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'Give Kids A Smile'

This article first appeared in the St. Louis Beacon, Feb. 17, 2009 - This was not your typical anxiety-producing trip to the dentist.

Give Kids A Smile is a two-day clinic providing dental care for under-served children in the St. Louis region. It is part dental office - with X-rays, cleanings, sealants and surgery - and part carnival. As they move through the clinic, young patients encounter tooth fairies, jugglers, and storytellers entertaining (and comforting) them.

Now a nationwide program supported by the American Dental Association, Give Kids A Smile began seven years ago in St. Louis. A group of local dental professionals, including Drs. Jeffrey Dalin, Ray Storm, Tom Flavin, Mark Ortinau and dental hygienist Janet Storm, started the program to provide free comprehensive dental care to children who would otherwise go without.

The Unmet Need

On Feb. 6 and 7, volunteers provided free oral health care to more than 600 children at the Center for Advanced Dental Education at the SLU Care Campus of St. Louis University. Nationwide the program reached more than 450,000 children in that two-day stretch. Since 2002, the St. Louis Give Kids A Smile clinic has been held in February and October and has served more than 7,000 children and provided more than $2.2 million in dental care.

The clinic also helps spread the word about the tremendous unmet need for dental care for children from low-income families, said Mark Zust, dentist and member of the Give Kids A Smile board of directors. "We don't want to be the primary source of care for these kids, but we do want to get them into the system, get their care started, and then find a regular dentist for each one of them."

Dental decay is the most common chronic childhood disease and is most prevalent in children from low-income families, according to a 2000 report from the U.S. surgeon general. In statistics from Give Kids A Smile, more than half of all 6- to 8 year-olds have tooth decay.

An Integral Part of Total Health

Evidence is increasing that dental health has a substantial impact on overall health. But often the connection between the two is not made in the minds of the public or in the minds of legislators and policy makers, said Lew Lampiris, director of the American Dental Association's Council on Access, Prevention and Interprofessional Relations.

Poor dental health can cause pain, embarrassment, even low self-esteem, said Lampiris. "A kid with a toothache is a kid who can't learn," he said.

As an extreme example, Lampiris pointed to the story of 12-year-old Deamonte Driver of Prince George's County, Md. Suffering from untreated tooth decay, Driver died in February 2007 after bacteria from a tooth abscess spread to his brain. He underwent two brain surgeries and spent more than six weeks in the hospital.

Caught early enough, an $80 tooth extraction could have saved $250,000 in medical bills - and his life. But, as reported in the Washington Post, Driver did not have easy access to dental care. His mother, Alyce Driver, did not know his tooth was bothering him. Her unsteady employment, including jobs in a bakery, construction and home health care, did not provide health insurance and their Medicaid coverage had lapsed - perhaps due to misdirected mail after a temporary stay in a homeless shelter.

When Driver complained of a headache, he was treated at Southern Maryland Hospital Center for that headache, sinusitis, and for the tooth abscess. But he only got worse. Finally rushed to Children's National Medical Center, he underwent emergency brain surgery. Suffering seizures afterward, he had a second surgery and the abscessed tooth was removed.

Over the next six weeks, he seemed to be improving with medical treatments and physical and occupational therapy at a different hospital. Nevertheless, he died on a Sunday, Feb 25. The exact cause of Driver's death is uncertain, but his death certificate lists meningoencephalitis and subdural empyema, conditions associated with brain infections.

Tooth decay cannot be ignored. Unlike a cold, it will not get better on its own.

With Deamonte Driver's story in mind, dental professionals point out that dental disease is preventable, through education, prevention and restorative care - such as filling a cavity. But both Zust and Rich explained that low Medicaid reimbursements are a major barrier to getting even simple care to those who need it, when they need it. Because reimbursement is so low - often about 30 percent of the usual fee -- few dentists take Medicaid patients.

According to the ADA, more than 90 percent of dentists are in private practice. "If a dentist accepts Medicaid patients, they lose money," said Zust. In most states, only about 2 percent of Medicaid budgets go to dental care.

Beyond the immediate impacts, there is increasing evidence that good dental care can help prevent heart disease and other systemic cardiovascular problems. Diseased gums that are inflamed and bleeding can allow bacteria into the bloodstream.

The mechanisms of how this might cause heart disease are not well understood, but people with periodontal disease are more likely to have heart disease than people with healthy gums. Heart disease is not a childhood illness, but making sure kids have early access to dental care -- learning to brush and floss properly and seeing a dentist regularly -- could help prevent these diseases later in life.

Extending Care

Dentists, hygienists, dental students, Spanish translators and other volunteers lead the children through the clinic. Corporate contributors, sponsors and companies providing equipment and supplies include, among others, Delta Dental, Keller Dental Laboratory, the Greater St. Louis Dental Society, Patterson Dental, Henry Shein Dental and Colgate.

Starting with a triage unit, X-rays determine what treatment each child needs. From there, the child might receive a cleaning, sealants, fluoride treatment, fillings for cavities, and even oral surgery. The children and their family members learn about good nutrition for oral health, proper tooth care techniques and receive free gifts like toothbrushes.

One long-time volunteer, Karen Young, a storyteller and self-described "professional hand-holder" said her job is to help keep the kids happy and distracted with stories, jokes and her puppet friends. Most of the children do not have a parent with them as volunteers lead them through the maze of dental stations. Wearing a heart-shaped balloon hat, Young said she listens for cries and tries to comfort the kids who need someone like a mom telling them they'll be OK.

"The staff here is phenomenal," she added, "That these dentists, technicians and hygienists come and do this twice a year is just such a service. It's an honor for me to be a part of it."

John Findley, president of the American Dental Association, who was on hand for the clinic, also spoke highly of the staff and the care the children receive from the volunteers. During his visit to the clinic floor, he saw what he described as one of the greatest rewards of dentistry - an upset and frightened child, who has never been to a dentist, coming to trust his caregivers.

"It did not take him long to feel -- not see -- but to feel the care and the concern about him," Findley said. "It is a tremendous transformation from someone totally afraid, totally in need of help, to someone who trusted his doctor. And you saw it all happen in a very short time."

Solving the Crisis

To help provide under-served children with better dental care, Findley talked about responsibility. "This is an example of the dental profession, the community and the dental industry realizing that it's a problem and that only through combined efforts can we solve it."

The first step, Findley said, is realizing the size and significance of the problem. The second step is giving those who know how to solve the problem the opportunity to suggest a solution. And the final step is to adequately fund the efforts.

Part of that funding can be through volunteer efforts, like Give Kids A Smile. "But, this problem cannot be solved by volunteers alone," Findley said.

Indeed, in the December 2008 newsletter "SMILE Lines," Ray Storm, president of Give Kids A Smile, lamented the number of children who had to be checked out of the October 2008 clinic without the fillings and other restorative treatments they needed. The clinic did not have enough volunteer dentists to provide restorative care for all of them, he wrote.

"We see, so many times, a program will be established, but underfunded. Without that attention, we're going to be in a situation we can't win," Findley said. "You have to start at the beginning," he said, "education, prevention and basic care." And caring for another human being, he emphasized, is what it's all about.

Julia Evangelou Strait is a freelance science writer based in St. Louis. She has a master's degree in biomedical engineering and works in hospital epidemiology for BJC HealthCare.

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