‘Many of Them Have Nowhere Else to Go for Oral Health Care’
Chicago dentist Dr. Flavia Lamberghini and her team provide care and education for underserved children in the city
Dr. Flavia Lamberghini was in a Chicago elementary school providing dental screenings to students when she saw one student that concerned her. The boy’s gums were bleeding quite a bit and things “just didn’t seem right.” She helped get him a referral and the diagnosis was immediate: leukemia.
“That kid, not having been seen by a dentist and nobody having ever looked at the gums, they may have missed this condition completely,” Flavia says. “These kids, many of them have nowhere else to go for oral health care.”
Now, a few years later, the boy is doing well. But without that intervention, the disease likely could have gone unnoticed — a story that is all-too-familiar for many children and their families who struggle to access preventive oral care.
Dental providers — like Flavia — and benefits companies — like DentaQuest — help many underserved families find the care they need. DentaQuest now serves more than 30 million members in 30 states, the majority of which are in Medicaid and CHIP programs. It’s a strong, growing network but only because of the individual patients, clinicians and other staff who focus on health and wellbeing every day.
Serving Medicaid Patients
That focus on health and wellbeing — especially for underserved populations — is what motivated Flavia when she founded Apple Dental Care in 2007.
Growing up in Argentina, Flavia’s grandfather was also a dentist, and she says some of her fondest memories are of visiting his office and playing in the dental chairs. She also recalls seeing the impact that dental care can have on a person’s life. So, when she came to the United States to finish her degree and start her own career, there was no question that she would focus on underserved kids.
“I wanted to provide care to those kids who really need it,” Flavia says. “The demand is just so great. You see pain, you see swelling, you see trauma that will not let go. Someone has to take care of these kids. I thought I should open a practice, and that’s when Apple Dental started.”
She began her practice with just two dental chairs and two people. Thirteen years later, despite initial warnings from colleagues that a practice focused almost entirely on Medicaid patients could not be financially viable, Apple Dental Care is thriving, with approximately 80% of the practice’s patients on public aid.
“We are booming with patients. We have grown from 2 people to 42 people,” she says. “I think a big reason for our success is the lack of other places that will take these kids and families.”
The Importance of Community-Based Dental Programs
The gap in access to oral health care, especially among low income and rural populations, is widening. More than 74 million Americans lack access to dental coverage — and that was before the COVID-19 pandemic caused millions of people to lose their jobs.
This takes a particular toll on children. Tooth decay is the most common chronic disease among children nationwide. According to the CDC, about 20% of children ages 5 – 11 have at least one untreated decayed tooth. And children ages 5 – 19 from low-income families are twice as likely to have cavities. Further, a study from PEW Trust emphasizes the disproportionate impact among children grouped as low-income, minority and rural, showing that more than 18 million children considered low-income went without dental care, including routine exams, in 2014, and 1 in 4 did not visit a dentist during a two-year period.
Flavia sees this in her practice daily, as many of the kids coming into her office have not had a dental visit in years and have significant cavities, tooth decay, pain and other complex issues.
Community-based dental programs like the school-based care offered with Chicago Public Schools, as well as programs in churches, after-school programs, and other community settings, provide essential access for these kids. They are extremely effective for increasing preventive care, as well as identifying more serious issues. School-based sealant programs, for example, have been shown to reduce decay by an average of 60% over five years.
Studies also directly link a child's access to oral health with their overall health and wellbeing, including school attendance and academic performance. Now, with COVID-19 forcing these programs to shut down or scale back significantly, a critical line to care for poor students and those who most need it is disappearing, as The New York Times recently reported.
One of the only dental practices in the Chicago area that has remained open throughout the pandemic, Apple Dental Care has seen the impact of this crisis first-hand. The practice’s patient volume in the fall of 2020 was more than double that of fall 2019, and kids are coming in with more severe cavities and pain than usual.
A Focus on Prevention and Integration
While the team at Apple Dental Care works to address the immediate needs of these patients, Flavia also has her eyes on the future and how the team can better treat patients and help solve these systemic problems. To do that, she is focused on prevention and integrated care.
“The preventive side of dentistry is very, very important,” she says. “If we get kids early, we can emphasize prevention and avoid treatment.”
She is also working toward a more integrated care approach and plans to use her recent DentaQuest Health Equity Hero Award to help bring on a social worker and a pediatrician to the Apple Dental team.
“I feel that even though we are providing the services we can, extending ourselves to the community, there is more to be done for these kids,” Flavia says. “As dentists, we know so much, but I truly believe that integrating pediatrics and social workers will make our team stronger and we will be able to provide better services. I think we will all learn from each other and it’s empowering to be working with colleagues and other professionals in an interdisciplinary team.”
As growing research continues to emphasize the connection between oral health and overall health outcomes, Flavia hopes that Apple Dental Care can be a model for medical-dental integration in pediatric dentistry.
“We are taking care of the whole body, and one part cannot be isolated from the rest,” she says, adding these kids have more issues than just dental and this approach will help ensure more holistic treatment.
And, she says, the rewards of serving these children go well beyond the chair.
“The smile from the kid, the hug, a little drawing — I have a desk full of the drawings the kids give to me – those are very rewarding,” Flavia says. “You feel you are making a difference, especially with these kids. We feel that as a team. We feel so proud of what we do.”