Helping the children
School of Dentistry impacts children's lives
 David Rogers, DDS, second-year resident, dental anesthesia program, screens a child at Big River Head Start preschool in preparation for her treatment. |
After three hours of driving in a severe desert rainstorm, I arrived at the fenced yard of a little Head Start preschool near the California border. I left my house at 4:00 a.m. with great apprehension about the long drive in the rain, but the phone call from the teacher the previous week sounded so desperate I knew I could not cancel or postpone this visit.
In her phone call, the teacher stated that no dentist had ever shown up in the five years she had been teaching, and that she really wanted to know whether she could count on me or not.
She stated that the kids in her center were in desperate need of dental care, and that she hoped I would at least come and look at them. So here I was."
This excerpt taken from a story about children's lives impacted by School of Dentistry faculty, students, and staff was written by Carla Lidner, DDS, assistant professor, dental educational services. The story, which tells of the School's use of nearly $1 million in Proposition 10 grant funding to provide oral health care to underprivileged children, has made its way to the desks of politicians and organizational heads throughout California. "I didn't send the story [to them]--others did," reveals Dr. Lidner, "but I am convinced God worked His wonders and that the incredible help and assistance given to this project is the result."
During recess in schools across the country, carefree children run and play. But what is not evident is that many of these youngsters are suffering in silence.
According to Oral Health in America: A Report of the Surgeon General, "Dental caries (tooth decay) is the single most common chronic childhood disease--five times more common than asthma and seven times more common than hay fever." The report goes on to say that more than 50 percent of 5- to 9-year-olds have at least one cavity or filling.
Children from poor families suffer twice as many cavities as middle-class children, and their disease is more likely to remain untreated--their parents may not have transportation to the dentist's office, or the parents may fear that if they take time off work, their jobs may be in danger.
 Dr. Lidner (third from left), director of the grant, discusses plans for the children's care with (from left): Drs. Ron Forde, Todd Milledge, Dan Pulsipher, and David Rogers.  Children from Big River Head Start preschool line up at the fence to wave goodbye to the School of Dentistry team that came to their school. Many of the children later received care in the School's surgery center for dentistry and the pediatric dentistry clinics. |
The children may also have poor nutrition and lack of dental education (youngsters may be put to bed with baby bottles filled with milk or juice, or parents may neglect to see that their children brush their teeth).
According to the Surgeon General's report, 25 percent of American children have not seen a dentist before entering kindergarten.
Uninsured children are two-and-a-half times less likely to receive dental care than those who have insurance, and social programs like Medicaid have not been able to increase levels of oral health care for children in the United States.
The social impact of oral diseases in children is great; more than 51 million school hours are lost each year to dental-related illness. Pain and suffering due to cavities can lead to problems in eating, speaking, and learning.
The children's plight weighed heavily on Dr. Lidner, who recently became mother to twin girls. "Much has been written about barriers to [dental] care," she says, "but up to now, little has been done to overcome these barriers."
When Dr. Lidner learned of funds available from Proposition 10, a cigarette tax approved by voters in 1998 that made California's cigarette tax the third-highest in the nation, she put her dental and public health experience (including service with the health department in Arizona) to work.
The new tax was estimated to generate approximately $700 million annually in California to be used for social services for families with children less than 5 years of age, including helping to fund prenatal care, daycare programs, and health care. Dr. Lidner saw the funding as a godsend and, if funds were granted to LLU, she wanted to do more than create brochures or advertising that parents might not see--she planned to find the children, traveling to where they were, screening them, and finding transporation for them if necessary to make sure they received treatment.
 Todd Milledge, DDS (right), chair, department of pediatric dentistry, and Ron Forde, DDS, director of service learning, set up portable x-ray equipment at Big River Head Start preschool. |
In 1999, Dr. Lidner and Charles J. Goodacre, DDS, MSD, dean of the School of Dentistry, submitted a Proposition 10 grant proposal to the Children and Families Commission of San Bernardino County. Yiming Li, DDS, MSD, PhD, professor of restorative dentistry, and Arlene Glube from the county health department, assisted in writing the grant proposal.
The grant was approved and it was not long before the startling statistics in the Surgeon General's report became names and faces for Dr. Lidner. Here is more from her story:
"Seated at little tables were seventeen 3- and 4-year-olds eating their breakfasts.
I introduced myself and introduced my assistant. The teacher's look of relief was easy to match with the voice from the previous week. She hurried the children with their breakfasts, asked them all to brush their teeth, and then lined them up at a little table in front of me for their dental screening exam.
"Blonde hair or brown hair, blue eyes or brown eyes, they were all as cute as any kids I had ever seen. They opened their mouths as wide as they could so that I could peer inside. Eyes may be the window of the soul, but a child's mouth can tell a story that even eyes cannot tell. Neglect, poverty, abandonment; all visible in their little mouths.
 Jennifer Hoffer, DDS (left), and Jennifer Barry, DDS, pediatric dentistry residents, screen a child at Big River Head Start preschool in preparation for treatment at the School of Dentistry. |
"Little teeth were decayed to the gum lines. The smiles were almost all completely toothless except for an occasional front tooth with a silver crown hanging on a decayed stump. It appeared that a dentist somewhere had tried to do low-cost dentistry to save some of these teeth, but many of the teeth had just been extracted. Without money to restore teeth, extraction is usually the only option. I fought back tears. These kids were only 3 and 4 years old!"
Baby teeth (deciduous teeth) play an important role in the growing child--both in terms of function such as eating and speaking, but also in guiding the permanent teeth into their proper positions. This prevents malpositioning of the permanent teeth. Even though baby teeth are eventually lost, they are essential to good health during the child's developmental years.
Dr. Lidner continues her story: "The teacher noticed my wincing. After each child was examined and sent outside to play, the teacher told me their stories... These little kids certainly did not have much money or any great prospects for their futures, and now they would have ugly mouths, too! Even more troubling than all of this was the fact their little bodies have to constantly fight these infected areas of their mouths. The teacher told me she routinely calls caregivers to take their children back home on the days when the children tell her their mouths hurt too much to even play outside. How are children supposed to be able to concentrate on learning when they don't feel well enough to play?"
After working on the grant proposal, waiting for approval, and signing the contract--all of which took two years--the funding had finally come through.
 Dr. Lidner found children in immediate need of dental care in preschools in some of California's most remote desert areas. |
Dr. Lidner promised the teachers a way would be found to provide needed dental care for the children, even if it meant busing them to the School of Dentistry.
She asked Dr. Goodacre and the pediatric dentistry faculty to close the pediatric dentistry clinic for two full days to see only children from the towns of Needles and Big River, and they gave immediate approval.
Dr. Goodacre suggested that fourth-year dental students become involved in providing the needed care, and the entire class signed up. Weekly meetings were held with School of Dentistry faculty, staff, and students to make certain numerous items--from insurance and billing concerns to feeding the children and their caregivers, and providing suitable places for them to wait--were taken care of so they would be comfortable during their time on the Loma Linda campus.
Dr. Lidner also recruited local dentists to become involved; and finally, she began negotiating transportation issues with the bus lines.
Following is the remainder of Dr. Lidner's story:
"I saw a TV interview with Rob Reiner this past week. He left Hollywood and movie making to set up Children and Families Commissions throughout our state. It is mostly because of him that these grant monies are available for poor kids.
"I wonder if he knows just how much his efforts have mattered. His sincerity has been reflected by all of the county officials and staff I have met who are involved with the distribution of these monies. The money is treated like it is sacred.
"Certainly I cannot speak for anyone else, but I am convinced God has assisted us and that He has caused many good things to happen for the sake of His little ones. It wouldn't surprise me if we end up with so many dental volunteers on those days that every child will return home on their bus--without an ugly silver crown in sight!"
The LLU school family and community help make the children's treatment a reality
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As she traveled locally and throughout the remote desert areas virtually inaccessible to dental care, Dr. Lidner screened more than 1,100 children. When she saw the extent of their pain, her heart went out to the little ones. Many evenings she worked late into the night to finalize plans to bring the children to the School of Dentistry.
In her creative plan, fun diversional activities would keep the children occupied before and after treatment, and oral health education would be offered to their parents and caregivers by dental hygienists, faculty, and students who were now involved in the project.
Employees from the Medical Center and Azure Hills Seventh-day Adventist School arranged for colorful toys for the children to play with; LLU donated $2,000 to help pay for costs associated with the event not covered by the grant; and after hearing a presentation by
Dr. Lidner, the Redlands Kiwanis Club also donated funds. Anita Rockwell-Hayden, director of community relations; and Kimberley Jeske Kuzma, publications editor, community relations, assisted with the media, and invited members of the commission from San Bernardino and Riverside counties.
In preparation for the event, Todd Milledge, DDS, chair, department of pediatric dentistry, joined faculty and staff leaving the University at 4:30 one morning and traveling to the children's hometowns where they screened and prepared individual treatment plans and charts.
Dr. Lidner describes the children's arrival on April 27: "The sun was setting, but the buses arrived on schedule. Everything had been prepared. Mr. Jeffrey Bennett, from a neighboring city, called Loma Linda Motel with instructions that all expenses for the children and families for two nights be charged to him.
"The children jumped down the stairs of the buses and ran excitedly around the hotel grounds. You would have thought they had just arrived at Disneyland! The teachers commented that many of these children had never left their hometowns, and certainly had never been on a trip like this!"
Dr. Lidner and her husband, Bradley Baum, MD (a 1982 graduate of the School of Medicine), an orthopaedic surgeon, placed bright orange armbands on the children's wrists to identify them as general anesthesia patients, and to alert everyone that they should not be given food or drink before receiving anesthesia in the morning.
Nearly 60 children would receive treatment the next day, and the many planning sessions with faculty and staff were rewarded as all of the scheduled care was given.
Clowns, storytellers, and friendly firefighters with firehats to give away and shiny red firetrucks to explore, helped make the hours go quickly for the children who were waiting.
The media had been alerted about the day's events and highlights, and the story appeared on television newscasts and received front-page newspaper coverage.
Commissioners from San Bernardino and Riverside counties had received invitations and attended a special meeting with Dr. Goodacre to discuss how to provide oral health care to the area's most vulnerable and underserved populations.
The April 27 event worked so well that, in addition to children from Needles and Big River, youngsters from areas including 29 Palms, Big Bear, Morongo Valley, Joshua Tree, and Yucca Valley have been bused to the School of Dentistry, with more than 200 children receiving full-mouth treatment during the last few months.
Dr. Lidner continues to seek solutions to the challenges of providing oral health care to the area's most underserved populations, and she has begun applying for grants which will provide care for older siblings and parents of her young patients.
She has also developed "Ready for Bed," a campaign which she has begun to promote in California. The program emphasizes the benefits of going to bed with a clean mouth so that saliva can rebuild and remineralize teeth while one sleeps. "Ready for Bed," she states, "is inexpensive, easy, and has no side effects."
Letters of appreciation from teachers, parents, and others continue to pour into the School of Dentistry from around the counties.
Terrell Johnson, family advocate in the preschool services department, County of San Bernardino Human Services System, recently wrote to the Children and Families Commission about one child's story:
"...He was suffering and in pain for at least five days due to tooth decay. The child would not eat during breakfast, lunch, or snack times; he cried and exhibited minimal interaction with classmates. This child, simply, could not function in class in this condition.
"Thanks to Proposition 10 funding and the helpful, courteous staff at Loma Linda University School of Dentistry, this child began treatment on July 16 and seems like a new person. He's participating in class more, eating, and interacting with peers. You are making an awesome impact in the lives of children and their families."
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