School-based dentistry program gives South Carolina families reason to smile

January 15, 2013

Sisters of Charity foundation steps up with financial support


Laura Zapata's four children smile a lot these days. So do her two young nieces, as well as her 8-year-old brother and 12-year-old sister.

The reason behind their smiles is pretty simple: they are all proud of their teeth.

That might not sound like a lot, but in rural Allendale County, S.C., the poorest county in the state and the 10th poorest county in the nation, regular dental care has long been considered a luxury that few are able to afford.

However, that changed for thousands of school-age children when the Columbia, S.C.-based Sisters of Charity Foundation of South Carolina and the Charlotte, N.C.-based Duke Endowment donated a combined $650,000 to open and begin operating a school-based dental center in Allendale County in 2001, a second one in Dillon County in 2003 and two more in Clarendon County in 2004. Each of these South Carolina counties has poverty rates at critical levels — at least 50 percent above the state average. A majority of the children receive Medicaid and qualify for free or reduced-price lunches.

"Many of these children would not see a dentist at all if one wasn't available through this program," explained Georgia Famuliner, a registered nurse and operations director for all of the "Smiles for a Lifetime" dental centers. "Many dentists don't accept Medicaid, and transportation is often an issue for these kids to reach a dentist in the state who will accept Medicaid."

Easy access
During the 2011-2012 school year, a total of 3,288 children were served by the four Smiles for a Lifetime centers. Famuliner says one of the reasons the program has been so successful is because it employs a driver at each location who picks children up from school during school hours, takes them to the centers that are located at other schools, and brings them back when they are finished.

The parents sign consent forms at the beginning of the school year to enroll their children in the dental program, but they are not required to attend the pediatric dental visits. "They can come, but it's not mandatory," said Famuliner. "We do call parents the day before to let them know their child has an appointment. If we find they have cavities that need filling, or they have other dental issues, we will let the parents know."

Zapata, 38, a single mother who speaks fluent Spanish and occasionally works as a translator, loves the convenience of the dental center. "I don't have to hunt around for a dentist and take them here and there," she said, explaining that her children are insured through Medicaid. "Before we had Allendale Smiles, I had to drive an hour to Aiken to a pediatric dentist and truthfully, the kids didn't like that dentist. Now, they don't complain at all, and it's so easy because someone drives them to and from their appointments."

Brushing-up on oral health
Dr. Ron Banik, a dentist from Charleston, S.C., drives 90 minutes in each direction to work at Allendale Smiles every other Monday. He's been doing this for the past decade.

"Since I started coming, I've seen some kids who have had catastrophic tooth decay. The worst of the worst has been 7- and 8-year-olds whose permanent molars in the back were completely rotted out," said Banik. "Too many have lost permanent teeth way before their time. I've also seen a lot of baby teeth issues and had to take them out prematurely because of decay."

Thankfully, though, the situation is improving. Both Famuliner and Banik said that they have been seeing the same kids for 10, 11 years — or at least several years in succession — so they've been able to work consistently with these children and educate them about good oral health.

"When we first started in 2001, we screened the entire Allendale School District of 1,976 kids, and 76 percent of them had cavities," said Famuliner, adding that oral decay is the number one chronic infectious disease among children in the United States. "It took us about five years to play catch up and get them all filled and teach them how to brush and floss properly.

Nowadays, we don't see the volume of decay and cavities we had seen in the past because we have been able to educate them and focus on prevention."

That education extends to the classroom. Famuliner visits elementary classrooms during February — National Children's Dental Health Month — to discuss nutrition and the importance of good dental hygiene with students in each of the school districts Smiles for a Lifetime serves.

Ongoing commitment
"Oral health continues to be a serious and chronic problem of epidemic proportion in many poor and rural communities throughout South Carolina. By providing these clinics and bringing dentists into these areas, we're able to not only treat current oral health problems but also focus on preventive care," said Tom Keith, president of the Sisters of Charity Foundation of South Carolina, which is a ministry of the Sisters of Charity Health System and is committed to helping the poor and underserved in all 46 South Carolina counties.

"The Smiles for a Lifetime dental clinics have made a positive difference in these communities and the lives of the children they serve," Keith added. "This model works."

Three of the four dental centers stay open five days a week throughout the school year. The other one, located in Summerton in Clarendon County, is open only one day a week because the school district there is very small. The clinics are not open during the summer, when school is closed.

About 15 dentists who now participate in the program come from all over the state to staff the centers, getting paid a nominal fee as well as gas mileage. Some work at multiple centers, others at just one. Regardless, they try to come the same day or days each week, or every other week, so that they can build a rapport with the students over time as well as become familiar with their dental history.

On the Mondays he works, Banik said he typically sees 18 to 22 students. "Usually, when I work on a child who has cavities, I work in quadrants," he said. "I'll get them numb and then do the entire lower right side jaw, or whatever needs to be done. That way if they have multiple cavities, I can do several at once. Though if they're little kids," he added, "their attention span goes quick, so I try to go as quickly as I can. I've been at this for a while, so I'm pretty fast."

Famuliner explained the program initially got started because Inez Tenenbaum, former South Carolina superintendent of education, saw the need for children in Allendale County to have dental services. She asked Welvista, a nonprofit that provides prescription medications for the uninsured and underinsured in South Carolina, to spearhead the management of a Smiles for a Lifetime pediatric dental center in Allendale, which later spread to the other counties.

Day-to-day expenses for the four centers are paid through Medicaid reimbursement since most of the children receive those benefits or are eligible. But with escalating costs of overhead, paying a staff of roughly 20 technicians and support personnel, and 15 dentists, and buying supplies, Famuliner said she must find new sources of operating revenue.

So crucial is the need that in 2011, the Sisters of Charity Foundation of South Carolina gave the dental centers two awards — $50,000 in March and an additional $120,000 in September — for ongoing support.

"The Sisters of Charity Foundation really stepped up to the plate," said Famuliner. "They've been a continuous force behind us in every center we've opened."


Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.