Dr. Clemencia Vargas
Dr. Clemencia M. Vargas, DDS, PhD is an associate professor at the University of Maryland School of Dentistry in the department of Orthodontics and Pediatric Dentistry. For nearly a decade, she has overseen a partnership with Wolfe Street Academy in Baltimore, a community school, in which dental students provide annual screenings for children at the school, as well as other dental support and services. She has a strong interest in improving oral health and dental care for low-income communities and has participated in a number of community outreach initiatives for families throughout Baltimore.
In this interview, filmed as part of our Community Schools and ELLs project, she discusses the reasons the partnership has been successful for families and her dental students alike, the obstacles that undocumented families face in getting regular dental care, and how oral health can impact school success. She also shares the story of Deamonte Driver, a 12-year-old Maryland child who died following a dental infection and the ways that his story has impacted dental care for kids in the state.
Goals of dental screening
We came today with students from the School of Dentistry to screen the children at the Wolfe Academy. We do this every year. We look for major problems, oral health problems, or small cavities, actually. And we are referring these children for dental care.
These dental screenings have – the importance of the dental screenings have changed over time. When we started coming here, the situation of the children were – was more dramatic than it is now.
We saw children in pain, and we saw children with tremendous amount of decay in their mouths. Now they are in much better shape, and the children with cavities we saw today are usually recent immigrants. And we saw children with restorations, crowns, silver crowns, and that’s very exciting.
At this point, more children are getting dental care, so they are – they are getting their exams, routine exams. But for the few children who are not going to the dentist, the screening is the opportunity to do a first quick view of what is inside their mouth, if they have problems or they are fine or maybe they have too much plaque and need to brush more.
So that’s the main point of screening. It’s also an educational tool, because we will have the opportunity to chat with a child, tell the child, this is important. Your oral health is important, and that’s why we are here working with you for your teeth.
Reducing cavities in siblings
One big advantage of treating the oral problems of other siblings is that the cavities are produced by bacteria, by germs, so if they don’t have the older children with bacteria or germs, there is less likelihood that younger children will acquire those bacteria and then will develop cavities of their own. We are treating the cavities in the older children, and the younger children are showing fewer cavities.
Undocumented and uninsured
Dental insurance has been demonstrated to be fundamental for dental care, especially among low-income children. So the fact that most low-income children are covered by Medicaid is one tremendous step towards oral health, but there are several children – there’s a group of children who are not eligible for Medicaid insurance.
And those are the children from undocumented families, children, usually, who were born in another country and come here without their papers in order. These children can’t apply for Medicaid. They have access to education, they have access to some health services, but they don’t have access to Medicaid, and so they don’t have access to dental care.
And we see the case that we have a family who comes for care at the dental school, and we have to say, “Yes, you have insurance, we can see you, but you don’t have insurance. You will have to pay out of pocket.” And that’s heartbreaking, having to say, ‘Yes, I can see you, see you, but no, I can’t see you.”
And we saw children who are recent immigrants who have serious dental problems, so, here we have been – through the years, we have been raising funds to be able to see these children and get them some discounts at our school of dentistry, but it’s a very serious problem that has to be addressed from a more general perspective.
Why good oral health is important to school success
Good oral health is very important for the success of the child at the school. We have seen that children with toothaches have lower grades, have problems in class. They misbehave because they can’t stay quiet. And they can’t really do homework well. So it’s very important that to prevent pain and problems of oral health in the school years, it’s important to start preventing the caries, the cavities earlier on.
We are recommending now that tooth cleaning should start with the first bath, right away, before the teeth are out. Start cleaning, and have the first dental visit at the first year. If we have these milestones ready, the child will get to the school years in much better conditions and with very good oral health.
Collaboration with Wolfe Street
This partnership started in 2007 or probably at the end of 2006. I got a call from Connie saying that she wanted dental care for her students here, and we used to receive a number of calls like that, and then they usually wanted us to go to a place and provide care.
The major problem at that time was the undocumented children without access to the dental care. She had a small grant, and we found funds to complement this grant, and we were providing kids – treatment to these children at the dental school. So that was the treatment part.
Then we started expanding. Very – it was very organic. We started one program we had with a Schweitzer Fellowship that was called – or is called Healthy Smiles for Baltimore Kids. So we said, “Well, Connie, we have this fellowship. Can we go to Wolfe Academy and do it?” And she said, “Of course.”
And she gets everything ready on her end, so we just have to negotiate how we are going to do all the authorizations at the school, and we started the program. That was probably 2009, ’09 or ’10. And every year we do that program with the after-school. This is an educational program.
And every time that we have students interested in doing education with Latino parents, we come here. This is our center, and from here we expand to the rest of the community.
Usually the parents come to – for breakfast, if you saw this morning. So that’s a great opportunity just to chat with the parents after the kids have gone to class, and that has worked really well. So we have been in this partnership for all these years, and for us it’s a model partnership.
Secret of a successful partnership
So the secret for this partnership, very successful partnership, is a complete collaboration between the School of Dentistry and the Wolfe Academy School with their principal, their social worker and the teachers. Everybody at the school is very supportive of our activities. So that allows us to really have programs that are very easy to plan, very easy to deliver.
We know the principal here is absolutely supportive of our activities. So we just email with Connie and say, okay, when do we want to do the screening? Do we want it this time? That time? And the communication is very easy. She trusts us. We trust her. And things happen naturally. If the school’s social worker is not that involved or we have continuous changes, it’s impossible to try to plan any program. We could plan one screening, but we can’t go back, because then we have to start all over to start with the relationship, to start the basic conversations about why we want to be there or what they need.
Opportunities for dental students
Dental students come here, and I think probably you saw them sitting down this morning. They’re quiet. They haven’t – this group hadn’t come to work before, and when they started working with the children, they change. They see the children in a very different light. We are talking about pediatric dentistry.
We talk about teeth, a lot of teeth, a lot of management, but there is no opportunity in that environment to see the child as a child. So here they start – they have more freedom to talk with the children. They learn to manage the children in a more relaxed way. They learn more about what the children are about.
What is the environment, how the classroom works. And that helps for management later. So for the students, it’s a very valuable tool – learning tool, and they appreciate it that way.
In my perspective, it’s making them better dentists, more rounded dentists. The students will see real-life activities, real life of these children where the problems – how is their life outside the dental school, that that’s known for them. So that brings – my perception is that it – that brings them a different understanding of the children and their problems, their behaviors, how to interact with them. So it makes them better people.
A student whose life was changed
There was a child with a speech issue, and we found out that the speech impediment came from a tongue situation. It was tongue-tied. And nobody had seen this. So during the screening, we were able to identify the situation, and with Connie, in collaboration with Connie, the child was taken to the dental school and one of the faculty there did a treatment.
So it’s a very simple treatment from the dental perspective, but for this child it was amazing. So the story that came from here – from this event is that, after the surgery, the child keep repeating, bolsa, bolsa [ph.], because he could put the tongue up in the upper teeth. For the first time, he could say that word.
And for us, that’s a very strong motivator, because we were able to find something that people haven’t seen before, that we don’t know.
A new generation of dentists
At this time, the fifth graders – we have seen them since first grade, so the older children already come here and talk to us, and they are helpers, and they want to – like you saw today, the girl holding the light – she wanted to be part of it.
And so could understand, and she’d talk about molars. So those are wonderful stories, and make dentistry – they make dentistry more accessible to the children. And maybe they will think about becoming dentists. You never know.
Dental programs for Latino parents
When we do programs for Latino parents, we are using – they’re curriculum-based, so we define very clearly what we want to talk about, and we are very sensitive to being culturally aware, so if we’re talking with Latino parents, we will talk, of course, in Spanish. That is the first part.
And usually we have students who are native speakers. We will talk about their own food. We use the music. We use their customs, their beliefs. There are a variety of beliefs about teeth in Latin America, about how long to breastfeed, for example, or what type of food to give child.
So we work within those parameters. We are not coming to the community and say, this is how you do it, and this is how it has to be done. We start with what the parents need, what the parents want to learn, and we use also – that brings me to the technique we use. We use motivational interview in our activities, so we start with where the parent is in oral health, what they know, what they need to know, what they want to know more, what changes they are ready to make.
And so far it has been very successful, and we can make sure there’s success in the fact that we have been able to end the programs with a number of participants, the appropriate number of participants. The evaluations have been very positive. That is, there’s high satisfaction with the programs.
And for the parents, it is exciting that they can ask questions. They can ask questions in Spanish, it’s a relaxing environment, and they like chatting. So chatting is a very important part in our culture, so that’s an opportunity. Most of the activities are with a small group of parents and a student leading conversation.
The Death of Deamonte Driver: A Call to Action
Deamonte Driver was a 12-year-old Maryland child who died from lack of dental care. He had a toothache. His brother had also dental problems, but he complained more, and Deamonte didn’t complain. At that time, his mother was having issues with housing, and they had the support of a lawyer, of an organization working with them to find housing and find a dentist.
And not even with the lawyer, they were able to find a dentist, so the child got – his toothache got very serious, and he had to have brain surgery because the infection spread to the brain. Unfortunately, he died. He died after the brain surgery. And the news – this information was picked up by Mary Otto, a journalist from The Washington Post at the time.
And she published the news, and Congressman Cummings saw it, and he said, this is unacceptable. So he called the state health department and immediately started reorganizing oral health in Maryland, because that was unacceptable that a Maryland child, or any child for that matter, would die from a toothache.
So they started the Dental Action Coalition and gathered people trying to figure out how to resolve the problem in Maryland, and it has been tremendously effective. After that we have better Medicaid reimbursement for dentists. They have started and actually they are finishing a social marketing campaign that increased education tremendously. One of the brochures that we handed out today comes from the campaign in English and Spanish.
And overall, Maryland moved from being at the very bottom in oral health to being the first place, as classified by the Pew Foundation. So all the success we see now in Wolfe Academy is part of the success in Maryland, and it’s very unfortunate that it had to be the death of a child that really spawned this – the benefit for all the other children.
Clemencia M. Vargas, DDS, PhD is an associate professor at the University of Maryland School of Dentistry in the department of Orthodontics and Pediatric Dentistry. Dr. Vargas holds degrees in dentistry, epidemiology, and medical sociology. Dr. Vargas’ research focuses on socio-economic inequalities in oral health, an area in which she has published numerous scientific articles. She has strong interest in oral health improvement at the community level and is the faculty advisor for several dental students groups that emphasize community service. She was a member of the Institute of Medicine committee that wrote the recently released report “Advancing Oral Health in America.”