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DENTAL NETWORK FOR EPHRATA KIDS
Submitted By: Shanna Richards, RDH

Children are our most valuable asset. They are our country’s future; but to our shame and through no fault of their own they are the fastest growing face of poverty. One out of every seven children in Pennsylvania lives in poverty and the stigma goes beyond where they live or the clothes they wear. It can leave a permanent scar on their self esteem and their smile. Far too often pain from tooth aches, rampant cavities, and abscesses become an accepted right of passage through childhood for these vulnerable children. Statistics show that dental care is the most common unmet treatment need in children and more children are affected by dental decay than asthma.1

Luckily for the children of Lancaster County, several community-based services have been created to address the disparities in access to oral health care. There are four school-based programs: Conestoga Valley Dental Partnership for Children, Eastern Lancaster County School District’s Got Teeth Program, Manheim Township School District’s Dental Clinic Without Walls and the Dental Network for Ephrata Kids.

The Dental Network for Ephrata Kids was started in the Fall of 2003 by Patricia Coiner, a registered dental hygienist, and Kathy Noll, an elementary school nurse in the Ephrata Area School District because there was an evident need due to the significant number of children that would come to the nurse’s office in pain with observable cavities and rampant decay. At that time, there was no place to refer the uninsured, underinsured, or underprivileged children. Their district is not alone. Studies show that Pennsylvania school nurses report that they deal an average of one or two dental emergencies per week. In economically disadvantaged schools that rate is even higher.1

The Ephrata Area School District is located in Lancaster County in the historic town of Ephrata which is surrounded by rolling hills and serene farm land. One would never image that 21.6 % of the population is living below the poverty level and that 22% of the District’s children qualify for free or reduced lunches.2,3 These numbers do not necessarily include the working poor, who make too much to qualify for Medicaid, but not enough to purchase insurance. As a result, a significant number of children who come from families of the working poor are uninsured. The majority who do qualify for Medicaid are unable to find a participating provider.

Patricia and Kathy created the Dental Network for these children. What makes this program so special is that it was the first one in the area to incorporate a dental health education class as a requirement to access dental care. The families must meet with a registered dental hygienist at the referred child’s school for a dental health screening and dental education. There are five hygienists who volunteer their time to help with the dental health class. As a practicing dental hygienist, Patricia firmly believes that education of the parents as well as the student in the etiology and prevention of decay is vitally important in order for the parents to take responsibility and help their children with healthy oral habits. As she said, “If we can make some impact toward better nutrition and dental care, then we have made a difference not only in getting children out of immediate pain, but in reducing the possibility of chronic pain and decay.”

Since its inception, approximately fifty children have been seen and referred to eleven local dentists who give their time either pro-bono or with reduced fees. The dental treatments have included restorative work such as amalgams, composites, crowns, root canals, and extractions. Unfortunately, in some cases, hospital sedation was necessary to treat severe rampant caries. In addition, some of the dental offices have generously provided comprehensive preventive care which includes dental prophys, fluoride treatments, sealants, exams, radiographs, and space maintainers. In all, over 130 hours of dental work and 35 hours of hygiene time have been donated at a cost of $14,000.

The Dental Network for Ephrata Kids will assist Ephrata students who have significant unmet dental needs and are from low income families to access local dental services funded by charitable community resources. Funding for the Network comes from the generous support of the Reformed Presbyterian Church; The Lancaster, Lebanon, and York Area Dental Hygienists’ Association; Matthew25 Reusit Shop; Bethany United Church of Christ; Akron PTA and private individual donations. In addition, supplies have been donated from Benco and other dental suppliers, and directly from Crest, Colgate and Oral B. If you would like more information or would like to support this school-based initiative, please contact Patricia Coiner, R.D.H. at the Reformed Presbyterian Church, 21 East Locust Street, Ephrata, PA 17522 or 717-733-0462.

1 PDHA White Papers
2 Census Bureau
3 Pa Dept. Of Education

Oral Health Literacy
Submitted by: Beth Zimmerman, RDH
Co-Chair PDHA Public Health Council

One of the workshops held in April at the National Oral Health Conference in Miami, Florida, discussed oral health literacy. What is oral health literacy? It is health literacy applied to the oral health setting. Health literacy according to the U.S. Department of Health and Human Services “is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” It includes reading, writing, speaking, math, and problem solving skills at a level that is needed to function. If a patient has difficulty in either of those areas they may not be able to follow detailed instructions or understand their health status or how to prevent disease. Filling out health forms or insurance forms may be a difficult task. According to the National Assessment of Adult Literacy exam, only 12% of adults scored at proficient and more than 14% scored at below basic. The populations most at risk for low oral health literacy are older adults, individuals with less than a high school degree, low income population levels, and minorities. They are the populations least likely to use preventative services. It is the responsibility of the health care professional to communicate using simple plain language. Plain language according to the government is the use of everyday words, short sentences and pronouns such as “you.” It could be saying “cleaning and checkup” instead of prophy and exam or “we are going to pull your back tooth” instead of “we are going to perform an extraction on tooth #14.” If information has to be written down, make the most important points come first. Define any technical words. Avoid words that have two meanings. Communicate in a culturally appropriate way. With all of us working together we can help all patients understand the need for oral health services and help them achieve oral health.

Chester County Health Department
Submitted by: Alberta Landis, RDH, BS, MEd
Co-Chair PDHA Public Health Council

The Chester County Health Department partnered with two non-profit dental providers, Community Volunteers in Medicine in West Chester and Chester County Community Dental Center in Coatesville to develop and expand school-based dental sealant programs in Chester County.
One charter school and 3 public schools having 50 % or more of the students enrolled in the free and reduced cost school meal program were chosen to participate in this program. Jaclyn Gleber, President of PDHA, and Alberta Landis, PDHA Public Health Council Co-Chair as well as
Luz Garzon, Dental Health Coordinator for the health department, made this program a success. The Chester County Health Department oversaw this program through its dental health outreach coordinator who partnered with staff at the clinical sites. Two complete sets of portable dental equipment were recently purchased through awarded grant monies. 1,295 sealants were placed by dental hygienists with approximate value worth over $50,000.

Community Volunteers in Medicine (CVIM) is a nonprofit community-based volunteer organization that provides primary medical and dental care for the uninsured working poor in Chester County. The organization is designed to provide services for those individuals whose gross income is at or below 200% of the Federal Poverty Level and who are not eligible for CHIP, Medical Assistance, Medicare or Veterans’ Association benefits. CVIM receives no government monies to provide services and depends on the generosity of the community as well as professional and lay volunteers who donate their time and talent to help sustain the clinic. It is now in its ninth year of operation and continues to meet the needs of a community facing increasing poverty and rising numbers of people without medical and dental insurance.

Patients at CVIM range from the working poor who cannot afford insurance, to the recently disabled, to Hurricane Katrina evacuees, to foreign refugees. The majority of those treated at the clinic work in service occupations. They are the invisible laborers who wash dishes, iron clothes, mow lawns and serve the bottom of our economy. CVIM’s mission is to keep these people healthy and thriving so they may continue to support themselves and their families.

Two part-time dentists, two certified dental assistants, and the director of dental services staff the dental clinic within CVIM. They are generously supported by 32 dentists, 10 dental hygienists, three orthodontists, two periodontists, and one endodontist, each one an unpaid volunteer. Additionally, students from Harcum Dental Hygiene School, Montgomery County Community College Hygiene School, and Temple University Dental School provide hygiene, dental, and educational services to patients. CVIM’s dental clinic has approximately 400 visits each month and offers treatments such as routine fillings, extractions, scalings and root planings, sealants, prophyalaxis, and fluoride varnish applications. The clinic is also able to offer specialty treatments including orthodontia, periodontal therapy, osseous surgery, endodontal therapy, periodontal therapy, and crown lengthening.

Above and beyond the routine and specialty care that CVIM offers to patients, the dental clinic also has a child-focused fluoride varnish initiative that provides more than 1,000 fluoride varnish applications to children from every Head Start Program in Chester County and to children who come to the clinic from Mission Santa Maria in southern Chester County. These children, who often have no access to care, may also receive dental exams required by schools before children may attend classes.

CVIM is extraordinarily proud of the work of its dental clinic and grateful to all those who assist in providing healthcare, hope and healing to so many who would normally go without routine care. The staff, in cooperation with both clinical and lay volunteers, lives the clinic’s vision statement each day as they continually “…have eyes to see those who are rendered invisible and excluded, open arms and hearts to reach out and include them, healing hands to touch their lives with love, and in the process heal [them]selves.”

One example of what a volunteer can experience each day in public health dentistry is as follows: Seven year old Miguel arrived at CVIM on the bus provided by Mission Santa Maria in southern chester county with a mouth full of pain and a heart full of fear. At first he refused to let the CVIM dental staff and volunteers near his mouth. But after three appointments with our volunteer dental hygienist, he began to feel more comfortable and allowed our dental hygienist to see what he had endured for a very long time--20 baby teeth with visual decay. It took 15 dental appointments to complete the extensive work that he needed, including four pulpotomies, four stainless steel crowns, four extractions and 16 fillings.

While the dental staff transformed his tiny mouth, the volunteers embraced Miguel and transformed his spirit. They made each visit fun and full of education about how to take care of his teeth and gums. By the end of nearly four months of treatment, Miguel took on the role of handing out free dental health products to the other children who came on the bus to receive much needed care. He became a joyful, thankful and very compliant patient who learned to ease the fear and anxiety of other children. He left CVIM with a new, pain-free smile and with his very own set of tiny little angel wings. With the reinforced dental health education and fluoride varnish provided by our volunteer dental hygienist, Miguel became a very compliant dental patient and his oral health was greatly improved. Miguel thrived in school and without the constant oral pain was able to excel in school.

If you have any questions about Community Volunteers in Medicine, or would like to volunteer in any capacity to help make a difference, please contact Alberta D. Landis, Director of Dental Services at 610-836-5990, extension 107.

With your continued support, we as dental hygienists can indeed help with the access of oral care problem in Pennsylvania. Wouldn't you like to be a part of these great accomplishments?

Dental Hygiene at Vision Quest,
Coatesville, PA

One year ago, a friendly and persuasive phone call came to my office, the center for a mobile dental program that delivers dental services to underserved children in Philadelphia. It happened to be a “slow month” for our new outreach program and the director, Dr. Phil Kruper needed help. He had searched for a dentist willing to do state mandated dental exams and cleaning “in house” unsuccessfully for over a month. Vision Quest was in danger of failing to meet state regulations, and, since the majority of the shelter youth were from Philadelphia, I was able to help.

July 14th, 2006, began a “temporary” relationship between St. Christopher’s Hospital for Children and Vision Quest. About every three weeks, the staff dentist and hygienist do 30 to 40 dental examinations on portable dental equipment set up inside the Vision Quest conference room. The exams are facilitated by Vision Quest staff and go quickly due to the pre-planning and organization. The dental hygienist visits on successive days to do “cleanings” and gum therapy.

I am the dental hygienist and have found the hours at Vision Quest have been some of the most rewarding in my hygiene career. I find teenagers who have been severely neglected and their mouths are full of infected teeth and gums - the result of lack of personal hygiene and professional care. Out of the over 300 residents we have examined, about 70% have cavities and over 30% are in pain and need urgent dental treatment. Many report that they have never had a professional cleaning and some are beginning to show supporting bone loss or, technically, periodontal disease.

Last month I met “John”. He is 15 years old and a handsome boy from North Philadelphia. His chief complaint: pain and loose teeth. It was apparent after a dental hygiene exam that John had a severe disease called Juvenile Periodontal Disease, caused by aggressive bacteria in his mouth. His lower front teeth were very loose and his gums were detaching from his back molars. I could feel the space between the roots of the back teeth that are normally imbedded in jaw bone.

I discussed the case with a Periodontist at St. Christopher’s Hospital for Children. She explained that Juvenile Periodontitis (JP) is more common in teenaged black males, and that, since JP goes through active and remissive phases (some think stress related), latest research recommended non-surgical therapy. She wrote the names of the two antibiotics that in combination and delivered over seven days, seems to have the greatest impact on the JP bacteria and said that irrigating the gums with diluted Povidine Iodine might help, also.

In a short term residential facility, these were treatments that were possible! The Vision Quest consulting physician approved and ordered the antibiotics, the nurse supervised the dosing regimen and in less that one week, when I returned to irrigate the gums and examine John again, his mouth was improving. He reported that his gums stopped hurting, and I confirmed his teeth were not so loose.

Meanwhile, I had contacted John’s legal guardian who was interested in learning about his gum disease and excited to have referral information in order to follow up when John came home.

I think I am lucky. I am lucky to have a profession that can change a person’s future. I know that John is a rare case, but I am sure he would have lost his teeth if not for my intervention. I know that many of the kids I see at Vision Quest have never had the attention of someone who not only treat their gum disease but teach them why and how to effectively keep their mouths healthy. Through a sometimes painful cleaning, these kids are cooperative, polite and interested in following what I do and say. “Thank you, Miss” is common and unprompted at the end of the visit.

Vision Quest does its best to find treatment for the urgent cases needing a dentist - but with great difficulty and expense. If these kids had oral health care when they were young, many of the problems they now face could have been prevented. Enduring tooth pain may provoke bad behaviors. Substance abuse can begin due to the temporary pain relief it brings. Phil Kruper and I discussed how untreated dental pain may be called a “gateway event” to entry-level drug use. Kids have admitted trying marijuana for the first time to “make the pain of my toothache go away, even for a little while.” I hope that the intervention the St. Christopher’s Mobile Dental service brings, supported by the team at New Directions, can help some of the teens at Vision Quest break the cycle of arrest and detention and find that they can be productive citizens in our community.

Judy Gelinas, RDH, BS
Program Manager Mobile Oral Health Services
Ronald McDonald Care Mobile Dental Program
St. Christopher’s Foundation for Children
Philadelphia, PA

Water Street Dental Clinic

Water Street Dental Clinic (WSDC) was started in May 2003 by the Water Street Rescue Mission Medical Clinic: a faith-based non-profit organization, who has been meeting the needs of the homeless uninsured since 1993. The Water Street Rescue Mission, parent organization of the Medical/Dental Clinic, has been serving the poor of Lancaster since 1905.

WSDC currently provides free dental services to the homeless uninsured of Lancaster County, Pennsylvania. This includes current and former residents of any Lancaster County homeless shelter and patients referred to us by organizations working with this population.

WSDC is a separate 501 c 3 organization and receives no federal or state funding. Our services are provided by 14 volunteer dentists, 5 volunteer hygienists, 12 volunteer assistants, plus other volunteers like receptionists and lab technicians. We have two paid staff members, the Dental Administrator who oversees all functions of the clinic, and a part-time dental assistant to work chair side and perform the routine maintenance necessary to keep a dental clinic functioning properly. The dental assistant position was made possible through donations from a group of volunteers who understood the need for consistency in maintaining the equipment. In order to try and meet our volunteer needs we also work closely with the Lancaster County Career & Technology Center and York Technical Institute dental assistant programs and the Harrisburg Area Community College dental hygiene program. We hope to work with Harcum and their EFDA program in the very near future.

In 2007 construction was completed on our newly expanded medical and dental clinics. We have increased our dental clinic from approximately 700 square feet to over 2000 square feet. The clinic now consists of 4 operatories, sterilization room, lab, dark room and storage area. All equipment for the expansion was provided through donations by dental supply companies throughout the area.

With our increased space, we have been able to offer some new and exciting programs for 2007. This included Give Kids A Smile Day in February and Sealant Saturday in March. Both of these events were well received and we look forward to repeating them again in 2008.

In 2006 we provided almost 1000 patient encounters with a value of over $250,000 in our old facility. To date in 2007, we have provided over 425 patient encounters and over $100,000 in services in our new facility.

The Water Street Dental Clinic is always looking for caring and compassionate dental professionals to assist us in our goal of providing free dental care to the uninsured men, women and children affected by homelessness and other life challenging situations. If you are a dental professional and would be interested in taking a tour of our dental clinic, please contact Robynn Rixse at (717) 358-2011, by e-mail rrixse@wsrm.org or by mail at: 210 S. Prince Street, Lancaster, Pennsylvania 17603.

Brush. Brush. Smile!

In May 2004, St. Joseph Health Ministries (SJHM) unveiled its innovative children's oral health initiative - Brush. Brush. Smile! As a non-profit community health service organization dedicated to improving the health of children in need within Lancaster County, PA, SJHM created Brush. Brush. Smile! using national, state and local data that supported the need for both short-term and long-term efforts to address the "silent epidemic" of oral diseases among low income children.

Today, Brush. Brush. Smile! works collaboratively with all 16 Lancaster County school districts and a growing number of community organizations to provide free dental care, offer preventive oral health education and develop an advocacy agenda that brings greater awareness to the issues around children's oral health in Lancaster County - especially when it comes to low income populations. To date, over 2300 children have benefited from the education and services provided through Brush. Brush. Smile!

The most visible component of Brush. Brush. Smile! is a 40-foot children's mobile dental clinic known as the Brush Brush Bus. Complete with a full-time dental team, the Brush Brush Bus travels throughout Lancaster County providing free dental care to low income or economically disadvantaged children. The Brush Brush Bus began seeing patients in October 2004 and has provided more than 640 children with over $500,000 worth of free dental care.

Last Fall, St. Joseph Health Ministries successfully added oral health classroom education for children in kindergarten – 3rd grade to Brush. Brush. Smile! Using a curriculum developed in partnership with the Susan P. Byrnes Health Education Center in York, PA, this interactive oral health classroom education focuses on improving everyday oral hygiene habits while highlighting proper brushing and flossing techniques and the importance of regular visits to a dentist in a fun and non-threatening way.

With an estimated 19,000 low income Lancaster County children failing to see a dentist each year, St. Joseph Health Ministries realizes that Brush. Brush. Smile! is only reaching the tip of the iceberg and continues to seek out additional means of reaching more children – even if it means reaching them one child, one family at a time.

For more information about Brush. Brush. Smile! and/or St. Joseph Health Ministries, visit their website at www.sjhm.org or contact Ann Goropoulos at 717-239-1197 or anngoropoulos@catholichealth.net.

Community Volunteers in Medicine

In the next few issues of the PDHA Journal we would like to recognize organizations who work with the underserved population. If you know of an organization who works solely with the underserved, please forward their name and email information to the PDHA Journal Editor so we may contact them for inclusion in a future issue.

If you have any questions about Community Volunteers in Medicine, or would like to volunteer in any capacity, please contact Alberta D. Landis, Director of Dental Services at 610-836-5990, extension 107.


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