COVID-19 Cripples School-Based Dental Programs for Low-Income Communities

Jan Badger

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The anniversary of the COVID-19 shutdown has caused reflection on its impact on the economy, our social lives, and the way we work and learn. For nonprofit organizations, however, the pandemic has shown just how wide the chasm is between low-income families and everyone else.

While most parents were inconvenienced by transitioning their kids to online school, families from marginalized communities scrambled to access not only the technology their kids needed to attend class, but also necessities such as food and childcare.

The number of kids who depend on schools for the basics like these that most people take for granted is not a surprise for organizations like America’s ToothFairy, a nonprofit that supports safety-net dental care providers across the nation.

School-Based Dental Care

Most people don’t associate school with dental care. But for America’s ToothFairy, school closings are a major problem. Up to 80% of the nonprofit dental clinics participating in the America’s ToothFairy Dental Resource Program (DRP) provide dental services through school-based programs.

For impoverished communities, these programs can be the only way for families to access dental care and are an effective way to prevent tooth decay in children. A recent study by NYU College of Dentistry showed that school-based dental programs reduced students’ cavities by more than 50%. That’s a big deal considering that dental disease is among the top reasons for school absence and, when left untreated, costs billions of dollars each year.

“At the onset of the pandemic, it became clear that the shutdown would have an enormous impact on access to dental care,” said America’s ToothFairy executive director Jill Malmgren. “A majority of the Dental Resource Program member clinics that rely on our resources closed for a period of time, and a handful are still not operating. Even a year later, getting into schools to provide essential dental services is nearly impossible.”

For families with single parents working multiple jobs to get by, or rural families that lack access to public transportation, or for others who live in areas where there simply aren’t enough dentists, school-based dental programs aren’t just nice to have, they are essential to the overall health and well-being of children. Students with untreated tooth decay often struggle to concentrate at school, have difficulty eating and sleeping, and even risk dangerous infections that can spread to the brain.

In addition to further restrictions on access to care, according to reports submitted to America’s ToothFairy by its DRP clinic members in August, the COVID-19 shutdowns caused a 20% decrease in the number of children who received oral health education.

“We had 15 schools scheduled for their spring school-based dental clinic days,” reported Let’s Smile Inc, a clinic located in Minnesota. “They had to cancel due to COVID-19 school closings.”

In a last resort attempt to compensate, the clinic’s executive director offered dental hygiene kits to children who completed simple oral health education activities. Dressed as “The Smile Fairy,” she left the kids’ rewards on their front porches.

Some organizations, including Sonrisas Dental Health in San Mateo, California, partnered with schools at food distribution locations.

“We utilized the schools’ hot lunch drive-through pickup program during the shelter-in-place mandate,” the clinic reported. “We provided students who picked up lunches with a take-home oral health kit that included a toothbrush, paste, floss, a 2-minute timer, and an informational flyer including a link to our web-based oral health programming.”

Despite valiant efforts like these, little could be done to accommodate for the 24% drop in the number of students who received screenings and for the 15% fewer kids who received sealant applications compared to the previous year. For those who already had tooth decay, the closures caused a delay in care with devastating consequences.

“We were unable to provide our free dental program at 15 different school locations,” reported Kids’ Community Dental Clinic (KCDC), a safety-net dental care provider located in Burbank, California. “Because of the length of time that we were closed to restorative treatment, the number of emergencies increased. What were two surface cavities in February turned into pulpotomies or root canals and crowns by June.”

With fluoride varnish donated by 3M Oral Care through America’s ToothFairy, KCDC is holding drive-through dental events called “Tacos and Toothbrushes.” Through events like these, some children are receiving preventive care along with other resources, but not in the high numbers seen at school-based events.

Even as clinics have reopened, access to children through schools is still restricted, adding hundreds of thousands of kids to the already high one-in-five who have not received a dental exam in the last year.

“We’ve been affected rather drastically,” said Genise Kelley, community dental health coordinator at Charlotte Community Health Clinic (CCHC).

In the year before COVID-19, the organization provided full exams, x-rays, and cleanings for 600 students at elementary schools in Charlotte, North Carolina, and referred students with more extensive needs to their clinic for restorative care. A year after the pandemic hit, the organization still lacks direct access to the students who rely on school programs for care.

In response, CCHC created an educational program that included videos to help students learn about oral health topics including how to brush properly. It also worked with teachers to teach students about the importance of oral health during virtual learning.

“We provided schools with 430 kits that contained two apples, toothpaste and floss, and toothbrushes donated by America’s ToothFairy, so that students who are learning from home can conduct experiments with the apples that replicate the effects of tooth decay,” Kelley said.

The clinic also began using telehealth for children who are in need of care to help address their dental needs. Kelley is hopeful that CCHC will be allowed to return to the schools it serves at the beginning of the new school year.

The Need for Solutions

What can be done in the meantime? While America’s ToothFairy acknowledges that efforts to educate communities about the importance of oral health throughout the pandemic are commendable, they cannot replace access to care programs for families in need.

“Oral health education and prevention programs have always been a major part of our mission, and even more so during the pandemic,” Malmgren said.

“However, it is essential to the health of our nation’s kids to get access to dental care back on track. School-based dental programs are not a luxury. They are essential for the hundreds of thousands of children who depend on them to stay healthy,” she said. 

“It is imperative that we do not overlook the proven, positive impact that school-based dental care has on the health of students. Local government, school systems, community leaders, and health professionals must work together to find new solutions to increase access to care to avoid long-term consequences that inhibit students’ ability to be healthy and thrive,” she said.

To learn more about America’s ToothFairy and discover how to get involved to help children in underserved communities access dental care, visit AmericasToothFairy.org/get-involved.

Ms. Badger is the communications manager for America’s ToothFairy. She can be reached at communications@ncohf.org.

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