“Close and bite your teeth together, bite like you’re biting into a hot dog or a cheeseburger,” Davis told Amber, to make sure the sealants were done correctly. After that, Davis got all “popcorn and chicken, pizza between your teeth.” The whole visit took 15 minutes.
“Look at you. You’re a pro at your first dental visit. I’m so proud of you,” Davis told the kindergarten teacher, who got up from his chair and was hugged by the teacher’s aide.
The mobile clinic is part of a cavity prevention program developed by the NYU College of Dentistry that is being rolled out in Concord and two other New Hampshire locations. CariedAway New Hampshire hopes to expand to Maine and Vermont — and eventually nationally — as part of a growing effort to improve pediatric oral health, especially among children from lower-income families.
There is not a good national assessment of dental programs in schools, but many larger school districts have them. The Boston University program operates in 20 schools and 30 preschools in Boston and eight other Massachusetts cities and serves 3,000 children ages 6 months to 21 years. In New York City, 81,000 students in 820 schools—just over half of all public schools—were treated last school year.
Nationwide Children’s Hospital has hosted 1,700 children in central Ohio since 2021 with its mobile dental clinics in schools, while Minnesota nonprofit Ready, Set, Smile is in 44 schools in the Twin Cities, serving 2,225 children.
“Dental care is usually treated as an add-on or add-on,” said Terri Chandler, who is the founder and executive director of Future Smiles in Clark County, Nevada, which includes Las Vegas and serves 7,500 children in 75 schools. “It’s not part of medical care.”
Intermittent dental care, if at all
Nearly half of U.S. children do not receive regular dental care, according to a 2022 report from the National Institute of Dental and Craniofacial Research, a federal agency.
That can lead to tooth decay quickly: More than half of children ages 6 to 8 have had a cavity in at least one baby tooth, and more than half of teens ages 12 to 19 have a cavity in at least one of their permanent teeth, according to the U.S. .P.A. Centers for Disease Control and Prevention.
Too many children fail to see a dentist before entering school — forcing them to go to the hospital to get treatment for a tooth decay, said Catherine Hayes of Harvard Dental School.
“If their parents don’t get any kind of oral health education at the doctor’s office, these kids develop extensive tooth decay,” he said, noting that it can take a month or more to correct. She added: “… It’s completely preventable. We know how to prevent it.”
At Boston Children’s Hospital, there is an eight- to nine-month waiting list for the dental clinic, said Man Wai Ng, the chief dentist. Ng points in part to the deterioration of dental care during the pandemic.
“I have patients who went to bed without brushing their teeth. They ate and drank at all hours of the day because there weren’t those normal daily routines,” Ng said. “They couldn’t get in for … preventive dental care. Children had more dental diseases without the opportunity to receive early care.”
Ruth Langwell struggled to find a dentist for her granddaughter Lola, a 10-year-old with autism. He recently managed to get the girl to the clinic.
“She needs someone who is very patient, obviously… We tried two other dentists and they were reluctant because of Lola’s challenges,” said Langwell, who added that she wanted Lola to see a dentist at age 2, but not until her five.
Funding habit-building programs
The challenge for many programs, especially mobile and school-based clinics, is sustainability, said Richard Niederman, professor of epidemiology and health promotion at NYU Dentistry and founder of CariedAway. That’s because school-based programs like Neiderman’s rely heavily on donations because they often serve low-income populations that are either uninsured or on Medicaid.
Niederman has spent two decades developing his program. Others he tried in the Bronx and Boston ended for lack of funding, but this time, Niederman has $1 million from Northeast Delta Dental, which ensures his New Hampshire program will remain in place for at least three years.
“It breaks my heart that children are not getting effective care that they could be getting … and the system is not supporting it,” she said.
But the picture of children’s oral health is improving — even outside of school programs.
Untreated tooth decay in preschool children has decreased by 50 percent since 2000, according to a report by the federal agency for dental research. He pointed to the increased use of sealants, which prevent tooth decay.
Jane Grover, senior director of the American Dental Association’s Council on Advocacy on Access and Prevention, said there has been “tremendous growth” dental programs in community health centersas well as efforts to place dental hygienists in pediatric practices.
Some states also better coordinate pediatric and dental care. MassHealth, the Medicaid program in Massachusetts, began requiring doctors last year to ensure a child has two applications of fluoride varnish and to refer them to a dentist, Hayes said.
“I remember my first dental cleaning and it left a lasting impression,” Grover said. “We want to get kids to understand that, but we want their families to understand that sugary drinks all day long on primary teeth where the enamel is a little thinner than on adult teeth, it doesn’t take long to… go from a potentially serious situation to a very serious situation.”
Neiderman’s team treated more than 60 students in one week at the Concord school. Among them was 10-year-old Evette Sesay, who dutifully describes how she brushes twice a day and flosses.
She wondered aloud if the treatment would “hurt”, only to be assured by Davies that it wouldn’t – but that she could raise her hand if she felt pain. Evette, who went to the clinic because she “wanted to check” her teeth, never did.
She said it was like a standard exam at her dentist’s office: “They cleaned my teeth really well. The flavor of the gum was also good.”
