On the Road 10 Years, Dental Van Helps 7,000 Children

BUFFALO, N.Y. -- Nine–year-old Kalishia Swager slides into the dental chair in the 39-foot mobile dental clinic parked outside Ripley Central School. Today, she will have two cavities filled. Without this traveling dental office, no one would care for her dental health.

Kalishia is one of the 7,000 children in Chautauqua County who have logged 20,000 treatment visits in the UB School of Dental Medicine's traveling dental van since it took to the Southern Tier's roads 10 years ago.

Despite its beauty and pockets of prosperity, Chautauqua is a poor county. Census data from 2000 shows a median family income of $33,000-$10,000 less than the median for the state. Nearly 10 percent of families live below the poverty line and one-quarter of those have children less than 5 years of age.

The county is primarily rural, dotted with small towns where dentists are scarce. There are no dentists in Ripley, a community of 2,711 that hugs the Lake Erie shoreline at the Pennsylvania border. UB dentists accept Medicaid and Child Health Plus, also a rarity.

"Am I going to have a shot in the gums, like last time or something else?" Kalishia asks Michael L. Phillips, a 1995 graduate of the UB dental school and one of four pediatric dentists who rotate through the clinic.

Assuring her she won't, "Dr. Mike," as he is known to his young patients, tips the chair backward, takes up his instruments and begins a patter of joking and chit-chat with Kalishia and Dina Hagen, his dental hygienist, which kept his patient giggling while he filled the fourth-grader's cavities.

Kalishia's mother, Leigh Swager, brings her two daughters, plus the dozen or so children she watches in her home, to the clinic whenever it comes to town. "I don't have dental insurance," she says. "I'm self-employed. This is very worth it. They are very good with the kids."

The mobile dental van is the brainchild of Louis J. Goldberg, dean of the UB dental school from 1993-2000 and now a professor of oral diagnostic sciences, and Paul Creighton, clinical associate professor and assistant dean in the Department of Community Dentistry. Expanding public service was one of Goldberg's primary goals for the school. Since Chautauqua County has the largest number of medically underserved persons in rural Western New York, it became his focus.

The Gebbie Foundation of Jamestown provided a $160,000 grant in 1995 to purchase the van. Clinic dentists treated their first patients in October 1996. Initially, there were skeptics, says Creighton. Community leaders wanted to know why the "big Buffalo university" was interested in them. Now, the UB dental van is part of the fabric of the community.

"If we don't show up for some reason, if the van breaks down or the weather is really bad, or the dentist can't get there, we hear about it," says Creighton, who has overall responsibility for the mobile clinic.

The clinic takes up temporary residence at 12 schools throughout the county during the calendar year. Four are in Jamestown, the county's largest city with a population of 139,000, and two are in Dunkirk, population 13,000. The remaining schools are in the towns of Ripley, Clymer, Brocton, Cassadaga, Westfield and Sherman.

The van stays at each school for two-to-four weeks during the academic year, except for two weeks at the end of the school year when the clinic moves to Connections North, a community center in Dunkirk. From late June through early September, it takes up residence at the Joint Neighborhood Project in Jamestown.

During the school year, mornings and early afternoons are reserved for children at the school. "We schedule 12 to 14 children per day, but not all show up," says Hagen. The remaining time, up to 4 p.m., is available for students from the surrounding area who need care. School nurses have spread the word, identified children especially in need of dental care, and even made children's appointments.

"Without school nurses, we would be absolutely 'cooked,'" says Creighton. In turn, the nurses appreciate the care the clinic provides to the district's children. "This is a godsend," says Eileen Skahill, Ripley's school nurse, "an absolute godsend."

Elizabeth, Swager's 7-year-old daughter, follows her sister into the dental chair. She has five cavities, but only one will be filled today. "We do as much as we can each session because the child might not come back," says Creighton. "But we don't push it. We balance the need against having them feel like 'victims.'"

Most of the dental work involves standard care -- fillings, extractions, cleanings and applying sealants. "The treatment is somewhat provider-specific," says Creighton. "Some dentists are willing to do more extensive work in the mobile clinic than others. We don't use sedation in the van, so any dental work involving an outpatient surgical procedure is referred to the pediatric dentistry department at Women and Children's Hospital. It doesn't matter where, as long as we get the patients cared for."

Sometimes the need is profound. "I saw a child who needed to have 20 of 20 teeth restored (the dentist's term for filling a cavity)," says Creighton. "Another child had 12 teeth that needed to be restored."

Creighton blames such extensive damage on a diet of high-carbohydrate, high-sugar food and the popularity of "retentive-type candies," such as Gummi Bears or Fruit Roll-Ups that cling to the teeth and gums, coupled with a lack of knowledge about the problems caused by dental disease.

James Wakeman, elementary principal at Ripley Central School for 16 years, says the clinic provides a vital service, but he would like to see more of his students take advantage of it. "Fifty to 60 percent of our children qualify for free or reduced lunches," he said. "I know the need is there. Having the clinic come to the school eliminates the barriers of cost and transportation.

"Still, many parents will not make appointments for their children, so we make the appointments," Wakeman says. "We push them. We hope that once they go to a dentist, it will lower their resistance."

Creighton notes that despite these efforts and despite providing dental care free-of-charge in the neediest of cases, the clinic reaches only 33 percent of eligible children. Parental resistance is one barrier. Another is the size of the clinic itself, he says.

"We can deliver care to about 3,000 children a year by virtue of the van's capacity. In the future, we hope to replace the current van with a larger one with four dental chairs. We are also thinking that we might not need to be in so many schools. Maybe if we could set up in a few central locations, we might be able to serve more people."

Also staffing the dental van are Thy Bui; Barbara Moore Krull, a 1995 graduate of the UB dental school; and Kedar S. Lele, UB clinical instructor of pediatric and community dentistry and a 1998 UB dental school graduate.