Once per semester, Save a Smile patients receive free treatments from hygiene and dental assistant students at the college while professional dentists also volunteer their time at the event.

The patients received treatments including scaling, polishing, X-rays, fluoride treatment and sealants, plus education on taking care of their dental health at home. If patients needed further treatment, they were identified and will receive referrals for services from volunteer dentists.

Save a Smile has more than 86 volunteer dentists who provide children with comprehensive treatment as needed, whether it’s fillings, surgery, root canals, orthodontics, etc.

Tonya K. Fuqua, D.D.S., is the Director of Child Oral Health under the Center for Children’s Health, Children’s Oral Health Coalition and Save a Smile program.

“We’re excited to partner with such an awesome community organization like Tarrant County College Hygiene School,” Dr. Fuqua said. “We’re seeing about 50 kids today that need our help.”

Depending on the severity of the problem, the age of the child, translation requirements and financial/insurance status, a referral is made to the appropriate volunteer dental provider. Dental care is given in the volunteer dentists' private offices, free of charge to the families. Children with CHIP or Medicaid are connected with a Medicaid/CHIP provider selected through their coverage.

“Usually when we contact the families, the first question they ask us is ‘how much money do I have to pay’ and we tell them this is completely free,” said Lourdes Ramos, Community Health Worker. “Volunteer dentists will volunteer their time and work and it’s completely free.”

Media partners may use this content for news stories and broadcasts with credit to Cook Children's.

RELATED:

Save a Smile Provides Life-Changing Dental Work for 3 Girls (checkupnewsroom.com)

A Bright Smile Begins With A Healthy Mindset: The Overlooked Link Between Dental and Mental Health (checkupnewsroom.com)

Kaden was born with a lymphatic malformation, the medical term for an abnormal growth of lymph vessels in his head and neck. His enlarged tongue makes it difficult to get to all the areas a toothbrush should effectively reach. Due to this condition, Kaden’s mother and his nurses use Toothette swabs in conjunction with a squirt bottle to clear out his mouth six times each day.

“We can’t get to his teeth really well because the tongue just kind of fills the whole space,” mom Kimberlee Lee said. “We realized we can’t leave food in his mouth at all, ever. He gets food stuck on the roof of his mouth because he can’t move his tongue around.”

Dental care for Kaden’s sister, Joslynn Lee, also requires a degree of finesse and patience. A rare genetic disorder caused strokes that left 7-year-old Joslynn autistic and developmentally delayed with behaviors more aligned with a 3-year-old child. She bites, squirms and resists whenever it’s time to brush her teeth.

Kimberlee says Joslynn responds better when she can watch her reflection in the mirror. And their routine involves music; Kimberlee sings a special toothbrushing song to both distract and calm her wiggly daughter. Singing also helps Joslynn make a connection to the purpose of the toothbrush.       

February is National Children’s Dental Health Month, an occasion to promote awareness of the importance of oral health to overall health. This includes the best oral care practices at home and while at the dentist office. Routine dentistry can be challenging for many children, and even more so for children like Joslynn and Kaden who face extra medical hurdles.

The various sensations that even a routine dental procedure entails – sounds, tastes, tickly tools and bright lights – can be overwhelming for a child with developmental or mental disorders. Patients with autism might need additional patience and care to mediate the sheer amount of sensory immersion they are experiencing all at once. Or a patient with muscular dystrophy might need specialized tools to keep her mouth open during the treatment. Or a patient with epilepsy might have chipped front teeth because of his seizures.

“Patients who have mental, developmental or physical disabilities have a harder time with communication or have difficulty cooperating for oral health practices at home. This all leads to a higher risk of dental problems,” according to Sheela Patel, D.D.S., a pediatric dentist at the Cook Children’s Renaissance Neighborhood Clinic.

“We often encounter families who put off seeing a dentist because they are fearful their child may not be able to cooperate. But it is very important -- especially for the special needs population -- for children to visit the dentist early on so prevention strategies can be created in order to address oral health issues before they cause pain or even infections,” she added.

Dr. Patel and Shawne Barron, D.D.S., M.S., both practice at the Cook Children’s Renaissance location, the only Cook Children’s neighborhood clinic that offers dentistry services in addition to general pediatric care. Dr. Patel estimates that out of the more than 50 patients treated in the dental clinic each day, typically 20%-30% of those patients have underlying medical conditions or special health care needs. The Lee family makes the drive from their home in Justin for dental services at Cook Children’s Renaissance Dental Clinic in Fort Worth.

The American Academy of Pediatric Dentistry (AAPD) reports that children with special needs tend to run a higher risk for tartar buildup, cavities, gum disease, overcrowding and tooth fractures. The AAPD cites various reasons to explain why these children often face a greater likelihood of oral health problems. Examples of complications include behavioral issues (attention deficit hyperactivity disorder, for instance); intellectual disabilities; and facial birth defects such as cleft lip or cleft palate.

“The more severe their health conditions, the more likely they are to have unmet dental needs,” according to the AAPD.

But the experts at Cook Children’s have some advice regarding strategies to ensure healthy oral care and treatment: Go to a pediatric dentist.  Communicate your child’s likes and dislikes to the clinic staff. Establish a daily brushing routine that fits your child’s needs and sensitivities. The guidance and encouragement can ultimately help keep every child’s smile as healthy as it can be.    

Children should make their first trip to the dentist between 6 months and 1 year of age, said Tonya Fuqua, D.D.S., director of Child Oral Health at the Center for Children’s Health, led by Cook Children’s. The first visit lays the foundation for a good relationship with the dentist and for healthy dental practices at home.

“I can’t tell you how to best help your child unless I meet them, I see them, I ask you questions and learn about your child and their special needs,” Dr. Fuqua said. “We as dentists want to help make toothbrushing the least invasive part of the day. We can give tips and tricks to help support a good dental routine at home with different gadgets, tools and ideas. There’s so much to offer, but a parent won’t know unless they take their child to the dentist and start early.”

 She calls the initial appointment the “happy visit” – a chance for the patient to meet the clinic staff, explore the surroundings, and maybe ride up and down in the exam chair. “The first visit should establish a positive experience for that child so that each time they come back they know that this is a safe and possibly fun place to go,” Dr. Fuqua said.

 To acquaint her patients with a few common dental items, Dr. Fuqua might send them home with mouth mirrors, gloves and masks, encouraging the family to play “going to the dentist.” Create a pretend scenario looking into each other’s mouths and using a flashlight to mimic the dental light on the swing arm above the dental chair. Having that play experience can help decrease anxiety when it’s time for an actual cleaning or checkup, she said.  

 Parents of children with special needs should be sure to update the dentist each time their child’s medication and health history change. The office will need to know any accommodations that might help the appointment go smoother, such as headphones or dimmed lighting. Dr. Fuqua recalled a patient with autism who requested a Taylor Swift playlist. “It made a huge difference,” she said.

Dr. Fuqua welcomes any favorite toy or blanket that helps soothe a child in the dentist chair. Parents may also hold their child’s hand and give words of reassurance during the dental procedures. “You have to find what makes them tick, what makes them engaged and smile, what makes that child happy,” she said.

 Alert the staff to any aversions, such as loud noises or a crowded room that could be upsetting. “You know your child best. Let the dentist know those things that trigger your child to get nervous or worked up, in order to help us know what to avoid.”

 Modifications and role playing at home can help a child with special needs warm up to going to the dentist and receiving dental care. For those with extreme sensitivity to taste and touch, Dr. Fuqua recommends limiting the stimulation. Start with a small toothbrush without toothpaste. Eventually, you can apply the toothpaste when the child is ready. Let the child brush a stuffed animal’s mouth. Read books and watch animated videos. All of these steps can start the process of making oral hygiene both fun and familiar.

 For children with dexterity impairments, a tool can be created by inserting a toothbrush into a tennis ball, making it easier to grasp. This modification not only teaches a level of independence, but also gives those children the confidence that they are capable of doing it on their own. 

 Dr. Patel and Dr. Fuqua understand that families juggling with stress and time constraints. possibly due to their child’s health challenges, might be tempted to make dental care a low priority. “It’s definitely one of those things that parents let slide because it’s just one more thing to deal with,” Dr. Fuqua said. The intense combination of medications and frequent doctor visits for the underlying health condition can be overwhelming. Even with these struggles. families should aim for brushing teeth at least two times a day (morning and before bed). Oral health impacts overall health, so it’s not something to ignore.

 The two dentists at Cook Children’s Renaissance Dental Clinic stay busy but are always accepting new patients. The clinic has seen an annual average of 5,434 dental patient visits since 2019. Depending on the medical issues, the safest way to perform dental procedures for some children is under anesthesia in the operating room. Annual dental surgeries at Cook Children’s averaged almost 1,100 in the past three years.

 Dr. Patel recommends finding a pediatric dentist who is comfortable with your child’s unique and individual needs, and can speak at his or her cognitive level. She attributes the resistant behaviors in some patients to a lack of understanding or an inability to express themselves. For a patient who is nonverbal like Joslynn Lee, the care must be extremely customized.

Kimberlee Lee says her daughter has a sensory processing disorder along with her autism. Joslynn’s desire for control makes brushing her teeth a battle. She won’t allow flossing or pulling a loose tooth.

During a dental appointment, Joslynn doesn’t understand why she has to sit still and can’t bite. As a result, she must be sedated for cleanings or other dental work, Kimberlee said.

At home, keeping little brother Kaden’s teeth clean involves the team of nurses who tend to his tracheotomy and restricted airway. The nurses collaborate with Kimberlee to sponge off his teeth and gums every time he eats. 

Unfortunately, a medication Kaden takes to control his lymphatic malformation makes him prone to mouth sores and tooth decay. At just 4 years old, Kaden has already needed several extractions and caps due to the damage to his enamel. Through all of this, he maintains high spirits at the dental office.  

“He loves the attention,” Kimberlee said. “So for the most part, he really is very cooperative. He’s happy to open his mouth. He’s excited about the little bag with the toothbrush and the new toothpaste and all the little things inside and to get the stickers at the end of the appointment.”

For parents with children who have similar needs, Kimberlee shared a few points that help dental visits go smoother for her family:

Plan ahead and bring whatever makes your child relax. Kaden prefers the iPad, and Joslynn likes fidget toys to keep her hands busy.

Offer a reward afterward as encouragement.  

Stay calm and positive. “Check your own energy and be able to show up and love and comfort for your child rather than feeding on their fear,” Kimberlee said. “When you’re scared, it ends up making everything worse.”

 Kimberlee advises parents to do their best to implement dental care at home, and be OK if it isn’t perfect.  The key is progress, not perfection.

“In the beginning of having special needs kids, I always felt like if they got a cavity or something was wrong, that it was my fault that I haven’t been taking good care enough of their mouth,” Kimberlee said. “I’m just going to have some grace, and if we have a problem, we have Dr. Patel to help us through it.”

Cook Children’s Medical Center has something to smile about these days.

Despite the toll of a lengthy pandemic, the hospital system hit two milestones since the inception of its Save a Smile program—it reached a 100,000-oral-screenings mark at the end of the 2020-21 school year in August, as well as tallied more than $10 million in value dentistry completed by private practice dentists who volunteered their services.

“It’s huge! I’m so proud we hit these milestones in such a difficult year,” says Tonya Fuqua, DDS, director of Child Oral Health at Cook Children’s. “And then to know that we were the only ones who went the extra mile to make things really happen (in oral screenings) and we didn’t give up.”

Instead of shutting down during the pandemic, the team suited up in personal protective equipment (PPE), created new safety protocol and procedures with the help of Cook Children’s infectious disease specialists, and took every precaution to safely enter schools, conduct screenings and treat children in need of oral health care.

“We were going to be at dental screenings where kids’ mouths would be open, so all of a sudden, it was like, ‘We have to rethink how we do this and do it safely,’” Dr. Fuqua says.

Other similar programs within the state paused operations during the pandemic, Dr. Fuqua says, but Save a Smile was boosted by “the generosity and quick thinking of a lot of people within our system,” including Cook Children’s leadership, infectious disease team, Children’s Oral Health Coalition, The Center for Children’s Health and legal department. The program also received funding for two new vans, which allowed the Save a Smile community health workers to offer free and safe transport for patients (and their accompanying parents) to dentists’ offices when needed for treatment.

“It took all of us together to make this happen…knowing we were going to do this effectively and safely for all—not just for our team, but for the kids and families and the schools’ staff, as well,” Dr. Fuqua says.

And our volunteer dentists didn’t say no either, she says. About 100 area dentists participate in Save a Smile, including Dr. Fuqua, who is in private practice while overseeing the program on a part-time basis.

“The dentists could have said, ‘It’s too scary out there right now…we’re not going into schools. Or my practice was impacted, and I’m not going to do free dentistry.’ But they didn’t do that. They didn’t tell us no,” Dr. Fuqua says. “I’ve always thought, ‘Wow. These dentists already do so much’—but to do it through a pandemic? It just makes me that much more proud to know they really feel there’s a need and that our program is worthy. That the kids are deserving of the treatment.”

The school-based, grassroots program has been part of the Promise that’s guided Cook Children’s Medical Center’s efforts to connect children in our communities with the care they need, says Chris Pedigo, senior vice president for System Planning, Health Analytics and The Center for Children’s Health.

“We’re beyond proud of the work Save a Smile has done in addressing the oral health of our children, especially during challenging times,” Pedigo says. “It’s fulfilling our Promise to the families we serve, and it’s what sets Cook Children’s apart.”

Save a Smile, which began in 2003, targets 21 elementary schools that are Title I schools (where at least 80% of the student body receive free and reduced-cost lunches) in Tarrant County. The schools are in Fort Worth, HEB and Keller school districts, respectively. Throughout the school year, the program’s team screens students to determine the level of urgency for immediate and potential oral health needs.

The program’s community health workers also help families determine if they are eligible for oral health care under Medicaid or CHIP coverage and get them connected to an appropriate provider. Students’ families who may not be eligible for those programs—but still can’t afford the cost of oral health care—are helped through Save a Smile.

The coordinated care and social service component of the program is the key element, Dr. Fuqua says, to ensuring children receive the dental care they most desperately need to be happy, healthy and productive in school.

Good dental health is critical for everyone, regardless of age. It's important to remember that the health of you and your children’s teeth and gums can have a direct impact on their overall health. While poor dental hygiene can lead to gum disease, cavities and tooth loss, the bad news doesn’t stop there.

Several studies show that the bacteria in your mouth from periodontal disease (gum disease) can contribute to various health concerns.

Here are 5 health concerns you may not have realized that are currently being studied:

1.Heart disease - People who develop gum disease as a result of poor dental health, have a higher risk of also developing heart disease. The bacteria that causes gum disease can cause inflammation as it travels through the blood stream which in turn can cause a stroke or heart attack. And those individuals who already have existing heart conditions are even more prone to developing endocarditis (an infection of the heart) which can be life threatening.

2.Respiratory disease - Scientists have found that bacteria in the mouth can be taken into the lungs and cause respiratory diseases such as pneumonia.

3.Pregnancy - New research suggests a possible link between gum disease and babies born with low birth weight or premature babies. And optimal oral hygiene during pregnancy may decrease the amount of cavity-causing bacteria that can be transmitted to the new baby.

4.Alzheimer’s - There is current ongoing research that states that the bacteria originating from gum disease can travel to areas of the brain which can trigger Alzheimer’s later in life.

5.Malnutrition - Gum disease and pain can often lead to people not getting the adequate amount of calories and protein needed to maintain a healthy diet. Therefore it is not uncommon for children and elderly to suffer from malnutrition if they are experiencing dental pain.

So make sure you take care of those pearly whites for a great smile and healthy body!

The obsessively clean freak with a dozen napkins at meals and the dust pan and broom standing by! I see the crumbs falling to the floor, the grape jelly graze the side of the chair, and the sticky fingers raking through the hair as my daughter enjoys her meal.

As a feeding therapist, I know as her skill in feeding develops so will the awareness of her fingers, hands, face and mouth. 

I MUST wait until she is finished before I attack with my arsenal of cleaning supplies. Sitting with her, eating with her, and having fun with her while she explores her dinner are the best things I can do as a parent.

Maybe you’re wondering, “Will my walls always be covered in food splatters?” or “Why does she continue to refuse foods I know she should be eating to have a well-rounded and varied diet?” “Does everyone’s baby require a bath after each and every meal?” “Is it normal for more food to be in her hair than in her mouth?”

Take comfort, mama. You are not alone in your exasperation when it comes to feeding your child while trying to maintain some semblance of tidiness in your kitchen.

Did you know that a baby’s mouth and hand have the highest number of sensory receptors per square inch than any other part of the human body?

That means the mouth and hands are the most sensitive parts of the body when it comes to what the brain can take in and learn.

So what does this all mean for your dinner table? Put away the fine china and good linens and get ready to embrace the mess. Researchers in the UK "found that playing with food may actually help kids overcome a fear of new flavors and eat a more varied diet, a small study suggests."

Children need the chance to explore new foods and textures with all five senses. In a perfect sensory world, your little one should have the opportunity to touch, smell, and taste new foods unabashedly. So, set the paper towels aside and join in the fun!

Your child will “learn” both good and bad habits depending on the mealtime experiences they are afforded.

For instance, if your child is given peanuts and experience an allergic reaction, he will most likely begin to refuse peanuts!

Alternatively, if broccoli and green beans are offered during a family meal in a way that is fun and supportive, you might find your little guy eating them with gusto! But, don’t be disheartened if he turns his nose up at beets the first time you present them.

Research has shown children may instinctively refuse new foods to survive simply because they are new. In addition, it can take up to 15 presentations before a food is deemed worthy in your child’s eyes. However, with good exposure, no illness or bad consequences, and repetition, children will learn many foods are safe to eat!

What can you do to help your child become a magnificently messy and healthy eater?

1. Make meal times a routine at the table, in their chairs, with NO distractions.
2. Allow your child to explore the foods that you’ve given him with the opportunity to say, “I don’t like this” without consequences.
3. Don’t set your sights on the spoon: allow him to eat with his hands!
4. Let him PLAY! Think finger painting with yogurt or building a tater tot tower.
5. Relax while he digs in and gets his hands dirty. He is learning about the different properties of the foods we eat when he touches, smells, tastes, and looks at the foods that are on his plate.
6. Keep offering the foods you desire him to eat. Remember, experts have found it may take your child 15 times of trying a food to decide how they really feel about it.
7. Lead by example! Tuck into the meal with your child. It is important for our littles to see us eating the same things we are asking them to eat.
8. Try to have as much fun at the table as possible while still enforcing the rules of “manners”. Talk about your day, talk about your food, smile, laugh, and make faces in your cheese. 

Your child may not have developed the oral motor or sensory skills to support a healthy, well-rounded, adult-like diet. Be on the lookout for the following feeding “red flags”:

• Drowsiness or sleepiness at every feeding.
• Poor oral tolerance (spits food out, shuddering, gagging, vomiting)
• Able to chew but prefers liquids
• Frequent gagging
• Coughing and/or choking

If one or more of these signs describes your child, consider talking with your pediatrician about your concerns and a possible feeding evaluation.

Satter, E. (1987). How To Get Your Kid To Eat…But Not Too Much. Boulder, CO: Bull Publishing Company

About the author

Melanie Van Noy is a speech pathologist at Cook Children's.Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.