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In Oregon, Healthy Smiles and Lifelong Care Start in Schools

Tom Holt is working with Oregon’s school systems to bring oral health care to children who otherwise may never see a dentist.

Hygienists and dental assistants treat students in Oregon’s public schools as part of a statewide initiative to increase oral health outcomes starting in kindergarten.

Tom Holt has worked on health policy in Oregon wearing various hats for more than 20 years, but his first foray into oral health started only recently. Last year, Oregon Community Foundation (OCF) hired Holt as a consultant to improve dental health initiatives statewide, and that meant interviewing stakeholders across various sectors to get a better understanding of the community’s dental health needs. As OCF states, “Oregon has one of the country’s highest rates of childhood dental disease, which is the most common chronic disease affecting U.S. children.” Holt views that focus — on school-based dental screenings and services — as a real chance to improve public health outcomes for every individual in Oregon. Because, as he sees it, it all starts with a child’s healthy teeth.

What’s the policy work you’ve done with the Oregon Community Foundation?

OCF reached out in 2019 for help with solidifying the state’s school-based oral health screening and sealant programs. At the time, they would go into schools — mostly ones with a high percentage of free and reduced lunch — and offer basic oral health screenings, and kids who are eligible get fluoride or sealants. Oregon certifies these programs and provides a baseline technical standard. The encounters are indirectly funded by Medicaid and delivered through various channels — sometimes dental service organizations, sometimes local nonprofits, sometimes communities of dentists who get together. Metrics are set and, as you’d expect in any managed care setup, there are financial rewards for hitting those metrics. This has of course all shifted after COVID-19. 

Since the vast majority of schools will be remote-only until at least January 2021, school-based programs are trying to reach kids in other ways, like drive-through oral health screenings during computer and school supply pickups, free home health kits, and the deployment of mobile dental vans to reach families wherever they are.

What is the greatest impact for kids in Oregon’s schools?

It's an extremely high-leverage opportunity from the start. If a child has dental pain, they're not going to study very well or pay attention. If that pain becomes a bigger problem, they're going to miss school — attendance is a key metric — and then their mom or dad or guardian is going to miss work to get them to a dentist. And if they're not successful in school, well, that has all sorts of social and economic impacts. Keeping kids’ mouths healthy is essential when it comes to overall public health: They do better in school, they have a better shot of furthering their education, whether that’s pursuing a trade or going to college, and they get better jobs. A young person who has poor oral health is going to be at a real disadvantage from the start. 

What did you hear when you interviewed the community about their oral health needs?

I spent six months speaking to people all over the state who walked me through the barriers around dental care and one early conversation had a big impact. The superintendent of the McMinnville School District, which is a small, diverse city on the outer edges of Portland suburbia, told me, “I want sealant programs in my schools because at graduation time I personally shake the hand of every high school graduate and hand them they’re diploma. And I’m sick and tired of seeing kids with bad teeth.” It crystallized for me the long-term goal. If we see these kids in sealant programs between kindergarten and second grade, then again in middle school — by the time that child walks across a graduation stage, they’re going to have good teeth. Then they’ll go on to have good health and a better shot at success.

Read more stories about Preventists changing their communities and learn more about the future of oral health at Preventistry.org.