The Greenville Daily Reflector: ‘The need is still there for oral care for children': Low turnout for free event belies scope of children's dental problems, health officials say

With no cheerleaders, clowns and balloon animals, National Children’s Dental Health Month arrived in Greenville last week without fanfare but not without dental care.

East Central Dental Society’s Give Kids A Smile, held on Groundhog Day, appeared to be a shadow of its former self. The annual event, part of a national effort to provide free dental care to children in need, drew about a dozen patients. This is a fraction of the number that turned out in the years prior to the coronavirus pandemic, and organizers are not yet certain what to predict for future events.

“We used to see 100 to 125 patients,” said Dr. Jasper Lewis, a pediatric dentist whose practice, Eastern Orthodontics and Pediatric Dentistry, has been the host site for the annual event since it started more than two decades ago. “We talked about that when we realized that we weren’t going to have enough children to really have an event like we’ve had. But for the handful that are coming, it’s important.”

Thirteen children treated at the Feb. 2 event received nearly $10,000 worth of free dental care, including four crowns, five extractions, seven fillings and 42 sealants, along with cleanings, fluoride treatments and X-rays. One 7-year-old girl had 12 teeth that needed to be sealed, filled, crowned or pulled.

Cases like that lead Dr. Lee Lewis to conclude that lower Give Kids A Smile numbers in the last two years are not an indication that children do not need the program.

“The real news is not that,” said Lewis, who co-chairs the annual event with Dr. Billy Williams. “We still see the same problems. We see them in our everyday practice. The problems are still there.”

According to the American Academy of Pediatric Dentistry, nearly 1 in 5 children under age 5 is affected by tooth decay. The percentage increases to about half of children ages 6-11 and more than half of those ages 12-19. In addition, AAPD reports children living in poverty are twice as likely to suffer from tooth decay, and their dental issues are more than twice as likely to go untreated as those of children from more affluent families.

Meeting the need

Florence Ileanni, a native of Nigeria, brought her three children, ages 9, 13 and 16, to their first Give Kids A Smile last week. It also was their first dental visit since moving to the area more than a year ago.

“When we were in Raleigh, they’d see a dentist,” Ileanni said. “They’re on Medicaid. But when we moved to Greenville, we don’t know where to go. So since they’ve gotten here, they didn’t see any dentist.”

Dr. Michael D. Webb, chair of the Department of Pediatric Dentistry at East Carolina University’s School of Dental Medicine, said that while Greenville has seen growth in the number of pediatric dentists in recent years, access to care can be more challenging for families of children in many areas of eastern North Carolina.

“Seventy percent of kids are seen by general dentists nationally,” he said. “It’s not like we have enough pediatric dentists in the country to see every child, especially in rural areas. There just aren’t pediatric dentists in rural health areas. We try to do as much as we can.”

Webb sees pediatric patients twice a month in Ahoskie, where one of the ECU dental school’s Community Service Learning Centers is located. Over the last five years, centers in Ahoskie and Elizabeth City have each seen more than 1,000 patients ages 16 and younger, accounting for about half the pediatric patients seen at all eight of the dental school’s CSLCs. The dental school’s Greenville location sees more than 2,500 pediatric patients each year.

“We are packed; all of our schedules are filled,” said Corey Stahley, chief resident of pediatric dentistry. “There’s a little bit of a waitlist to be seen if you’re a new patient.”

Webb said that, in recent years, the dental school has extended its outreach to schools in Bertie and Jones counties. The programs, funded by grants by BlueCross BlueShield of North Carolina Foundation and the Duke Endowment, allow children to be seen on campus during the school day, eliminating the need for parents to have to transport them to the dentist. Participating children receive dental exams, X-rays, cleanings, fluoride applications and sealants, but no restorative care is done in the schools.

Students in Pitt County have had similar access for more than two decades through Smile Safari, a mobile dental unit operated by the Pitt County Health Department. Smile Safari has traditionally traveled to elementary schools during the school year and parked in the summer at the Health Department or local Boys & Girls Clubs, providing care to about 500 qualifying students annually.

Office Manager Heidi Shelton said a new Pitt County Dental Service unit is preparing to go out on the road this year. The $535,000 unit is a replacement for Smile Safari, which has not been used to treat patients since June 2023.

“The Smile Safari that started on the road here in Pitt County in 2001 just needed some upgrades, some repairs,” she said. “It had been on the road for nearly 23 years, so there was some wear and tear on it, so it was time to get a new one.”

The new unit is expected to begin service in late March, and the county is in the process of hiring a new dentist to run it.

Jennifer Pope, one of the coordinators of the local Give Kids A Smile day, said Smile Safari provided the majority of the referrals for the 2023 event. With the unit not seeing patients for the last several months, she said, there were no referrals for this year’s Give Kids A Smile.

Pope said she and co-coordinator Robin Bass reached out to nearly two dozen organizations to promote this year’s event, including schools, health departments, social service agencies, churches and Boys & Girls Clubs.

“I think there are several factors (in low registration numbers),” Pope said. “There are more options now, the dental school and a few more clinics that do take Medicaid. But I do think the need is still there.

“I do think transportation for parents and taking off on a Friday (are issues), and I still think we’re seeing COVID effects,” she said.

Seeking smiles

Even before COVID, Give Kids A Smile had experienced some difficulties in identifying patients for the free service. Participation sharply declined in 2011, after state budget shortfalls caused public health dental hygienist positions to be eliminated in about a dozen counties in the state, including Pitt. Without routine screenings the hygienist provided in schools, many parents were not made aware that their children were experiencing dental problems.

Through some restructuring of the Oral Health Section of the North Carolina Department of Health and Human Services, school screenings have returned. Two hygienists have been assigned to cover a nine-county area that includes Pitt.

“Oral Health Section public health dental hygienists make every effort to screen kindergartners annually in each public school that allows it,” a spokesperson for the Department of Health and Human Services said in a statement. “If we are unable to screen a school in our region annually, effort is made to screen that school at least every one to three years.”

Give Kids A Smile has undergone some changes as well. The local event expanded in 2013 to include additional health services such as blood pressure, height, weight and body mass index measurements, a vaccination history review and health education information.

Partner agencies joining the effort included health specialists from Pitt County Health Department, the James and Connie Maynard Children’s Hospital at ECU Health Medical Center, ECU’s School of Dental Medicine, College of Nursing and Brody School of Medicine.

Pope said event organizers plan to continue to adapt to the changing landscape so that children will still have access to free dental care.

“The things we did in the past aren’t working now,” she said, “so we’re looking at restructuring.”

Pope said organizers have discussed moving the event to a Saturday so that fewer parents would have to miss work to bring their children, or arranging to provide transportation for children who need it.

Stahley, a native of Houston, Texas, said a Give Kids A Smile event he joined while he was a dental student in San Antonio used school buses to deliver students from their school campuses to the dental clinic. Dental students treated 300 to 400 children in a single day.

“It’s a good idea that we put on a day like this where people can come and get any sort of dental care that they need,” he said.

Partner agencies joining the effort included health specialists from Pitt County Health Department, the James and Connie Maynard Children’s Hospital at ECU Health Medical Center, ECU’s School of Dental Medicine, College of Nursing and Brody School of Medicine.

Pope said event organizers plan to continue to adapt to the changing landscape so that children will still have access to free dental care.

“The things we did in the past aren’t working now,” she said, “so we’re looking at restructuring.”

Pope said organizers have discussed moving the event to a Saturday so that fewer parents would have to miss work to bring their children, or arranging to provide transportation for children who need it.

Stahley, a native of Houston, Texas, said a Give Kids A Smile event he joined while he was a dental student in San Antonio used school buses to deliver students from their school campuses to the dental clinic. Dental students treated 300 to 400 children in a single day.

“It’s a good idea that we put on a day like this where people can come and get any sort of dental care that they need,” he said.