Taking Dental Care to the Streets

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At 7:30 on a recent Thursday morning dental assistant Liz Simpson is surveying her workspace while she sips her coffee. Dental chairs are bolted to the floors and portable equipment is strapped to the walls. Toothbrushes, syringes, gauze and protective glasses are in full supply.

And there’s gas in the tank. The Smile Mobile is ready to roll.

With the size and smooth ride of a recreational vehicle, the Smile Mobile is a dentist’s office on wheels that makes house calls primarily to elementary schools and serves children in Orange County who are either not insured or underinsured.

It is operated by Healthy Smiles for Kids of Orange County, based in Garden Grove, which performs about 8,000 dental procedures a year on children with advanced dental disease, in addition to serving special-needs children, educating kids on dental health in schools and connecting families to long-term care.

Oral health might be the most overlooked health issue in America. The journal Health Affairs called dental care “the greatest unmet need of American children,” and the advocacy group Children Now said poor oral health is “the most common chronic disease of childhood in the U.S.”

On this particular Thursday, the Smile Mobile started its day in the parking lot of Sunkist Elementary School in Anaheim. Simpson, who is the site coordinator, and Rosy Torres, another dental assistant, prepared for a stream of young patients.

The previous day, the dentist, Dr. Sholi Rotblatt, determined which kids had healthy mouths, which had abscesses needing attention right away, and which had teeth that were not yet decaying but had cracks and fissures signaling future problems.

On this day, four dental professionals will apply sealants to the teeth of children sorted into the last group. A sealant is a protective covering that is brushed onto children’s molars and dried under a special light.

After assembling more than 40 trays of dental tools and materials, two teams gather at each dental chair. While the Smile Mobile is cramped, it is a state-of-the-art and fully equipped dentist’s office. There is even a waiting area in the van — a comfy bench where kids can watch a video about dental hygiene as they wait their turns.

Yet the kids in the waiting area are sometimes more interested in watching their classmates be worked on. Leaning forward, a group of second-graders, two girls and one boy, glance nervously at their friends sprawled in the chairs nearby and turn to one another to voice their concerns:

“Uh oh, I don’t want to do it.”

“I don’t feel like doing it.”

“It’s not that bad.”

Luckily, sealants are painless, and the dental assistants keep the mood upbeat, commending kids for cooperating and gushing over pretty barrettes and sneakers with rainbows (or skeletons, in one case). Rotblatt said the novelty of the truck is fun for kids, compared with “coming into the dentist’s office with an abscess hurting and swollen, and you’re going to do something invasive.”

The low-income minority patients served by the Smile Mobile are especially vulnerable to disparities in dental care. Last year, the staff screened 9,135 kids in some of the most underserved communities in Orange County. Of those, 3,052 had some form of decay, and 582 were considered emergency cases.

Without ongoing dental care, kids end up in emergency rooms for expensive treatments, or they suffer from painful toothaches that distract from studying. And though it’s rare for dental disease to be life-threatening, it can be when left untreated.

Deamonte Driver, a 12-year-old from Prince George’s County, Maryland, died in 2007 after a dental infection spread to his brain; his family couldn’t afford a dentist. Such cases underline the need for greater access to dental care.

But access is decreasing. The number of people in the U.S. without dental insurance has reached 45 million, according to the National Center for Health Statistics. And even those low-income people who do have government insurance often find that it is of little use. Only 24 percent of private dentists in California accept Medi-Cal, down from 40 percent in 2003.

Orange County is home to 57 pediatric dentists, but only Healthy Smiles and six other clinics focus on treating low-income children. Getting to these few locations can be difficult for the many patients who don’t have access to a car.

“Transportation is huge,” said Dr. Francisco Ramos-Gomez, a professor of pediatric dentistry at UCLA who works extensively to motivate and educate low-income patients on dental health. He said the barriers that particularly affect Latinos are language and lack of education on oral health.

Less obvious impediments exist as well, he said. For example, immigrants from countries where tap water is not safe to drink use bottled water here in the U.S., but this misguided attempt at better health actually deprives kids of fluoride in tap water.

A 2009 report by the Children and Families Commission of Orange County attests to the challenges of improving dental habits, showing that education of patient families at clinics in underserved communities did not yield better rates of flossing or parental involvement in children’s tooth-brushing.

One way to get better dental results with children is to educate and treat parents, according to Children Now, but most adult dental benefits under Medi-Cal were canceled in 2009.

While dental experts are recommending regular dentist visits starting at age one or two, young patients often don’t show up until years later, in contrast with numerous doctor visits during the same time period. As a result, health experts want to integrate dental health into early pediatric visits and introduce dental education and care at Women and Infant Children (WIC) sites.

Healthy Smiles is working at WIC sites as well as schools around Orange County. But like every health service for low-income people, it has lost funding in the state’s budget cutbacks and staff is anticipating more.

“We’re facing some really difficult choices,” said Dr. Rotblatt, the Smile Mobile dentist, “but I would like to see this program funded and not just let it fall by the wayside. … Let’s look at things in perspective. These kids will have a fighting chance to compete.”

Amy DePaul is a freelance writer and lecturer in the University of California, Irvine Literary Journalism program. You can reach her directly at depaula@uci.edu


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