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When school closed suddenly in March, Boston students not only lost the daily connection to teachers and learning, but dental services that the city’s most vulnerable children depend on for critical care.
That has left nearly 4,000 Boston public school students without an opportunity to see a dentist or hygienist in school this academic year, practitioners say, a significant concern given the strong correlation between poor oral health and learning loss and the risk of chronic illnesses.
"I’m worried that there’s going to be dental consequences that may not be reversible . . . and that complications with gum disease can lead to lifelong consequences,'' said Farah Faldonie, school nurse at the Josiah Quincy Elementary School in Chinatown, where the Tufts University School of Dental Medicine has a clinic on the third floor.
In recent decades, schools across the city and country have helped establish a public health safety net for the most vulnerable students, partnering with eye doctors, dentists, and physical therapists to provide essential services to students during the school day.
Boston school officials, in a statement, said a limited number of organizations ― such as those providing physical and mental health supports to students ― are allowed inside the schools for now. But other groups, including dental programs, have been asked to find alternative ways to provide services, while the district explores “creative ways to provide in-person services” to students and families.
Poor oral health has a direct connection to learning loss and high risk for chronic illnesses, such as cardiovascular disease, diabetes, and depression, research shows. The most vulnerable are Black, Hispanic, and low-income students who don’t have a family dentist.
If students lose access to dental care, it will only lead to further health and education disparities, said Dr. Myechia Minter-Jordan, chief executive of DentaQuest Partnership for Oral Health Advancement and Catalyst Institute, which operates and supports such in-school dental programs across the country.
"We know that children who are in pain from oral health issues are not able to learn [as well],” said Minter-Jordan. “For many students, going to the dental clinic inside their schools is their first encounter with an oral health specialist, and for others the clinic is their only source of oral health care.”
Roughly 50 percent of children who receive dental care in schools did not see a dentist in the prior year, she added.
But with access to school buildings tightly restricted this fall, dental health practitioners say it may take another year or two before they are allowed to return to the schools.
The temporary halt of in-school dental services has affected children all over the state. Carlos Canelas of Chelsea said he felt assured in the past when a hygienist visited his son’s public school two or three times a year.
"It was better [before the pandemic]; I didn’t have any worries,'' said Canelas, speaking in Spanish, while James, a 10-year-old fifth-grader at Kelly Elementary School in Chelsea, translated.
James has not been to a dentist since school closed, and Canelas said he is unsure where he will get similar dental care. James also shared some of his worries: "Half my body feels like [the school-based dental program] are just never gonna come back and [the other half] is worried that I’m never gonna be back to see a dentist again,'' James said.
Statewide, officials estimate that about 20,000 children participate in school-based dental care in the 2018-2019 academic year, including nearly 6,000 in the SEAL program, according to state public health officials. Individual schools, with coordination from the school nurses' offices, often partnered with independent providers to offer oral health services.
As stated in the response below, the 5,814 figure represents the number of students served by the SEAL program alone – which is only 1 oral health program – not all of the students served by all portable dental programs statewide. We estimate that to be about 20,000. We also said in our response that Boston was already being served by other portable dental programs, which is why it did not participate in the SEAL program.
For now, dentists and hygienists are waiting to be told that it’s safe to come back into the schools, said Mark Doherty Jr., a New Bedford endodontist who runs Commonwealth Mobile Oral Health Service.
Before the pandemic, the mobile service deployed seven teams (each with a dentist and hygienist) to 300 locations across Massachusetts, including Boston public schools, Doherty said. They normally visit a school or community facility twice each year to perform things like X-rays, exams, and restorations, and return for emergency care if needed.
The organization partners with Tufts and Boston University school-based dental programs, which provided preventive care ― the screenings, fluoride treatment, education and referrals for follow-up dental care ― in roughly 60 Boston public schools that mostly serve elementary and middle school students.
“Usually we’re pretty good at thinking outside of the box,'' said Doherty, who’s trying to think up ways to resume in-school dental care. “And over the past seven months, we’ve certainly thought of different ways we could try to provide this service to kids who again are not receiving it. It’s very challenging.”
When schools closed in March, BU’s dentists had seen more than 60 percent of the public schools children they had planned to see that year, said Corinna Culler, director of school-based oral health programs at the Boston University School of Dental Medicine.
That means that “we were not able to serve over 550 children,” Culler said, “therefore, we do not know what types of dental services they may need.”
Faldonie, the school nurse at Josiah Quincy School, expressed concerns, particularly for younger students with development and learning challenges. About three years ago, she said, a boy in kindergarten came into her office holding the side of his face in obvious pain. The boy had delayed learning and could not fully express himself. Faldonie eventually discovered that he had decaying teeth in the back and front of his mouth.
"He was in a lot of pain, and he just couldn’t focus,'' said Faldonie, who sent the boy to Tufts’ school-based dental clinic on the third floor of the school.
With no signs of the pandemic abating, dental health officials have been trying to figure out how to continue their outreach to families and students, but so far it’s been difficult.
This spring, Tufts officials handed out fliers with contact information along with toothpaste and toothbrushes at various food distribution sites across the city, hoping to connect with students about their oral health concerns and assure families that it is safe to visit a dentist.
“I don’t think we got one phone call,” said Kathryn Dolan, director of Tufts Community Dental Program, which also arranged a virtual class on oral health this summer that drew six students.
Seventy-five percent of the students Tufts serve are enrolled in MassHealth and many have special health care needs, including children on the autism spectrum, Dolan said.
“We don’t want to forget about these kids but we are figuring out that our old model just isn’t going to work right now,'' she said. "And it may not work for quite a while.”
On Tuesday, ForsythKids ― a mobile, school-based oral health program that provides preventive care in Lynn, Randolph, Boston, and Cape Cod ― set up a pop-up clinic inside the Boys and Girls Club in Lynn for about three hours, offering cleanings, fluoride treatment, and a visit with the dentist. It was their second visit at the site, and four children ― ages 2 to 11 ― were seen, said Mandy Sadri, one of the program’s managers.
The team aims to get the word out and serve more children. But it’s been tough getting community spaces because of the pandemic.
“Our mission is to provide care for these children,” Sadri said. "The message for these families is that we are still here for them.”
CLARIFICATION: An earlier version of the story said that nearly 6,000 students participated in school-based dental programs statewide in the 2018-2019 school year. But that data, provided by the state, is only for participants in the SEALs oral health program. The state estimates that overall, an estimated 20,000 students received in-school dental care during that period.