When the dentist comes to school, kids’ teeth are the winners

By Celeste Gracey / Special to The Herald

Two second-grade boys wiggle in nervous excitement outside the makeshift dental office, swinging their feet in matching red shoes while they build up the confidence to face the dentist inside.

Unlike the odor of acrylic fillings that permeate most dental offices, this lobby smells like crayons and rubber erasers. This is because the dentist has come to them, setting up shop in a family resource room off the Lake Stickney Elementary School foyer, where the noise from dental tools is drowned out by a nearby gym class.

While introducing children to dentistry in a familiar environment is helpful for establishing care, the Community Health Center of Snohomish program, which brings preventative dental care directly to schools, has a bigger goal.

If their dentists can reach children at a critical age, when their permanent molars have first erupted, they can apply dental sealants, which reduce the risk of cavities by 80 percent. They can also catch children who have decay, before the need for fillings becomes a need for root canals or extractions, said Dr. Sue Yoon, CHC chief dental officer.

“Some of these kids have never been seen by a dentist before,” said Debra Suggs, the school’s nurse. “There are kids who have significant oral health concerns, mostly due to barriers to care.”

Those barriers are often rooted in awareness. Washington Apple Health provides free dental coverage for children and adults, but it’s estimated that about 51 percent of children who are eligible for the program don’t access it, Yoon said.

For many families, especially those who’ve recently immigrated, there’s also an education gap. They come from cultures where dentists are primarily sought after once a tooth begins to ache. Preventative care, such as regular cleanings and sealants for kids, is a new idea to them, she said.

Most children also benefit from a refresher in oral hygiene, which includes both regular brushing and flossing as well as cutting back on sugary snacks. CHC dentists give presentations covering these basics about a month before coming back to the schools to do exams and sealants.

Back in the school foyer, the first boy is invited to lay down on a folding dentist chair. Behind him a counter is full of neatly arranged instruments in sterile wrappings and a bundle of kids’ sunglasses, bathing in a bucket of cleaner. Hygiene was a concern for organizers, and it’s clear the setup is professional.

A dental assistant invites the boy to show her how he brushes, and then corrects his technique. From around the corner, his friend sneaks a peek and elicits a smile. For a moment his nervous wiggling stops, until he, too, is invited to join them in a second exam chair.

“It’s amazing the power of peer pressure,” Yoon said. “It can be a positive thing.”

Once the cleaning is complete, Dr. Ratika Chandra finds cavities in the first boy. She tells him the dental assistant is going to paint his teeth in vitamins that taste like strawberry cupcakes. Then she writes a note to the parents, instructing them to take him to a dentist right away. If he doesn’t already have a dentist, he’s invited to make an appointment at CHC.

“It’s amazing how many kids we find who need a lot of oral care,” she says, adding how she looks forward to participating in this program every year.

Last year, about 90 of the 461 students who participated in the program needed repair work. This year, they’re expecting to see about 800 students in 16 schools from Edmonds to Darrington.

While the program is free to everyone, some of the cost is recouped through Apple Care, which covers school-based dental care. CHC is dedicated to helping under-insured families. It has five dental and seven medical clinics in Snohomish County.

The second boy, who spied on his friend, is cavity-free, but he hasn’t received sealants for his molars yet. Sealants prevent the bacteria that causes cavities from building up in naturally deep grooves of permanent molars.

Talking him through the process, dental assistants insert foam guards to keep his mouth open and then dry the tooth. The pink sealant is squeezed through a needle-like tube. It turns white and hardens with a blue light. The process is pain-free, but the boy still nervously fiddles with a bag of hygiene freebies. Once they’re finished, he’s happy to shuffle back to class.

By increasing access to preventative dental care, the organization hopes “that the next generation of patients won’t have the extreme dental needs that we’re seeing in current adults,” Yoon said. “It allows us to spread prevention to a much wider group of students than just the families that have the resources and means to schedule an appointment in a traditional dentist office.”