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Share the Care

Dec. 1, 2009
San Diego program provides sealants for the underinsured.
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San Diego program provides sealants for the underinsured.

Billy, like a lot of children, had never visited a dentist. Ideally, children begin receiving dental examinations while still in infancy, but Billy had reached the age of 10 without ever having had that opportunity. For some, it's lack of money — for others, lack of education. In Billy's case, his parents had never understood the importance of dental care. They were also underinsured. Then they found out about the sealant clinic at Share the Care in San Diego, Calif.

The Dental Health Initiative of San Diego/Share the Care is a public–private partnership between the County of San Diego Health and Human Services Agency, the San Diego County Dental and Dental Hygienists' Societies, and the San Diego County Dental Coalition that was formed in 1994. Share the Care targets families with limited resources, providing free or reduced–cost emergency dental care, and preventive services in neighborhood–based programs through sealant and fluoride varnish clinics.

At the Share the Care clinic, Billy was able to get sealants on eight teeth and his brother Jayden, age five, received fluoride varnish. Both had never been to a dentist. After a positive experience at the Sealant Clinic, Billy's parents began taking the children for regular dental care. The program has now reached more than 4,000 children like Billy and has provided treatment worth more than $700,000. Billy (now age 13) recalls: "It was really cool. The people were nice and it didn't hurt!" His mother added: "I was happy to have this option available. And the boys got to see what it was like to go to a dentist's office. It was a really positive experience."

Poor oral health has a negative impact on children's social relationships, and has been related to reduced school performance and less success later in life. According to the Surgeon General's 2000 report "Oral Health in America," dental problems result in an estimated 51 million hours lost from school, costly emergency department visits, and hospital–based medical and surgical treatments. Dental pain causes children to be easily distracted, unable to concentrate on schoolwork, and have difficulty completing schoolwork. Left untreated, the pain and infection caused by tooth decay can lead to problems in eating, speaking, and learning. Early tooth loss can result in failure to thrive, impaired speech development, and reduced self–esteem.

Share the Care has been holding sealant clinics at least twice a year since 1996. The clinics are a huge undertaking for Peggy Yamagata, RDH, MEd, program manager for Share the Care. She, along with staff member Nancy Starr, RDH, MPH, and others, must identify the location and volunteers, schedule the children, order and pack the materials and equipment, set up the facility, make sure the day runs smoothly, and then take it all down, follow up, and put things away.

Nancy Starr, left, and Peggy Yamagata coordinate the Share the Care sealant clinics.
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The largest clinic served 410 patients in five hours at a site with 18 chairs. Yamagata remembered that the sun was just coming out from behind the clouds as volunteers and staff from the Dental Health Initiative started arriving to prepare for the hundreds of children and family members who would be there that day for dental screening and preventive care.

"Balloons brightened up the hallway and signs pointed the way," recalled Yamagata. "The first family arrived early, anxious to not miss their appointment and excited at the thought of their children seeing a dentist for the first time."

At Share the Care clinics, everyone is screened and receives either varnish or sealants. Parents are informed of resources in the community for additional treatment and establishment of a dental home. Any emergencies are followed up the next week to be sure they are linked to care. In addition, families and children have an opportunity to go through a health fair, where they learn about daily oral care, can sign up for community programs, and review immunization records for the children.

Over the years, Share the Care has worked with various products to improve efficiency and increase the number of children being treated. One of the volunteer hygienists recommended Pulpdent's Embrace products after using them in private practice. Sandra Furnari, RDH, BA, western regional manager for Pulpdent, gave Share the Care some samples of the products to try.

"We experimented with Pulpdent's Embrace Sealants in 2005 at an event held for the public at an Indian health clinic, where we had issues with several young children," says Yamagata.

Furnari adds: "These were patients where maintaining a dry field was impossible. Because Embrace products are hydrophilic, the sealants could be applied in a moist environment, making them much easier and quicker for the dental team to apply. They were very happy with the results."

Yamagata agrees. "Embrace made the difference. Not having to start over meant more children could be seen."

By the time Share the Care held its sealant day clinic at Southwest College later in 2005, the program was using Embrace Sealants 100% of the time. Furnari volunteered to work as a hygienist for that clinic. As a dental hygienist licensed in California, she was able to actually work on the children and was there to give technical help to the clinicians.

"It was at this clinic that I saw in person the incredible work that Peggy does with Share the Care," Furnari says.

Seeing the value of the program, Pulpdent Corp. began donating Embrace Pit and Fissure Sealant, Etch–Rite Etch Gel, and Flecta Disposable Mirrors, as well as posters and Embracelets (giveaway bracelets for the children). The company has continued to support Share the Care with its generous donations.

"Pulpdent has always had a special interest in public health and the oral health of children in particular," says Fred Berk, vice president of Pulpdent. "The Share the Care program serves as a model for public health providers throughout the country and demonstrates what can be accomplished through strategic public–private partnerships."

Families learn about oral care at the health fair above. In the center, a "Sticky Snacks Cause Tooth Attacks!" display greets sealant clinic participants. At right, sealant patients are all smiles as Grape Man (a nutrition educator) gives them balloons as they leave.
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The program has also used volunteers from a local high school, which gives students a glimpse at a future career as a dental professional. One volunteer, Sonia, was a member of the Health Careers Club at Valley Center High School, so she was already interested in dentistry, but Share the Care gave her a chance to see what it is really like. "It was really fun helping kids and being exposed to a career that I want to pursue."

Geri Geis, a bilingual migrant resource teacher who has volunteered at many Share the Care clinics, adds: "The Share the Care fluoride varnish/screening clinics are a great way to spend a Saturday morning. The positive energy of the dedicated volunteers is contagious and children leave smiling."

"We are proud to support the exemplary work being done by Peggy Yamagata and the Share the Care team to provide preventive oral health care to underprivileged children in San Diego County," says Berk, "and we are pleased that our products, including Embrace Wetbond Pit & Fissure Sealant, Etch–Rite Etching Gel, and Flecta Disposable Mirrors, play an important role in achieving this goal."

In today's economic environment, the clinic serves a vital role. Many people who never thought they would need assistance are finding themselves in a difficult financial position. Adrienne "Druann" Andrecht, RDH, a hygienist who works with Share the Care, recalls one family that was no longer able to afford basic preventive dental care.

"At the time of check–out, I asked the mother if they had need for referral for medical and dental insurance for their son," Andrecht said. "She explained that in the last year and a half her husband had lost his job with a salary over $100,000 a year. They had lost all of their insurance coverage, as well as their home, and had to move in with their in–laws. They had Medi–Cal/Denti–Cal (the California insurance program), but for some reason their Medi–Cal/Denti–Cal was cancelled. So now they were without any coverage for their son, who suffers from asthma and also had a possible sprain or fracture of his wrist, but they had no financial means to cover the cost of his medical needs.

"The family was very appreciative of the services provided at the sealant/varnish clinic. Staff was able to give the family a direct line to an individual that could expedite reinstating the Medi–Cal/Denti–Cal for their son."

Sandy Furnari has enjoyed being involved in the Share the Care clinic, first as a sales manager for Pulpdent; now as a volunteer hygienist. "Peggy and her small staff at Share the Care provide excellent care and a great service to the children of San Diego County," says Furnari. "They provide care to an underserved population who would not receive it otherwise. They truly do ensure the oral health of these kids in a fun, caring atmosphere. As I have worked with Peggy over the years, I have realized that she is a tireless worker and a motivated professional who only has the children's best interest at heart. Peggy is a friend and a person that I truly admire for her devotion to public health."