Heart disease, the leading cause of death in the U.S., can have a surprising cause – gum disease. In this episode, we continue the discussion around the importance of dental care and hear how Corning is partnering with the county and health organization to address the crucial need for dental care in Western New York.
Transcript
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Denise: If I can just get in with the little kids and help them understand how important oral health is and make sure that they feel comfortable and understand everything. Then as they grow up, they won't be so scared of it.
SISSY: You're listening to Vital Voices, a podcast from Corning Incorporated, exploring the innovative ways companies can be a force for good in our communities. I'm Sissy Siero.
MILLICENT: And I'm Millicent Ruffin, Director of Community Affairs in the Office of Racial Equality and Social Unity here at Corning. We just heard from Denise Nierstedt about the fears of the dentist.
And even as an adult I still have anxiety when I go to the dentist. I remember going to the dentist as a kid and having to chew those little pink tablets, and then the dentist would make you smile, and then you could see all the places you missed where you brushed (laughs).
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SISSY: Yes. I hated that (laughs).
MILLICENT: Right?
SISSY: And you know, for me, I think I, in general, I didn't like to go because all the poking and prodding, but I know my mother was afraid of the dentist. So thank goodness, you know, Dad was adamant about it.
I just remember my father really being there and sitting there with me as a kid. And I think that's what made it an experience that wasn't so frightening, even though I didn't love to go.
And, um, I think we all need that reassurance. You know, my mother, I don't think got that and that's one of the reasons she was so scared about going to the dentist.
I was so grateful for his presence in that way. You know, he was insistent and well, he informed me taking care of myself as an adult. But thank goodness, uh, I have that today and I'm so grateful for that.
MILLICENT: Yes and the reality is dental care is not a given for everyone and not everyone gets the same access to it at an early age.
In episode 2, we discussed how dental issues could have a negative outcome on general health. Like when untreated gum disease results in life-threatening heart conditions.
In this episode, we’re going to start at the beginning. When it comes to those initial first experiences at the dentist, we’ll discuss the importance of a positive introduction to dentistry, as well as the challenges faced for kids and their parents when it comes to access to dental services. Because not having those preventative services early in life can have costly health consequences down the line.
SISSY: Right, and we’ll talk specifically about what Corning partners are doing to address the lack of dental care access for children in the western New York region – and we’ll discuss plans for a dental van that will help close the dental care gap for the broader underserved community.
MILLICENT: But before we get to that, we’re going to talk a little bit about how we in the Office of Racial Equality and Social Unity - or ORESU as we refer to it - became interested in dental disparities in the first place.
Michele Johnson: I'm Michelle Johnson, senior project manager in the Office of Racial Equality and Social Unity.
I feel extremely lucky to be in this role and to be able to do the work that ORESU does in the community that I grew up in. And to investigate some of the same inequalities or lack of services that were here when I was young.
MILLICENT: Michele is my colleague here in ORESU and she leads our work stream related to access to quality healthcare. She brought to my attention some health issues that she was researching in the counties surrounding Corning, NY – where many Corning employees and their families live.
Michele Johnson: One of the leading causes of death in Chemung and Steuben County in New York is heart disease. And one of the underlying factors of heart disease is periodontal disease.
MILLICENT: As mentioned in our last episode - periodontal disease is a serious gum infection.
Michele Johnson: And so drilling down and finding the root cause of the heart disease, we ended up at dental care and looking at the different ways that people can access dental care locally.
We started with the number of dental care providers available to low income and minority populations.
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And we found that there are 45,000 people in the two counties that have state provided Medicaid but there's only one dental provider to serve those 45,000 people.
MILLICENT: So only ONE medicaid dental provider for over 45,000 people. And that one provider is a non-profit that's had to expand their services.
Michele Johnson: And so that one dentist provides services to anyone in the surrounding counties that can get in on the schedule. Because as you can imagine, they're, they're booked.
MILLICENT: At the time of this interview, there was an eight month waiting list for existing patients for a basic routine checkup.
Michele Johnson: And so it was an easy decision that dental would be the first place we focus our healthcare efforts to try to alleviate a little of the backlog until we can continue to work with local providers to find a way to make a larger long-term solution.
SISSY: Michelle relates personally to this focus too. She felt her early experiences with the dentist were formative.
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Michele Johnson: I grew up in this area and when I grew up here, I would have been considered one of the low income minority population that we are serving. And as a child, I received services from the county Medicaid based dental clinic, as did many of my friends I went to school with.
I honestly remember it was fun to go to the clinic. And we would see our friends after school at the clinic. I don't remember my parents going to the dentist because they grew up in a generation that didn't do that. They couldn't afford to do that. And so I think without the dental clinic, myself and many of my classmates wouldn't have gotten into the habit of going to the dentist and knowing the importance of that.
SISSY: That clinic that Michele Johnson went to as a kid closed down over a decade ago.
This made us wonder about the kids today and the schools in the local area…what are the needs they’re seeing with their student population.
Melissa Montopoli: It's really a team effort to get these kids to be successful, healthy adults.
MILLICENT: That’s Melissa Montopoli. She's the nurse practitioner for the Elmira City School District and she works with a team of health professionals and nurses to provide support and health safety services to 14 schools in the district.
Melissa Montopoli: At the school district. I am fortunate enough to be able to interact and work with our students, which on any given day, our population is slightly over 5,400. And it's the best job I've ever had.
MILLICENT: In the last 20 years, and especially since COVID, she’s seen a general lack of healthcare access that affects the children in her district.
Melissa Montopoli: We also run into issues with dental care in this area because we don't have providers in this area specifically for dental care that provide Medicaid services.
When I'm seeing students for their physical exams, this year specifically, I've done a thousand physical exams, and there's probably 40% of that population that I see that say to me - “Nope, I've never been to the dentist.”
MILLICENT: Mosaic Health - is a network of federally qualified health centers in the Mohawk Valley region, and also in the Finger Lakes region of New York State. One of their programs sends dental hygienists into schools to provide preventative care... Melissa Montopoli again..
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Melissa Montopoli: When Mosaic Dental comes, some of these students have never had access to that. So they're excited because they get to have their teeth cleaned. They get to have their discomfort fixed.
Melissa Copella: We really wanna provide quality healthcare for all people regardless of their past, regardless of their ability to pay, regardless of what barriers they have to care. We wanna make dentistry affordable and something that's accessible to all people and not a scary thing.
MILLICENT: That’s another Melissa, Dr. Melissa Copella -- She’s the chief dental officer for Mosaic Health.
Melissa Copella: So many people dislike going to the dentist. So many people have traumatic events that cause them to avoid dental care. So I try to be warm and fuzzy and personable. Dentistry, there's some pain involved. It is scary, there's noises, and I just do everything I can to try to minimize that and really make the experience a positive one.
Dentistry to me is an art. There's a real reward in bringing somebody's smile back when they haven't had one for a long time.
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I think patients know, if you like what you do or if you don't. Patients know if it's really just all about selling and money and making an expensive treatment plan. So that's one thing at Mosaic Health, I'm, I'm very lucky that I don't have to upsell anything. I just treat every patient that comes in like a person. And what would I recommend for my family if they were the person in the chair?
Our dental patients might be coming in because they have a toothache, but maybe there's these other services that we can get them connected with as well, is just a nice part of being in community health.
It's not just, I'm only here to look at your teeth and that's it. I'm here to look at you as a whole person and care about you as a person and see what I can do to improve your overall health.
And during our dental appointments, we take people's blood pressure. So we have found that a lot of people might visit the dentist once or twice a year, but they don't always go to the doctor. So they may be walking around with hypertension that they don't know they have. So trying to make a connection between their dental health and their overall well- being is, is really important to us.
MILLICENT: That's what I really appreciate about Mosaic's approach as a federally qualified health center. They have a view of everything that their patients may need and may be experiencing, and they try to treat as much as they can while that person is in the chair.
SISSY: Yeah. And, and they're seeing the whole person and that makes me really question, you know, why medical systems separate care when some simple health checks like this can happen in tandem every day. Anytime you go to a doctor, you know?
MILLICENT: That’s what I appreciate about Mosaic Health and why we at ORESU decided to partner with them.
As I mentioned earlier, they have brick and mortar locations all over upstate New York. But they also have a proven record of mobile dental services. And so their community dentistry program, the one that brings preventive dental care onsite to schools, is mobile.
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Melissa Copella: So the hygienists move around to different schools. So they actually do the dental care onsite at the school. It's different than treating people in a health center. You kind of carry all your stuff in and you set up your equipment in a nurse's office or in a classroom and the kids come down and, and get the care there, and then you pack everything up in the van and take it out at the end of the day. They provide preventative dental care, so cleanings, sealants, exams, x-rays and we currently serve about 150 schools.
SISSY: For Denise Nierstedt, going to the dentist was never a chore.
Denise: I just really enjoyed going to the dentist. That was really the weird thing,
SISSY: Andrea Ramsdale on the other hand, had a much different experience.
Andrea: To be honest with you, I hated my dentist when I was a kid.
SISSY: Despite those very different formative experiences, as dental hygienists for the community dental program, they are both equally passionate about making the dentist a less scary experience for kids.
Denise: I've always wanted to be involved, helping children because I have seen so many adults have such anxiety and fear from previous experiences when they were younger, and it just all starts with the little ones.
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So I'm like, if I can just get in with the little kids and help them understand how important oral health is and make sure that they feel comfortable and understand everything. Then as they grow up, they won't be so scared of it.
Because I have seen so many older patients with such a fear. I remember one situation, this one gentleman, he was a really strong man. He was probably like 75, and he was an ex-marine. But he would not sit in the dental chair until somebody was there and looked him in the eye because he was so scared and traumatized from the past. And you look at this man, and you wouldn't think he'd be scared of anything, but he was so scared of the dentist and I'm like, this isn't right. This has got to stop. So that's the reason why I wanted to get involved in that and hopefully make a difference in terms of fear and anxiety.
SISSY: As school-based hygienists for Mosaic’s community dental program, they usually start out by giving dental presentations.
Denise: One of our first visits there is going in and talking to all the kids. So they get used to our face and you know everything about it. And they have a chance to ask questions. And some of the stuff, they're like, I didn't know we were supposed to brush our tongue or, I didn't know that.
What we do is we have some slides, a PowerPoint presentation. I bring out my little dinosaur chopper guy and I show them how to brush their teeth, just demonstrating the ways to hold your floss and your toothbrush. So it's a little bit of everything.
Andrea (presentation tape): All right. Good afternoon boys and girls. How is everyone today? Good! Good.
Can everyone smile for me? Let's look at your beautiful teeth. Look at all those wonderful teeth.
SISSY: This is dental hygienist Andrea Ramsdale giving a presentation to pre-K students.
Andrea (presentation tape): So today we're gonna talk about some things we can do to keep our teeth nice and healthy. One thing we can do to keep our teeth healthy is brush them - right? Raise your hand if you brush your teeth at home. Awesome.
Andrea: So we talk about nutrition, we talk about the decay process…
Andrea (presentation tape): Do you know what cupcakes and candy and ice cream have in them? Sugar. They have sugar in them. Very good. And sugar is not good for our teeth.
Can you all say plaque? Plaque! Good so, plaque is yellow. It's fuzzy, it's furry, and it does the same thing sugar does. It eats away at our teeth and it can give us cavities.
Andrea: …we talk about obviously brushing and flossing…
Andrea (presentation tape): So boys and girls, when we wash our hands, do we wash one side or both sides of our hands? Both sides! Both sides. So we need to remember to brush both sides of our teeth. The front and the back. Okay. Not just the front, but the back is dirty too.
Denise: I enjoy that time because then I'm like, have any of you guys ever been nervous or scared? And some of them are just like, yeah, me. And why am I scared? And so I, I, I like to be able to talk to them about that too.
I usually try to tailor the presentations to the age group. So, you know, it's really fun when we have the kindergartners and the pre-Kers and we are kind of just sitting in a circle and talking and it's different. As opposed to as the kids get older, there's more things that we talk about. And even when we get into like the fifth, sixth, middle schoolers, we start talking about things like, vaping and, you know, energy drinks and stuff like that too, because they don't even realize how harmful that stuff is.
Andrea: And then once we do the presentations, we send out permission slips with all the students at the schools that we go to.
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Andrea (presentation tape): Now, boys and girls, this is your permission slip. Your parents can sign you up to have your teeth cleaned or counted by me here at school, but I need this permission slip back.
SISSY: And then the parents or guardians have the option to sign their kids up for a number of services.
Denise: We provide the cleaning, we take x-rays, we apply sealants, which is a protective coating we paint on the permanent molars to hopefully prevent cavities, fluoride treatments - everything that you would get in a preventative appointment.
SISSY: For both Andrea and Denise, it's important to approach these appointments in the right way, to make it comfortable for the kids.
Andrea: You know, you get kids down that are very scared, they're anxious, they don't even wanna come into the room sometimes. And you know, I just kind of break out the mom-mode in me; you might not talk right about teeth right away. You might ask them if they brush their teeth at home and show them some of the things that we're gonna be using in their mouth to make them more comfortable. A lot of times, hygienists that work with children, we do this, "tell, show, do". And so we, we tell them about it and then we show them, maybe not in their mouth, but like maybe on their finger, what the polishing brush looks like and how it feels-
[Denise with Patient audio]_________________________________
Denise: This is Mr. Tickles. You ever see a toothbrush that spins around?
Patient: No.
Denise: No? Okay. So here, feel him with your finger. Is he soft?
Patient: Yes.
Denise: Yes! So then what I do is I step on my little pedal and then he spins around with that.
Patient: Can I try?
Denise: Well you can feel him, but you can't step on the pedal. And that's gonna tickle you. And I'm gonna see how ticklish your teeth are. Do you think they're ticklish?
All right, let's try, we got some chocolate toothpaste. That sound good?
Patient: Mm-hmm.
Denise: Mm-hmm. All right. Can you sit back for me?
Patient: Yeah.
Denise: All right, buddy. Here we go. Tickle time.
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Andrea: You know, your mouth is a, a pretty invasive space and when someone's putting sharp things in your mouth, it could be pretty scary. So they can, you know, be familiar with it before something goes in their mouth.
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Denise: What I find that helps to get the kids at ease is seriously just your overall attitude, demeanor, and just kind of the vibe you're putting out. If you just act chill and be like, “this is okay”.
And I really feel I get a better response from the children when they just act in that just matter-of-fact way. And I show them everything and I make them touch things. But I never force them. So if they're truly petrified, I'm not gonna ruin their day at school. I just want them to know what it is so they can at least say, all right, I saw it, I tried it, and that's that.
[Denise with Patient audio]_________________________________
Denise: So I'm gonna show you what I'm gonna use. Okay?
Patient: What's, what’s that?
Denise: These are my counting instruments. So that's my mirror.
And then I use my tooth counter. Okay. And what I do is I go 1, 2, 3. Can I show you on your finger?
Patient: Um, you’re not gonna use the point -
Denise: No, I don't use the pointy part. I use the rounded part. Can I show you?
Patient: Yes.
Denise: Watch. Like this. 1, 2, 3. Okay.
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Denise: I just make it fun and just goof around with them.
[Denise with Patient audio]_________________________________
Denise: And then I use some water. This is my little water hose. And water comes out. Blooooop! And then I have a vacuum cleaner. You know how vacuum cleaners are really loud? Okay. This is my little vacuum cleaner. His name is Mr. Thirsty, and it sounds like this.
Patient: Oh, are you gonna vacuum me with this?
Denise: I'm gonna vacuum your mouth at one point. Feel that. When we put some water in there, we're gonna vacuum it out. Okay. Wanna try it? It tickles! Here. Woooooo! That feel weird?
Patient: No.
Denise: No. It feels okay, huh?
Patient: Yeah.
Denise: All right.
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Denise: When you have that first moment with them of being in the dental chair, they never forget it. They really don't. Last week I was at a school, this little boy who he came in, it was his first time seeing a dentist and he was very apprehensive and he was reserved and didn't want any part in it. But then he went back to the classroom, he's like, I just had my teeth cleaned. I had my own dentist and this and that. And he was so excited and they shared that email with me and that just made my day because I'm thinking, okay, he had a great impression and he's gonna remember that, so the other kids wouldn't be scared. So I kind of like that domino effect too, about the program and it being in the schools, is they're all talking about it.
MILLICENT: One of the barriers they see for kids getting to the dentist is, again, the lack of medicaid dental providers in the local area -- meaning parents would have to travel very far for care.
Denise: Where we live right now in Elmira, there is not many dental providers who accept state insurance or are accepting new patients. Many dentists in the area have since retired or they have sold their business to a corporation.
So a lot of families have to travel and the closest one is probably about 45, 50 minutes away, which is really difficult just to spend that much time to go to the dentist, you know, for a cleaning that you could have at school.
MILLICENT: And in fact, providing these services in school may actually be a better overall experience for kids than in a traditional dentist office.
Andrea: Being in the school setting, it's nice because the parents don't have to take off of work for these preventative services and we can see them right there in school. It's a lot less time taken out of class, when they only have to go down to the nurse's office or the room that we're in.
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And it's a comfortable place for the kids too, which is nice. You know, they know school is a safe place and a lot of times they know their school nurse or you know, it's a familiar place for them, so they're not as anxious for their dental appointment either.
SISSY Wow. That's so true. I'd never thought about that. The fact that the kids would be more at ease because they're in a familiar environment with people they know. That's just, that seems like a win-win and sets them up for not being afraid then as they get older, you know, to go take themselves to the dentist.
MILLICENT: Exactly. And so the convenience of bringing the care to the school covers a lot of bases, right? The child isn't going to miss much school. They get the services they need, the parent doesn't have to take off work. So it's really just taking all of those barriers out of the way and really helping create access for kids to get the dental care that they need.
SISSY: Hm. That’s so right. And you know, as Mosaic's chief dental officer - Melissa Copella knows how vital a program like this is.
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Melissa Copella: Doing the exams for the community dentistry program, you can see the need. You can see the cavities, you can see the abscesses, the lack of care, and a lot of times the parents are saying, there's just nobody around here that takes our insurance, or there's nobody that's seeing new patients. And dental decay is a big reason that kids miss out on school days.
So that's really our goal of the Community Dentistry program, is bringing care to the kids who are not otherwise receiving care and making it accessible for them and their parents.
SISSY: The Community Dentistry program is delivering on their goal of providing dental services to children at schools but what about the rest of the community? According to Mike Leary, CEO of Mosaic Health, the program, in its current form, is limited.
Mike Leary: The program we operate today is one where the, the hygienists and the dental associates who work with them - they basically have to lug equipment into the school and they set up in the school. So it's within the school and we can't really invite the community in to get those services.
SISSY: That's where Corning came in.
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Mike Leary: What Corning offered was the opportunity to provide additional services to those kids, but also just extend these services to folks in the community who, who don't have access to dental services at all.
Michele Johnson: It was easy to decide to partner with them to provide those same services to the parents of the students that they already serve.
SISSY: That’s Michele Johnson again – she was working on finding a way ORESU could address the lack of medicaid dental providers in the area. So the mobile dental unit project came about as a way to provide dental services in Chemung and Steuben Counties. The team will offer preventative services like cleanings and x-rays to community residents.
Michele Johnson: So the project is Corning, Mosaic, and Chemung County. And the van will primarily serve residents of Chemung County based on statistics of low income and minority populations.
ORESU is going to help determine local locations where it might be easily accessible for low income people. And it will be community centers and places where the community gathers that they are comfortable and will be willing to go to get service.
For low income and minority populations healthcare is not always a place where they feel safe and they feel heard, and utilization is low for dental and healthcare services in spaces where people don't feel heard or they don't feel valued. And so we wanna make sure that the van is accessible in places where people are comfortable and they know the service is truly for them and will be nonjudgmental and will be to their benefit.
SISSY: Because of the backlog at the local dental clinic... Michele expects that the need and interest will be great.
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Michele Johnson: This will be a brand new service for people who have not ever had the ability to go to the dentist before. And so we think that the waiting list will be long.
It's anecdotal that people that have Medicaid have never been able to get into the local dentist. And so there is a point where you just stop trying and then you wait for emergency care, which is what we're seeing with people that go to the emergency room. They just wait until it's an, it's a problem they can no longer avoid.
SISSY: The team is working through some ideas of how it can make the most impact.
Michele Johnson: Our plan is for the van to operate five days a week. And with location to be determined, but ideally it will stay in a location for at least a month so that people can get familiar with that site. And then we'll move it to different locations so that we're sure to be accessible to different areas of the community.
So ORESU's role is really just making sure that we help to promote it and that we support Mosaic and finding locations and ensuring resources so that we can make it a long-term successful project.
SISSY: I just find this really exciting, the possibilities of this and the impact it's gonna have.
MILLICENT: Yeah, this is, you know, one of the longer term efforts where we get to be in the community indefinitely. And we get to meet the community where they are. And I love the idea of having a service that can go wherever, wherever it's needed, and be what the people need it to be.
And this mobile unit will start out as a dental unit because that is the highest need, as we mentioned, those 45,000 residents. But this unit also has the capability to provide medical care. And so we designed this unit with a lot of forethought -
SISSY: Wow!
MILLICENT: Of how do we need to serve the community now and what might the community need in the future? And so, this has the potential to serve the community for decades, and we are really excited about it.
SISSY: I mean, that to me is following the philosophy that we heard earlier, which is, you know, just taking blood pressure, you know, so it's like, so that's the next thing. Then they can see if, oh, in fact you have, do a diabetes check, or you do some blood work in there and, you know, see what's happening and really get the whole person involved.
MILLICENT: It also opens the possibility of co-locating near daycare centers or near other nonprofit organizations that are providing other services to the community. And so we are actually prioritizing the needs of the underserved community. And I love putting them first and going to them as opposed to saying, “here's this service, you get to it as best you can”. So what we're doing is building healthy communities, which is the mission of our organization.
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Next time on Vital Voices…we’ll dive into the importance of health equity research.
Dr. Sanchez Vega: We believe that some of the insights that we are starting to get may really have a clinical impact in the future and be helpful for managing patients.
SISSY: Thanks for listening. You can find and listen to episodes of Vital Voices wherever you get your podcasts. For more information about the Office of Racial Equality and Social Unity and how its programs are impacting the community, click on the links in the show notes.
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