Sinking teeth into dental care: Program brings fight against tooth decay into area schools

At many Spokane County schools, children can see a dental hygienist who sets up on-site for a day or two.

The new school dental initiative is part of a fight against high rates of tooth decay in Spokane County. Other grant-backed efforts include partnering with physicians to recognize tooth decay earlier and increasing dental access for seniors and Medicaid adults.

For part of the 2017-18 school year, an early phase of the dental program supported 400 kids. That number grew to 1,200 students receiving such care in 2018-19, and it’s expected to reach 1,600 kids this school year.

“In Spokane County, 38% of our families are classified as being working poor with sometimes two and three jobs to make ends meet,” said Chuck Teegarden, executive director of Communities in Schools of Spokane County.

“The challenge is when you’re working that hard, when do you take your children to the dentist? One thing we and many other people have observed is when children have toothaches, they can’t study. They can’t pay attention in school.”

Communities in Schools has partnered with Toothsavers Washington, an oral health program that employs dental hygienists who visit Spokane County schools where a majority of students are in free or reduced-price meal programs.

With parents’ consent, the dental hygienists clean students’ teeth and apply dental sealants for cavity prevention. Sealants are a thin, plastic-like material quickly hardening on teeth to protect over the deep grooves on the chewing surfaces of molars.

The method can prevent cavities for many years, says the Centers for Disease Control and Prevention. Arcora, Delta Dental of Washington’s foundation, recently gave $200,000 in grants to support the school program along with several other regional strategies through a collaboration called Smile Spokane.

Arcora estimates that in Spokane County, 6 in 10 kids in third grade have experienced tooth decay. One in 3 Spokane County adults has lost one or more teeth to decay, according to the organization’s news releases.

Spokane Valley pediatrician Dr. Brian Simmerman is among area physicians who have received training to integrate oral health into patient exams.

Simmerman said it’s been a multiple-year effort through Spokane Regional Health District and dental experts to provide such training in physicians’ offices. But he’s seen a recent renewed emphasis.

“Now I think we’re making a more concerted effort to say not only am I looking at whether teeth are coming in, I’m making sure teeth aren’t developing cavities and not developing pits or stains or other indications there may be some trouble,” he said.

Child wellness visits have much to cover – from growth and development to diet – but catching dental issues needs to be among the priorities, Simmerman added. During a head-to-toe exam, physicians will look into the mouth anyway, he said. Then office staff can do a fluoride treatment.

“Specifically, our staff gets trained how to do a topical fluoride application – both when there is an indication for dental disease, but also in a preventative way,” he said. “Then we make appropriate referrals to dental care if they don’t have that already.

“The concentrated fluoride that sits on teeth for a number of hours has been shown to make a significant difference. In our office, we don’t have dental assistants, but our staff takes gauze and wipes and dries the teeth and then paints the (fluoride) varnish on.”

Simmerman said it isn’t uncommon to see kids in his office with dental concerns and added that the Spokane area doesn’t have fluoride in its water supplies. Tooth decay can affect children’s overall health, he said.

“In our community, we see more cavities in people who live here, kids specifically, so it’s trying to make sure we’re identifying it,” Simmerman said. “In kids, dental disease is usually one of the top two or three chronic illnesses. We actually see a fair bit of that.

“If kids have a cavity and associated pain, they may have difficulty eating. It can affect their diet, their sleep and school-related activities.”

Typically, physicians can watch closely for dental concerns when children are ages 6 months to 3. “It’s the greatest opportunity because the child may not be plugged into a dentist yet.”

If he or a staff member notices early cavity formation, Simmerman will recommend an in-office fluoride treatment, then encourage a dentist’s follow-up within a few weeks.

“At the same time, we reiterate what should be preventative home care of teeth – brushing at least twice a day, use of a small amount of fluoride toothpaste and, if the child is over 6 months, getting a daily supplementation of fluoride.”

Fluoride supplements are still recommended in drops or chewable tablets, but the fluoride topical treatments are proven to be more effective, he said.

In schools, the dental sealants are offered as a prevention tool. Teegarden said the school dental program is reaching about 50 sites, mostly for elementary grades but also at a few middle schools.

If a family has dental insurance or Medicaid, Toothsavers will bill that provider directly, he said.

“But if a child has no coverage at all, they can still receive the service for free,” he said. “We’re about making sure the kids are getting the sealants.”

State laws allow dental hygienists to go into schools and apply sealants without a dentist’s supervision, he said.

“That dental hygienist might see anywhere from 15 to 40 children in one day,” he said. “They’ll clean their teeth, inspect their teeth, then they’ll apply sealants. If there is any significant damage to the teeth, they’ll send a note home to the parents so they know that. We don’t put sealants over cavities.

“It’s a substance that goes on quickly. It’s painless, and kids never seem to be bothered by it, but it’s very effective in preventing tooth decay.”

Founded in 2015, Smile Spokane is a local impact network of health care, oral health, public health and social service organizations. The Spokane Regional Health District, Aging & Long Term Care of Eastern Washington and Arcora are among the leaders in Smile Spokane’s seven anchor strategies.

Along with the school sealant program, other strategies are:

Coordinate community care with outreach to medical and dental providers, care coordinators, managed care organizations and Medicaid beneficiaries to provide people with diabetes and pregnant women with oral health care, including increased reimbursement for dental providers.

Work with the dental community and other stakeholders to identify ways to enhance prevention, treatment and recovery among efforts to reduce opioid-related mortality.

Integrate oral health into 100% of primary care settings by providing training, tools and technical assistance to medical teams to address their patients’ oral health needs.

Double the current rate of access to oral health services for adults enrolled in Medicaid and seniors by identifying and implementing evidence-based models.

Provide care coordination and support to connect people experiencing mental illness to dental care.

Communicate the benefits of good oral health through community education.