Dentist Brian Westover and dental assistant Steven Sadaya care for a Scott Elementary School student in the Tooth Taxi. (Rachel Alexander/Salem Reporter)

Dentist Brian Westover leaned over a reclined chair.

“I’m just gonna make your tooth go to sleep, buddy,” he explained to his young patient, a second-grade student at Scott Elementary School, before a numbing injection.

Westover was working in a space much like any dentist’s office, with overhead lights, sterilized metal instruments and colorful stuffed animals dangling from fixtures to make children feel at home.

But that Friday’s appointment was inside the “Tooth Taxi,” a retrofitted 38-foot van with two dental chairs operated by the Dental Foundation of Oregon. A dental team conducts clinics across the state, serving kids who otherwise couldn’t afford care.

These visits are one piece of 20-year-old dental health initiative in Salem-Keizer schools that’s provided free screenings for nearly 125,000 kids and referred about 5,700 to care since 2002.

Children’s dental health is a serious concern in Oregon, where half of kids had a cavity by age nine, according to a 2017 survey from the Oregon Dental Foundation. Forty percent of cavities in children go untreated.

The district’s dental health program, which started as a shoestring project at Richmond Elementary School, now reaches every student in Salem-Keizer’s high-poverty elementary schools on a budget of about $200,000 per year.

Nearly all that is paid through grants and in-kind work donated by local dentists.

“I’ve learned to live by faith and not fear because it keeps on working,” said Jessica Dusek, the district’s dental health coordinator.

Tooth Taxi program manager Carrie Peterson, a dental hygienist, sterilizes equipment inside the mobile clinic. (Rachel Alexander/Salem Reporter)

Twenty years ago, Dusek was the community school outreach coordinator at Richmond, which has one of the highest student poverty rates in the district.

Many parents couldn’t afford dental care for their children, either to prevent decay or treat problems when they arose. It was years before Medicaid expansions made far more children eligible for dental care.

School employees often saw kids who missed class or couldn’t focus because of pain from serious cavities, abscesses or infections.

Kids came to the front office seeking ice to put on their face, Dusek said. “They would be hungry because they weren’t able to eat.”

In 1999, local leaders with Stand for Children surveyed Richmond staff about what their students needed most.

Then-principal Kathy Bebe expected to hear books, school supplies or backpacks.

Instead, the response was, “Children need dental care. They’re really suffering,” Bebe recalled.

Bebe asked Dusek to find ways to connect kids to dental care “because that’s what was interrupting kids’ learning,” Dusek said.

Dusek reached out to Medical Teams International to bring a mobile dental clinic to the school each month. Dentists, dental assistants and hygienists donated their time, and funding from Salem Kiwanis Club helped pay other costs. On one visit, 10 students could get cavities filled or teeth extracted. But that wasn’t enough to meet the need.

In 2000, Dusek worked with a young Richmond boy with a severe toothache caused by an abscess. She connected him with a local dentist, who donated his services to extract the tooth. The dentist told Dusek the boy’s abscess was so infected the child could have died if he’d gone a few more weeks without care.

That served as a wake-up call for Richmond staff and community leaders.

Catherine Pederson learned of the need for dental care in schools at a Stand for Children meeting at her church. Her husband, Gary, was an oral surgeon.

When she learned about the boy who’d almost died, she convened local dentists and others interested in a solution. She had no idea serious dental infections were so common among kids.

“I was frankly kind of appalled that this would even happen,” she said.

Dental Health Solutions for Children from Salem-Keizer Public Schools on Vimeo.

A Salem-Keizer School District video explains how the dental screening program works.

Pederson, Bebe and Dusek asked the dentists whether they’d be willing to donate services to students in need. The response was an enthusiastic yes, with some guidelines.

Dentists wanted the schools to help prevent tooth decay to reduce the severity of issues over time. They wanted to make sure they were part of a group stepping up to help so the burden wouldn’t fall on any one dentist.

A group agreed to donate one appointment per month to a student in acute pain in addition to the mobile clinics.

“They broke their own rule,” Pederson said with a laugh. Many saw several students, and once word got out about the need, school workers started getting calls from oral surgeons, pediatric dentists and other specialists.

Dusek said some would ask, “How can I apply to become a neighborhood dentist?”

“You just did,” she told them.

Word got out about the Richmond program, and outreach coordinators at other schools who wanted to bring in a dental clinic called Dusek. Bebe, Dusek and Pederson began training other schools.

“It opened the eyes of other principals,” Bebe said.

But prevention was still a challenge.

Dental hygienist Patty Kintz was a regular volunteer on Richmond’s monthly dental van and asked Dusek if the school could teach kids how to brush and floss.

Kintz said the staff on the van had trouble getting work done because they had to spend so much time cleaning plaque and debris off the kids’ teeth.

“Someone needs to come teach them how to clean their mouths daily,” Kintz said to Dusek. “She looked at me and without a beat said, ‘Would you like to do that?’”

Dental assistant Steven Sadaya checks in with Isabella Flores Angulo, a first-grader at Scott Elementary, after dental treatment. (Rachel Alexander/Salem Reporter)

Many of the kids had never been taught how to brush their teeth, so Kintz began classroom presentations. She explained how bacteria in the mouth cause tooth decay, and that they especially loved sugar.

She wanted the kids to understand they weren’t dirty because they had bacteria in their mouths.

“I wanted them to know that everybody had bacteria - it wasn’t just them. It was me, it was the President of the United States, it was everybody,” she said. And she showed them how to brush correctly.

“The kids would go home and educate the parents,” Bebe said.

For some, such hygiene was a challenge for other reasons. Dusek arranged to hand out toothbrushes to kids since some couldn’t afford them at home.

Kintz said one student was confused when she talked about brushing teeth at night.

“One little girl kept raising her hand and said, ‘You mean before dark?’” Kintz recalled. Some follow-up questions revealed the girl’s family had their electricity shut off, and the 6-year-old sometimes couldn’t find her toothbrush in the dark bathroom if she forgot to brush before the sun went down.

The dental program grew beyond Richmond after both Bebe and Dusek were promoted. Bebe became an elementary school assistant director for the district and was told to address needs she saw, so she expanded the dental program to more schools.

Dusek got a newly-created job: dental health coordinator. She started in 2003 and began screening students for dental problems, rather than waiting for the worst cases to come to school needing ice packs.

In the early years, dental hygienists and school workers looked at kids’ mouths and rated them based on the presence and severity of cavities. Kintz worked with Linda Mann, a hygienist who now serves as community outreach coordinator for Capitol Dental, to screen kids.

Pederson, a longtime member of the Salem-Keizer Assistance League, soon signed up group members to volunteer, taking notes during screenings so the hygienists could focus on the exams.

Grants from the Oregon Community Foundation pay for the hygienists’ time, and kids go home with donated toothbrushes and floss. Dusek’s part-time salary is paid by the district, and she pursues grants and other funding to cover the program costs.

More children are now covered by Oregon Health Plan, the state’s Medicaid program, because of the Affordable Care Act and a 2017 change that made all low-income children eligible regardless of immigration status.

That’s lowered the need for treatment through school clinics and donated dental care. Thanks to a district partnership with Capitol Dental Care, kids can now get sealants to prevent decay during school dental screenings.

Dusek said as coverage has expanded, her role has shifted toward one of navigator. Many families with coverage don’t realize they can see a dentist or have trouble finding one who accepts Medicaid, so she helps them find a local dentist. For kids with urgent needs, or those who still lack insurance, free treatment through school remains important.

Dusek can also connect students with the Children’s Program, an effort by Moda Health, Willamette Dental and Kaiser Permanente that provides free care for kids without insurance.

Colorful toys and stuffed animals in the Tooth Taxi help kids relax during dental treatment. (Rachel Alexander/Salem Reporter)

At Scott Elementary, the Tooth Taxi treated about 20 kids over the course of the week, hygienist and program manager Carrie Peterson said. One student’s x-ray showed a large cavity in a baby tooth, near the nerve. Others needed more routine fillings.

Some of the patients have coverage, Peterson said, but still struggle to access care. Many kids’ families make less than $10,000 per year and can’t afford the time to take kids to a clinic.

“Taking a day off work to go do this is probably not an option for them,” she said. “The ones that are falling through the cracks are at highest risk.”

A dozen originators of the program gathered last week at Pederson’s house to celebrate the program’s longevity and laugh at the days when volunteers rushed between classrooms with a teetering stack of paper forms to conduct screenings.

Several, including Bebe and Kintz, are now retired.

Kintz said in the roughly 15 years she volunteered, she saw improvements in kids’ oral hygiene as older siblings taught younger ones to brush and parents became more aware. Teachers told her kids were better able to focus in class after having pain addressed.

“Even if there was a small group or generation of kids we helped, they know that stuff now ... and they can hopefully pass it on,” she said.

Reporter Rachel Alexander: rachel@salemreporter.com or 503-575-1241.

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