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A FOUNDATION-SUPPORTED PROJECT…

South along El Camino Real:
Amigos de Los Californios Mobile Clinic

Every story needs a beginning in time to anchor from whence it begins to where it goes. And this story starts in about 1697 when Jesuit missionaries, soldiers of Spain, and Spanish settlers began their trek to open up their part of the New World, starting at their first successful Mission in Baja California at Loretto. In the succeeding years, these missions became so successful that the Jesuits, Franciscans, and Dominicans began a chain of some 51 missions along California from the tip of Baja to Yerba Buena, Alta California (now San Francisco). Each was connected to the other by a road called El Camino Real—the Road of the King.

Along this road the swallows would come back to San Juan Capistrano on St. Joseph’s Day every year. And some of those mission villages became cities, and towns, or were covered with dust. A California photographer was following the King’s Road in 1995, south into the volcanic mountains of Baja California, south of the border, to record the lesser known and the deteriorating missions when he was approached by a goat herder for some relief from a seriously infected tooth. One thing led to another and the next year, Dr. Roger Kingston of San Diego ventured into the unknown world of Baja California with primitive dental equipment, eight highly charged dental volunteers, to the tip of the peninsula where no dentist had been before. The Californios, descendents of the original settlers, came from small ranchos nestled in the mountains. One family of four generations there traveled eight hours by mule to attend the clinic—bringing Valencia Oranges planted by the original missionaries.

Dr. Roger S. Kingston, an Oral and Maxillofacial Surgeon, organized the first trip in 1996 and has returned ever since to service these poor but friendly natives. Each year, his group grew and their dental equipment needs did as well. Having exhausted his many charitable contacts, International Trustee Charles Eller and other PFA Fellows from our Southern California Section suggested that Dr. Kingston apply for a PFA Foundation grant simply to purchase folding dental chairs to replace the beach chairs they were using for patients, doctors, and assistants along with a halogen light for a four-operatory, portable mobile dental clinic used in providing dental needs in the Sierra de San Francisco Baja California Sur area of Mexico below California. This was on their tenth trip these volunteers had planned to make into Baja California. And in those 10 years, their volunteers had grown from eight, including three dentists, in 1996, to 24 with two general dentists, one pediatric specialist, one oral surgeon, three dental lab technicians, two physicians, an optometrist, and 14 support personnel. Volunteers came from both the United States and from Mexico, mostly from San Diego and from Tijuana.

The mission had expanded from a three-day clinic in one village to a five-day clinic in each of two villages. In that time, the number of people served had grown from some 80 to over 250, with all the volunteers putting in 10-hour days in very primitive conditions. This pace placed a great deal of stress on the volunteers and on the equipment. The travel time to get to these villages is two days driving each way with two days rest and doing laundry between villages for a total of 16 days away from their offices and living comfort. But playing with the whales in San Ignacio Lagoon, visiting the Missions at San Borja and at San Ignacio, and the wondering awe of 5000-year-old cave murals are experiences of a lifetime, never to be forgotten as well.

Once the project was expanded to two weeks, it was determined that part of the exhaustion problem was due to the poor positioning and low comfort of the folding chairs, certainly for the dentists and the assistants. It was an ergonomic thing.

John Hayes of Hayes Handpiece Repair Company donated a four-operatory, portable dental unit with each of the units having high and low speed hand pieces with fiberoptic lighting and high and low volume suction units.

Three halogen surgical headlights were donated from the Rotary Club of Del Mar (California). And St. Leo’s Dental Clinic of Solana Beach (California) loaned the project an autoclave, ultrasonic tooth cleaning units, composite curing lights, and trays of hand instruments. Torrey Pines Oral Surgery of San Diego loaned an autoclave and several trays of surgical instruments.

But it was discovered that due to the prolonged activity of the volunteers and their pushing themselves to do the most for their indigent patients, proper portable ergonomically designed folding chairs for four patients, four assistants, and four dentists were required. While the idea of a few chairs seems such a small a thing, Dr. Kingston reports that their volunteer dentists and assistants were able to work longer hours, see more patients, have less personal stress, and provide greater quantity and better quality of dental care in these remote mountain villages.

The mobile dental lab

With no ready access to those items, the Foundation funded these purchases and another halogen operating light. The group decided to test out these new chairs on a weekend trial run at a Mexican Indian reservation, and then on a two-week clinic in southern Baja California. The chairs worked very well and the volunteers improved in their ability to provide quality dental care.

Three years earlier, the project introduced plastic tooth replacement prostheses on a limited basis. Each year, the demand for these removable partial dentures increased. With the remaining funds from the Foundation grant, they were able to purchase a lathe, a light, a pressure pot, acrylic, and teeth for this growing portable dental lab project.

The 2005 clinic was held 2-16 April in the villages of Santa Marta and San Francisco de la Sierra in Baja California. In addition to their regular patients, word has grown and many new patients make their way some distances to get their dental needs served—a dental pilgrimage as important to them as any saint’s feast day celebration. Yet, we here are but a phone call away and fail to make that call.

The project has also started occasional weekend trips to Indian Reservations in the northern part of Baja California. Actually, the project had been designed to serve those needs when in 2003 there was an administrative change in the Indian Welfare Agency. Undaunted, the project’s volunteers reached out to the dental needs elsewhere in Baja California.

All the equipment is cleaned and stored safely in a locked storage unit to insure security and the functionality of this equipment. To us, they are just lights and drills. But to the people they serve, these are the Treasures of Amigos de Los California.

Our PFA banner is hung in each of the dental clinics to acknowledge the Foundation’s support. Dr. Kingston also wished to thank our International Trustee Charles Eller for all his help in the continued success of this project. Dr. Eller has made a slide show to illustrate the benefits this single project provides year after year. But the best summation of this professional to people project was made by Dr. Kingston in an article that appeared in the ACD Journal: “Organizing mobile clinics like these and taking two weeks at a time out of private dental practices may seem like quite a sacrifice, but I have learned that the friendships we have developed and the health care we have delivered in an atmosphere of mutual respect is worth far more than taxable income.”

A FOUNDATION-SUPPORTED PROJECT…

The Student-run Free Dental Clinic Project
by Dr. Irwin B. Silverstein and Brock Lorenz

The grant from the PFA Foundation has aided us much in continuing to operate and grow.

You may learn more at our Web site at http://acs.ucsd.edu/ucsdfdc/

Many cities across America do not have dental schools, but most of them have colleges and universities, a contingency of dental professionals, and an underserved dental population. These three components can be successfully merged to create much the same program for their areas. Many organizations have taken note of the success of our project, including the ADA, which has awarded several of our faculty leaders the prestigious Access to Dental Care Award. The ADA Foundation, the California Dental Association Foundation, the San Diego County Dental Health Foundation, and the Pierre Fauchard Academy Foundation have seen fit to recognize our success by providing funds. For this we thank them all.

This project has generated success in our community, and it can do the same for other communities. The first step would be to view our Web site, then contact me for how you can begin such a program in your area. You will be amazed at the response and the value of self-worth you get from serving those who so terribly need your help.

A FOUNDATION-SUPPORTED PROJECT…

Generations Family Health Center (GFHC)

Dr. Margaret Ann Smith has written a report on GFHC that was published in the Winter 2005 issue of the newsletter Oral Health Matters for the Connecticut Department of Public Health, Office of Oral Public Health entitled “Smiles for the Quiet Corner.” She notes that GFHC is the only community health center in Windham County, Connecticut. The PFA Foundation grant was an investment in a program to partner community dentists and hygienists to provide dental treatment to underserved children and their parents in the professional volunteers’ own private offices at no cost.

A pilot program began in Autumn of 2003 between GFHC and several dentists in Windham County who were alarmed by the disease prevalence in their communities. The DMF rate was 35% to 40% with additional long-term serious implications from the untreated dental disease for the children’s overall health. The plan was to address the significant oral health needs in northeastern Connecticut called “the Quiet Corner.”

The first goal of their grant was to provide access to dental care to some 200 underserved children and their families. Using the success of their pilot program, GFHC has partnered private practitioners to provide some 120 dental visits and close to 400 treatment procedures at no cost during last year. The original intention was to refer patients during a donated session for short visits where one or two procedures would be provided. But the dentists and hygienists preferred to provide as much dentistry as was comfortable for the patient during the one visit. This resulted in ore treatment being provided during longer visits.

Volunteers also preferred to accept one child at a time for comprehensive treatment, instead of periodically donating a block of time.

The Foundation grant of $5000 was to encourage the development of a partnership between the private dental providers and the not-for-profit community health center to address the significant access barriers the medically underserved (Medicaid and uninsured) patients face in their attempts to seek oral health care. As a community health center, the capacity of the Generations Willimantic Dental Clinic to provide comprehensive oral health care to all medically underserved is limited, given the high poverty and low socioeconomic status in this distressed area. Often, lateral referrals to private dentists were necessary to handle the overload or specialty care. GFHC would identify these patients in need and schedule them into private dental offices in their community coordinating the paperwork.

Thus, the clinic has sought to expand the network of services available to their patients through innovative partnerships.

So the initial goal of per patient visits was lower, but the number of procedures provided was greater. The final result was fewer patients received more treatment. The Generations Willimantic Clinic has a waiting list of some 550 patients, 25% of them children, so “follow-up” visits were difficult. Thus, the dental volunteers providing comprehensive treatment was in the best interests of the patients. In addition, the volunteers willingly provided more complex procedures, like root canals, extractions, and space maintainers, when indicated.

The second goal of the grant was to partner with at least three local dentists to provide the necessary space for preventive and restorative care for children and their families, and to provide at least seven “Smiles for the Quiet Corner” sessions to the target population. Six dentists and two hygienists volunteered their time to provide 12 separate “Smiles for the Quiet Corner” sessions. Volunteering were Drs. Jeniffer Bear of Hebron, Walter McGinn of Putnam, Jeff Simpson of Putnam, Jack Mooney of Putnam, Bernice Szafarek and her hygienist of Columbia, Gary Weller and his hygienist of Putnam, and Jamie Roach-Decker of Colchester. Drs. Michael Goodman and Ron Albert, both pediatric dentists, have provided treatment for three children in the hospital.

The third goal was to eliminate transportation, cultural, and language barriers to oral health care by providing a coordination of services. The GFHC’s receptionist would ask about these matters and, with the help of a GFHC Health Support Worker, would address the identified need to aid the family in keeping their appointments.

Nurturing Families, a part of the Generations Family Health Center, coordinated patient visits from the Windham Hospital prenatal clinic to several of the volunteer offices by arranging transportation and interpreters. The relationship between periodontal disease in mothers and preterm births make it essential that pregnant women have access to oral health care.

The fourth goal was to educate parents and care givers on the importance of regular oral health care. All patients were given oral hygiene instructions, a toothbrush, floss, and educational pamphlets.

Thus, the grant went to offset the costs for logistical and care coordination, for dental supplies and materials, for oral hygiene pamphlets, for transportation vouchers, and for medical record supplies. By coordinating the patient referrals so effectively, as one example of its success, the “no-show” rate was only 10% among the referred patients compared with 30% for the clinic. This value alone insured that appointments made to private dental volunteers were not a waste of their office time and staff.

Certainly, this program will not close the gap in needed care, but it is making a significant difference in the lives of the patients it reaches. Small incremental steps over time by committed individuals bring significant change, which may result in broader reforms in the health care system. Community health centers need to be integrated into the greater dental community, which has a vested interest in the health of their neighborhoods, and understand the consequences that result without such services.

As a result of this project, focus has brought legislative attention on the area’s health care needs. And several of the volunteer dentists are in the process of being credentialed to work in the GFHC clinic.

A FOUNDATION-SUPPORTED PROJECT…

The Thousand Smiles Foundation
by James P. Vernetti

The Thousand Smiles Foundation officers and members are deeply indebted to the PFA Foundation Board members for their ongoing financial assistance to this most worthy humanitarian project. Over the years, we have restored not only several thousand smiles, but in addition, tens of thousands carious lesions, hundreds of orthodontic procedures, and an equal number of audiological needs.

The magnitude of this project is difficult to explain adequately by the written word.

Those of us who are deeply involved in the actual operations obtain our rewards from seeing the patients’ parents shed actual tears of joy, especially when they see their child’s face restored to a normal stature. On the dental mouth operations, the relief from pain and restored tooth aesthetics brings equal appreciation.

A FOUNDATION-SUPPORTED PROJECT…

The Children’s Dental Center

This clinic in Inglewood, California, located in the Los Angeles area, is run by Dr. Cherilyn Sheets, who addressed the PFA California, Southern Section‘s annual Luncheon on the progress of its activities upon receiving a $10,000 grant from the Foundation. The clinic has increased access to oral health care, with treatment services and prevention education for the dentally uninsured children from an economically depressed area. With estimates of some half a million children in Los Angeles County without any dental coverage, the magnitude of the need is daunting unless we confront the problem one child at a time. And that is the same for undertaking any huge task—one step at a time.

During the first nine months of the grant year, the Foundation funds supported 20 uninsured children for 66 visits to reach a level of covering their entire basic dental needs.

On the first visit, the children start at the Shannon Kelly Tooth Fairy Cottage with oral hygiene instructions and a review of their nutrition. These visits were not a one-shot episode. They were repeated until the child understood what was being explained. Thus, over 90% of the children have improved their brushing and flossing to demonstrate a reduction in plaque.

During this process, a majority of the parents and siblings of the scheduled patient were present and participated in the prevention education process.

Dr. Sheets notes, “Even though our children have a lot of cavities because they could not be taken to a dentist when they were small, they now enjoy coming here. The dental assistants sing when the children get nervous and that makes them both feel better. There is no other place in the area like the Children’s Dental Center.”