Bringing dental care to kids in schools is helping take care of teeth neglected in the pandemic

In the teachers' lounge of an elementary school in New Hampshire, Amber Warner is getting her teeth checked for the first time.

The 5-year-old sat in what looked like a beach chair and wore a pair of sunglasses as certified public health dental hygienist Mary Davis examined Amber's teeth and then used a small syringe to apply a traditional Dental sealant, which has the consistency of a gel like fingernails.

“Close your mouth, clench your teeth, and bite down like a hot dog or a cheeseburger,” Davis told Amber, to make sure the sealant is done correctly. “, pizza between your teeth.” The entire visit lasted 15 minutes.

“Look at you. That first time you went to the dentist, you were a professional. I'm so proud of you,” Davis said to the kindergartner, who stood up from his chair and was hugged by the teaching assistant.

The portable clinic is part of a cavity prevention program developed by the NYU School of Dentistry that is being rolled out in Concord and two other locations in New Hampshire. CariedAway New Hampshire hopes to expand to Maine and Vermont, and eventually nationwide, as part of an ongoing effort to improve pediatric oral health, especially among children from low-income families.

There is not yet a good national estimate of school dental programs, but many larger school districts have them. Boston University's program operates in 20 schools and 30 kindergartens in Boston and eight other cities in Massachusetts, reaching 3,000 children ages 6 months to 21 years old. In New York City, 81,000 students in 820 schools (just over half of all public schools) received treatment last school year.

Nationwide Children's Hospital's mobile school dental clinic in central Ohio has treated 1,700 children since 2021, while the Minnesota nonprofit Ready, Set, Smile works in 44 schools in the Twin Cities and has treated 2,225 Provide services to children.

“Dental care is often viewed as an extra or add-on,” said Terri Chandler, founder and executive director of Future Smiles in Clark County, Nevada, which includes Las Vegas and has 75 Serves 7,500 children in 7,500 schools. “That's not part of health care.”

Intermittent dental care (if any)

Nearly half of American children do not receive regular dental care, according to a 2022 report from the National Institute of Dental and Craniofacial Research, a federal agency.

This can quickly lead to tooth decay: More than half of children ages 6 to 8 have cavities in at least one baby tooth, and more than half of teenagers ages 12 to 19 have cavities in at least one permanent tooth, according to the Centers for Disease Control and Prevention.

Clayton Warner holds a mirror as dental hygienist Mary Davis examines his teeth at the Christa McAuliffe School in Concord, New Hampshire (Robert F. Bucatti /Associated Press)
Clayton Warner holds a mirror as dental hygienist Mary Davis examines his teeth at the Christa McAuliffe School in Concord, New Hampshire (Robert F. Bucatti /Associated Press)

Katherine Hayes of the Harvard School of Dentistry says too many children don't see a dentist before starting school, forcing them to go to the hospital for treatment for cavities.

“If their parents don't receive any kind of oral health education in the doctor's office, these kids will develop extensive tooth decay,” she said, noting that it can take a month or more to repair. She added: “…This is completely preventable. We know how to prevent it.”

Man Wai Ng, dental director at Boston Children's Hospital, said the dental clinic's waiting list is eight to nine months long. Wu noted that part of the reason is that dental care has worsened during the pandemic.

“I have patients who go to bed without brushing their teeth. They eat and drink all day long because they don't have those normal daily routines,” Wu said. “They don't have access to… preventive dental care. Children are getting more dental disease and not getting timely care.

Ruth Langwell struggled to find a dentist for her 10-year-old granddaughter Lola, who has autism. She recently successfully admitted the girl to the clinic.

“Obviously, she needs someone who is very patient… We have tried two other dentists, but they have been reluctant because of the challenges Lola faces,” Longwell said, adding that she Lola was expected to go to the dentist when she was two years old, but didn't.

Sponsored programs develop habits

Richard Niederman, professor of epidemiology and health promotion at New York University School of Dentistry and founder of CariedAway, said the challenge facing many programs, especially mobile clinics and school clinics, is sustainability. That's because school-based programs like Needleman's rely heavily on donations because they often serve low-income people who are uninsured or rely on Medicaid.

Needleman spent twenty years developing his curriculum. Other projects he attempted in the Bronx and Boston ended due to lack of funding, but this time around, Needleman secured $1 million from Northeast Delta Dental, ensuring his New Hampshire project will last at least Three years.

“It breaks my heart that children are not getting the effective care they could be getting… and the system is not supporting it,” he said.

But pediatric oral health is improving—even outside of school programs.

According to a report by the Federal Dental Research Agency, the number of untreated cavities in preschoolers has decreased by 50 percent since 2000. It noted the increased use of sealants to prevent tooth decay.

Jane Grover, senior director of the American Dental Association's Council on Advocacy and Prevention, said there has been “significant growth” in dental programs at community health centers and the deployment of dental hygienists in pediatric clinics.

Some states also better coordinate pediatric and dental care. Hayes said MassHealth, Massachusetts' Medicaid program, began requiring doctors last year to make sure children receive two fluoride varnishes and refer them to a dentist.

“I remember my first dental cleaning, and it made a lasting impression on me,” Grover said. “We want kids to understand that, but we want their families to understand that the enamel on baby teeth is a little thinner than the enamel on permanent teeth, and it doesn't take long to drink sugary drinks all day long… Moving from a potentially serious situation to a very serious situation.

Neiderman's team treated more than 60 students in a week at Concord schools. Among them is Evette Sesay, a soft-spoken 10-year-old who dutifully details how she brushes and flosses her teeth twice a day.

Evette Sesay smiles after a dental checkup at Christa McAuliffe School.  (Robert F. Bucati/AP)
Evette Sesay smiles after a dental checkup at Christa McAuliffe School. (Robert F. Bucati/AP)

She wondered aloud if the treatment would “hurt,” but Davis assured her it wouldn't — but she could raise her hand if she felt pain. Evette went to the clinic because she “wanted to have her teeth checked,” but she never did.

She said it felt like a typical check-up at the dentist's office: “They cleaned my teeth really well. The bubble gum tasted great, too.”

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