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| Loretta
Fishburn comforts her granddaughter, Amber, while Dr. Gerald Awadzi
examines the first grader’s teeth in the tiny Miles for Smiles
mobile dental clinic. Dental assistant Gail Scott waits by. The
clinic provides free medical care to school children in seven southwest
Missouri counties. |
When 10-year-old Lynn Smith
broke a front tooth her mother tried, unsuccessfully, to find a dentist
near the family’s home in Macks Creek who would see her.
“I had to drive clear
to Jefferson City to a dentist who would take her Medicaid and they
wouldn’t do anything,” Denice Smith says. “All they did
was take an X-ray and write notes.”
Smith was told it would cost
$500 to fix the tooth. She couldn’t afford the work and her daughter
would have gone untreated if it weren’t for an unusual program
which provides free dental care to school children in seven southwest
Missouri counties. Now Lynn can flash a toothy smile, her broken tooth
repaired in a tiny 8-foot by 18-foot dental clinic that pulled up to
her school recently.
Each week the Miles for Smiles
mobile dental clinic sets up shop at one of 28 schools located within
a band of small towns that stretches from Lamar and Nevada, to the west,
to Buffalo to the east. From Monday through Thursday a parade of school
kids pass through the trailer’s two dental chairs, receiving all
manner of treatment — everything from cleanings and sealants to
fillings, extractions and even root canal therapy.
The program is a response
to a severe lack of dental care in rural areas. The situation is particularly
serious for those who rely on Medicaid, the federal program that funds
health care for low-income families.
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| Many
of the patients Miles for Smiles treats have never been to a dentist
prior to the clinic's visit to their school. Each child wears sunglasses
to reduce the glare of the dentist’s light and to protect their
eyes. |
“In our seven county
area there’s 29 dentists and none of them are taking new Medicaid
patients,” says Tina Munroe, project coordinator for Miles for
Smiles. “Quite a few of them aren’t taking new patients at
all, even if they have insurance.”
The shortage is not limited
to southwest Missouri. “Only about 15 percent of private dentists
accept Medicaid,” says Chris Stewart, director of the Oral Health
Initiative of the Missouri Primary Care Association. Stewart’s
organization represents 15 Federally Qualified Community Health Centers
in the state, 11 of which offer free dental care to anyone who walks
through their doors.
Citing low Medicaid reimbursement
rates — about 55 percent of normal fees according to the Missouri
Dental Association — dentists say they simply can’t afford
to treat low-income patients. “It costs them money every time they
see anyone (on Medicaid),” says Dr. Jake Lippert, executive director
of the association.
The effect is that many children
never see a dentist.
“When the money’s
tight, if the kid’s coughing or throwing up (parents) know they’ve
got to go to the doctor. If their tooth aches, well, ‘Eat on the
other side.’ It’s something you can put off,” Munroe
says, explaining the thinking of some parents who can’t afford
dental care.
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| El
Dorado Springs R-II School nurse Loree Schweizer greets a young
patient at the door of the Miles for Smiles trailer following his
appointment. School nurses screen patients for financial need and
bring students to and from their appointments. |
The Miles for Smiles program
began when Barceda Families, a child abuse and neglect prevention program,
set out to address the poor dental health it found in children. Working
with Citizen’s Memorial Hospital of Bolivar, Barceda Families (named
for Barton, Cedar and Dade counties) applied for a grant from the U.S.
Department of Health and Human Services’ Office of Rural Health
Policy.
The $200,000 annual grant,
awarded in May 2000, allowed the organization to purchase and repair
a 1960’s-era travel trailer that had previously been used as a
dental clinic but was sitting unused on flat tires with its interior
in dire need of attention. Over the next few months the program’s
first dental assistant was hired, the trailer was restored and new dental
equipment purchased.
Miles for Smiles started
treating children in February 2001. It relied on volunteer dentists
until Dr. Gerald Awadzi, the clinic’s first full-time dentist,
began work in July.
Today, the clinic treats
low-income and uninsured students in kindergarten through 8th grade
at schools in Barton, Cedar, Dade, Dallas, Hickory, Polk and Vernon
counties. In addition, it keeps a full summer schedule, visiting health
department offices and summer schools.
Working with school nurses
who screen the children for financial need, the Miles for Smiles clinic
has no shortage of takers. During a recent visit to El Dorado Springs
R-II School parents requested service for more than 160 students. With
two dental chairs and two dental assistants, the clinic only saw about
15 patients a day — leaving nearly 100 children to wait for the
clinic’s next visit.
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| Dr.
Gerald Awadzi talks with Jonathon Michlich, a student at Eldorado
Springs R-II School who received dental care during a recent visit
of the Miles for Smiles clinic. |
“We only have so many
hours in a day. We try to get in all we can but we can’t see them
all in four days,” explains Gail Scott, a dental assistant who
has worked for Miles for Smiles almost since its inception.
As great as the demand is,
the condition of the patient’s teeth is an even more dramatic indication
of the need.
“People don’t realize
that right here in Missouri there are kids with just bombed out mouths
and serious decay and problems,” says Munroe, a social worker who
occasionally fills in as a dental assistant. “We had a child one
time with 16 cavities and you only have 20 baby teeth.”
For Awadzi, who practiced
dentistry in his native Ghana before attending the University of Pennsylvania,
the condition of children’s teeth in southwest Missouri was hard
to imagine.
“If I didn’t come
here I wouldn’t have believed it,” he says. “This is
America!”
Awadzi says children’s
teeth are no better here than they are in rural Africa where people
brush their teeth with twigs. A sugar-rich diet is responsible for much
of U.S. children’s tooth decay but lack of even basic dental care
is also to blame.
“You see 12, 13-year
olds who tell you they’ve never brushed their teeth or they don’t
have a toothbrush,” he says of his American patients.
While every Miles for Smiles
patient leaves the clinic with a toothbrush, Munroe says the problem
is not that families can’t afford basic necessities. Many children
aren’t being taught to care for their teeth, she says.
“You can just see a
lot of the parents that come (with their children). You can tell that
they were not taught to brush their teeth,” Munroe says.
To counter the generational
spread of poor dental hygiene the program also tries to teach children
the importance of brushing and flossing.
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| Gail
Scott, Miles for Smiles first dental assistant, shows David Green
the results of her efforts cleaning his teeth. Often the Miles for
Smiles staff must educate children about the importance of brushing.
|
“Maybe it’s the
first time anyone has ever explained to them why they need to brush
their teeth,” Munroe says. “If we can get the kids to realize
how important it is then we’ll be able to make a big impact.”
But no matter how well a
child brushes they still need to see the dentist on a regular basis.
The Miles for Smiles project barely begins to address the staggering
need for dental care, especially for low-income families.
“When you’ve got
850,000 people, or one in seven bodies, in the state of Missouri on
Medicaid, there’s a lot of patients out there that want to be seen,”
says Lippert.
Despite criticisms to the
contrary, Lippert says Missouri’s dentists are doing their part
to serve low-income families. Besides dental clinics funded by hospitals,
federal programs and county governments, dentists themselves often volunteer
their time, he says.
Still, in seven Missouri
counties at least, there remains more than enough work to keep Dr. Awadzi
and his staff hopping. How long that will continue remains to be seen.
The clinic’s grant expires in 2003 and, like regular dentists,
it’s unlikely Miles for Smiles can survive on Medicaid reimbursements
alone.
One thing’s for sure.
The steady stream of kids with poor dental health that passes through
the Miles for Smiles trailer doors is not likely to subside any time
soon.
“I have school nurses
who call me all the time saying, ‘I’ve got a kid in pain here.
We’ve called 15 dentists and nobody will take them. Is there anything
you can do?’” Munroe says. “If we weren’t here they
wouldn’t be going to a dentist anywhere else.”
For more information about
Miles for Smiles call (417) 328-6334. To find a Federally Qualified
Community Health Center offering dental care near you, call (573) 636-4222.
