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Los Gatan David Lees, DDS, directs the Children's Dental Initiative, which oversees the Mobile Dental Clinic.
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Reason to Smile
Many low-income youth now enjoy dental health services, thanks to Children's Dental Initiative
By Sandy Sims
Photographs by Paul Myers
It's a Thursday afternoon. Vanessa Moran, 8, and her 5-year-old brother Enrique head for a huge, chartreuse-green trailer in the back parking lot at Erikson school on Pearl Avenue in South San Jose. Vanessa has had a toothache for a long time. It's gotten so bad that's she's missed school and cries during the night. Vanessa's mother works but can't afford dental care, which is why Vanessa comes to the Mobile Dental Clinic, David Lees explains.
Just a few miles northeast of the mobile unit, Diego Baños, 13, slides into a dentist chair at the Franklin-McKinley School district offices. Diego is a little nervous. He cranes his neck to see what's on the instrument tray. Bill Comport, DDS, a volunteer dentist, gets Diego to giggle and then hands the boy a mirror. "You can watch while I clean your teeth," Comport says.
There's a lot going on these days in children's dental care in Santa Clara County. And Los Gatan David Lees and Saratoga resident Bill Comport are major players. Lees is the director of the Children's Dental Initiative, a program organized to reach children who are not getting dental care. And Comport is the original force behind such programs in Santa Clara County.
Reaching these children is no small feat when one looks at the figures. In Santa Clara County, Lees says, there are 140,000 children whose dental care needs are underserved. "We only have enough capacity to serve about 15,000 of those children, he says. "Our objective is to get that capacity up. We want every child to get dental care."
And the problem is rather urgent because one-third of the children have untreated dental problems, and in the Hispanic community, one in four children have immediate dental needs. This means they are like Vanessa, sitting in the classroom in pain. "There's a huge Hispanic community here," Lees says. "So that's a lot of kids hurting."
Comport's involvement began in 1992. As president of the Santa Clara County Dental Society, he joined a county coalition that included then-County Supervisor Diane McKenna, Judge Len Edwards and Dave Barrum of Apple Computer. "Our goal was to better kids' lives," Comport says. The project became know as Kids in Common. The coalition wanted to help at-risk youngsters get the services and support they were lacking.
While other members of the coalition were gearing up projects for legal, social and medical services for these children, in 1992 Comport created SOKS (Save Our Kids Smiles). Dentists in the county volunteered their offices and their time to treat children who didn't have access to dental care.
As it turns out, bad teeth can have far- reaching effects on children, keeping them out of school, hurting their self-esteem, and interfering with their learning, not to mention their health.
SOKS targeted children whose parents were the working poor, unable to afford dental insurance and ineligible for state or federal programs such as Medi-Cal or Healthy Children. At that time the criteria for eligibility for SOKS was twice the federal poverty level or $28,000 for a family of four. Medi-Cal was also accepted because Medi-Cal patients have a difficult time finding dentists who will take them.
The program ran into a snag. The children were located in areas that had few SOKS dental offices, or, for that matter, any dental offices. Parents had difficulty taking time off work to take their children across town.
Comport says a school nurse begged him for a long time to start a clinic in the Franklin-McKinley School district in San Jose, where many of the children needing dental care lived. After having some success with the SOKS program, Comport agreed.
The district applied for a Healthy Start Grant through the state, saying that dental care was a major problem, and that the children in the district did not have access to dentists. The grant of $30,000 for a dental unit and $15,000 for equipment came through. Comport set up a clinic in the Franklin-McKinley district offices near the San Jose Historical Museum.
He got other dentists in the county to donate equipment. The Dental Society kicked in $6,000, as well. Comport was surprised when the Good Samaritan Charitable Trust golf tournament donated another $5,000.
With the school district supplying the facilities and dentists volunteering their time once or twice a month, the clinic was on its way in the early 1990s. The district was able to provide a van to pick up children from nearby schools and bring them to the clinic. "That was great," Comport says. "We had few no-shows."
"These kids are wonderful," he says. "They are so grateful and such good patients. I get energized when I come here." Comport says he feels a slower pace at the clinic. He tries to schedule plenty of time for each child. Tall and slim and wearing khaki pants and a Levi's shirt at the clinic, Comport says this is an opportunity to work with these children in the way the original coalition had planned.
"I talk to them about how to care for their teeth," he says. "See the yellow stuff here, that's plaque," he says to Diego quietly. "Be sure and get to these back teeth when you brush." Comport talks to the children about school, asks them what they've been reading. He encourages their dreams. "These visits are not one-shot treatments," he says. "We try to give long-term care." Diego will be scheduled when Comport's next volunteer Friday comes around to have two cavities filled.
Comport tells children like Diego to go tell their buddies it's OK to go to the dentist.
Eight-year-old Vanessa Moran sits in a chair in the Mobile Dental Clinic while her teeth are being worked on.
Comport doesn't mention it, but he was selected for one of George Bush Sr.'s "Point of Light" awards for his commitment to serve the nation's children and youth. Comport received letters of congratulations from President George Bush, President Bill Clinton, U.S. Sen. Barbara Boxer, and Gov. Gray Davis.
Still the clinic is not without its struggles. The district could not afford to continue staffing the van to drive the children. Even though the clinic is closer to the children, they often need a ride to the clinic, and parents have difficulty getting off work. "We give out bus passes and taxi vouchers," Comport says. "But sometimes the children have to take two or more buses, and the taxis don't like the small amount they get from vouchers."
Another concern, Comport says, is getting enough volunteer dentists to fill every weekday. Dentists typically take off Mondays, Wednesdays or Fridays, which means Tuesdays and Thursdays are difficult to fill at the clinic. Recently, the clinic has been able to pay per diem payments for a couple of dentists. "We now have a dentist who is here all day on Tuesdays and Thursdays," Comport says. The clinic also employs one dental assistant, Sokha Mok, who says she is so busy she needs an assistant.
Comport is thrilled with the per diem, which means a more regular staff and hopes for more of this in the future and for another dentist chair in the clinic.
It was, veteran journalist Walter Cronkite who unwittingly helped out Comport and got Lees his job.
Lees says, "Dr. Harold Slavkin, dean of the school of dentistry at the University of Southern California, loves to tell this story." It seems Slavkin, who was also director of the National Institute of Dental & Craniofacial Research, was at a cocktail party in Washington, D.C., having a friendly conversation with Cronkite when Cronkite found out Slavkin was a dentist. Cronkite mentioned that it might be a good idea to do a study on the country's dental health.
A few days after the cocktail party, Slavkin was in his office when he got a call from Donna Shalala, the Health and Human Services secretary at the time. Shalala said Walter Cronkite had been talking to her at the cocktail party about doing a national study on the dental health of Americans. "Let's do it," she said.
Slavkin says this suggestion was not out of the blue. Cronkite's father and grandfather were Kansas dentists, and for years dentists and others have been urging different administrations to do such a study. Shalala's dentist was an enthusiast, too.
In the year 2000, the first-ever Surgeon General's report on the oral health of the nation came out. The report showed a nation with dental problems of epidemic proportions: Among low-income children, almost 50 percent of tooth decay goes untreated. While 44 million Americans lack medical insurance, some 108 million lack dental insurance. And uninsured children are three times as likely to have dental needs as those with insurance.
On the strength of this report, grant money became available for dental care for at-risk children. With SOKS in place, and the Franklin-McKinley clinic in full swing, Santa Clara Country already had a dental-care backbone to build on.
The Health Trust, a nonprofit agency, had been set up to administer the proceeds from the sale of Good Samaritan Hospital in the late 1980s. The trust created the Dental Initiative and wrote a grant to the California Endowment and received $6 million for a broad dental program. The Health Trust hired Lees, a dentist with a master's degree in business administration and a law degree, to be the director.
The grant has been used to fund the per diem dentists and other expenses at the clinic
It also paid for the $400,000 mobile dental unit, the centerpiece of the initiative. Lees bubbles over when he talks about the trailer. Inside, the trailer feels like a real dentist's office with a reception area, three dental units (called operatives) and a small room in the back for sanitizing instruments.
Everything in this roving dental office is state-of-the-art. X-ray machines are digital. When Vanessa crawled up into her seat, her teeth were X-rayed, and the images of her teeth appeared instantly on a computer screen to the right of her. Dr. Ngoc Nguyen showed Vanessa the problem tooth.
Nguyen, a recent USC Dental School graduate who works at the unit for per diem pay, says, "Kids love this." Nguyen shows how she can change the colors, which she says reminds the kids of their computer games.
The Mobile Dental Unit was set to open on the fateful Sept. 11 last year, but the dentist heading there that day hurt her thumb and wound up at her doctor's office getting stitches. The next day the unit opened, and since then, Lees says, they've served more than 300 children.
The most important aspect of the trailer is that it can move around the county, bringing dental care to those children most in need of it. Children are screened in the schools by volunteers as well as employees of the Dental Initiative who go into schools to put sealant on the children's teeth. "This sealant is the best thing that's happened in dentistry in years," Lees says. It protects the pits and grooves of the teeth.
Bill Comport, DDS, who volunteers with the Children's Dental Initiative, works on Diego Hernandez Baños in the Franklin-McKinley dental clinic. Comport was a driving force behind local efforts to provide dental health care for underserved children.
The program identifies the schools where children might not be getting dental care. Lees says they are trying not to get ahead of themselves. "There's a saying that goes, Don't screen unless you can intervene'," Lees says.
Those children who are screened are given a dental report card. "If the child needs care, we suggest they go to their own dentist if they have one. If not, we recommend our facilities," Lees says. "We want every child to have a dental home."
For now the big green trailer parks at various schools for six to eight weeks. They eventually hope to show up every six months at regular locations for follow-up work.
It seems dentists are getting on the bandwagon for treating at-risk youngsters. On Feb. 14, Valentine's Day, some 50 dentists are opening their offices for Dentists With a Heart day. Lees says, "They will have the capacity to treat 500 children." The problem Lees is trying to solve is how to get these children to the dentist's offices. "We are joking around here [at the Health Trust] that we may all be driving children around on Valentine's Day." Then there's the other problem of follow-up that they are working on.
"There's lots of payback with these kids because you get them young and educate them," Comport says. "Their teeth may last their whole lives." He tells Diego his teeth are good and strong. Diego must have been drinking water with fluoride, he says. He shows Diego his X-rays. "Your roots are a little short, Diego. You need to take good care of your gums."
Diego scrambles off the chair and smiles. "Do your teeth feel clean?" Comport asks.
"Yes."
"Go tell your buddies, it's OK to go to the dentist," Comport says.
For more information about these projects, contact David Lees, 408.879.8420.
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Los Gatos, California Since 1881
