It is also recommended that pregnant women see their dentist for preventive dental cleanings and evaluation. During pregnancy, increased acidity in the mouth increases the risk of tooth decay. Vomiting during pregnancy can aggravate the problem by exposing the teeth to more gastric acid. The bacterium that is associated with tooth decay could be carried over to a newborn child, possibly passing the bacteria to the baby.

Pregnant women go through hormonal changes during pregnancy that can lead to gingivitis and inflammation of the gum tissue. Both can lead to a pre-term birth or low birth weight. Ideally, if a woman is planning a pregnancy, she should schedule an exam ahead of time to treat any dental problems. Certainly upon becoming pregnant, a woman should schedule an exam with her dentist right away. Dr Jung of the Willow Creek Community Health Center, explains, “Dental care during pregnancy should be a normal part of prenatal care. The woman’s body is changing and that affects her oral health and the future health of her child. Preventive and maintenance exams and cleanings are recommended for all pregnant women.”

UCSF Dental Intern Johanna Chung

One of the unique aspects of the Burre Dental Center is its connection to the School of Dentistry at the University of California, San Francisco. Fourth-year students and post-graduate residents rotate through the clinic, bringing their training to the clinic and getting a “real-world” experience in providing community dentistry. According to Tram Vu, fourth-year intern, “Our experience at Burre has provided confidence with both our clinical and patient relations skills. We have become more efficient with our time while still providing quality care and education. After our rotations, we definitely notice an improvement in speed and skills. We work with wonderful dental assistants, which is something that we do not have at UCSF. The dental assistants have exposed us to the effectiveness of four-handed dentistry. We see an amazing range of dental needs at Burre. We try to see an average of 10 a day here; at school, we average 3. As future dentists, our time at Burre has taught us the importance taking an active role in providing for the community.

UCSF Resident Grayson Palmer, DDS

Grayson Palmer, DDS Resident, explains, “We apply to be placed at a site and Burre is a very popular site because of the quality of our experience. I have done much more hands-on dentistry here than many of my classmates at other sites. This has been an amazing learning opportunity. I really enjoy working as a team with my assistant. I am now interested in continuing to work in a community health center. I’m hoping to continue on as a provider at Burre once my residency obligation is completed. My wife, daughter and I enjoy living in this community.

Johanna Chang just completed her second internship rotation at Burre. “I love working with the children, and I now recognize the importance of screening and education. This has been an incredibly challenging and inspiring experience. The lectures and clinics at school were mere shadows in comparison to what I’ve experienced and learned here. I have gained so much that only this kind of hands-on experience could give me. And I feel confident, with the great team around me, that we are providing patients with the best care possible. We are not compromising quality. I am grateful to train at a site where advancements in treatment alternatives are being used on a regular basis. The environment itself motivates me every day.”

According to Dr. Wright, “Our partnership with UCSF creates access to care that we wouldn’t have any other way. These students are not only skilled and eager to learn, they are committed to the highest standards of quality and care. They are learning valuable lessons while contributing to our knowledge, bringing with them the latest training and advancements in dentistry. It is a great association for the students, for our staff, and for our patients.”

Congressman Mike Thompson with the children of Smith River Elementary School celebrate the new Del Norte Dental Van by showing their teeth to the camera

This van, and a newly hired staff, will serve children in Del Norte County exclusively. This new van was funded by The California Endowment as part of its Building Healthy Communities: Del Norte County and Adjacent Tribal Lands initiative. The van will visit schools throughout Del Norte County, providing comprehensive dental screening and treatment to children. According to Barbara Davis, Dental Sites Administrator and Mobile Dental Service Coordinator, “We can do almost everything on the van that we can do in the clinic. We schedule several schools to visit during the school year. In this, our first year, we’re starting at Smith River School. We’ll stay there until all of the children who need dental care, and have parental consent, are screened and treated. We won’t leave until all of the kids are taken care of. Then we move on to the next school and do the same thing. This means we may only get to 3 or 4 schools during a year.”

States Laura Olson, Program Manager for The California Endowment Building Healthy Communities initiative, “At the ribbon cutting, someone came up to me and said, ‘So this is really ours?’ referring to the new van and the idea that it will be in Del Norte and not leave the area. It was so gratifying to be able to say, ‘Yes!’ This is a major step forward in creating the infrastructure of access and services so needed if we are to address the pressing health needs in our community.”

During the extended school holidays and over the summer, the van will be located at the Del Norte Community Health Center and serve as extra treatment space. “We’re excited to be able to open up more access to dental services all year, whether at schools or here at the clinic,” notes Hilda Yepes-Contreras, site administrator of the Del Norte Community Health Center. “Access to care; that’s our priority.”

Robert Chiang, DDS, dental provider for the new Del Norte Mobile Dental Van

This sentiment is echoed by Robert Chiang, DDS, a dentist recruited specifically to work on the new Del Norte dental van. “It is wonderful to be able to provide a high level of service for so many kids . We’re still working out some of the kinks, this is only our second week, but I’m impressed with the van, the staff, the schools and the kids. This is a very exciting project.” Dr. Chiang works with registered dental assistants Linda Inman-Bourne and Laura Johnson. “We’re rapidly becoming a good team.”

The Del Norte mobile dental van is not a first for Open Door. Open Door has been providing mobile dental services at schools in Humboldt County since 1991. While not using a vehicle quite as shiny as the new van in Del Norte County, Diane Patkowski, DDS and registered dental assistants Claudia Wells and Mindy Ferreria have been “on the road” providing a full array of dental services to children throughout Humboldt County. During a typical year, the van visits 4 or 5 schools, staying at each school as long as it takes to provide dental screening and treatment to all children who have received parental consent for such services. Explains Barbara Davis, “We couldn’t finish up at South Fortuna Elementary School last spring, so that was the school we started with this fall. In all, we completed treatment for 120 children. We hope to get to four more schools this year, but we have to remain flexible based on the kid’s needs.” The schedule permits the van to return to a school every 3 years. The van is now at Grant Elementary School in Eureka and 86 children are lined up for screening and treatment.

Open Door's mobile dental van serves Humboldt County children.

“In both Del Norte and Humboldt,” explains Barbara, “We are treating children who might go without dental care due to limited access, lack of transportation or other family hardships. With the vans at the schools, parents don’t have to take time off from work and children actually miss less school time because our van is right here on campus.” Barbara emphasizes, “Every child qualifies for services; all we need is parental consent. Being at the school works to the children the dental care they need.

“In addition to treating children’s dental needs, we work with them to improve their self-care. We provide instruction and education about oral health care and talk with parents whenever possible. A person’s smile has a big impact on their self-esteem. For children, their health, happiness and well-being are particularly linked to how they feel about themselves. Following treatment we see how kids develop greater confidence as they begin to smile more” explains Barbara. “We focus on education and proper care at home, including how to brush and floss properly. We teach the children how to have fun with their dental care and to be proud of their efforts. We understand that kids all have different experiences and life situations. For children who are frightened we first give them a “Happy Visit” just to get them used to visiting the dentist. With full dental services offered on the van, starting with a comprehensive exam, the experience is the same as going to any dental office.”

Dr. Chiang notes, “When kids come in with pain it can be difficult to treat them because they are fearful of dentistry, particularly if this is their first visit. I remember one child who needed to have a tooth pulled, it had been bothering him for a long time and was totally decayed. It was scary for him. The next time he came in, he was more relaxed. Children are less fearful the second or third time they come in. Because it is designed to kid-friendly, children have a good experience coming to the van. There is less waiting and less anticipation and they see their peers going to the van too.”

Stephanie Nelson, RDA shows patient Kalliyanne Palmer how to brush and make healthy food choices during a monthly Well Child Dental Exam at Burre Dental Center

“Education is essential, and our team is dedicated to oral hygiene education,” says Kathy Dilling, assistant to the director of the Burre Dental Center. “For parents and children, it makes a big difference, in health, time and money.” Kathy, a registered dental assistant, has been with Open Door for more than 18 years. “We believe that education will help set up the kids for a healthy lifestyle.”

Open Door dental centers work to educate children and families. Well Child Dental Exams, otherwise known as “Smile Days” are offered once a month at the Burre Dental Center in Eureka and the Del Norte Community Health Center in Crescent City.

Dr. Carter Wright gives patient Clara a fluoride treatment at her well-child dental exam.

These are free walk-in clinics for infants and children up to age five. Kathy Dilling explains, “We offer simple examinations and education in a relaxed and kid-friendly environment. The whole clinic is geared toward kids on these days. We want children to be comfortable coming to see a dentist, starting at a young age. We help kids and families learn about proper dental care, brushing, diet and safety. We want kids to be proud of taking care of their teeth. There are usually lots of other kids around, so it can be a little hectic, but a lot of fun too.” At both the Burre and Del Norte clinics, dental assistants go through a basic dental checkup with young children and talk to the kids and parents about oral health. Every child is seen by a dentist and if problems are identified, appointments for follow-up care are made on the spot. Every parent receives a goodie bag filled with toothbrushes, toothpaste and other supplies for preventive care as well as a healthy, tooth-friendly snack.

At the Del Norte Community Health Center, these kid-friendly clinics are held the first Friday of every month from 9:00am to 11:00am; call ahead or walk-in. The events are held at the Burre Dental Center on the first Wednesday of every month from 9:00am to noon. Calling ahead is recommended. Visit www.opendoorhealth.com for more information.

Suzanna Torres, RDA shows patient Aimee Rogers how all of the dental instruments work

I’ve seen a real decrease in the number of children with cavities, but I still see way too much decay. And I often see serious decay in an entire family, across multiple generations. If your parents didn’t know about oral hygiene, you probably didn’t learn how important it is, and you probably aren’t helping your children establish good habits,” explains Dr. Wright. But the cycle can be broken. Samantha Hani emphasizes, “We need to educate parents and children together. Oral health care needs to start at an early age, so the parents need to be involved. Our well-child checks (Smile Days) are for children up to age 5. Lately, we have been seeing a lot of children return once or twice a year for a check-up. This is great.” The dental staff is seeing the results of their efforts to educate the community about prevention and good oral health routines, particularly in the youngest generation. “Things seem to be getting a lot better,” Samantha states.

“Maintaining oral health is a daily activity. You can’t wait until something goes wrong. But it only takes a few minutes and doesn’t cost very much,” says Susan Wellman, DMD, of the Del Norte Community Health Center. “Our dental assistants and dentists encourage parents to take care of their teeth and to model good oral health for their children. Most of the time, parents just don’t know what to do, and if they can’t help, children will probably develop problems.” The Open Door dentists offer the following recommendations:

● For infants, try to stop using bottles after the first year and encourage the use of an open cup as soon as possible; limit the use of ‘sippy’ cups as much as possible;

● To prevent ‘baby bottle tooth decay’ never put your baby to sleep with a bottle. At night, only put water in the bottle. Milk and juice pool around the child’s teeth as they sleep, causing tooth decay. Babies can develop tooth decay as soon as their teeth start coming in.

● Start brushing your baby’s teeth as soon as they start to come in, gently using only water and a soft toothbrush. Around age 2, your child will be able to follow simple instructions, such as spitting out toothpaste foam and you can begin to use a “pea-sized” amount of toothpaste. Letting your child watch you brush your teeth will create a good example, one they are likely to copy.

● Children – and adults – should brush their teeth twice a day. Brushing should last 4 minutes each time. An inexpensive egg-timer can be helpful.

● At any age, fruit is better than fruit juice, which typically has a lot of sugar (natural or added). Don’t use bottles or sippy cups for juice.

● See your dentist for a regular check-up at least annually, twice a year if possible. If there is any tooth or mouth complaint or problem, bring your child to the dentist. It is much easier to fix little problems.

● Children should wear mouth guards during all sports activities. Many broken or missing teeth could have been prevented by the child wearing a mouth guard. This applies to bike riding and skate-boarding as well, particularly when trying out tricks.

● It is never too late to start taking care of your teeth. Whatever the age of your child, whatever your age, starting to brush regularly, floss and reduce sugary snacks will make difference. For young children, you are preventing future problems For older children and adults with dental problems, you are slowing the disease process and making it easier for your dentist to correct the existing problems.

● Talk with your dentist. They will be happy to answer your questions about caring for your teeth and the teeth of your family.

Brandy Boone works in the newly created position of case manager at the Burre Dental Center. She works to help find treatment solutions for extreme or immediate situations, including cases of neglect. “I mostly manage cases for little kids with high risks, most are under six years old. We usually have to send them to specialists. After specialized treatment, it is important for the child to return to the clinic for follow-up. We don’t want them getting lost in the shuffle and we don’t want a repeat of what caused the severe problems in the first place.” Brandy’s usual cases involve severe tooth decay, sometimes related to neglect, poor habits or poor diet. “Most of the cases I see are the result of parents who don’t know what to do or don’t know that we are here to treat young children. No one wants their child to suffer now or in the future. We can help prevent these problems if parents bring their children in for a check-up and then follow-through with the treatment plan.”

Paul Jung, DDS examines Willow Creek resident Jan Joki at WCCHC

In 2009, the California Medi-Cal program eliminated most dental benefits for adults; children’s services are still a covered benefit. A court challenge briefly returned adult dental care to the Medi-Cal program, but a final ruling in May upheld the elimination of adult benefits. “This has been a real blow to services for many of our patients,” states Carter Wright. “We still offer services to adults, and we work out discounts and payment plans, but a lot of people still choose not get the treatment they need.” This ruling cut most dental benefits for adults throughout California. “Virtually all adults were affected by these cuts,” says Dr. Wright.

“For adults, Medi-Cal pays for treatment that relieves pain and infection. It doesn’t cover work that saves teeth. The Medi-Cal cuts certainly weren’t our choice, but we’re stuck with the regulations,” explains Dr. Wright. “Medi-Cal pays for extraction, not restoration.”

Current law requires that Medi-Cal pay for treatment related to the relief of pain, infection and trauma; however, the treatment option is tooth removal. “We will work with patients to find ways to treat the problem without removing teeth that can be saved, but many patients just can’t afford the work,” notes Dr. Wright. Medi-Cal eliminated what were termed optional benefits. Medi-Cal will no longer pay for most oral examinations, fluoride treatments, fillings for cavities, root canals and crowns, treatment of gum disease, complete or partial dentures and bridges or repairs to existing dentures, partials or bridges – virtually all procedures that save teeth or restore function.

On a positive note, Medi-Cal covers most dental services for anyone under the age of 21, and some services for women who are pregnant and adults who live in skilled nursing facilities or care homes. “We really encourage parents to bring their children in for a routine exam as soon as the child’s teeth start coming in,” says Samantha Hani, lead registered dental assistant at Burre Dental Center. “Starting a routine of good oral health right from the start will prevent most problems later on. We always find a way to make room for children and teenagers. We’ll fast-track pregnant women and coordinate our care with prenatal providers as necessary.”

Samantha continues, “Though most dental services for adults are no longer covered by Medi-Cal, we still offer comprehensive dental care to the community. We accept CMSP and private insurance and we’ll work out a payment plan for folks who don’t have any dental insurance. The demand for care has increased and it’s hard to get an appointment, but keep trying. Our staff is doing their best help you get the quality care you need.”