School-based Care

by Mary Martha Stevens, RDH, PhD

It might appear that, in the richest county in Kansas, access to dental care would not be a problem for school children. Fortunately, Kim Geelan, RDH, a 17-year veteran of dental hygiene, was not blinded by the obvious wealth that was apparent in Olathe, Kan. This modern-day tooth fairy has spent the past two years developing Miles of Smiles, a successful, school-based, dental prophylaxis and education program for low-income children who would otherwise have been overlooked in this economically booming suburb of Kansas City.

What motivated Geelan to grab her tooth fairy wand in the wake of 9/11 to volunteer weekends and her one-day off from private practice to develop Miles of Smiles?

"The Westview Elementary School nurse, Joyce Sheffield, contacted me to discuss the dental health of a select group of her students," said Geelan. "An area dentist, Dr. Nevin Waters, had received a grant to place dental sealants on low-income children in the school district. In addition, Joyce wanted comprehensive dental care for her students. So, I decided to do something about it."

After checking on what Kansas' laws would allow her to do, Geelan asked Dr. Waters to sponsor her idea of a school-based, prophylaxis program. Since he was already screening the target population, Dr. Waters agreed to contact the Kansas Dental Board for their approval. Geelan was certain that if the children could have their teeth cleaned at school, there would be a higher rate of participation and compliance.

For her first meeting with Westview Elementary School officials, Geelan developed a health history and dental chart. The planning committee consisted of Sheffield; the school principal, John Harris; and the Olathe Public Schools nurse, Cindy Galemore. During the meeting, the committee compiled a consent form, in Spanish and English, for Westview parents to sign. The form included a health history and other pertinent information. Low-income students who were uninsured and did not receive Medicaid would be eligible to participate in Miles of Smiles.

Once Miles of Smiles was approved by the Kansas Dental Board and the Olathe Board of Education, Geelan borrowed a mobile dental unit from the Johnson County Dental Hygiene Association and two portable dental chairs and an autoclave from local dental suppliers.

"It all happened so quickly," said Geelan. "Two weeks after the school board approved our proposal, we met our target date to begin oral hygiene instruction and cleanings at Westview. During that time, we received consent forms from 85 percent of the children who qualified for the program, which ended up being about 44 students."

Sometimes good news travels faster than bad news

The first day students received preventive dental hygiene care at Westview Elementary School, The Kansas City Star and The Olathe Daily News interviewed Geelan, Sheffield, and participating students. The story made the front page of The Olathe Daily News the next day. Geelan immediately received a call from a nurse at the Olathe Head Start program who wanted to enlist the dental health program's services.

Westview Elementary was just the beginning of Geelan's "almost no budget" dental health program. Miles of Smiles started with 44 Westview students in November 2001. By the end of the 2002-2003 school year, approximately 260 students from four Olathe elementary schools and the Olathe Head Start program had received on-site, dental hygiene care and education. Geelan reported that 90 percent of the parents signed consent forms during the first year of the program, and 70 percent were returned the second year.

The good brusher's diploma and other shining moments

At the end of each student's dental hygiene appointment, a follow-up report was sent home to parents. This included a copy of the student's dental chart with findings marked, and a list of dental clinics that would provide comprehensive, follow-up dental care at a reduced fee.

The follow-up dental card stated: "We (dentist and dental hygienists) recommend that your child receive the proper dental care to prevent or relieve any pain your child may experience, and prevent early tooth loss. A child who experiences dental pain is unable to learn effectively at school."

Each student also received a "Good Brusher's Diploma" and other treats, including a toothbrush holder, toothbrush, floss, toothpaste, and fluoride rinse.

The Kansas City Star reported that Westview first-grader Maritza Sanchez liked the cleaning because it was "tickley." Juan Villareal, also a first grader at Westview, said he hadn't brushed his teeth for three days. "I forgot to brush them," he explained. "Tomorrow, I will brush them."

Kathleen Elder, RDH, OM, who spent many hours assisting Geelan with the dental health program, described her experiences with one student: "On my first day in the clinic, I had a shy, young man slide into my dental chair. When he hesitantly opened his mouth, I hope I didn't gasp out loud as I looked in horror. The full deciduous dentition consisted of nothing but blackened stubs!

"By way of an interpreter, he answered that his teeth did, indeed, hurt sometimes. I smiled, picked up the handpiece and proceeded to polish his teeth. When I finished, I gave him the hand mirror and told him how beautiful his teeth were. He beamed! I then gave him his own toothbrush, and demonstrated how and when to brush his teeth. Carrying his bag of goodies, he thanked us and left to go back to his classroom.

"A short time later, the school nurse returned to tell us that as my little guy made his way to the classroom, he had stopped everyone to look at his beautful smile, something they had never seen on his little face before. This was the shining moment in my 23-year dental hygiene career!"

The best statistics are yet to come

Although Geelan and her Miles of Smiles team members seem contented with the high percentage of eligible students participating in the program, it seems that the best statistics are yet to come.

Johnson County and Tri-County dental hygienists are confident that the elementary and Head Start participants will now receive more than preventive care through Miles of Smiles. In June 2002, Dr. Waters opened the Health Partnership Dental Clinic, a dental clinic designed to serve the dental needs of uninsured, low-income families in Johnson County. In the clinic, dental students from the University of Missouri-Kansas City School of Dentistry provided comprehensive dental care under the supervision of local dentists.

One year after Miles of Smiles began providing dental hygiene care, 44 percent of the program's participants have received follow-up, restorative care at one of the following locations:

• In Olathe, Dr. Kelly Lineback's private practice or the Health Partnership Dental Clinic.

• In Kansas City, Children's Mercy Hospital Dental Clinic, the University of Missouri-Kansas City Dental Clinic, and the Swope Parkway Health Center.

"By the end of the 2002-2003 school year," Geelan reported, "the most dramatic benefits were found in the dollar amount of preventive dentistry we had provided to low-income Olathe school children. That amounted to approximately $24,600. And the 2003-2004 school year is full of promise. We have expanded our target population to include children who are receiving Medicaid and HealthWave benefits. HealthWave provides low-cost medical and dental insurance benefits to qualifying Kansas residents."

Dr. Lineback is one of the dentists providing comprehensive, follow-up dental care to Miles of Smiles participants. She commented on her experiences with the program: "This program reaches out to children in our area who have no other means of receiving dental services. Most of the patients we have seen in our office are so grateful for the treatment. We have been glad to provide them with treatment at an early age in hopes that their dental health will benefit in the long term."

Miles of support, miles of recognition

Geelan readily admits that her success with Miles of Smiles was not only due to her commitment to the program, but the support of other volunteer dental hygienists, dental hygiene students, and dentists residing in Johnson, Leavenworth, and Wyandotte counties in Kansas. By the end of the 2002-2003 school year, more than 20 dental hygienists had volunteered their time to provide school-based dental cleanings and dental health education to low-income children. Drs. Waters and Ross Thompson, practicing dentists from Olathe, screened each child prior to treatment.

Additional support came from dental hygiene students attending Johnson County Community College (JCCC) in Overland Park, Kan. Dental hygiene students assisted with dental charting and home care instructions.

Donated dental supplies were provided by Proctor & Gamble, Oral-B, Colgate, Johnson & Johnson, Patterson, Omni, and Goetze Dental Supply companies, and Johnson County dentists — Drs. Lineback, R.H. Willits, David Woltkamp, and Kevin Krause.

The Olathe Public Schools district initially provided $250 to purchase dental hygiene instruments and other supplies. Geelan personally paid for a portion of the supplies and operation costs that were needed to develop the program.

Although Geelan's goal in starting Miles of Smiles was not to gain recognition, she has innocently done just that. In December 2001, Geelan and the dental hygienists who provided care at Westview Elementary School received certificates of appreciation at the monthly Olathe school board meeting. Then, the Johnson County Dental Hygiene Association presented the Robin Almsberger Community Dental Health Volunteer of the Year Award to her in May 2002.

In June 2003, Geelan was named a recipient of the 2003 Colgate/ADHA Community Outreach Award, which was presented at the opening ceremonies of the American Dental Hygienists' Association's 80th Annual Session. The $2,000 award will be used for Miles of Smiles' operation costs during the 2003-2004 school year. And, in September 2003, she received the Community Service Award from the Kansas Dental Hygienists' Association.

"It's not about recognition," commented Geelan. "All I really want to see is miles of healthy, happy smiles from the school children we have been privileged to serve."

Geelan explained that the goal of her community involvement was to provide dental hygiene care and education to low-income children. Secondly, she wanted to develop a model program that would stimulate other dental hygienists to initiate their own school-based programs.

For more information about Miles of Smiles, e-mail Kim Geelan at [email protected].

In 1905, Dr. Alfred Fones, the father of dental hygiene, trained his dental assistant, Irene Newman, to perform a dental prophylaxis on children in his private practice. He then formed the first school of dental hygiene in 1913, The Fones Clinic for Dental Hygienists, in Bridgeport, Conn. Convinced that every child in the Bridgeport schools would benefit from a periodic dental prophylaxis, he convinced the board of education to finance this service. As a result, most of Fones' first graduating class of dental hygienists found work in the Bridgeport school system.

Ruth Bugbee, RDH, a pioneer of dental health education in the public schools, was interviewed in the 1981 September/October issue of RDH. Bugbee reported that after she graduated from the first class of dental hygienist at the University of Pennsylvania, she was required to serve a year's internship in the public schools.

"I was assigned to three schools in different districts," said Bugbee. "I would go to a classroom, make a little speech on nutrition, take them up to a portable office, and give them a prophy."

At the end of each prophylaxis, Bugbee would provide oral hygiene instructions, and send a note home to the child's parents.

So it seems there is nothing new under the sun. Dental hygiene care and education in the public schools is as old as the profession itself.

Mary Martha Stevens, RDH, PhD, is an Adjunct Instructor for the Center for Independent Study at Butler County Community College in Andover, Kan. She can be contacted at [email protected].