Dental bus spreads smiles

BY JIM SHAMP jshamp@heraldsun.com; 419-6633

Martha Ann Keels makes her living fixing smiles as an assistant clinical professor of pediatric dentistry for the Duke University Medical Center.

But many Fridays during the school year, she might be found in a van parked behind Eastway or any of several other Durham public elementary schools with large populations of children from low-income families, fixing teeth for free.

Keels and dentist Ronald Spain, who is a member of the Durham County Health Department board, have led an outreach effort that's putting several area dentists and technicians into the Tooth Ferry van operated by the health department. The program helps hundreds of local children whose families have no dental insurance and no way to pay for preventive services.

The regular Tooth Ferry staff dentist, Janifer Ellis, works four days a week. That left the 40-foot custom-designed dental office on wheels sitting idle every Friday, even though there was more than enough business to keep its two dental chairs, X-ray room and front office humming every school day.

"It struck us as crazy to let a great bus like that sit still on Fridays," said Keels, who grew up near Asheville, where two mobile dental clinics have been pressed into service. "We have unbelievable dental needs among Durham children. I was just amazed at the amount of tooth decay that I saw when I started working with the poor and uninsured. It's impressive to me that children's teeth are so bad in the City of Medicine."

Keels said she initially became aware of the prevalence of dental decay among local children when she conducted a six-year follow-up study, starting in 1990, to look for possible adverse effects after the city of Durham's water utility accidentally turned off its fluoride treatment system for a year.

Keels said she initially became aware of the prevalence of dental decay among local children when she conducted a six-year follow-up study, starting in 1990, to look for possible adverse effects after the city of Durham's water utility accidentally turned off its fluoride treatment system for a year.

Now, however, she finds significant problems among Hispanic children, most of whom have never seen a dentist. That's especially true at Eastway, she said, where enrollment of Hispanic children has gone from 10 percent to 48 percent in just six years. For many of them, the Tooth Ferry is their only hope for halting the cascade of problems that can result from poor oral health.

Besides pain and associated distraction from cavities, unchecked tooth decay can lead to expensive infections, extractions, reconstruction and all sorts of misery, said Keels.

Keels said tooth decay is the nation's No. 1 infectious disease, and tooth pain is one of the top reasons that children miss school.

"This is also motivating me to become bilingual," she said. "I'm learning Spanish, but I need to get better. Duke's offering Spanish classes at night for health care providers so we can learn Spanish related to health care. We're learning things like, 'Are you in pain? How long have you been in pain?' Things like that."

"In this economy so many of these parents can't afford to take off work to bring their child to my office," said Keels. "But with the Tooth Ferry, parents can stay at work and their child can still get the service. The kids are only in the chair about 45 minutes, so they don't miss much school."

She said even though the service is aimed mainly at poor families without insurance, no one is denied service.

The Tooth Ferry was started in 2001 through a partnership among Duke's Division of Community Health, the Durham Public Schools and the Durham County Health Department. Startup funding came mainly from a $198,000 grant from the Duke Endowment and another $15,000 from the Durham County taxpayers.

So far the service focuses on four elementary schools in low-income neighborhoods: Eastway, Fayetteville Street, Y.E. Smith and W.G. Pearson. The schools were chosen by Health Department dental screenings, which showed that about one in three students in some elementary schools had dental cavities or oral pain. Children are seen for free after they get permission from their parents or legal guardians.

Concrete pads were built at the target schools, said Keels, so the Tooth Ferry could be parked conveniently. The pads include hookups for electric power and suction required to make it run as a dental office.

Ellis, the regular Tooth Ferry dentist, conducts screenings at the beginning of the school year to identify children with dental problems. Their parents or guardians are asked for permission to treat the child, and when that's granted the child is scheduled for an appointment.

Someday, said Keels, if elementary children get caught up on oral health, the Tooth Ferry might move to middle schools. But that's not likely to happen for a while, she said, with Ellis seeing children all week long and volunteers "flat-out flying," seeing another 10 to 12 children on Fridays.

"So far we have every Friday for the whole year filled up with volunteer dentists from the Durham/Orange County Dental Society," said Keels. "The group has made this its mission, and the members are really responding."

Chapel Hill dentists conducted a screening program a year ago in the schools, she said, and took uninsured poor children into their offices for free services. But now the greatest need is in Durham.

Most of the work involves extracting teeth, inserting spacers and filling cavities, said Keels, so general and pediatric dentists provide the volunteer support. The van isn't equipped for specialized procedures like oral surgery. But Keels said area specialists like oral surgeons, orthodontists, endodontists and periodontists help the program financially, buying needed laptop computers, nitrous oxide and other equipment and supplies.

The Tooth Ferry is "a huge corrective program," said Keels, but the staff and volunteers also teach children about preventive measures like brushing and flossing -- concepts new to some of them.

"I think the message most of us try to impart on the children, because we aren't able to talk to their parents, is that it's important to take care of teeth so they won't hurt and your smile will be pretty," she said. "Then, as they get older, we tell them it's for health reasons and to protect their pocketbook. To fix teeth is expensive, so in the long run you're saving money."

"We try to give them pearls of wisdom - not to eat so much candy, for instance. You could use that money to buy a dress, a book, a football. For the older ones it's always about saving money."

"At some point I hope -- it's my dream -- that we'll catch up in Durham, that we'll be working to maintain healthy smiles. But right now we're behind the power curve. I don't know that we're even halfway there yet."

© Copyright by The Durham Herald Company. Original copyright 2004. Copyright renewed 2005. All rights reserved. All material on heraldsun.com is protected by U.S. and international copyright laws and may not be reproduced or redistributed in any medium except as provided in the site's Terms of Use.