Dimensions Healthcare System

by Nancy Trejos, Washington Post

Needy Students Find More Reasons to Smile

May 12, 2003, WASHINGTON D.C. -- Elena Portillo-Rosales should have been studying accounting at her Prince George's County high school. But on a recent morning, another subject was more urgent.

"How often do you brush your teeth?" Preston Shelton asked as his assistant lined up his instruments on a tray.

"Every day. In the afternoon, in the morning and at night," Elena answered proudly.

The junior at Northwestern High School settled into a dental chair and opened her mouth wide. Shelton, a Baltimore dentist, hovered above her. With a metal pick, he probed for cavities and tooth decay. Finding nothing, he cleaned her teeth and sent her off with a free toothbrush and dental floss.

Until her recent checkup, Elena, 16, had been reluctant to see a dentist. Two years ago, shortly after her family arrived in Hyattsville from El Salvador, she developed a toothache but endured the pain because her mother is paid only $100 a week baby-sitting and doesn't have health insurance. The family ultimately had to borrow money to pay for a dentist. "They checked my teeth -- that was $600," Elena recalled.

Once a month, Shelton sets up shop at Northwestern's health care center to offer something not traditionally not found in public schools: free dental care.

More and more schools across the nation are providing this service to such students as Elena, who would otherwise have a hard time paying for it. And for many teenagers who have recently come here from impoverished nations, having the perfect smile is seen as a way to assimilate into a country where many adolescents sport expensive braces.

"Dental care is sometimes not high on the list of priorities in war-torn countries," said Patricia Papa, an administrative nurse practitioner for the Prince George's school system. "Dental care is really expensive, and it's not a high priority to people who live in poverty and don't have money to eat."

For Elena, looking good is important: "I love my teeth. I know they're not perfect, but I love them."

To school principals, the issue is more than cosmetic. More than 51 million instructional hours are lost each year because of dental-related illnesses, and nearly 80 percent of 17-year-olds have experienced tooth decay, according to the U.S. Department of Health and Human Services.

It doesn't help that the proliferation of revenue-generating vending machines on high school campuses has given many high school students easy access to sugary soft drinks and candy, some health care professionals say.

"We feel that it's important to make sure we do everything we can to prepare students for learning, and having healthy students certainly would be primary in doing that," said Michele Freeman, principal of Sterling Elementary in Loudoun County, where an orthodontist screens students yearly for dental problems.

Several schools in the Washington region have dentists who visit regularly or at least once a year. Shelton, for example, also visits Fairmont Heights and Oxon Hill high schools in Prince George's one day each month.

In other parts of the country, educators have found other ways to tackle the problem. Schools in Washington Heights, N.Y., which has a large Dominican population, and New Haven, Conn., have created full-fledged dental clinics, said Burton Edelstein, a local spokesman for the American Academy of Pediatric Dentistry.

"This is a little bit of a twist on taking care of children," Freeman said.

It's a twist that leads to a philosophical debate: Are schools in the business of teaching or healing?

The answer, to some, is simple. "You want to make the learning environment as easygoing as possible, as comfortable as possible," said John Jones, an orthodontist who volunteers at five Loudoun schools, including Sterling. "It's hard to learn how to conjugate a verb if you have an abscess going on."

But this kind of holistic schooling can be costly, and cash-strapped school districts have a hard time financing it on their own. At Northwestern, the equipment costs about $10,000. The salaries for Shelton and his staff to serve the three Prince George's schools adds up to about $44,000 a year, Papa said.

The money comes from a Maryland State Department of Education grant, and with the state facing tight budget times, school officials worry about the dental program's future.

In Montgomery, schools with health care clinics screen students for dental problems and in some cases refer them to a community clinic, where immigrants who don't have dental insurance can get free services. "Most of the time, these kids come with a lot of health needs," said Ladys Lux, a nurse with Linkages to Learning, a program run by the school system, the county health department and private companies.

Lux, a native of Ecuador, screens students at Silver Spring's Broad Acres Elementary School, which has a large concentration of Latino students. "In my country," she said, "you don't go to the dentist unless you have a really bad toothache, and that's too late."

At Northwestern High, there's no question about the need for dental services, school officials and parents say. About 61 percent of the school's 2,585 students are on the free or reduced-price lunch program, a key indicator of poverty. Students represent 67 countries, Principal William Ritter said.

"For us who don't have the money to pay for it, it's a big help," Sandra Rosales, Elena's mother, said in Spanish.

The school's health care clinic, run by the nonprofit Dimensions Healthcare System, offers a range of medical assistance to any student. But Shelton's visits are so popular that there's a six-month waiting list, Papa said.

"We try to help them as much as we can," Shelton said. "Hopefully, we can at least help them get started."

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