Vineyard Smiles brings dentist to schools

By Janet Hefler - December 7, 2006

A new oral health program aimed at Island preschool children in Head Start and students in grades K-8 from low-to-moderate income families makes a trip to the dentist just a walk down the school hall.

Appropriately named Vineyard Smiles, the program provides school-based portable dentistry services through Commonwealth Mobile Oral Health Services (CMOHS), based in Lakeville.

Island Health, Inc., in partnership with the Vineyard Health Care Access Program (VHCAP) of Dukes County, operates Vineyard Smiles, funded by a three-year grant recently awarded from the Oral Health Foundation of Dental Services (OHFDS) of Massachusetts. The in-school program offers general checkups, sealants, minor restorative work, and preventative education.

"It is so gratifying to know that kids are getting these basic services," said Sarah Kuh, director of Vineyard Smiles and VHCAP director, at Oak Bluffs School last week. "Part of the goal on our part is raising awareness overall."

Vineyard Smiles program coordinator Henrietta McElheny scheduled the first mobile dental clinic conducted by Dr. Qui Nguyen (who goes by Dr. Qui) and his dental assistant Phong Vu with 20 Project Head Start preschoolers in September. Last week they completed the last of four visits for 50 children signed up for the program at Oak Bluffs School.

Today Dr. Qui and Mr. Vu are at Edgartown School where 48 children will be seen over four visits. After finishing in Edgartown in mid-January, the dental team will head to Tisbury School, then to the up-Island schools and the Martha's Vineyard Public Charter School. After completing their first round of visits by March, they will return for follow-up visits.

Although Vineyard Smiles contracted with CMOHS for 24 days, Ms. Kuh said that the company has offered to provide some flexibility within the contract for more days if needed for follow-up visits.

Arrival of the tooth ferry

Last Thursday Dr. Qui and Mr. Vu drove their CMOHS van off the ferry and headed to Oak Bluffs School. In a matter of minutes, they unloaded duffle bags containing dental equipment and set up a portable examining chair and lights in school nurse Mary Vivian's office. A compressor used to power the dental equipment was hidden in the bathroom behind a closed door to lessen the noise and fright factors.

Ms. McElheny schedules 25-minute appointments for 12 to 13 children in a day. "The program has fit into the school without any major disruption," she said. "We want to promote oral health as a part of the whole health picture. The kids are used to eye and ear checks, so hopefully this will become something that seems just as routine to them."

Ms. Vivian, the school nurse, strongly advocates paying attention to the connection between oral health and a child's overall health picture as well. Sometimes children labeled with behavior problems suffer from dental problems that cause them to be inattentive and restless, she pointed out.

Ms. Vivian said she was upset when Dr. Qui discovered two children with tooth abscesses, thinking about the pain they must have been coping with in school. She also found it surprising there were some eighth graders who had never been to a dentist.

Although Dr. Qui does not have a portable x-ray machine and cannot do extractions, Ms. Kuh said if a child needs additional services, VHCAP will work with his or her family to find a source of care.

At Oak Bluffs School last week, kindergarten teacher Holly Hawks escorted her student, Giovanna Alvarez, age 5, to see Dr. Qui as his first patient. Ms. McElheny thoughtfully scheduled her big sister Kezia, a nine-year-old fourth grader, as the second appointment so she could stand close by and offer reassurance to her little sister, if necessary.

Dr. Qui's smile and friendly manner appeared to quickly dispel any apprehension. He engaged his patients from the beginning, mixing friendly conversation with education and advice about dental care. "My motivation to become a dentist was my bad mouth," Dr. Qui confessed with a laugh. "I loved candy!"

A graduate of Boston University, Dr. Qui is one of only five dentists in the state of Massachusetts working in the mobile oral health program. He and Mr. Vu travel statewide six days a week, providing dental services mostly to teenagers.

Handing Giovanna a mirror so she could watch as he worked, Dr. Qui explained every procedure beforehand. After examining and cleaning her teeth, he drilled away a small superficial cavity. In turn, her sister Kezia, had sealant applied to her premolars and molars, which Dr. Qui said protects teeth from 90 percent of cavities.

Each child received a "goody bag" at the end of the visit, complete with a toothbrush, toothpaste, dinosaur flosser, and a two-minute timer. Ms. McElheny also gave everyone a Vineyard Smiles sticker to wear, including superintendent of schools James Weiss, who stopped by to welcome Dr. Qui and Mr. Vu.

OHFDS program officer Judi Foley, who worked for a year on data assessment that led to Vineyard Smiles, also wore a sticker proudly as she observed the program last week.

Growing Vineyard Smiles

Vineyard Smiles grew out of the efforts of the Oral Health Working Group (OHWG) of the Dukes County Health Council. Ongoing problems at the Martha's Vineyard Dental Center prompted the formation of the working group of dental professionals, health professionals, and members of the Island community in 2003.

The dental center, the only MassHealth provider and the only program designed to meet the needs of lower-income and medically underserved children and adults, closed in June 2004.

That same year, the VHCAP began offering oral hygiene education in preschools and kindergarten and grade one classrooms, overseen by an OHWG subcommittee, the Children's Oral Health Promotion Committee.

In 2005 Island Health, Inc., VHCAP's non-profit administrative and program partner, secured a planning grant from the Oral Health Foundation of Dental Services (OHFDS) of Massachusetts. The purpose of the grant was to conduct a community assessment of oral health assets and needs on Martha's Vineyard, focusing on low-to-moderate income children and adults, and to plan for a comprehensive program of oral health services for a targeted population.

The assessment program, named Vineyard Smiles, included questionnaire responses from 359 people, as well as interviews with 17 medical, health, and human services professionals which documented their experiences and perceptions of the status of oral health and access to dental care among their low-to-moderate income clients or patients.

Children on Martha's Vineyard enrolled in MassHealth, the Massachusetts Medicaid program, face additional challenges in access to dental care compared to other children in the state, due to a shortage of general dentists on the Island, no pediatric dentists, and a very limited number of dental specialists. Traveling off-Island for their dental care also might result in lost wages for some of their parents.

With the receipt of the program implementation grant this year, Vineyard Smiles' services include the portable dentistry component, outreach and education, as well as a program to refer children and adults to affordable oral health care.

With approximately 600 children in preschool to grade eight in the target population, Vineyard Smiles aims to reach at least 300 of them by the end of the three-year grant period.

Other goals for the program include expanding services to high school students, as well as facilitating oral health care for high-risk adults, such as those insured by MassHealth and senior citizens who are homebound. Vineyard Smiles also hopes to develop a program to promote fluoride use as a proven method for preventing cavities.

Debbie Simon, a dental assistant whose children attend Oak Bluffs School, conducts the Vineyard Smiles tooth tutoring program, teaching children about eating healthy snacks, proper tooth brushing and flossing, and fluoride. Her job at Vineyard Health Care Access also involves finding care for patients with emergency dental problems.

The OHWG, in conjunction with VHCAP, developed an education program and a reduced-fee dental program. The working group, now chaired by Dr. Peter Strock, continues to offer guidance to Vineyard Smiles.

The group has also been working on plans with Martha's Vineyard Hospital to reopen the dental center under the hospital's management.