The fourth grader in Amanda Whiting’s chair had never been to the dentist, so she was a little nervous to be seen at the clinic at her school, J.A. Rogers Elementary.
“We don't use scary terms when we are treating a kiddo,” said Whiting, the dental director at Samuel U. Rodgers Health Center, which runs the clinic for Kansas City Public Schools.
“We don't talk about needles and anesthetic. ‘I have a squirt gun full of sleepy juice that is going to help put your tooth to sleep,’ and we snore loudly. That's usually the hardest part to get kids through, getting them numb so we can do the work that we need to do.”
The student, who KCUR is not identifying to protect her privacy, was new to the school and had a toothache for a few weeks. Whiting determined the tooth was infected – it would have to be pulled. The dentist had hoped it wouldn’t get to that, but it’s not uncommon when kids haven’t had routine dental care. In fact, about a quarter of kids get 80% of all childhood cavities, according to the American Academy of Pediatric Dentistry.
“When these kids have a tooth that’s hurting them, they’re likely not eating well. They’re likely not sleeping at all,” Whiting said. “The last thing they’re gonna be doing is focusing on what the teacher is saying.”
Children who live in poverty are more likely to experience tooth decay. That’s why Whiting said it makes sense to put dental clinics in schools, where students spend most of their day.
Barriers to access
Clinics like the one at J.A. Rogers are increasingly common – the number of school-based health and dental clinics has doubled in the last twenty years, according to the School-Based Health Alliance, which calls the clinics a “logical” response to the challenges low-income students and their families face trying to access health care.
It’s not that the parents of low-income students don’t see dental checkups as important, Whiting said. “(They’re) focused on putting shelter over their kid’s head, getting food on the table – those are higher up on the hierarchy of needs.”
Ginger Vaughn-Pullen, a family nurse practitioner and the lead provider for school-based services at Samuel U. Rodgers Health Clinic, said besides cost, the reason low-income children don’t get routine health care is because their families don’t always have reliable transportation, or parents can’t take time off of work.
Where a more affluent family might pull a child out of school for a few hours for an appointment, low-income students often miss entire days if they need to see a doctor. All those missed minutes for appointments can add up, and in Missouri, schools are penalized if too many kids are absent.
“If we can be there where the students are, they don't have to miss class,” Vaughn-Pullin said. “They're not missing those key reviews for tests. They're not missing learning new concepts. They're also not missing all the fun stuff too, like recess and activities, gym class, music class, all of those things that help stimulate those students to learn.”
J.A. Rogers Principal Adriane Blankinship-Johnson said there are other benefits, too.
“When the students feel good about themselves, you can see that portrayed just in the way they carry themselves. If there’s an issue with their teeth, they might not feel as confident being at school and smiling big,” she said. “But when they realize they have a special person working on their teeth to make their smile pretty, it’s like, yeah, I can show my pearly whites.”
Fewer costly ER visits
It’s not just urban districts adding school-based health clinics, either. In December, Pirate Primary Care opened in the Belton School District after almost seven years of planning.
“We wanted to take care of staff, but we also wanted to take care of kids, especially those who are uninsured or underinsured ... and help them get on Medicaid if that's what they need to do,” said Lisa Cummings, the district’s assistant superintendent of human resources.
Southland Primary Care, part of HCA Midwest Health, runs the clinic, which is located in an unused school and is open five days a week when classes are in session.
“Staff can go while they're on the clock. We get coverage for their classroom when they go,” Cummings said. “Kids, we can work it out to where we can get them over there if a parent can't leave work.”
Already, at least one seriously ill student has been seen at the clinic, Belton Superintendent Andy Underwood said.
“We have seen some students that do not have insurance. They'd been very sick,” Underwood said. “Their parents will not seek out healthcare unless it's dire straits because they don't have the financial means to provide that care.”
Of the 4,400 students enrolled in Belton schools, about half are low socioeconomic status, according to Underwood. He said the district is committed to figuring out how to provide care, even if a family can’t pay.
Underwood said that was key in discussion with Southland Primary Care.
“There are some districts that have done this for staff, and they did it to save on healthcare costs,” he said. “We saw that model, but we wanted more ... We did not want people to be turned away. Most importantly, the little people. We did not want (students) to be turned away.”
Building healthy habits
For Whiting, the biggest benefit to seeing students at J.A. Rogers is not treating cavities, but preventing them.
“If a kiddo is able to hear about proper ways to brush their teeth, how often you should brush and floss, and also nutrition information – you shouldn’t be drinking that soda, candy’s not great to snack on – we can start instilling healthy habits as their adult teeth are coming in,” she said.
But if she can instill those good habits before they get their adult teeth, she can save them years of pain down the road.
And that’s what school-based health care is all about.
“If we can make healthy children, they can turn into healthy adolescents,” said Vaughn-Pullin, the lead provider for school-based services at Samuel U. Rodgers. “And they turn into healthy adults.”
Elle Moxley covers education for KCUR. You can reach her on Twitter @ellemoxley.