Archive for April, 2012

The Dental Foundation of Oregon Tooth Taxi

Monday, April 30th, 2012

By: Mary Daly

The Tooth Taxi is a 38’ state-of-the-art dental office on wheels with two dental chairs, a full-time dentist, two dental assistants and a program manager. It visits schools and community sites throughout Oregon to provide free dental care and oral health education to uninsured and underserved children.

The van spends up to a week at a school/site providing dental screenings, cleanings, sealants, X-rays, fillings, minor oral surgery and in-classroom oral health education. Each child receives oral hygiene instruction, a toothbrush, toothpaste, floss, mirror, and a brushing timer.

Site partners and schools are selected based on high percentage of students qualifying for the free & reduced lunch program, limited or no access to dental care and a dedicated project coordinator from the site to prepare for the Tooth Taxi visit.

The Tooth Taxi was created through a partnership with OEA Choice Trust, ODS, and The Dental Foundation of Oregon, the charitable arm of the Oregon Dental Association. The van is funded by leading foundations, corporations and individuals who care deeply about improving the oral health of Oregon’s children.

The Tooth Taxi team is charged with implementing the Dental Foundation of Oregon’s mission, “Improving oral health for Oregon’s children.”

In our fourth year of service we continue to modify and evolve the program to enhance services rendered.  We have instituted repeat site visits that account for 40 percent of our visits, decreasing the introduction time necessary with the site partner and allowing us to complete treatment on many students.  Our program can be a bit intensive for some schools, especially in light of diminished budgets and staff. Return visits allow us to make more of an impact both with education and with treatment rather than just reaching the tip of the iceberg.

At the end of each site visit a list of students identified as uninsured and still needing dental treatment is given to the site partner to refer students to The Children’s Program.  This not only provides a follow up resource but is a reminder to school staff that they have a referral option for students with dental needs throughout the year.

In 2011 we ran our most successful summer program partnering with school migrant programs and community non-profit centers.  Establishing relationships with dedicated site partners ensured a steady stream of patients and kept the Tooth Taxi on the road.

Tooth decay is preventable and that is a message we try to get across to students through our in classroom oral hygiene program.  Teachers are invited to sign up for a presentation from one of our staff members while we are on site.  With a focus on offering the education each week we have increased the number of students that receive the oral hygiene news.  This also prompts discussion in the classrooms and reaches the teachers who often share their own dental care stories.  Each student receives a bookmark that reinforces the oral hygiene message and each school receives a Tooth Taxi library bookpack, four books that provide invaluable oral health education information for teachers, parents and children.  How do we know the presentations have made a difference?  Checking out of the hotel Friday morning the desk clerk told us her kindergarten daughter came home from school all excited about the Tooth Taxi staff visit to her classroom.  She’s excited to take care of her own teeth and told her Mom “if you don’t brush them you get holes in them.”  She really liked the BIG toothbrush and the fake teeth.

Our ongoing goal is to keep the Tooth Taxi staffed (first things first).  It is a challenge to recruit and retain staff when the van is on the road three weeks a month, away from home Monday through Friday.  We modified our schedule so that we are within 60 miles of Portland during the summer and we spend every 3rd week within 60 miles of Portland (so staff can sleep in their own bed at night).  These changes allow staff to have a bit of a home life, take care of personal business, and stay in the position longer.

We give kids a positive experience and teach them to be good patients.  Acknowledgment from schools and parents reinforce that we are doing the right thing.

Dental professional volunteers are a key component of our program.  Volunteers are asked to give ½ or full day of services.  If we have two dentists in the van we set up our portable unit in the school for hygiene services by a volunteer hygienist. Volunteer hygienists provided cleanings and sealants to students that don’t need restorative care from the dentist.

Since the Tooth Taxi launched in late fall 2008 we have visited 157 schools/sites all over the State of Oregon, and served over 10,000 children while delivering $2,734,557 in donated dental services.  The Tooth Taxi services provide immediate relief of dental pain and infection for thousands of children who lack access to basic dental care, in addition to preventive services and education.

 

Mary A. Daly is the Program Manager for the Dental Foundation of Oregon’s mobile dental van affectionately known as the Tooth Taxi.   Mary has spent the past year criss-crossing the state of Oregon with the new mobile dental van, as close as she can get to her childhood dream of running a book mobile.    Mary may be contacted at 503.329.8877 or Mary.Daly@SmileOnOregon.org

 

How to help our Parents, Grandparents and other Elders keep their teeth

Monday, April 23rd, 2012

By Dr. Janet Peterson

My grandfather lost his first permanent tooth at the age  of 89.  A lifetime of wear and tear on this upper canine had resulted in a crack that split the tooth and it had to be extracted.   He was lucky, though, in that a lifetime habit of brushing  twice a day and little or no snacking  between meals, in addition to good memory, allowed him to keep his oral  health.

My aunt was not so lucky.  In her mid-eighties she began to experience some memory problems.  Living alone, meals disappeared and she snacked on cookies and milk throughout the day.  She pretty much forgot to brush her teeth.  Her six month cleanings were followed by more and more repairs as decay encircled her teeth and  they broke off.  It was finally decided that a complete denture was the only reasonable solution.  Because of her frail health, two teeth would be extracted every two months to allow for healing.   Unfortunately, she passed away before the treatment plan could be completed – with only three teeth left and with  considerable embarrassment at the demise of her smile.

Memory loss is a big factor in the catastrophic increase in tooth decay  that so many elderly people experience.  It can be difficult to determine if this is a factor as elders  learn to “cover” memory lapses and we tend to respect their assurances that everything is all right.  Asking when their next dental appointment is may give a clue as to whether they are keeping up on dental check-ups.  If they have no appointment scheduled, getting an appointment is the first step.  Having someone go with them can be a good way of getting information from the dentist or hygienist as to whether there is an increase in the rate of decay in their mouth.  Because of the privacy rules of  HIPPA ( Health Insurance Privacy and Portability Act) ,  staff may be unwilling to discuss an elder’s health over the phone or by letter, whereas it is easy to have a three way conversation with the elder and their dentist or hygienist in person.  If there is an increase in rate of tooth decay,  it is necessary to find out what are the contributing factors and to start trying out possible solutions to slow this rate of decay.

The usual contributing factors and some first steps to mitigate them are:

Change in dietary habits with more frequent  snacking,  more sweets.

  • Provide balanced meals that require little or no preparation
  • Try to group sweets with a meal and decrease snacking between meals

Physical difficulty with brushing with weakness or uncoordinated hand movements or pain

  • Try an electric toothbrush,
  • Adapt the manual brush by bending the handle or enlarging it with foam

Apathy or depression – the attitude of “why bother?”

  • Engage the professional services of a psychologist or counselor
  • Discuss the benefits of good oral home care, and the downside of neglect – pain or missing teeth

Memory  problems leading to the forgetting of established daily habits

  • Place the toothbrush by the bathroom  sink in plain sight
  • Tape a note on the bathroom mirror – “Brush Teeth”
  • Remind the elder daily to “ go right now and brush your teeth”
  • Have staff at assisted living residence or nursing home remind the elder or brush for them

Problems of calling for a dental appointment or transportation to the office 

  • Have family or caretaker make appointment and arrange for transportation
  • If necessary, have office front office staff call to make appointment and arrange transportation

 

Dr Janet Peterson is a 1983 graduate of the Oregon Health Sciences University School of Dentistry and just recently retired after practicing as a general dentist in the Salem area for over 25 years.

ODA Celebrates the Passage of HB 4128 and the Expansion of Children’s Dental Health Coverage

Tuesday, April 17th, 2012

By: ODA Staff

Over the last two years, the Oregon Dental Association has worked with our partners  to help families of those born with craniofacial abnormalities to overcome some of the challenges associated with these types of birth defects  through legislation. Craniofacial abnormalities are the most common birth defect in the United States. In Oregon, 68 cases of cleft lip/palate amongst newborns were reported in 2007. These children are faced with real and potentially lasting challenges associated with oral clefts such as breathing, social integration, hearing, speech and language abilities.

HB 4128  helps the  families of patients with craniofacial abnormalities by preventing the costs of dental care from being prohibitive, which often forces the family to delay needed treatment for a child.  HB 2148 requires health benefit plans to cover medically necessary dental and orthodontic services for the treatment of craniofacial abnormalities.  A child born with a cleft frequently requires several different types of services over a number of years with treatment often beginning in the first months of childhood. In the treatment of oral clefts, timing is critical and delaying due to cost can impede or permanently stunt the development of a child. But with proper and timely treatment, a child with an oral cleft can develop on a normal arc.

ODA member dentists, Dr. Daniel Saucy and Dr. Judah Garfinkle along with ODA Lobbyist, George Okulitch and Dean Hale (father of a cleft palate patient) watched as Governor Kitzhaber signed HB 4128 in to law after unanimously passing both the Oregon House and Senate.  Our sincere thanks go out to Rep. Val Hoyle, HB 4128 chief sponsor, for all her hard work and dedication to improving the oral health of Oregonians and to Regence Blue Cross Blue Shield, Oregon Dental Services, Children First for Oregon, and the Oregon Medical Association for supporting the bill.

 

Protect Your Teeth, Wear a Mouthguard!

Monday, April 9th, 2012

By Dr. Teri Barichello

Soccer players don’t question wearing shin guards, football players their helmets, volleyball players their knee pads. Clearly shins, heads and knees are worth protecting. Why then don’t we place the same value on our teeth? Why isn’t the use of mouthguards just as routine as other protective measures?

Millions of children and adults participate in sports and recreation activities, and depending on the activity, they are at an increased risk of sustaining dental injury. When teeth sustain a traumatic blow or injury, the damage can often lead to permanent alteration in appearance or irreversible changes to its function. A single accident can create the need for lifelong follow-up care and maintenance.

April is National Mouthguard Month. The intention is to draw attention to the increasing and serious issue of oral trauma and injury as a result of sports and recreation activities. One in six sports related injuries is to the craniofacial area. Football, boxing, basketball, lacrosse and hockey are obvious examples of high contact, high risk activities but injuries aren’t confined to these sports. Often participating in non-contact sports results in dental trauma. Some of the most traumatic injuries have been reported as a result of baseball, bicycling, gymnastics or skateboarding. Studies show that while young boys show a slight higher prevalence of dental injury than girls, that gender difference evens out as they enter young adulthood.

The great news is that we can all easily protect our smiles by wearing a properly fitted mouthguard.

There are three types of athletic mouthguards, two of them are available over the counter and one is custom fabricated by a dentist. The over the counter versions offer convenience and are lower cost but have limitations in their comfort and level of protection. The first over the counter type is a pre-sized, stock version. They are generally available is sizes S-L and there is no customization for fit. They often don’t fit comfortably and wearers usually need to hold their teeth together to keep them in. For this reason, this type is considered to be less protective. The second over the counter type is commonly called a “boil and bite”.  The guard is warmed in boiling water then self adapted to the users mouth. This type has better retention than the stock version but is often bulky which can make it hard to speak or breathe. For optimal protection, there needs to be certain thickness of material in key areas.  This is a concern with the boil and bite due to the self adaptation process which often leads to dangerously thin areas. In addition, lab impact tests have shown that the boil and bite mouthguard has less adequate cushioning and shock absorption than that available with a custom fit. A custom made mouth guard is by far the most protective and comfortable type of guard. This version requires a visit to your dentist who will take impressions and either fabricate it onsite or send it to a laboratory for a precise, customized fit. Custom versions tend to be more expensive, but offer superior protection, are far more comfortable and are more easily adaptable to orthodontic appliances. The expense incurred to have a proper mouthguard made could save a person thousands of dollars if there is damage from an accidental injury.

Mouthguards for All!

The use of a mouthguard is not age dependent. It is recommended for all people, young and old, who participate in activities with the risk of injury to the face or teeth. When parents consider enrolling a child in an activity, they are recommended to have a conversation with their dentist to discuss the level of risk and whether a guard is appropriate. Good habits start young, so there will be increased acceptance and compliance by young adults if wearing a mouthguard has been part of their routine all along.

 

Dr. Barichello is a 1998 graduate of the OHSU School of Dentistry.  She was a private practicing general dentist in Oregon City for 13 years before taking her current position as Vice President and Chief Dental Officer at The ODS Companies.  She is a Past President of the Oregon Dental Association and trains in the high contact martial art, Poekoelan, for which she is an avid proponent of the use of mouthguards.


The Creston Children’s Dental Clinic of Portland

Monday, April 2nd, 2012

By Dr. Kurt Ferré

 

Creston Children’s Dental Clinic is the only school-based dental clinic in Multnomah County, Oregon.  It has a long history dating back more than 50 years when the Assistance League of Portland (ALP) opened the doors to the clinic.  Due to capacity limitations, the ALP could no long sustain its operations, and the clinic was scheduled to close in early 2010.

In January, 2010 Dr. Dale Canfield, Lora Mattsen, Executive Director of the Multnomah Dental Society, and I met with one of Dr. Canfield’s patients, Duncan Campbell, who started a successful non-profit organization, Friends of the Children years ago, and Mr. Campbell outlined a template on “how to” set up a non-profit organization.

Thus, in February, 2010, a new non profit took over stewardship and operations for the clinic as the “Friends of Creston Children’s Dental Clinic” (FCCDC).  Easier said than done, however, because the IRS moves at it’s own speed, and it took almost 1 year to receive our official determination letter designating us as a non profit organization.  In order for us to be able to go out and do some immediate fundraising, we had to find a non-profit organization that could act as our fiscal sponsor.  Enter the United Way of the Columbia-Willamette.  Then president/CEO, Marc Levy, helped facilitate the process.  In a word, they were “great”, and they totally supported FCCDC without charging us any administrative costs.

So,  fund raising was our immediate task.  To keep the clinic open for the remainder of the school year (February to June 15th), we needed at least $30,000.00.  The Multnomah Dental Society donated $10,000.00, Lora Mattsen and I approached Multnomah County for $20,000.00 of emergency funding, and with the help of Commissioner Jeff Cogen and his chief of staff, Marissa Madrigal, the county commissioners voted 5-0 to grant our request.

Thus, with some breathing room, we began the task of building a sustainable model for FCCDC.  We wanted to return the clinic to a completely all volunteer clinic as regards to dentists and hygienists to reduce the clinic operating expenses.   Our first two recruits to board of director membership were Barry Rice and Sue Sanzi-Schaedel.  Mr. Rice is past executive director of the Oregon Dental Association, and now retired from his positions as an executive in ODS Company and Advantage Dental.  Ms. Sanzi-Schaedel is a retired public health hygienist with a MPH, having worked with Multnomah County Dental Health Department for over 30 years.

As Mr. Rice told me early on, our core quality that we wanted in any board members or future employees is that “their head bone has to be connected to their heart bone”.   Essentially, anyone directly involved with Creston has to believe in its mission.  Thus, we have recruited 3 addition board members, David Novitsky of the Daisey Company, Catherine Kittams, RN, a retired MESD school nurser in Multnomah County, and Jay Ward, a retired area sales manager with the A-Dec Company.  Our board is a working board, and they all bring long-time connections in the dental community to the table for the benefit of the clinic.

We have hired 3 wonderful employees:  1) Erica Soto, Administrative Director; 2) Annette Rotrock, lead dental assistant, who keeps everything running in the clinic area; and 3) Jenny Poach-Gagnon, our front desk extraordinaire (believe me, she does more than answer the phone and make appointments).  Both Ms. Soto and Ms. Poach-Gagnon are fluent in Spanish as our patient base is over 50% Hispanic.  While all the children are fluent in English, most of the parents speak little English, and it is wonderful having that resource to bring the families into the preventative picture to combat oral disease.  Lastly, we have an incredible grant writer, Eli Levine, who has helped the clinic obtain over $300,000.00 in grant funding.

In two years, the clinic has had a complete makeover.  First, we had the clinic completely painted and new furniture in the waiting area and back professional work area is all donated. We have 5 operatories, new A-Dec chairs, fiberoptic handpieces, and digital radiography, including panorex.  Again, much of this equipment was donated to FCCDC.  We have been amazed with the generosity of the dental community to help sustain the clinic.

With a good clinic infra structure in place, our focus is on the care of the low-income children in the Portland Public School System, ages 5-18, who lack adequate access to dental care.  We know that oral disease is a 100% preventable disease.  However, for this to be a reality, one needs education, prevention, and access to care.  We know that there are just too many holes to fill in our patient population.  Treating a disease and filling holes are not necessarily the same thing.  We need to go to the root causes of dental decay, and educate our patients in prevention.  This also means educating the parents of our patients in prevention.  We encourage every child in elementary school to sign up for the King Fluoride supplement program that is offered free to the children in Multnomah County schools (hopefully, someday soon we will see Portland’s public water supply fluoridated).

Our results have been most positive.  We now have a bulletin board full of patients’ photos who initially showed up with cavities, but at their next recall visit, they were cavity free, and now they are members of the “Cavity Free Club”.  It’s heart-warming to see how excited the kids are to get their photos on the wall.  We are looking to add additional bulletin boards, because we are almost out of space.

I’m embarrassed to say that I practiced 23 years before I did my first volunteer dental care.  I can honestly tell you that I get back in return from these children more than the sevices that I have been trained to deliver.  To break down the barriers for these children, to see a child, who was initially fearful about going to the dentist, and now love coming to Creston with a smile on their face……..priceless.

For those of you who are in a position to volunteer at Creston, try it.  I believe we’ve created a clinic and atmosphere that you will want to come back again.  If you are at a stage in your life when you cannot volunteer the time, please consider a cash donation in the form of a “Smile Scholarship”.  To learn more about Creston, visit us at www.crestondental.org

 

Dr. Ferré is a 1976 graduate of Northwestern University Dental School in Chicago.  He retired in December, 2008, after a 28 ½ year career with Permanente Dental Associates in Portland. He is past-president of the Multnomah Dental Society, and he currently serves on the board of directors for the Oregon Oral Health Coalition, the Oregon Dental Association’s Government Relations Council, and the dental advisory board for Medical Teams International (MTI).