A head start in public health
By Kristen Zapata
As Reiss Nguyen smiled down at her pint-sized patient, she couldn’t help but relate to the apprehension and uncertainty looking back at her. Nguyen, then a first-year dental hygiene student, was confident in her purpose and training, yet the child sitting in her dental chair would be her first patient, and likely, she would be his first dental provider.
She understood what was at stake in providing a positive first impression and a comforting experience: his trust. Knowing she and her fellow hygiene students would be seeing more than 200 children that morning, she set her nervousness
aside and got to work.
Nguyen’s patient cried and didn’t want to receive the fluoride varnish that would help prevent future tooth decay. All she needed was five seconds to apply the varnish, or as she described it to him, “painting on vitamins to get rid of the sugar bugs.”
Those five seconds would be important though, so she wouldn’t rush him.
Breaking down walls
Nguyen’s experience last fall was courtesy of a required rotation with the San Antonio Metropolitan Health District’s (Metro Health) Oral Health Program, which provides support to the City of San Antonio Head Start program. The rotation, built into all School of Dentistry students’ first-year curriculum, offers the chance to provide dental evaluations and fluoride varnish treatments to children enrolled in Head Start, a program funded by the U.S. Department of Health and Human Services.
Laura Hernandez, BS, RDH, oral health senior management coordinator for Metro Health, knows exactly how Nguyen felt when she began her rotation. Hernandez, a class of 2010 alumna of the dental hygiene program, participated in the community rotation during her clinical training and credits the experience with igniting her passion for public health.
As a dental assistant in private practice prior to earning her dental hygiene degree, exposure to a new patient pool was enlightening.
“In that previous setting, we had to be focused on the business — the more patients the more revenue. When I was able to do my rotation in school, it opened my eyes to the public sector of dentistry and it filled my heart. I chose public health because I wanted to be able to help those who might not be able to get the help themselves.”
Today, Hernandez, an adjoint faculty member with the School of Dentistry, works with Metro Health’s Oral Health Program to coordinate dental services for school-aged children and connect families in Bexar County with oral health case managers who pave the way for a child’s access to urgent or routine care. A key part of her work involves identifying and breaking down treatment barriers.
“We help break down those walls one by one to restore a child back to health,” Hernandez said. “Many of the children we see come from low socioeconomic households, or they are migrants and refugees who do not qualify for Medicaid benefits. We receive state funding from the Title V Maternal and Child Health Block grant to partner with UT Health San Antonio. Through these evaluations conducted on behalf of Metro Health’s dentists, we are able to send children to the School of Dentistry’s Pediatric Dentistry Clinic and the Oral and Maxillofacial Surgery Clinic. There, they can receive the care that they need.”
Hernandez also supervises dental and dental hygiene students during their Head Start rotation. She enjoys the teaching moments in which an interesting clinical finding presents itself. Hernandez recognizes those full-circle moments — and prizes them — because of what the rotation cultivated in her.
“I love sharing this experience with the students. They get to see the needs of our community in Bexar County and learn how they can make a difference,” Hernandez added.
And, to use her word, the difference is enormous.
Making a difference, gaining experience
Thanks to the collaboration with the San Antonio Metropolitan Health District’s Oral Health Program, UT Health San Antonio’s dental and dental hygiene students are able to treat over 425 Head Start enrollees on average each year, a service that can be translated into more than a $25,000 value.
“The Head Start program benefits from receiving oral health preventive services,” said Beatriz Hicks, MA, RDH, clinical associate professor of dental hygiene. “More than 6,500 children participate each year just in San Antonio.”
Hicks has collaborated with the program since UT Health San Antonio became a grantee through the Head Start Oral Health Initiative in 2006. She agreed that the benefits of dental students rotating at the early childhood centers gives them firsthand experiences with oral health disparities within their own city.
“Once these students graduate, many will go into general practice and will treat children as young as we see in Head Start — from 3 to 5 years old,” Hicks said. “They are able to experience patients who do not want to cooperate and they learn behavior management techniques to make their patients feel safe. Students also have the opportunity to conduct a basic screening survey on a child, see all the baby teeth and determine their risk for early childhood decay.”
As for Nguyen, determined to make the most of her opportunity, she tried a new approach with her hesitant patient.
“I gave him a Spider-Man sticker,” she said. “I asked him how he thought Spider-Man was strong enough to fight the bad guys. He said, ‘He fights them with his web.’ So, I told him ‘And, he brushes twice a day!’ He laughed and began to trust me. On his own, he gave me the five seconds I needed to apply the varnish.”
Now in her senior year of training, Nguyen — who never had considered a career in public health or with pediatric patients before her Head Start experience — looks forward to having both in her future.
“I’m from San Antonio and this rotation fuels a passion to build relationships in my community and with at-risk populations,” she said.
“Our program at UT Health San Antonio is focused on outreach and helping others, so I feel ready to make that difference.”
The Head Start Oral Health Initiative
In 2006, through a collaborative grant, the U.S. Department of Health and Human Services awarded $300,000 to the Department of Dental Hygiene (then within of the School of Health Professions), Parent/Child Incorporated and the San Antonio Metropolitan Health District to develop and implement a culturally sensitive pediatric practice model.
Kathy V. Guerink, MA, RDH, retired associate professor of dental hygiene, was the grant’s principal investigator who appointed fellow dental hygiene faculty Michelle Landrum, MS, RDH, class of 2003, and Beatriz Hicks, MA, RDH, class of 1986, as program managers. They collaborated with partners including Jennifer M. Bankler, DDS, class of 2003 alumna and former Metro Health dental director; Parent/Child Incorporated Chief Executive Officer Sharon Small, PhD; and Joe Segura, Parent/Child Incorporated’s compliance officer.
A model that works
The collaborators established a model that incorporated preventative services such as dental screenings, yearly fluoride varnish applications and an extensive case management system for Head Start children with urgent dental needs or other oral health concerns.
An oral health instruction program was also constructed for family support workers and Head Start teachers, allowing them to implement those lessons into their work with families or in the classroom. Classrooms were likewise equipped with educational material for teaching the children such as books, toothbrushes and puppets. The initiative also supported awareness campaigns such as National Children’s Dental Health Month.
To date, all programs from the original grant have remained part of the Head Start program that serves thousands of children in Bexar County each year.
Sharing the knowledge
Dental hygiene faculty have promoted the program at the local, state and national levels to generate awareness of the model’s success and consult other Head Start programs interested in implementing similar initiatives. Subsequently, Geurink and Landrum helped to develop the celebrated Dental Hygienist Liaison project, a program in which volunteer dental hygienists from each state promote oral health among children and pregnant women enrolled in Head Start.