As California educators struggle to boost student achievement across economic lines, the teeth of poor children are holding them back.
Hundreds of thousands of low-income children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem.
Increasingly, dental health advocates are looking to schools to help solve the crisis. Several school districts, including Oakland Unified, are running innovative programs to provide dental care at no cost to students. Third-party insurers are billed whenever possible, but insurance is not a prerequisite for treatment.
Meanwhile, a full-service dental clinic opened last year at Peres Elementary School in Richmond's Iron Triangle neighborhood. The clinic offers everything from applying resin sealant to kids' teeth -- a vital preventive measure to stave off cavities and decay -- to fillings and extractions. The West Contra Costa school district hopes to expand the model to other schools.
Dental disease is at "epidemic" levels among California children, according to the U.S. Surgeon General, and low-income children are disproportionately affected. They are 12 times more likely to miss school because of dental problems than children from higher-income families, according to a 2008 report by the Healthy States Initiative, a coalition sponsored by the Council of State Governments to study state health problems.
What's more, students suffering from toothache tend to have lower grade-point averages than students with healthy teeth.
"The issue is huge," said Gordon Jackson, director of the state Department of Education's Coordinated Student Support and Adult Education Division, which oversees health, counseling and other support programs provided at schools. "Tooth decay remains one of the most chronic diseases for children and adolescents. As we're having the conversation about California's future and student academic achievement, we have to have a conversation about oral health as well."
Inside the sleek new student health center at James Madison Middle School in Oakland, dental hygienist Linda G. Cannon has beamed her headlamp into the mouths of hundreds of students from the middle school and nearby Sobrante Park Elementary School.
Two days a week, during the physical education class period or the "sixth period" extra time, students spend about 50 minutes each in the baby-blue dental chair. With the whoosh of the suction tool as a soundtrack, Cannon screens for tooth decay, cleans teeth, applies fluoride varnish, which can help prevent tooth decay, and applies tooth sealant, an effective barrier to cavities, particularly on molars. The clinic doesn't provide fillings or restorative dentistry to fix severe problems.
The Alameda County Public Health Department and The Atlantic Philanthropies, a New York-based private foundation, fund the dental services.
While Cannon said she's starting to see signs of improvement in student dental health since the clinic opened in February 2011, the problem persists. "It sometimes looks like they've never been to the dentist," she said.
Of the more than 400 students screened at James Madison in the past two years, nearly three quarters of elementary school students and just over half of middle school students showed signs of tooth decay, Cannon said.
Out of about 200 school-based health centers in California, James Madison is one of 61 centers that offer dental disease prevention, which means having a dental hygienist who screens and refers students out to full-scale dental clinics. Of these 61 school heath centers, 36 offer full dental treatment services and can provide on-site oral health care to students.
While similar dental care programs operate in other districts, they are still a rarity in the state. Many other districts lack the resources to offer dental care, and still others balk at being asked to provide dental care on top of a rigorous curriculum.
Still, schools have a vested interest in addressing the issue.
Dental problems keep California students out of class an estimated 874,000 days a year, costing schools nearly $30 million in lost attendance based-funding, according to the 2007 California Health Interview Survey, an ongoing statewide survey by the Center for Health Policy Research at UC Los Angeles. The study is still considered the benchmark for children's oral health.
Dental clinics at schools provide an important bridge, advocates say, because it is difficult to find a dentist outside of a school setting that accepts Medi-Cal's dental program, Denti-Cal.
Another barrier is the need for a parent to miss work to take a child to the dentist.
"You've got to bring the services to the children," said Roseann Mulligan, chair of Dental Public Health and Pediatric Dentistry at the Ostrow School of Dentistry and one of the authors of the study about oral health and student achievement.
Data that show the connection between oral health and student achievement will help persuade districts to support school-based dental care, said Maryjane Puffer, executive director of the Los Angeles Trust for Children's Health, a nonprofit founded to serve students in the L.A. Unified district.
"School districts are eager to find a way to help kids stay in school and achieve," she said.
The Bay Area News Group contributed to this report. EdSource Today is the journalism arm of EdSource, a nonprofit, nonpartisan organization founded in 1977 to engage Californians on key education challenges. Read more at www.edsource.org.