Ben Romo: I’m using my widest smile to welcome MaryEllen Rehse, MSW, an oral health program manager in the Health Linkages Program at the Santa Barbara County Education Office. We’re here to talk healthy teeth.

MaryEllen Rehse: Yours are looking good, Ben.

BR: Thank you! Tell us more about your work.

MER: The Children’s Oral Health Collaborative, under the direction of Health Linkages, works together with partners to prevent dental disease in children, identify and track current needs, and improve access to care.

We also work in the community to engage and sustain support for Children’s Oral Health. We provide support to medical and dental providers to implement fluoride varnish applications within their practices.

The Health Linkages program coordinates fluoride varnish application two times a year for state preschools, children’s centers, school readiness and Head Start programs, and kindergarten students at targeted elementary schools.

For the last eight years, we have provided 4,000 children with two fluoride varnish applications per year, and 2,000 children at targeted low-income schools with dental screenings each year.

BR: That’s a lot of smiles. Why is oral health critical to overall health and child development?

MER: Children need their teeth to learn to speak properly and to eat healthy foods for proper nutrition. Dental disease is an infectious disease. When a child has untreated tooth decay that develops into an abscess, they are not just facing a localized infection, it’s now a dangerous systemic infection that can lead to occasionally fatal complications, such as the infection going to the brain.

This is not common, but discomfort is. Pain dramatically affects a child’s health — the whole body is in stress, which negatively affects their mental and emotional health, as well as their ability to concentrate and learn.

We have a huge problem with kids missing school days when they have dental pain. I get calls from schools that have kids in their offices with pain or abscesses looking for help, particularly in Santa Barbara.

Of course, dental disease isn’t just a children’s issue. In adults, the bacteria spreads through the bloodstream to other parts of the body, most commonly affecting the heart and respiratory systems. As an example, gum disease affects diabetes, and is now being associated with increased rates of dementia.

When we develop good oral health skills, we are promoting health outcomes for the life of the child.

BR: At First 5 Santa Barbara County, we believe that building systems is critical to long-term change, and that’s where we invest. What changes have you seen since starting the Oral Health Collaborative?

MER: I’m thrilled to be a part of so many people joining across public and private sectors to share ideas and resources and to find solutions. Locally, our collaborative has grown exponentially in the past eight years. Schools, public health, community organizations, clinics and private providers are all working together to put effective strategies in place.

Our network partners give huge contributions. As an example, First 5-funded Family Resource Centers provide case management and follow up to make sure identified children complete their treatment — although we don’t see many emergencies in Santa Maria, we still have many in Santa Barbara and Lompoc.

BR: You want every child to have two fluoride varnish treatments a year. How has more widespread fluoride varnish changed your outcomes so far?

MER: We have seen dental disease cut in half among the state preschool population in Santa Maria — dropping from 40 percent to 20 percent of children now found with untreated dental disease when we do our dental screenings. The same dentists have been doing the preschool dental screenings in Santa Maria for 20 years, so we have consistency of clinical observation.

Achieving this kind of outcome was a team effort. People from schools, community agencies, private dentists and community health centers, public health and WIC came together through the Dental Access Resource Team. They worked to get Santa Maria to fluoridate their water in 2005. Santa Maria is still the only city in our county to do so.

All Santa Maria primary care physicians and pediatricians are varnishing children three times a year, as soon as the first tooth emerges. Medical offices in Santa Maria are providing about 10,000 applications of fluoride varnish each year to young children.

I just got back from Kinder Bridge in Santa Maria and I didn’t find a single emergency. Eight years ago when we screened this same preschool camp, we found so many emergencies it raised the county average to 15 percent.

BR: That’s amazing! Even with all that you’re doing, it seems like when it comes to prevention, there’s always more to do.

MER: Absolutely. As an example, Head Start provides a high level of oral health screening and support as part of their program model, and that is phenomenal. However, those services are not funded in other preschools — the screening, classroom brushing, parent and child education, case management to access complete dental care and treatment.

To the extent that we have funding, Health Linkages has provided these services to state preschools, but those programs do not have the funding for the wrap-around services that Head Start provides. Ideally, we’d be doing this work in all preschools.

BR: A lot of the work of the collaborative has been around expanding access to services. What challenges have you faced?

MER: Getting young children treated if they need sedation and have Medi-Cal is difficult, since there are no providers who do this on the South Coast or midcounty, only in Santa Maria. Since one major surgery center closed recently, that leaves only private providers with wait lists currently of four months and extra fees.

That’s pretty demoralizing for a family when a child has pain today and cannot eat.

Even infants benefit from fluoride varnish.
Even infants benefit from fluoride varnish. (Children’s Oral Health Collaborative photo)

BR: If you could tell all parents one thing, what would it be?

MER: So-called baby teeth matter — good oral health begins at birth. Very young children can develop very serious oral health problems. I had no idea that young children (5 and under) could have so many cavities, much less the abscesses and large holes I see far too often. These cases are very sad and do not need to happen — they are absolutely preventable. As a parent, you can do a few key things and prevent tooth decay:

» Brush your child’s teeth twice a day

» Reduce (ideally eliminate) soda and candy from your child’s diet

» Limit snacking, even on “healthy” foods, to reduce the amount of time food is in contact with enamel

» Drink fluoridated water, take fluoridation tablets, or my favorite, get a fluoride varnish, which eliminates any risk of ingesting too much

MaryEllen Rehse’s kindergarten photo.
MaryEllen Rehse’s kindergarten photo. (Rehse family photo)

BR: Great tips. Click here to visit our Oral Health page if parents want more information based on the age of their child, tips on teething pain, brushing strategies and videos, or when to schedule a first dental visit.

MER: First 5 helped us do a great brochure for parents on how to care for their children’s teeth. We want to see those in the community who work with children getting key messages to parents for prevention. Together, we can make oral health a priority by including it in all health discussions — whether that is insurance coverage, treatment access or general health training.

BR: I’m glad you like it! We have some great books, brochures and children’s toothbrushes we distribute to parent groups, preschools and kindergartens. This is a lovely picture of you at Vetal Elementary School in Detroit. What was your favorite part of kindergarten?

MER: Learning new things from a very encouraging teacher we all loved. I remember being especially proud when I learned how to tie my shoes by myself. My mom says I would come home and teach her the new songs we learned.

BR: We teach our First 5 parents to make toothbrushing time easier by making up silly songs while brushing. Maybe we can release some of your tunes as examples.

MER: I’ll start rehearsing!

— Ben Romo is executive director of First 5 Santa Barbara County. Click here for previous columns. The opinions expressed are his own.

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