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Smart Mouths

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Dr. Gregory McClure, dental director for the Delaware Division of Public Health, and Sarah Matthews, executive director of the Delaware Oral Health Coalition, show a young patient proper brushing technique. Photograph by Christian Kaye The biggest hint that something special was going to happen for the 100 pre-schoolers at the White Oak Head Start Center in Dover might have been the lady with the wings.

The Tooth Fairy herself had paid a visit to the center, along with dentist Dr. Kathy Hilton and hygienist Kimberly Hickman-Bowen, to show children the best way to brush their teeth.

The secondary goal—one that has become a statewide issue for Delawareans of all ages—was to reinforce the importance of good oral health. It’s a message that has been lost among the buzz of other health information, resulting in surprisingly high numbers of adults who don’t simply skip dental visits, but who rarely even step into a dentist’s office.

On the surface, such a situation doesn’t scream “statewide health crisis.” But any healthcare professional will tell you the quality of dental care a person receives has a huge impact on overall health.

That’s what prompted the state to form the Delaware Oral Health Coalition. The advisory group to the Delaware Division of Public Health unites dental professionals, public health agencies, government and others with a vested interest in the overall health of the citizenry to promote awareness of good oral hygiene, says Sarah Matthews, executive director of DOHC.

The broad net the coalition casts is necessary because of the variety of underlying issues that affect oral health. They range from cultural to economic to geographic in nature.

Among the cultural challenges the group faces is ambivalence, says Dr. Gregory McClure, dental director for the Delaware Division of Public Health. In many families, oral health and dental care have never been a priority.

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“Starting with children, people just aren’t taking it as seriously as they should,” McClure says. “A lot of people take it as normal that having teeth means having decay also. If they haven’t formed the habits of getting into a dentist for a routine cleaning, it becomes a factor.”

National and state statistics show how widespread the problem is. In a 2008 Gallup-Healthways poll of 355,344 Americans, 34 percent reported that they did not visit a dentist during the year. Among individual states, Delaware ranked 26th in number of residents who had visited a dentist in the past year—66 percent. That leaves 34 percent who didn’t, just like Gallup said.

For those who have not made dental visits a priority, the key to driving home DOHC’s message is through children and programs such as the one at the White Oak Head Start Center, Matthews says. It’s especially important in Delaware, where it’s estimated that 56 percent of third-grade children have had tooth decay. The decay has gone untreated in more than 30 percent of them.
 

The key to driving home Delaware Oral Health Coalition’s message is through children, especially in Delaware, where it’s estimated that 56 percent of third-grade children have had tooth decay. The decay has gone untreated in more than 30 percent of them. In terms of kids, untreated tooth decay is not just painful, but can lead to long-term problems like delayed speech development, poor nutrition, poor school performance, and low self-confidence or self-esteem.

“Obviously, in terms of kids, untreated tooth decay is not just painful, but can lead to long-term problems like delayed speech development, poor nutrition, poor school performance, low self-confidence or self-esteem, and embarrassment if they have damaged or unhealthy teeth,” Matthews says.

Emphasizing to children the importance of good oral health and giving them the tools to help them follow through helps in several ways, McClure says.

First, children build good habits for the rest of their lives, potentially staving off large and expensive oral-dental issues later. DOHC estimates that $2 spent on a child’s toothbrush could save the $100 it would cost to fill a decayed tooth, not to mention the thousands of dollars in potential dental maintenance that child could incur by age 40.

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Second, a child’s enthusiasm can inspire an older family member, especially when that child is conveying the messages he or she learned in school.

Getting those messages across is one of the major challenges DOHC faces, especially with the elimination of dental hygienists from the public school system. Many schools, however, recognize the importance of maintaining the link between dentists and students, so they have continued programs to get hygienists into the schools. DOHC attempts to strengthen those connections and help schools build new ones, recruiting hygienists to work with students and school nurses to raise awareness and connect students to dental offices for care.

“Through our campaigns, we are trying to reach out to schools, and one thing we’d like to achieve through this program is engaging more dentists and dental hygienists who like to devote an afternoon to speaking to kids or attending a health fair,” Matthews says. About 22 dentists participate now, “but we’d certainly like to expand that and have more dental professionals become engaged and active.”

DOHC is seeking federal funds to provide children under 5 and their families with access to a dentist and preventative care, McClure says.

Another large part of the group’s work is uniting the work of pediatricians and dentists. By making pediatricians more aware of their patients’ oral health and encouraging them to refer problem patients to dentists, many issues could be headed off early, Matthews says.

By combining the messages of basic maintenance, regular care and the overall effects of poor oral health, DOHC hopes to reach adults who are in charge of their own care and that of their children.

The issues DOHC has to tackle among adults include inability to pay for dental care and lack of transportation to the dentist’s office. Children eligible for Medicaid for dental coverage can get transportation, but adults have no such coverage. And though dentists are clustered closely in New Castle County and densely populated areas downstate, there are few offices or clinics in rural areas.

New Castle and Kent maintain low-cost clinics, and DOHC is working to create one in Sussex, but as Matthews says, having to take a half day off work, then ride a bus to the dentist, can dissuade many adults from something they already view as unpleasant.

With that in mind, Delaware maintains a loan repayment program for dentists who locate their practices in Kent and Sussex counties, with the hopes of increasing the number of convenient offices, McClure says. “We feel there are some great opportunities for dentists to set up practices down there.”

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