can’t get down in there.”

In fact, according to that same 2000 Surgeon General’s report, children who receive dental sealants as part of a school-based program have 60% less decay in back teeth for at least two to five years.

“We take care of the second-graders, but what about the sixth-graders, who are starting to get their second molars? Why aren’t we doing programs for them as well?” asks Julie Collette, executive director of KIND. “There’s no funding for that right now, but we’re applying for grants to see if we could start doing that too.”

In the past decade, schools as well as state officials have stopped thinking of oral health care as a luxury. They’re seeing a direct link between dental health and a child’s performance in school.

“We don’t have quantifiable data, but we do have anecdotal evidence about the number of kids who come into the school office with a toothache,” says Anselmo. “Imagine the concentric circles created by those untreated cavities. Kids may not be sleeping at night because of the pain, so they’re tired. They can’t study. They don’t feel like they can take part in recess activities. And if they’re not ready to learn when they get to school, they’re less likely to achieve.

“Can I tell you graduation rates would increase if we got more dental care? I can’t. Most research can’t quantify that yet. But there’s more and more attention in the research now to how children are affected by oral health.”

In additional the traveling dental clinics put on by KIND and other dental care providers, 10 of the state’s 16 school-based health clinics also offer some dental care in addition to medical care, Anselmo says.

“Schools really are grasping at any resource they can come across to offer these resources within the school setting,” she says. “It’s a resource drain to figure out how

to get kids to and from a dental office. There’s the time that parents have to take off from work to take them, plus the transportation it requires.

It makes sense to keep the kids on campus and bring the services to them. Yes, it’s expensive to outfit a dental clinic. It needs to be utilized fully to offset the cost of the investment, so fixed dental clinics aren’t really the answer. But we’re looking at more mobile and portable options.”

For More Information

To learn more about the Colorado Department of Public Health and Education’s school-based sealant program, click here.

For more information about children’s oral health, see this overview from the Centers for Disease Control and Prevention.

To read a 2005 report on the status or oral health in Colorado, click here.

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