Ohio dental program, data showcases the need for in-school care, advocates say
Rural communities especially targeted to provide care to kids in need
Kim Hammersmith, DDS, and her team examine a patient at one of the school-based health centers spearheaded by Nationwide Children’s Hospital. (Photo provided by Nationwide Children’s Hospital.)
Dental disease impacts the ability to eat, the ability to carry on with everyday activities and overall quality of life for Ohioans.
For children, it can be the difference between a productive school day and a day full of worries about eating at lunch and distractions in the classroom.
Those living in poor communities and rural areas struggle to access dental care for adults as well as children, leading some advocates to push programs that would provide the care in school.
“What we’re seeing every day in the hospital is that these children at young ages have dental disease,” said Dr. Kim Hammersmith. “We have had a 2-year-old coming in with 10 to 15 cavities.”
Hammersmith is a pediatric dentist at Nationwide Children’s Hospital, who also leads the Advanced Education in Pediatric Dentistry Program, in which she works to bring more pediatric dentists to the state.
Nationwide’s school-based dental program brings, with parental consent, services from routine cleanings, exams, X-rays, sealants and fluoride treatments to fillings and crowns, right to schools, rather than taking children out of school and parents away from work to go to a dentist’s office.
“These are the parents who can’t get time off work,” Hammersmith said. “They punch a clock, so every minute they’re gone is important.”
According to the Pew Charitable Trusts, tooth decay is the most common chronic disease among U.S. children while dental care remains “one of the nation’s greatest unmet children’s health needs, especially in low-income, minority and rural communities.”
The analysis by Pew also showed as of 2014, more than 18 million low-income children went without dental care, including routine exams.
“A number of factors contribute to the lower levels of preventive care that children in low-income, minority and rural households receive, including barriers to transportation, a scarcity of dental providers in many communities and cost,” researchers for Pew stated.
A 2022 update from Pew showed racial and ethnic inequities in children’s oral health “persist from coast to coast.”
There is an absence of data for many states in the U.S., including Ohio, but researchers found that of the 15 states who did have data showed Black third-graders were 2.6 times more likely to have “untreated decay” and 2.3 times more likely to have decay than their white peers.
Though Pew’s research concluded that school-based dental programs “provide a critical service to at-risk children,” a 2015 study showed “most states programs have failed to meet national goals.”
Part of the issue in Ohio is a lack of dentists who specialize in pediatric dentistry. While general dentists can work on younger children, often they refer children with major dental issues to pediatric dentists, typically found in urban and suburban areas, according to Hammersmith.
As part of a training program for pediatric dentists, Hammersmith is leading an effort between Ohio State University and Nationwide Children’s Hospital to give dental students an extra two years of education to learn the speciality and encourage those dentists to stay in the state to improve access to care and health equity.
Because of the current lack of access, tooth decay and dental disease is concentrated in rural and low-income areas.
“20% of the kids have 80% of the problems,” Hammersmith told the OCJ.
The Ohio Department of Health found in 2017 that seven of 11 counties where children have the poorest oral health are in Appalachia, including Coshocton, Carroll, Highland, Brown, Pike, Scioto and Meigs counties.
Even compared to other rural counties, the ODH found children in Appalachia have 50% more untreated cavities than children in rural counties, and 69% more than children in urban or suburban counties.
In October 2020, the ODH announced an “oral health surveillance plan” to span from 2021-2025 in order to “provide information necessary for public health decision making by routinely collecting data on oral health outcomes, access to care, risk factors and intervention strategies for the whole population, representative samples of the population, or priority subpopulations,” according to the plan.
The data would target outcomes for third grade children and look at the percentage of children in Medicaid and the Children’s Health Insurance Program. The state would also look at everything from its own oral health programs and their environments to the ingredients found in public water systems to study the effects on oral health.
The surveillance data could then be used to show the needs of the state and where improvements can be made to target dental needs.
Programs like Nationwide’s school-based concept to help kids get dental care have focused on rural and low-income areas. In that program, they’ve found 85% of children who receive care have never seen a dentist before that point.
The Nationwide program, and a similar on in Cincinnati are “mission-driven,” according to Hammersmith, and work with grant dollars and donations to do their work. So far, they’ve served eight schools and 21 Early Head Start centers across the state.
But the program is still growing, and without an increase in dentists to do the work, there’s only so much reach the program can have.
“If we had unlimited dental workforce, we could be out in almost every school,” Hammersmith said. “If schools could hire a dentist, pay a dentist who gets paid out like they do in private practice, they would, but schools don’t have that money.”
With a bigger dental workforce and having the prevention available through in-school programs, Hammersmith believes the quality of life for children could only get better.
“They’re able to learn, they’re able to sleep, they’re able to grow, and do all the things they should be able to, to be a kid and enjoy their childhood,” she said.
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