Nearly 30 years ago, a group of hygienists, school nurses, and dentists in greater Derry grew concerned that students were coming to school with such painful tooth decay they were missing class. If kids weren’t getting to the dentist, they asked, could dental care come to kids?
With help from a local funder and some used equipment, they launched a pilot project with two elementary schools, visiting both to provide students with cleanings, fluoride treatment, and referrals to dentists willing to donate their services. By the end of the year, they’d expanded to eight schools.
Today, the Children’s Dental Network in Derry works with 30 schools in Derry, Londonderry, and Salem, providing nearly 600 students each year with free oral health screenings and cleanings, as well as sealant and fluoride that protect teeth from decay and halt a cavity’s growth until a child can see a dentist.
“One thing about dental disease is that it causes a lot of pain, and in school, children can’t really learn or concentrate if they are in a lot of pain,” said retired hygienist Hope Saltmarsh of Bow, the group’s first executive director.
Yet, fewer than half of the state’s 450-plus schools offer dental care. The New Hampshire Oral Health Coalition, which includes the state Department of Health and Human Services, hopes to change that.
On Wednesday, the coalition will launch a statewide push to expand school-based dental care in New Hampshire with a series of public presentations and listening sessions. The first is Wednesday, at Dartmouth Hitchcock Medical Center, from 9 to 11:30 a.m.
The coalition is reaching out to a broad audience, from school and community leaders to local health care providers and elected officials to civic organizations. That’s intentional because there isn’t a state or federal program running or paying for school-based programs.
“These programs appear to bloom and grow in areas where someone or some organization really has a passion or concern about children’s dental health,” said Gail Brown, director of the coalition.
Brown wants to not only get dental care into more schools but also identify barriers to launching and sustaining a program so local and state leaders can find ways around them.
Currently, 14 programs, many run by hospitals, federally qualified health centers, and communities, such as Manchester and Milford, provide dental care in about 200 schools, Brown said. Eight programs have closed in recent years, Brown said, for reasons ranging from funding to staffing.
“The real value in the school programs is that number one, they send a provider out to the school, meaning that one provider can serve many, many children . . . as opposed to all those children trying to get into a dentist’s office,” Brown said.
School-based programs are especially valuable, she said, in rural areas with too few dental offices and for children with no insurance or Medicaid. “This way, a provider comes to them, so the kids are not missing school to go to the dentist, and parents aren’t having to leave work to take them there,” Brown said.
They have been a priority in urban areas too, like Manchester, where the health department and school district provide care in 21 schools. The program began in 1970 and has relied on federal and state funding as well as support from local civic groups.
But there are challenges, and funding is a big one.
Programs look to a combination of Medicaid, state and private grants, donations, and funding from some cities and towns for support. Some dentists and hygienists donate their time. Support from charitable organizations has also been critical.
That has been true for the Children’s Dental Network, said Dianne Powers, its current executive director.
She said their program would not exist without annual funding from the Alexander Eastman Foundation, a local charitable organization that supports greater Derry, as well as donated care from local dentists. The town of Salem asked the group to expand to its schools and paid for it with help from civic groups like the Rotary Club of Greater Salem and local chapters of the Lions and Kiwanis clubs.
Powers said the group bills Medicaid for eligible services. Parents pay nothing, she said, thanks to the local funding.
“We have portable equipment and we lug all our stuff to 30 different schools in the rain and snow,” Powers said. “It doesn’t matter. We use our own cars. We are a small group that is just very committed to helping children. To us, it’s worth it.”
In the program’s early days, Saltmarsh tracked the students she was seeing to show it was worth it to children and the community as well.
“Their oral health was improving,” she said. “It can make such a big difference because the earlier you can find their issue and do something about it, all those things are critical to improving their oral health. And oral health is health.”
A second challenge is securing parental permission. Parents are not unwilling to let their child participate, Brown and others said. Instead, schools find it hard to get permission slips home and back for a lot of programs.
“Despite hygienists and program managers working on the permission issue for the decades the program’s been open, we’re still looking at the best way to do it,” Brown said. “It will vary from school to school.”
Powers said when schools in their program moved to electronic permission slips, she asked that paper permission slips be sent home as well because she knows some low-income families who would benefit most from the school-based program don’t have access to reliable internet or technology.
“Every year, it’s a hurdle,” Powers said. “If we want the right kids to take advantage of this, we need to do paper.”
Saltmarsh, who spent the last few years of her career at the Department of Health and Human Services working on school-based dental care programs, among other things, sees a third hurdle. It’s difficult to get already oversubscribed schools, community leaders, and dental care providers to take on a new initiative. She said dentists would donate their services every time she asked, but they wouldn’t commit to taking on a school for a year.
She is hoping the New Hampshire Oral Health Coalition’s statewide campaign will persuade more to participate.
“It’s kind of a hard sell when you think about the income you could make as a hygienist doing public health versus doing something in private practice,” she said. “And it’s always kind of iffy about the continuation of funding for all of these things.”
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