I Am a Registered Nurse with Ten Years of Experience Working with Bennington Preschool

I am a registered nurse with ten years of experience working with Bennington preschool children who are “at risk” for various reasons: poverty, disability, DCF involvement, homelessness, etc. Part of my job is to work to improve the oral health of the children in Bennington. I’m writing to inform the community about the potential impact of community water fluoridation on our children. We can help our kids keep their teeth for life. I hope to make the stakes clear.

My professional stake: The Molly Stark Dental Program office is the only feasible provider for about 2/3 of the children I serve, and probably for many other children in Bennington, too. I depend on this practice for a child-friendly environment and exams, and our families rely on the practice’s flexibility when they cancel or fail appointments for reasons related to life in poverty – poor organizational skills; inability to take time off work or school; health, transportation, and legal problems, etc - reasons for which their children should not suffer, but which are not acceptable for most dental practices.

About 90+% of the children I work with who have cavities are treated by one provider at Molly Stark Dentalthrough the hospital’s Bright Smiles program, because many private dental offices refer young children for treatment rather than do it in their own office. Without this one provider, 147 of the 157 children with Medicaid who received treatment for cavities through the Bright Smiles program in the OR in 2014 wouldprobably have to make multiple trips to Burlington for treatment. Yes, Burlington. That’s where Bennington’s children on Medicaid will almost certainly have to go if they are referred for treatment and the Molly Stark Dental Program is no longer available. I support community water fluoridation for this reason.

What we’re up against: The schools in Bennington have had no swish and spit program since May 2013. We have had no dental hygienist in the middle and high schools for about three years. We currently have no health department hygienist that some other Vermont counties have, though as of 12/9/14 we have been promised funds for a half-time hygienist. 57% of the population of Vermont consumes optimally-fluoridated water (at or near0.7ppm), either naturally or through community water fluoridation, but the entire southwest corner of the state is an exception to that, completely lacking water sources with enough fluoride for optimal oral health.

Bennington County, in a recent report from the state, has the third highest level of poverty in the state. The town of Bennington has both the greatestincomedisparityin the county, and the lowestaverage per capita incomein the county, despite those who are on the upper end of that disparity scale.

Surveys show that 50% of Vermont children on Medicaid see a dentist less than once a year, or never. Bennington has very few dental office openings foradultson Medicaid, much less their children. In many practices two missed appointments by any person in a family, no matter what the reason is, can result in the entire family being dismissed from that practice. The exception to all of this is theMolly Stark Dental program, but that practice usually only sees children up to age 8.

What does this all mean? Overall, Bennington is a high-poverty town, with lots of Medicaid and severely restricted dental access for that population, and we have a LOT of kids who are not getting adequate oral health care. We have a serious problem with health disparities. For these reasons I support community water fluoridation.

So let’s look at the numbers…

How our Kids rate:

The Bennington County Head Start program ensures that all children brush daily and see a dentist at least once a year. Head Start also has a tooth tutor program that provides staff training, classroom education, oral health screenings, parent education, and topical fluoride application twice a year. Despite this, in a typical year, 18 of the children they serve will be diagnosed with cavities, and that’s just a sampling of one age group in Bennington. From this it should be clear that we cannot brush our way out of this oral health problem. Add to this data all the Bennington preschoolers who do not get this level of oral health support and multiply by 4, and that leads us to the following data on third graders.

In a 2013-14 survey of Vermont third graders in 24 schools, Bennington Elementary and Molly Stark students had two of the state’s highest rates of past experience with cavities – meaning at one point in their lives they had one or more cavities: Ben El was #1 in the state at 58% past experience with cavities, and Molly Stark came in #3 with 53%; compare this to the statewide average of 35% of students with past experience with cavities.

For children withuntreated cavitiesBen El was #2 at 24% and Molly Stark students were #4 at 22%, compared to 11%, on average, of third-graders statewide in the survey. So, for this study, almost one in four of our third grade students had cavities that were untreated.We all know that untreated cavities can, and do, result in serious infection, which then can result in loss of attention and attendance.In fact, many years in my job I have at least one child I work with who hasn’t received treatment for cavities, which develops into severe dental pain and infection, which I then must report to DCF as medical neglect.

Additionally, the study shows that fewer children at both Bennington schools had received sealants, which prevent decay in permanent molars, than most other Vermont schools screened: Out of 22 schools, Ben El ranked #17 with 43% of third-graders having had sealant application, and Molly Stark ranked #21 of 22, with only 35% sealants. State-wide, 52% of third-graders have had sealants applied in those 22 schools.

To summarize that: Bennington’s two largest schools are doing really badly in oral health compared to the 22 schools surveyed. Our third grade students are 66% more likely to have had cavities than the average of these other schools, twice as likely to have untreated cavities, and are only getting about 75% of the sealant applications. Our status quo is not enough, even with all the good work that is happening in dental offices, doctor’s offices, and schools. I support community water fluoridation for this reason.

Source:http://healthvermont.gov/family/dental/documents/oral_health_survey_2013-2014.pdf

How at-risk adults in our families are doing: The Kitchen Cupboard serves an astonishing 25% of households in Bennington. Workers there note that many of the Kitchen Cupboard clients have painful teeth, missing teeth, or no teeth at all. You also may have read in the “Bennington Banner” on 12/10/14 that the Kitchen Cupboard is sometimes providing toothbrushes and toothpaste because some families in our community cannot afford them.

Here are some predictors of tooth loss in adults:

Disability - 11% of Vermont adults with disabilities have lost all their teeth, compared to only 3% of the general population; an additional 19% of disabled adults have had 6 or more teeth extracted.

Low income - 2/3 of Vermont adults living on $15,000 or less have had a least one tooth extracted, compared to 1/3 of those living on more than $15,000. 14% of those with incomes under $25,000 have had all teeth removed, compared to 9% of those in all other income brackets combined.

Low educational attainment - 59% of adults who have a high school diploma or less have had at least one tooth extracted, and 11% have lostallteeth; compare this to 31% with least some college education who have had one tooth extracted, and only 5% of those with some college who have had all teeth removed.

This triad of disability, low income, and low educational attainment applies to many of the families I work with. They’re your neighbors, employees and coworkers, parents of your children’s friends, your cashiers and mechanics and customers. They are “us”. For this reason, I support community water fluoridation.

Sources:http://healthvermont.gov/family/dental/documents/oral_health_plan.pdfhttp://healthvermont.gov/research/brfss/documents/data_brief_201406_oralhlth.pdf

The Cost:Dental pain is one of the primary reasons for preventable emergency room use at Southwestern Vermont Medical Center.Economic Services provides general assistance vouchers to adults for extractions in cases of dental pain, and in the first 6 months of 2014 they provided 178 vouchers for adults in Bennington.One local practice reports having seen 185 voucher patients, for a total cost of $143,375 in care in 2014.

Last year’s Free Dental Day provided $112,300.00 worth of free dental care to 132 individuals in our community.In 2014 the Bennington Free Clinic also provided $6000 in vouchers for dental services to adults seen there.This money is donated by our own community, and the free dental day is provided through 470 volunteer hours, over and above the tax dollars we all contribute to oral health. And those tax dollars? The state of Vermont uses those to cover $2.5 million annually on Medicaid coverage of dental care related to cavities in children under the age of 6, and $2.5 million on emergency room care for dental pain, in addition to the vouchers for extractions.

We all have a financial interest in this topic. Community Water Fluoridation (i.e. adjusting the fluoride level in water to that which promotes optimal health) can have a significant impact on oral health, especially of children, and is “the best bang for our buck”. Studies have demonstrated that 0.7-1.0 ppm (parts per million) of fluoride is safe, effective, and cost-effective over decades of research in fluoridated communities. Studies show it reduces dental decay by 20-40% by strengthening tooth enamel, and for every $1 spent on fluoridating water, $38 is saved in treating cavities.Even if there were only $1 saved in treatment for every $1 spent, it would be worth the investment because of the intangible improvements in population health. For this reason, I support community water fluoridation.

A few fluoride facts:Fluoride is a mineral, not a medication. It is found naturally in all water sources, and very small amounts are found in dietary plant and animal sources… essentially you can’t eliminate it from your diet. Water in Bennington’s water supply naturally contains 0.1 ppm, but there are water systems around the state where there is six or more times that amount of fluoridenaturally. Fluoridating the Bennington community water supply would mean adding to the fluoride already there to bring it up to a level that is optimal for teeth, not adding some new ingredient.

http://healthvermont.gov/family/dental/fluoride/documents/guide_to_fluoride_levels_in_public_water_systems.pdf

There are plenty of myths, outright lies and hyperbole about fluoride, so it’s always wise to fact check your source for peer-reviewed evidence. I’ve seen some realistic-looking “science” that falls apart once you start looking with an understanding of context. Fluoridated water at 0.7 ppm does not cause cancer, lower IQ, or allergic reaction (if it did, please note that you would have to stop eating, drinking, and brushing your teeth), and it is not an industrial poison, though these are all arguments those opposed to fluoridation use to distract from solid scientific studies. The primary down-side to fluoridated water is the risk of fluorosis, a cosmetic white discoloration of the teeth, which is usually so mild that only a dentist can discern it, and this does not increase risk to the health of the teeth.

Check the CDC.gov, ilovemyteeth.org, or ADA.org for more information. The ADA has a wonderful PDF called “Fluoridation Facts” that lists 359 citations for fact-checking.

Grace Winslow, RN, BSN

Bennington Oral Health Coalition