LEXINGTON, Ky. (Aug. 20, 2015) — Stephen Richardson isn't a dentist - he's the director of pupil personnel in Knott County schools - but his 27 years as a teacher and administrator in the county have taught him a few things about oral health. Toothaches, for example, make it hard to concentrate in class. Additionally, losing your teeth can impact not only your smile but also your self-esteem and your chances of getting a job. He's also learned that in his county, many children go without a toothbrush, let alone regular dental care.
His county experiences some of the highest rates of child tooth decay in the nation. At the elementary school in Hindman, Kentucky, for example, UK's dental outreach program, the Eastern Kentucky Ronald McDonald Care Mobile, found that 65 percent of kindergarten through second grade (K-2) students were in need of urgent dental care or showed early signs of tooth decay.
Such statistics, combined with his understanding of how oral health impacts children's lives and futures, led Richardson to collaborate with researchers and the dental care clinic to make tooth brushing part of the school day for K-2 students at his district's highest need elementary schools — Hindman, Emmelena, and Beaver.
More than 80 percent of students at these schools qualify for free or reduced lunch, and many change residences frequently. Richardson says this makes it hard to keep a toothbrush, and that for some families, other expenditures take priority over replacing a lost toothbrush. He hopes that incorporating tooth brushing into the classroom will not only address the immediate oral health needs of students, but also foster a culture of oral health that will last a lifetime.
Richardson developed the project, called "Bright Smiles, Brighter Futures", as a participant in the inaugural class of the Community Leadership Institute of Kentucky (CLIK), sponsored by the UK Center of Excellence in Rural Health, the Kentucky Office of Rural Health, and the UK Center for Clinical and Translational Science. The program provides intensive training, technical support, and $1,500 to community leaders to address local health issues. He says the curriculum and support of CLIK helped him refine his project and connect with local resources.
"The question I was asking initially really wasn't the question I wanted to ask. I was saying I wanted them to be able to brush their teeth, but that's really not what my goal is. My goal is to change the culture of oral health, because I have a generation going through here that doesn't necessarily value oral health and how it affects their future," he said. "You get tired of going to a restaurant to eat and seeing a young girl or boy working that just graduated a year or two ago and they won't even look up at you because they hardly have teeth. It's frustrating as an educator."
Richardson worked with a local dentist to purchase toothbrush and toothpaste kits at cost, which enabled him to stretch his funding and purchase two years' worth of toothbrush kits. When school starts back this year, third grade classes, in addition to K-2 classes, will also receive toothbrush kits.
To get the students excited about tooth brushing, the "tooth fairy" delivers the kits to each classroom. (Richardson's daughter, a volunteer with the dental care mobile, dons the costume.) Jamie Cornett, who works as a dental hygienist with the dental care mobile, then teaches the children how to brush their teeth properly. In her experience, making oral health fun for kids is an important part of addressing dental problems and creating a culture of oral health in the area.
"We want the kids to have a very positive experience with dentists, because sometimes the older generation hasn’t had as many positive experiences," she said.
According to Cornett, the causes of oral health problems are multidimensional, and therefore require a broad array of interventions. Since the dental care mobile began rolling a decade ago, rates of tooth decay in the area have declined by about 20 percent, but unaddressed need remains high, and the underlying causes of the problem are so systemic in nature that mobile dental clinics can only do so much.
"Definitely it is not just one thing. It's a combination of the amount of pop that we drink. It's access to care, which is a problem for a lot of people. And it's not as much of a priority as it should be, and that goes back to the economic problems here. Your teeth aren't as much of a priority if you can't pay the light bills. It's a real issue," she said. "It's so many factors that go into it. But that's why we're so passionate about anything we can do, like this project. Anything we can do to help, we're gonna do."
Dr. Nikki Stone, director of the UK Eastern Kentucky Ronald McDonald Care Mobile and dental director of the UK North Fork Valley Community Health Center, has seen that collaboration is essential to addressing the oral health needs in the region.
"I think that one of most important aspects of our program, and the reason it's been so successful, is the partnerships," Stone said. "I always say that everything we do starts with the letter 'P': We're a prevention-focused program, but it's through the partnerships that we're able to keep children pain-free."
While the concept of toothbrushes in the classroom might seem straightforward, the logistics can be complicated.
"It seems so simple, to brush your teeth at school. But it actually isn't that simple," Cornett said. "The schools have a schedule and it's very tight, and to add something like this is not necessarily easy. But they took it head on, and they've done a great job. It's proven that kids with poor oral health don't learn as well, and in a principal's eyes, that’s a huge problem. But they know that we're helping the kids and essentially we're helping their education."
Richardson acknowledges that taking time for tooth brushing cuts into instructional time, but he and the leadership of Knott County schools are committed to the full well-being of their students, not just the test scores.
"Oral health isn't assessed on the state assessment. That's not what teachers are judged by," he said. "But this about educating the whole child."
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