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ForsythKids provides public health dentistry on the front lines of the COVID-19 pandemic

When the COVID-19 pandemic shut down schools, it removed access for thousands of children who rely on school-based health programs to receive regular dental care. The consequences of that disruption are only beginning to be understood and will likely have lasting effects on oral and overall health.

The ForsythKids team has witnessed these consequences first-hand. As one of the few mobile dental clinics providing care to underserved communities in Massachusetts, ForsythKids has treated nearly 20,000 kids since 2010, traveling to more than 60 sites throughout the state. Many of these types of mobile health programs have shut down or reduced capacity due to the pandemic.

The ForsythKids team visits schools, day care centers, and other community-based organizations multiple times each year, providing dental care at no additional cost to patients or their families. The team offers dental cleanings, fluoride varnish, toothbrush kits, oral health education, and dental sealants when needed.

Dental sealants are incredibly effective at preventing cavities. They act as a protective barrier that keeps bacteria and food particles from getting caught in the grooves of teeth. According to the NIH’s National Institute of Dental and Craniofacial Research, sealants have been shown to protect against 80 percent of cavities for two years, and half of cavities for up to four years. They are a key component of the ForsythKids prevention program, but their efficacy largely depends on reaching the tooth before decay begins.

“That’s why it’s so important for us to keep going back to the sites,” says. Helen Nguyen, DDS, MPH, Public Health Dentist for the ForsythKids program and Assistant Investigator at the Forsyth Institute. “Kids are getting new teeth, they’re changing their dentition, so we need to be there regularly.”

When the pandemic made regular school visits impossible, the ForsythKids team evolved. They hosted pop-up clinics at community health centers and developed a new care model using inflatable medical tents. ForsythKids became one of the only mobile dental programs to continue providing care on the front lines of COVID-19. And what they’ve witnessed illustrates the widespread lack of healthcare access so many children experience.

“I’m seeing that there are kids we had identified in 2019 as having an active dental infection, and it still hasn’t been addressed,” says Amanda Sadri, ForsythKids Business Manager, who has helped run the program since 2016. “Some of these kids still have infection in the same areas. After three years, it just keeps building and building.”
The COVID-19 pandemic left tens of thousands of children in Massachusetts without access to school-based dental care. When schools returned to in-person learning, many restrictions were in place that limited visitors and service available at the school. The ForsythKids team created an innovative medical tent model to allow the team to provide care where children live and learn while these restrictions are in place. This video takes you through the journey.

Children from low-income families are three times as likely to suffer from untreated tooth decay than their more affluent peers, according to the Centers for Disease Control and Prevention. Racial disparities also exist within oral health, with 33 percent of Mexican American and 28 percent of Black children presenting with cavities, compared with 18 percent of White children. ForsythKids works to address these inequities in Massachusetts, serving primarily communities of color, individuals experiencing homelessness, recent immigrants, and other vulnerable populations—90 percent of whom live below the poverty line.

But many of the patients ForsythKids used to see regularly remain unreachable. Schools are still grappling with ongoing closures, staffing shortages, and surging COVID-19 cases. School districts have been slow to reintroduce healthcare programs that require visitors to enter the building, which means thousands of children may be left without care.

“Since we’ve been out of the schools for a bigger chunk of time, I want to know—are more of the new molars that are erupting starting to decay before we can actually get them sealed? For some kids, we’ve missed our window to intervene before they develop decay,” Dr. Nguyen says.

Despite the challenges of the pandemic, the ForsythKids team has continued finding new ways to reach communities in need. They recently partnered with the Quincy Head Start program to provide twice-yearly preventative dental care to 60 children aged 5-years-old or younger. The team has also restarted services at many of the schools they visited regularly before pandemic restrictions halted their efforts.

For example, ForsythKids is now back to operating in the Lynn school district, where they have served more than 600 patients since the start of the pandemic and are the only source of dental care for many students. Over 17 percent of ForsythKids patients in Lynn were found to have urgent dental needs.

“I treated a middle-school student last week who had never been to the dentist before,” says Olivia Costner, a ForsythKids Dental Hygienist. “She was nervous to pull her mask down because she thought we were going to make fun of her or talk poorly about her to other kids. I was able to talk her out of that. I told her, ‘We’re here to help you.’ She smiled at the end of the day.”

February is National Children’s Dental Health Month, and this year’s theme is “Sealants Make Sense.”

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