Dental outreach program in Eastern Ky. celebrates 10th year; has improved both oral health and Head Start treatment completion

The University of Kentucky, UK HealthCare and the UK North Fork Valley Community Health Center celebrated the 10th anniversary of the Ronald McDonald Care Mobile dental program in Eastern Kentucky at a ceremony held at the UK Center of Excellence in Rural Health in Hazard on Sept. 9.

“This whole program was a gift to the children of Eastern Kentucky and I am so blessed to be a part of it,” Dr. Nikki Stone, director of the program, said in a telephone interview with Kentucky Health News.

The mobile dental clinic is made possible through a partnership between UK and Ronald McDonald House Charities of the Bluegrass. It provides free preventive dental care and in-classroom dental health education to some of Eastern Kentucky’s children.

“Prevention is always the key to improving both oral and general health for all Kentuckians and to the many people here who have been instrumental in this program, I offer my appreciation and admiration for the great work that has been achieved,” UK President Eli Capilouto said at the event.

The clinic is managed by the North Fork Valley center and serves Perry and Knott county elementary schools and all the Head Start programs in Perry, Knott, Leslie and Letcher counties.

The program also provides “case management” for each of the children in the program, referring them to the dental facility at the Appalachian Regional Hospital to see the pediatric dentist or the fixed dental clinic in Hazard if they need further care.

The fixed dental clinic in Hazard is a federally qualified health center and was awarded its first Health Resources and Services Administration grant in 2006, allowing it to offer services through a sliding scale fee to uninsured and under-insured residents of Perry and surrounding counties.

Reason to celebrate

Since its inception in 2005, the children served by the program have seen a nearly 20 percent decrease in tooth decay rates and their urgent care needs, like pain and infection, have been cut in half, Stone said.

Dr. Nikki Stone

She also noted that one of the programs greatest successes was increasing their Head Start treatment completion rates to 60 percent the second year from only 8 percent the first year. She said they accomplished this by recognizing and finding solutions to some of the transportation, logistic and access challenges many of the families in the region faced to get dental care for their children.

“We considered that to be one of the greatest successes that we have had because it was such a huge jump,” Stone said. “And it was really related to seeing a problem, recognizing that something has to be done and then an opportunity that occurred when a pediatric dentist located closer to us.”

Stone said that this success resulted from a partnership between the Head Start program, the dental outreach staff, the medical staff at Appalachian Regional Hospital and the pediatric dentist, who agreed to come to Hazard one day a week.

While Stone said that she was proud of their quantitative success, she said she is most proud of the things that can’t be measured.

“These children are growing up with such a different attitude , they have little to no dental anxiety,” Stone said. “They know the importance of oral health, they know what foods are healthy to eat, they know what drinks are healthy to drink.”

Stone said in a UK news release that since being seen in the mobile dental clinic, these children are not only taking better care of their own teeth, but are teaching their families about the importance of dental care, are better students with fewer absences related to dental pain, and exude more self-confidence and self-esteem because of their healthy smiles.

Why do these children have such poor dental health?

When the program started in 2005, children in Eastern Kentucky had the worst oral health in the state and the second highest rates of untreated tooth decay in the nation.

“The baseline data was disturbing, especially when compared to national data and the HealthyPeople 2010 goals. A staggering six of every 10 Head Start children and seven of every 10 elementary-school children had untreated tooth decay, and nearly 20 percent had urgent dental needs.

“At nearly every Head Start center visited over the four-county area, at least one child in each center had all 20 baby teeth grossly decayed with multiple abscessed teeth. Compared to national data, the children in this service turned out to have the second highest untreated tooth decay rates in the nation, second only to the isolated Alaskan Native/Native American populations,” Stone told UKNow.

Stone said that since that first year they have learned that transportation and lack of access to a pediatric dentist were two of the greatest barriers to these children getting dental care, noting that prior to the pediatric dentist coming to Hazard on Thursdays, the closest pediatric dentist was two hours away.

“One of the big issues that we have had that has grown exponentially in the 10 years we have been here is the number of children who are transient,” Stone said. “They have parents, but the drug culture is so heavy here that their grandparents are actually raising them. So now we have grandparents who are trying to figure out how to navigate all of the needs of these small children.”

Stone also noted that many of these grandparents who are responsible for these children have a generational attitude that doesn’t see the value in taking care of baby teeth because “they are going to fall out anyway,” increased transportation issues and poor health literacy.

She attributes some of the success of the program to the fact that it is constantly “renovating and revising” to respond to the evolving challenges families in the region face, as well as responding to the feedback they get from parents, teachers and school officials.

“Over these 10 years, I think that we have made more changes than we have kept anything stable,” she said,”We have learned that flexibility is the key to the success of any program.” 

Hope for the future

Stone said that programs modeled after this one are beginning to pop up all over Kentucky, although she notes that each of them are a little different to meet the needs of their communities.

She also said that because the children in the region are now being exposed to dentist, many of them are saying that they want to become one. Stone said they actively encourage the kids who express an interest to pursue this career path in hopes they will accomplish this and come back to the region to practice.

“We plant the seed,” she said.

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