Jan Grutzius, RDH, member of OPEN’s National Oral Health Connection Team

I want to share a story that is both a moment in time, as well as a collective memory, of my last 45 years as a dental hygienist. In 2010, I moved to Phoenix to become the Dental Sealant Program Coordinator for Maricopa County in a federal/state funded preventive program. The programs were no-cost to the schools and parents. Since I was new to public health, I was beyond enthusiastic about helping kids to learn about preventing disease and cavities. One way to do that is with dental sealants — coatings applied to the chewing surfaces of molars to prevent cavities. Sealants are one of two preventions proven effective in preventing cavities; the other is other fluoridated water. Although I didn’t work in the schools on a regular basis, I did step in when providers were unavailable.

And one of those times, a day in 2013, I provided dental screenings and sealants to second graders at a low-income school. As background, Federal sealant programs cover the cost of both screenings and sealants on permanent molars. These teeth erupt around age 6 and 12, so second and sixth grades are the best targets for the program. The school had about 130 kids enrolled in second and sixth grade and we had 38 signed consents to provide service. That’s only about a third of the total students who could have received the free services; but that’s a different story about the need to increase consents.

Of the children screened, eight, or twenty-one percent, had urgent needs. “Urgent” need means pain, infection (abscess), and/or five or more advanced carious lesions (cavities). Next steps for us meant telling the school health aide (sometimes a nurse) who would try to notify the parents to seek care for their child within 24-48 hours. Sadly, there was no way to track outcomes and whether those referrals actually happened.
I left the school with such a heavy heart. I felt helpless. The kids in low-income schools often have no alternative for care other than the nurse or health aide at their school. The schools, and these staff, do the best they can but to complicate the story, funding (especially in Arizona) has been cut repeatedly, and most school districts have only one nurse to cover as many 30 schools. Health aides do not always have the training or the needed infrastructure to refer at-risk children for follow-up care. So, the kids go home unwell, without the interventions that would allow them to succeed in school, and potentially in their future lives. At least a record of the problem was documented in these children’s files, so with recognition and documentation comes a sliver of hope for change.

Have you ever had a toothache? A really bad toothache? No child should have to suffer that pain for a day or a night, let alone weeks months and even years, regardless of financial barriers, immigration status, or ethnicity. Some of these kids have had toothaches since they were three years old and think the pain is just “normal.”

What can we do? How do we reach the children when the schools are closed because of COVID? How and where do they get help? How can we change the perception that “cavities” are a serious chronic disease?
This is a systemic problem that has been ignored, sometimes blatantly, by healthcare, political, and academic systems. We must recognize, identify, and advocate for change. Share this story widely — with parents, policymakers, friends and neighbors — and ask them to support oral health prevention efforts for our children.