One morning, about a dozen children in Transitional Kindergarten (TK) through third grade at Deer Creek Elementary School were getting much needed dental care – from cleanings to addressing painful tooth decay that can make learning difficult.

“The reason why we’re here is because there’s a lack of affordable dental care in Nevada County. This is a big issue and Public Health is trying to bridge the gap,” said Health Education Coordinator Jamie Hanf.

Tooth decay is the most common chronic and preventable healthcare need for children in the state, according to the California Department of Education.

“We are seeing tooth decay earlier and earlier in children. Education is key, but there also needs to be a pathway to care, which unfortunately has been challenging in our county,” said Hanf.

Nevada County’s Public Health team has been working to address this need by going school to school to provide free screenings to hundreds of students and follow ups with children who need extra care such as cleanings, sealants, fluoride treatment and referrals to dentists. A fully equipped mobile health van helps county staff meet kids where they are at. 

The school-based screenings are part of Nevada County Public Health’s Local Oral Health Program and a coalition of school staff, nurses, parents, providers and community clinics known as Smile Nevada County. In April, during National Public Health Week April 7 – 13, county staff celebrated and highlighted the oral health program as one of several quiet-but-powerful county programs making a positive difference in the lives of local residents. 

At Deer Creek School, the program is already making a difference.

“Deer Creek is excited about this proactive approach, combining preventative screenings with convenient access to essential dental care, which reduces oral health problems and minimizes school absences. This partnership is a win for students, families and the school community as a whole,” said Principal Robin Black.

The dental program focuses on four things: Education, screenings, prevention and creating a pathway to care. Most of the screenings are for Kindergarten Oral Health Assessments, but this year, the team expanded services to include second and third graders who may benefit from sealants and other treatments. Every school in the county benefits from services, but the team prioritizes those with the highest needs and least access to dental care, including the San Juan Ridge and Penn Valley.

The team makes dental health education fun with take-home dental kits, a colorful stuffed dinosaur named “Flossy Flossasaurus” and a giant toothbrush to show kids how to brush. By keeping early dental experiences positive, the team is building trust and creating good memories that will help create healthy oral health habits for a lifetime.

So far this school year, the county program has screened hundreds of students in Western Nevada County and is planning a trip to Truckee schools soon. In total, the program will visit 19 schools and is reaching out to other vulnerable populations through programs such as Women, Infants and Children (WIC) – for children from birth to 5 years of age and Community Beyond Violence – a group that provides resources for survivors of domestic violence.

“We want to reach our most vulnerable populations. We realized the way to do this is by bringing services to them,” said Hanf.

Paving the road for other rural counties

For years, many children living in Nevada County, like other rural counties in the state, have struggled to get the affordable dental care they need. A couple of years ago, Nevada County’s Public Health team started providing dental screenings and quickly realized more was needed.

The team identified many children with urgent needs but there was nowhere to send them locally. Nearly half of Nevada County elementary students have Medi-Cal insurance coverage, yet there are not enough Medi-Cal dental providers to meet the need. Only two Medi-Cal dental clinics provide treatment for thousands of families, leaving many residents with long wait times or long drives just to find a dentist who accepts their insurance.

Access to affordable dental care is a huge barrier and many families drive all the way to Sacramento or Yuba City for care, or go without.

“We realized pretty immediately that we would need to begin providing more than just screenings if we are to really make an impact on oral health in Nevada County,” said  Hanf.

The key to the success of the County’s state-funded Local Oral Health Program is bringing in Registered Dental Hygienists in Alternative Practice (RDHAPs) to provide cleanings and molar sealants. For those with emerging cavities, Silver Diamine Fluoride (SDF) stops decay and pain until a child can see a dentist.

The dental hygienists who work with Nevada County’s Local Oral Health Program travel all over the state to provide dental care to the most vulnerable, underserved populations. This nomadic model is likely the future of dental care in rural counties like Nevada County and is moving toward a concept known as Virtual Dental Home, which combines mobile care with telehealth.

By next year, Nevada County should have technological infrastructure in place to collect X-rays at school and community-based clinics and send information in real time to dental offices. Dentists review the care plans, approve them, and RDHAPs can provide much of the care or refer patients for more urgent care that can only be provided by a dentist. California Northstate University College of Dental Medicine is a partner and advisor of the program.