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Dental care

Schools partner with providers to put more teeth into students’ dental care
Kentucky School Advocate
January 2017
By Madelynn Coldiron
Staff writer 
Embedded Image for:  (20161219114233595_image.jpg) The report issued last October was alarming: Even though more Kentucky children have access to dental care today than 15 years ago, their oral health has gotten worse.

The information is not encouraging, but it offers some recommendations, and state education and public health officials say there have been incremental improvements.

“We still have a lot of people that dental health is just not a priority, so that’s what we’re working on. But we have a lot more resources than we used to,” said Barbara Basham, coordinator of the family resource center at Saffell Street Elementary and Sparrow Early Childhood Center in Anderson County Schools.
Dental hygienists and other staff with the Purchase District Health Department
set up shop to provide services at Paducah Independent’s Clark Elementary School.
(Photo courtesy Purchase District Health Department) 
The data that the state education department collects for students entering kindergarten showed the number of students enrolling with dental screening/exams improved by 5 percent for 2015-16, though it is still less than 58 percent of kindergartners overall. State law requires children to show proof of a dental screening between Jan. 1 and Dec. 31 of the year they enroll as 5- or 6-year-olds in kindergarten.

The department is working on several fronts to increase the number of children being screened, said Karen Erwin, education nurse consultant in KDE’s Division of District Support. “Definitely, there is always a need for improvement in our dental screening/exam compliance and we always are open to suggestions on how to improve,” she said.

School districts all over the state are doing their part, working with several types of providers to bring dental services to their students, rather than having children depend on parents or others to get them to a dentist’s office. Whatever type of provider is used, there are some general commonalities:

• Their programs are voluntary and must receive parental permission. Parents receive a report on the screening, with recommendations and referrals.

• They focus mainly on preventive work and strive to hook up the child with a “dental home” in their community. Services range from sealant and fluoride treatments to X-rays and scaling.

• The provider bills Medicaid for services to eligible children. Some accept private insurance, some bill on a sliding scale and some provide services free.

• They include an education component.

• They rely heavily on the support of school family resource/youth services centers.
Embedded Image for:  (20161219114628342_image.jpg) Family practice
A nonprofit primary care center drives its 40-foot dental unit to nine school districts, where a licensed dental provider performs comprehensive dental exams; cleaning, including preventive scaling; and X-rays if warranted. Ibby Hopper, director of School-Based Services for Cumberland Family Medical Center, Inc., estimates 35 to 40 percent of students on average take advantage of the services, with participation highest in elementary schools.

Children can watch educational videos on dental hygiene while they wait to see the dental provider. They also are educated by Cumberland Family Medical staff on proper brushing, flossing and oral care. Afterward, they receive a goody bag that includes a toothbrush, toothpaste, floss and a timer.
Staff with Cumberland Family Medical Center pose
with the nonprofit provider’s new mobile dental bus.
(Photo courtesy of Cumberland Family Medical Center) 
Mobile programs
Anderson County Schools uses School Smiles, an on-site dental health care provider based in Greenwood, Ind. Basham said the company provides preventive services and if restorative work is needed, sets up a return visit to the school “so the parent doesn’t have to take off work to take those kids to the dentist or out of town.” School Smiles brings portable dental equipment and sets up in whatever space is available at a school.

School health nurses with the county health department also do some preventive work at Anderson County schools, Basham said, while last year a local dentist and her staff gave oral hygiene instructions to students. Education about brushing is the missing piece of the puzzle, she said.

“They’re just not doing it well, or they’re not taught the proper way to brush,” she said. “If they’re not doing it correctly it’s not going to prevent the decay.”

Health departments
A program operated out of the Purchase District Health Department is one of nine launched a couple of years ago with state funding that enabled health departments to launch mobile dental programs. The program provides preventive services but makes a big push to get kids to a dental home.

“We stay with those families and keep in contact with them in any way possible to see what we can do to help them. We try to find out what their obstacles are in getting to a dentist – is it transportation, is it time, is it even knowing where your providers are,” said Jennifer Nettles, program manager/dental hygienist for the cleaning and sealant program that serves schools in the Purchase and Pennyrile district health departments.

Every child on Medicaid receives a list of dentists in their area that accept Medicaid, but finding a dentist that accepts that form of payment can be problematic in some areas. Nettles said some counties in her area don’t have a dentist at all.

Further, she said data show that a little less than half the Medicaid-eligible children in the area she serves actually receive any form of dental care. “We’re making progress, but I’d say they’re baby steps,” she said.

School events
Angela McDonald, who was health coordinator for Mercer County Schools before joining the state education department’s school-based health unit, said the district’s back-to-school Readi Fest was among the ways the district found to encourage dental screening. The event is specifically designed for kids “that tend to fall between the cracks that don’t really have a medical home,” she said. “It’s open to all grades, too, so a parent could get dental screening for all their kids in one place at the same time.”

At the Readi Fest, children receive the dental screening, plus a toothbrush and education about brushing and the importance of seeing a dentist. Parents also are told about the option of care provided by a mobile clinic and given the necessary paperwork.
FRYSCs are key
School dental service providers sing the praises of family resource/youth services center staff. Their role can include identifying students who need dental work, collaborating with the school nurse, setting up visits by the dental providers, organizing education programs, walking students to their in-school appointments and arranging transportation – or providing it themselves – to a dentist’s office for restorative work.

“We work very closely with our FRYSCs,” said Jennifer Nettles, program manager/dental hygienist for a project that serves schools in the Purchase and Pennyrile district health departments. “And it’s moving to see them take such an active role in the welfare of the kids. They realize how important dental health is to the child’s overall health and how that can impact their school performance.”
Board view: “The need is there”
Embedded Image for:  (20161219133745629_image.jpg) Barbourville Independent school board Chairman Dr. Edwin Smith has firsthand knowledge of children’s dental health in many Kentucky school districts from, he says, “Paducah to Martin County.”

That’s because he takes his skills as a dentist on the road in a tractor-trailer truck outfitted as a mobile dental clinic, serving students in their schools.

“If you know the need is out there, and once we got there and saw how great the need was, it’s not something you can turn your back on,” Smith said. “I didn’t have time to do it, didn’t really have the resources to do it, but we just figured out a way to make it work. It had to be done.”

The idea came about when he began working with a family resource center coordinator in Barbourville on ways to get students to his office whose parents didn’t have transportation.

“I saw kids at that time in high school who had never been to the dentist,” he said. “First thing you know, I had a bunch of kids wanting to come to the dentist.”

The upshot was the mobile dental clinic.
Dr. Edwin Smith checks West Irvine Elementary fifth grader
Shaun Andrews during a visit by the Kids First Dental Van
to the Estill County school district.
“At that time, 2005, I had a busy practice and didn’t really have time to do that, but I figured we could take a couple of weeks a year and go to the schools. That went pretty well for a while and the word spread through the FRYSCs (family resource and youth service centers). Next thing you know, I had people from several school districts calling and wanting to know if we could come and do the same thing at their school,” he said.

Now, he and two other dentists are on the road part-time. Instead of two weeks a year, it’s two days a week with two mobile clinics, reconstituted as a nonprofit called Kids First Dental Services. The service has been featured in stories in The New York Times and ABC’s 20/20, and netted Smith a CNN Heroes recognition last year.

Their focus is eastern Kentucky, but they travel statewide, including urban Jefferson County, where he said there are dentists but families “are just not making the connection.”

Smith and his team provide checkups, dental exams and teeth cleaning, and do X-rays and apply fluoride and sealants as needed. A detailed treatment plan and names of local dentists are provided to parents. School FRYSC coordinators get a binder with all the treatment plans, along with a list of children that need to be seen by a dentist immediately.

“The coordinators go to work on those. They know these families,” Smith said. “This would never have been able to happen without them.”

He said his goal “is to work ourselves out of business – have all of them have their own family dentist and they don’t need the services brought to the school anymore.”

A majority of the students Smith serves are covered by Medicaid, which he bills. However, those without any coverage are treated for free. It is true that in some communities there are no dentists who accept Medicaid, he acknowledges, “because it keeps getting worse as far as reimbursement and is complicated.”

But he also said the dental profession “has not done a good job of educating the public about the need” for good dental health.

Smith said he’s seen “drastic improvement” in the districts in which Kids First has worked the longest, both in the incidence of tooth decay and in awareness of the importance of dental health. Data he gathered a couple of years ago showed a decrease in tooth decay of more than 20 percent.

“So many of these kids have not been told how to brush their teeth properly or how long to brush their teeth or when they should brush them,” Smith said. “Those are simple things, but how are they to know if no one has told them what to do?”

He said the key to improving dental health in Kentucky is to educate children early on, “and they educate the whole family, then.”

For more information on Smith’s program, go to
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