Better than the tooth fairy: Pediatric dentistry outreach offers health care to young Iowans in need

Eileen Hermiston, a research assistant in pediatric dentistry, brushes Jatavia Hill’s teeth with chlorhexidine gel in March during a visit to the preschooler’s Head Start class at Lincoln Elementary in Davenport. Photo by Tom Jorgensen.

Dental health care workers fit a 15-year-old with a full set of dentures.

They pull the four top permanent front teeth of a 10-year-old.

They take photographs of an infant’s mouth infested with painful decay.

What sounds like severe oral health disease in some faraway place actually happens in America’s heartland. Michael Kanellis and his colleagues see these problems every week in large cities and small towns throughout Iowa.

Kanellis, associate professor and head of pediatric dentistry, hopes his crews see fewer children in pain as they strengthen prevention education efforts and offer their services to those who might otherwise continue to suffer without any care at all.

To fight the battle against decay and to gain experience working in a community setting, dental faculty, students, and residents participate in outreach programs. They travel the state, providing exams and cleanings at schools and clinics, and teaching parents and local care-givers about oral hygiene.

“Most of the children we see come from low-income families, where a priority often is not placed on dental care for a variety of reasons,” he says. “Maybe the parents can’t get off work to take children to appointments, or they don’t have transportation. They may not have access to dentists who will accept Medicaid, or they may not have any insurance coverage at all.

“When we’re talking about children, it’s a very simple question—should children have access to oral care? Yes. Which children? All of them.”

Kanellis supports the American Academy of Pediatric Dentistry guidelines recom-mending that children have their first dental visit within six months of getting their first primary tooth and no later than their first birthday.

When this does not happen, some children end up with serious dental problems. Some even end up in the operating room. More than 100 children each year at UI Hospitals and Clinics undergo general anesthesia for the treatment of early childhood caries, commonly known as baby-bottle tooth decay.

They are usually 2 to 3 years old and have waited three to six months for an appointment, Kanellis says. They typically have more than eight decayed or abscessed teeth, have been experiencing chronic pain, and have had difficulty eating and sleeping.

Studies have shown that the dental disease affects the children’s growth and development, and Kanellis expects that they will weigh less and be shorter than others their age who do not have dental decay.

“The dental disease these children experience is severe, debilitating, and is likely the most severe health problem they will face in their childhood,” Kanellis says.

UI pediatric dentistry representatives provide care to about 40 children and young adults living in group homes for those with severe/profound mental retardation in Forest City. They see dozens of children of migrant farm workers each summer at camps in the Williamsburg area.

Pediatric dentistry residents visit the Community Health Care Clinic in Davenport two days a week year-round to provide dental care to low-income children. Another program sends a resident one day a week to St. Luke’s Dental Clinic of East Central Iowa in Cedar Rapids. Yet another takes a resident to the Des Moines Health Center two days a week to see young patients.

About 200 eastern Iowa preschoolers are participating in a study of an antimicrobial gel that researchers say could be a potential defense against tooth decay. The project, which is funded by a $200,000 grant from the Roy J. Carver Charitable Trust of Muscatine, involves children in Head Start programs in Muscatine, Durant, and the Quad Cities.

Eileen Hermiston, project coordinator and pediatric dentistry research assistant, and dental students visit 21 sites once a month to apply the raspberry-flavored chlor-hexidine gel, developed by Cindy Marek, College of Dentistry pharmacist and clinical associate professor, and approved by the FDA as an investigational new drug. Half the participants get the gel, the other half a placebo.

At each monthly visit, bacterial testing from the children’s mouths is conducted so that comparisons can be made between the beginning and end of the study. Children get their teeth brushed with the gel, then take their new toothbrushes home to use.

“We’d love to see the test gel really reduce the amount of germs that cause decay. If it works, it can be done in the sites so we make sure it gets done,” Hermiston says. “Compliance at home isn’t always great. This is a terrific way to hit this susceptible population of kids and save them the pain and the costs of treatment—which can be $6,000 or more.”

Closer to campus, the Johnson County WIC Clinic works with the University to offer preventive dental care for infants and toddlers in the Women, Infants, and Children program. Karin Weber helped launch the program in 1998. She is a fellow associate in pediatric dentistry, originally from Brazil, who officially will become a UI visiting professor in July.

There are more than 600 patients enrolled. Children from a few months old to school age get dental exams, fluoride treatments, sealants, and simple fillings, all at no charge.

“I’ve seen the massive destruction of almost all teeth in many children’s mouths caused by early childhood caries. It’s upsetting, especially because it’s a disease that could’ve been prevented in the first place,” Weber says. “I want to break the barriers to access to dentistry.

“Dental health is linked with the entire health of the child. A toothache will interfere with a child’s normal life, and it’s unacceptable that little ones have to go through such pain.”

Article by Amy Schoon

Editor’s note: The Department of Pediatric Dentistry maintains a registry of 200 dentists in 68 Iowa counties who are willing to accept referrals of children under 3 years old. For more information, go to www.iowapediatricdentistry.com and click “outreach.”

For a list of frequently asked questions about pediatric dental care: www.aapd.org/media/faq.asp.