March 6, 2012
When shaping the mission of the Washington Oral Health Foundation more than a decade ago, one thing was clear— while offering a variety of programs and opportunities for the less fortunate across the state would be at the core of what the Foundation would do, the educational component of the organization was the keystone. Foundation President Dr. Sally Hewett says, “The emphasis on oral health education for all is paramount. Prevention education and resource information should be available to everyone — in communities and families — but to change values, it must be understood and accepted. As we expand the availability of the knowledge and support for healthy practices and lifestyles, WOHF’s school presentations and the Boys and Girls Club Oral Health Initiative are excellent arrows in our quiver.” WOHF Executive Director Sandy Hardymon couldn’t agree more, adding that, “We must change the way future generations understand dental disease, and how to prevent it. To this end, our programming is designed to reach across the many cultures and ethnicities in Washington’s underserved populations with interactive, visually stimulating teaching tools, and with resources available in eight languages. Community leaders and teachers are telling us that both kids and adults are ‘Getting the message’”.
The Boys and Girls Clubs Statewide Oral Health Initiative
Perhaps the most far-reaching of current programs, this multi-faceted initiative combines educational opportunities for children and their families, dental examinations and treatment with referrals to potential dental homes. The best part about the education model WOHF created for the Boys and Girls Clubs? It can be replicated anywhere in the state, in nearly any size facility or organization, and its components are vital elements to change people’s values and the way they perceive the value of oral health — one of the biggest challenges facing dentistry today.
The Education Component
Rainier Vista Club Director Rick DuPree is keen on the educational programs offered by the Foundation, explaining, “The WOHF initiative fits well because one of our three program areas is Healthy Lifestyles, and oral health is a big part of that. Much of the population we serve hasn’t been to the dentist in several years because their parents either don’t have the money, or don’t have dental insurance.” Budget cuts have hit the club hard, and like many social service organizations across the state, they are now tasked with measuring the benefit of any program they offer to justify funding. DuPree says, “Boys and Girls Clubs have historically been a drop-in center for kids to come to and hang out, but we’re moving in the direction of offering more structured programs and curriculum with measurable results. WOHF’s educational programming fits nicely within those new expectations.”
For Andrea Locati, Program Director for Pasco’s Boys and Girls Club, education is key — and WOHF’s educational offerings nest perfectly with what her club’s demographic most need. “Fully 85-90 percent of our kids are on free or reduced lunch programs,” she says, “Most of the kids are Hispanic, and Spanish is their first language. They’re probably not getting this type of education at home because of the culture. It’s not that the parents don’t want the kids to get the education, it’s just not something that they grew up with.” Adding that “knowledge of resources” was the biggest obstacle to good oral health in her area of the state, Locati continues, “Many of our families do not have insurance, or they don’t know how to use the resources they have. There are also cultural barriers — if oral health is not a concern to the parents and grandparents, then it is not likely to be a concern for the children. That’s why getting the education to the whole family is a necessity.”
That’s what WOHF’s presentations at Boys and Girls Clubs’ Family Nights are all about — putting the mouth in the body, helping parents and their kids to understand dental disease…how it happens, its impact on the entire body, and how to prevent it from happening. Locati says, “On our recent Family Night Dr. Ronald Snyder and dental hygiene students from Columbia Basin College Dental Hygiene School were present, and while the conversations that happened when we did the kids-only presentation earlier in the year were great, and I think the kids took a lot away from the discussions — the interaction between Dr. Snyder and the parents was key to getting the message to the home.” Locati knows that delivering the message once isn’t enough, and to that end, she’s scheduled four presentations this year. “I think it’s going to take multiple exposures to get the message across,” she says, “And, what I like about the presentation is that it was open and honest, which is really important for the kids. There isn’t a lot of sugarcoating — there are a lot of cause and effect conversations — whether the discussion was about tobacco or baby bottle tooth decay. So even though the content can be a little sensitive at times, I do think the kids need the unvarnished truth.”
Snyder, one of WOHF’s newest Board members and presenter at the Pasco club’s Parent Night, explained that the focus of the evening was dental health as it relates to general health, and that volunteers helped man the seven table clinics — each with a different topic — like nutrition, oral health and radiography. He was impressed with the resources of the Foundation, saying “As dentists, we tend to just focus on teeth, and they brought information about general health issues, too. Also, they had different ways of teaching to the different age groups — slides for younger kids, small groups for older kids, and give and take sessions. I thought it was very well done — the kids were able to relate at their level. Parents got some face time with us to ask questions and get information, too. I think they were pleased that we came to their world. It’s only 15 miles from my office, but it’s a culture and a demographic I typically don’t see. They appreciated that we extended our hand and went to their world, rather than asking them to come to us. I think they got a lot out of it, I know I got a lot of thank you’s from folks.” Hardymon says this is critical to the work they do around the state in all venues, stating, “We’re completely focused on talking TO people, not AT them, demonstrating that we genuinely care about them, building relationships as we go, empowering people to effect change in their lives.” She recalls one presentation where a young girl thanked her for teaching the kids that they should strive for a healthy smile, as opposed to a pretty smile. The young girl told Hardymon, “I can have a healthy smile, but my mother says I wasn’t born pretty, so I’ll never have a pretty smile.” Hardymon blanches every time she tells the story, but knows that it’s all part of the greater message the Foundation is spreading to Washingtonians: You can’t have a healthy body unless you have a healthy mouth — and a healthy smile is a pretty smile!
The Treatment Component
Now in its third year, the single chair WOHF Dental Education and Treatment Operatory at the Rainier Vista Boys and Girls Club accepts members from all King County Boys and Girls Clubs, and recently expanded its services, adding simple orthodontic procedures while remaining a vital community resource for children without dental access. DuPree recalls, “We had a 16-year old young lady who hadn’t been to the dentist in several years, even though she had coverage through DSHS. She didn’t have a regular dentist, but she wasn’t having any dental problems or pain. We set up an appointment for her at the operatory to check her mouth out, and it turned out that she had five cavities and one tooth so severely compromised that it had to be taken care of immediately.”
A full-time assistant was recently added to the staff roster, and Dr. Darlene Chan volunteered to be the first-ever Dental Director. Chan is warm and friendly, but it’s clear that she’s a cool customer who likes things run smoothly. She’s an oral/maxillofacial surgeon who was in private practice for 27 years until retiring recently, but shows no signs of slowing down. Instead, Chan is carefully cherry-picking the opportunities that best suit her skills and interests. In addition to her new duties for the Foundation, Chan serves on a variety of boards and associations in the area, including serving as the President-Elect of the American Association of Dental Consultants, and doing some work in medical forensics. She’s always seen giving back to the community as an integral part of who she is, and as an advocate for the underserved, has long championed their cause, taking DSHS patients and offering pro bono services throughout her career.
For Chan, the opportunity with the Boys and Girls Club Dental Health Initiative was a perfect fit — in addition to her dental degree, she received a Certificate in Medical Management from the University of Washington School of Public Health. As such, running this program isn’t just something she’s interested in, she was trained to do it. She first answered the call to help when she saw a request for volunteers in the WSDA News. Chan elaborates, “Ruth Abate later contacted me and described what their needs were — that they were looking for an individual who would spend perhaps four hours a week helping with clinic oversight and developing protocols going forward, which is very much the kind of thing I want to be doing.” She’s already shaking things up a bit, by securing a second chair for the diminutive operatory.
But Chan is clear: it’s not just the services of the operatory they’re offering at the facility, it’s the opportunity to educate from the ground up — again, tapping into the Foundation’s mission of empowerment. “Chan says, “We see many different value systems in patient populations. Not everybody’s idea of health is the same. For example, if there is a child who comes from a family where the cultural norm is that he or she will have lost all their teeth by the time they are 35 and have dentures, they have a different dental IQ than a child who believes that they don’t have to have a cavity if they take care of their teeth. We can’t give the impression that we don’t like their cultural norm — but we have to make recommendations to ensure that they are healthy and stay healthy.” By offering education for children and at parent nights, and educating children as they participate in care at the club’s operatory, Chan plans to expand the stream of information flowing to all the stakeholders. As Chan notes, it’s not just top-down anymore — doctors telling patients to brush, floss and get regular checkups — now, healthcare organizations want to know if their providers are sensitive to different value systems, to better integrate educational programming within their cultural perspective. Chan, too, sees that as vital for programs like the Oral Health Initiative — where part of what they need to do to be successful is to create two paradigm shifts — one in the patient population, the other in the dental population. Chan notes, “I think the staff and the dentists need to be more cognizant that we have a patient population that’s different from the one they typically treat at their office. We can’t expect everything to change overnight — we have to develop trust with the parents. We need to communicate to them that their children are receiving excellent care like any other patient, and that there will never be shortcuts taken. We want parents to know that if there are any questions, they can communicate with the people performing the treatments. That’s part of developing the trust — parents know where it’s going to happen, how it’s going to happen, and if there’s a problem, they know they can reach someone.”
For Chan, there are three hallmarks to any organization she’s involved in: clarity, commitment and accountability. She defines clarity as “Knowing what the goal is. Here, we know that our goal is to stamp out dental disease.” The second, commitment, is a dedication to the end result, saying, “We need to be willing to walk through a wall to get there. We want to make sure that dentists and students who are volunteering will have a good time when they’re here — that they’ll feel confident and trust that we have the equipment they need and the patients to work on — that’s our commitment as the people running the operatory. We’re also going to communicate to the patients that if they fail to make their appointment and they don’t notify us, someone else didn’t get the chance to come in — and that’s not fair to others. Similarly, Chan notes the responsibility of the dental volunteers — be they dentists or students — to the patient population, saying, “If a dentist or student find they cannot fulfill their commitment, it is their responsibility to find a replacement to fill in for them. We’re going to put a system in place so that they can contact someone else who is already familiar with the facility — just like they would do in their own practice.” Chan’s last hallmark is accountability, which she says has to include people on both sides of the equation — patients and families, as well as providers and staff. All, she says, have to understand that 90 percent of anything is just showing up. For the patients, it means making the commitment to follow through on the recommendations that the dentists make — from making healthier choices at mealtime, to understanding the mouth-body connection, and more. For providers and staff, it means understanding that sometimes concessions and flexibility will be necessary — to accommodate things like cultural differences, language barriers and transportation issues.
Setting the goals in motion
Chan is excited about the challenges ahead, but she’s resolute: this kick-boxing, globe-trotting surgeon has energy to spare. Chan, who admits she wasn’t expecting the enthusiastic, encompassing reception she received, says, “My experience here is limited, but I have to say everyone I’ve interacted with here has been enthused and happy to be involved — and welcoming to me — and they’re ready to roll. The main thing they expressed was that they wanted someone with experience running a practice — who could help them use their facility, time and resources to the optimum, and that’s what I’m here to do.”
Reaching out to low-income children and their families in the communities they call home is central to the Foundation’s mission. The WOHF has created high-impact PowerPoint presentations, educational brochures, and interactive teaching tools for Pre-School, K-12, Adults, and the Senior community; has acquired the most recent, science-based, award-winning DVD’s addressing the dangers and oral health consequences of tobacco, meth, and marijuana; and addresses diversity issues with translators and information and resources in eight languages. Last year, the Foundation had a presence in 100 schools across Washington, with a typical audience of about 150-200 children in each school, seeing nearly 11,000 Washington students in the year. Since 1998, they estimate that more than 283,000 have heard WOHF’s message in schools alone. But what does it all mean? How successful is it? Andrea Locati, from Pasco says, “The visuals of the rotting teeth stayed with them.” Rachel Hyde, School Counselor for Mann Middle School, who watched WOHF’s school presentation with 125 eighth graders, agreed, saying, “Eighth graders aren’t excited by anything, but the presentation definitely held their interest — they are more in tune with graphic visuals rather than lectures, so that appealed to them, and it was in kid-friendly language. Each time the presenter used a technical term, she explained what it meant, which kept the kids on message.”
At Mann, the teachers were having a “Healthy Choices Fair” so the presentation began with “Five Keys to Prevention of Dental Disease” and continued with cutting-edge videos of the consequences of “Poor Choices” that included use of tobacco, meth, marijuana, and its effect on oral health — important because Hyde says dental health is not part of the curriculum taught there, and while 50 percent of the kids at Mann are from military families and have access to dental care, they don’t necessarily get it. Seeing doctors at Madigan can be a real challenge, as deploying soldiers get first dibs on appointments, making it difficult to get in. Hyde continues, “The biggest takeaway for my group was the connection to their overall health — that if you don’t take care of your teeth there could be serious repercussions, and what can happen to your teeth if you do drugs — the before and after shots really got them going. Drugs are part of their vernacular — all the schools here deal with it, although it’s not so much meth that we’re seeing in the schools — it’s marijuana with friends and parents outside of the school. Still, the Foundation’s message hit home.”
For Dr. Rob Merrill and his brother Dr. Tom Merrill, bringing WOHF’s spit tobacco messaging to a targeted population in his hometown of East Wenatchee has been part of his personal mission for 13 years. Prior to starting the program, close to 20 or 25 percent of the seniors in high school used spit tobacco. When they started the spit tobacco cessation program —using materials from the National Spit Tobacco Education Program (NSTEP) that was being managed in Washington state by the WOHF — they asked the school district to insert specific questions about spit tobacco into the risk behavior assessments they conduct about every three years to kids in the 7th, 10th, and 12th grade. The first assessments would be used as a baseline, since none of those kids had seen the spit tobacco program, and then subsequently, as kids moved up through the system, the Merrills could see whether or not their presentations were effecting change in spit tobacco use. More importantly, they could see how use trends in their town compared to peer group usage across the state. For 13 years, they have addressed nearly every 7th grade class in the Eastmont district — about 4,000 kids. The brothers are pleased to note that after they began their program in the area, spit tobacco use not only dropped, but it was the only risk behavior associated with substance abuse that was lower than that of other kids statewide, which suggests that their efforts have made a difference. But the presentations have had an ever further-reaching effect, as Merrill explains, “A few weeks after I had given a presentation I was examining a new patient in the office for braces, who came in with his mother. Before she left she shook my hand and said “You’re the reason I’m not smoking anymore.” Merrill was confused — he didn’t recall meeting the woman prior to that day. She continued, explaining that her son had brought home information from a presentation that Merrill had given to his class a couple of months before, prompting him to ask his mother to stop smoking. As Merrill says, “Kids sometimes can have influence that spouses can’t, because they do it in a loving way. Sometimes, no matter how a spouse approaches a subject, it’s perceived as a nag.”
The impressive numbers of this program speak for themselves: 752 schools “adopted” across the state, 200 WSDA members participating in the delivery of emergent care to children without access to dentistry. The Foundation’s Melissa Holt says, “Most volunteer dentists are seeing four kids per school and donating around $500 in treatment per child. 200 dentists have donated approximately $1 million dollars in donated dental services, and served 2,500 patients through the Adopt-A-School program since 2007. We now have 752 schools adopted throughout Washington State.”
The program is simple enough: conceptualized by WSDA past president and former WOHF board member Dr. Jim Ribary, member dentists agree to provide free emergent care for children referred by the nurse at any school they have “adopted.” Nurses call the dentist or Holt, the child is scheduled in at the earliest convenience and the source of the pain is eliminated. Dr. Andrew Lewis of Seattle adopted the Secondary Bilingual Orientation Center three years ago, and counts the experience among the most rewarding of his dental career, saying, “My first case was very complex and happened within months of joining the program. I saw the patient a lot — probably nine times. I understood that the goal was to get her out of pain, but when you see these kids and their mouth is filled with other problems, you just can’t turn them away and say come on back when you’re in pain again. I think I ended up doing three root canals, nine fillings, and cleaned her teeth.” He continues, saying, “The most rewarding thing about the whole experience was that Helene (the school nurse who referred the student) said that her teachers assumed she had a learning disability — when in reality, she had been in so much pain that she couldn’t concentrate. It just broke my heart -— she wasn’t eating, she probably wasn’t getting good quality sleep, and was doing poorly in school, all because of dental disease. It was so rewarding to see her smile.” It was only later that he discovered the full horror of her personal struggle: how she’d grown up in the Sudanese refugee camps, making her way to the US via Egypt — all the while never complaining about her pain.
As Lead Nurse for the Auburn School district, Jan Schneider shepherds some 1,500 high school students. Although she’s been fortunate enough not to have to use the program excessively, Schneider is clear, “I’m at the high school level so I don’t have to use it very often, but it’s a wonderful resource when you have a child who is in dental pain.” Just this week, Schneider had cause to call on her “adoptive” dentist. “I had a 16-year old girl who came in crying in pain holding the side of her face,” she recounts, “She had tooth pain that had been going on for two days, but had become excruciating. I checked and she had a broken tooth. She had no dental insurance, no way of paying for dental care, and no DSHS or any kind of medical coupons. I called Melissa at WOHF, completed the nurse screening form that they require, and referred her into the system. Her mom came to get her and they were able to work her into a dental office that day. I think that both her parents are working, they simply don’t have insurance or the means to pay for dental care.”
For his part, Lewis can’t say enough about the program — and is quick to implore others to get involved, saying, “This is a program that really needs to be done by a dentist who has a servant’s heart and is willing to help kids. I got more fulfillment out of doing free dentistry for these kids than I have for some of my patients — the adopt-a-school program is just pure giving, and the patients are so thankful.” He continues, saying, “We need dentists who really want to serve. This is not something that’s going to impact your schedule. You can afford to do an extraction, you can afford to do a root canal, you can afford to do a filling. They’re not that expensive. The work we do for these kids is routine, general dentistry that takes a short amount of time, with very little overhead. We all have the capacity in our practices to help these kids — put your name on a list, see one child. You’re not obligated for anything after the limited exam — if you need to refer to a specialist, you can. It’s one of the most important volunteer programs because it gives us complete flexibility and freedom with the maximum return on our investment.”
WOHF Education Resources and Teaching Tools
These turnkey tools are used in presentations across the state, and are available for you to use when you make a presentation to a group in your local area. They include PowerPoint presentations, printed materials, table displays, brushing models and other interactive props and teaching models. Presentations are scripted to ensure message consistency, since many schools choose to schedule annual assemblies or grade level presentations, and we track the effectiveness and constantly update the content. WOHF President Hewett says, “When I’ve done presentations I have really appreciated all the materials the Foundation provided. They were age-appropriate, designed to communicate with students and to encourage critical thinking, making it much more likely that they will retain and comprehend what they’ve learned.” If you would like to use WOHF materials in your presentation, please contact Melissa Holt at Melissa@wsda.org or (206) 973-5234.
Give Kids a Smile Month
Each February, the WOHF focuses public attention on the prevention of dental disease and the importance of good oral health, and reports the events and names of the Washington dentists and dental teams who provide free oral health education, exams and treatment worth tens of thousands of dollars to underserved children all over the state. Dr. John Carpenter of Auburn saw 21 kids on February 22 and donated $8,914 in dental care. This is his fourth year having a Give Kids a Smile event at his office! His office did cleanings, fluoride treatment, x-rays, fillings and extractions.
In Clark County, the annual Children’s Dental Health Day was held at the Clark College Dental Hygiene clinic. The focus was on helping the children of low-income families. Dozens of Clark County Dental Society members participated, along with members of their teams. Faculty and students of the dental hygiene department at Clark College and dental assisting students were also on hand. By day’s end, 264 children had been examined, and 190 restorations had been placed. Preventive services included 442 sealants and over 200 fluoride varnish applications.
On the horizon:
Board member Dr. Keith McDonald, and former board member Dr. Lisa Block, both pediatric dentists, have been instrumental in creating a new initiative that is aimed at hospital maternity wards to provide soon-to-be moms with critical prenatal oral care and oral health education for infants. Dr. Keith McDonald is spearheading the Maternal and Infant Oral Health Initiative that will be launched this Spring. “There is great potential in this type of programming,” Dr. McDonald said, noting, “There are a lot of opportunities with other partners who already support the health and well-being of moms and babies, such as the ABCD program and the La Leche League. Both groups have powerful advocates in the state, especially among pediatric dentists.”