Vale learning lab_Courtesy of Oregon Community Foundation.jpg

Bolstered with a grant from Oregon Community Foundation, Penny Allen and her colleagues started asking questions about the unmet needs of their South Coast communities.

One of the answers they kept hearing stuck out like a sore tooth.

It was 2008. Allen, who today serves on the board of Oregon Community Foundation, at the time was a member of one of the foundation’s regional leadership councils throughout the state.

That year, to celebrate the fact that the foundation had reached $1 billion in assets, the foundation launched its Regional Action Initiative (RAI), sending a total of $7 million in grants to its regional leadership councils to help them target local issues.

Facts and figures about children’s dental health in Oregon

• Nearly half of the children in Oregon have a cavity by age 9, and two out of every five cavities go untreated.

• Children with poor oral health miss more school days and receive lower grades than their peers.

• Children in rural Oregon experience more cavities than children in urban areas (55% versus 45%). Rural children have higher rates of untreated and rampant decay and are more likely to need urgent dental care.

• In Oregon, 63% of children in low-income households have tooth decay, compared to 38% of children in higher-income households. Children of color have higher rates of tooth decay than white children and are half as likely to receive necessary treatment.

• The Children’s Dental Health Initiative has provided nearly $3 million to 15 school-based dental health programs through multiyear grants throughout Oregon.

• During the 2017-18 school year, programs funded by the Children’s Dental Health Initiative served students in at least 279 elementary and middle schools in 22 Oregon counties. The programs conducted more than 23,500 screenings, placed more than 27,500 sealants, performed more than 6,900 fluoride varnish applications and provided oral-health education to more than 25,900 students.

For Allen and her leadership colleagues, it meant $500,000 “to create a program that might make a better life for the people in our communities” in Coos and Curry counties.

“So, it was absolutely an open slot, and we could have given the money away to local entities or we could do something ourselves,” Allen said. “We decided to do something ourselves.”

Allen and the members of the leadership council spent a year interviewing community leaders about unmet needs in the South Coast. “We talked to a plethora of people.”

One issue kept recurring, Allen said in a recent interview: The dental health of community children amounted to a hidden epidemic.

Over and over, Allen said, Regional Action Initiative committee members heard the same story. Children in the community weren’t seeing dentists. “They have dental decay. They miss a lot of school, so it’s impacting their education. And there was nothing that was really helping them get through this.”

Today, there is help for children suffering from dental issues. And not just along the South Coast, but throughout Oregon, thanks in part to the work of Allen and her regional colleagues. In 2009, they launched Ready to Smile, a program that brought dental services directly into South Coast schools.

That effort, and similar work around the state, prompted the Oregon Community Foundation to declare children’s dental health a strategic priority. In 2014, the foundation launched its Children’s Dental Health Initiative.

The work continues today, as the foundation leads the Oral Health Funders Collaborative, a group of dental health stakeholders aimed at developing policy approaches and tools to improve the integration of oral health into Oregon’s health-care delivery system. The foundation also is a partner, along with more than two dozen organizations, in a coalition called Healthy Teeth, Bright Futures, which among other activities lobbies the Oregon Legislature to try to remove barriers preventing children from accessing dental services.

“The rallying cry was that this is a preventable disease,” said Melissa Freeman, who led the Children’s Dental Health Initiative when she worked at Oregon Community Foundation from 2008 until 2022. “Kids should not be in pain. And if we make sure they have toothbrushes and toothpaste, and access to fluoride, we could make a dent in this crisis. And we did.”

But the work isn’t nearly finished, Freeman cautioned: “At the end of the day, after many, many years of investing in it, we still don’t have a good system for serving children. And so, continued advocacy is really needed.”

Oregon Community Foundation is among the leaders in that advocacy effort.

But in many ways, the story has its roots in the South Coast.

Ready to Smile

Freeman called the lack of dental care for children throughout Oregon a “hidden epidemic.”

But if you knew where to look in the South Coast in 2008, you might have noticed the signs, Allen said, if you just paid attention to the faces of children: “They just don’t smile. They put their tongue in front of their black teeth and then life goes on.”

Teachers knew about it, of course, and so did school administrators and parents.

“There are a lot of other issues that children have,” Allen said, “and we could have looked at those as well. But this one just continually rose to the top. And it was also something we could wrap our arms around. I mean, if we were trying to change the world, we couldn’t have done that with $500,000. But we thought we could at least get our toe in the door and try to put a spotlight on this issue.”

They did more than that.

Allen and the Regional Action Initiative Committee did their due diligence and approached school superintendents and dentists. The response was enthusiastic.

“It just lit a little light under a lot of people, and they knew that this was going to be very important for the kids in our area. And, it turns out, it was.”

Ready to Smile worked with elementary schools and dental-care organizations to create a prevention program to go into schools and provide screenings, sealants and fluoride varnishes for students. Students received toothbrushes and toothpaste and coloring books about good dental health. Students who needed additional work were referred to dentists, who donated their time to the program.

Parents embraced the program — an “incredible response,” Allen said, “just an incredibly positive response.”

Allen and her team also worked hard to make sure that Ready to Smile was more than just a one-year program, raising money from the community to keep it running.

The success of Ready to Smile caught the eye of staffers and board members at the Oregon Community Foundation. Allen was invited to speak to the foundation’s board, and one of the questions was inevitable: If a program like this can work so well in Southern Oregon, what about the rest of the state?

Facts and figures about children’s dental health in Oregon

• School-based dental health programs, such as the ones Oregon Community Foundation and other donors have funded, are important for children who don’t receive care in other settings. In 2018, 8% (29,125) of Oregon children ages 6-14 enrolled in the Oregon Health Plan received preventive care only through school-based programs.

• In 2017-18, over a quarter of screenings conducted by programs funded by the Children’s Dental Health Initiative identified students in need of early or urgent dental care. About 3% of screenings (788) identified a need for urgent care — students experiencing pain, infection or swelling that necessitated a dentist visit within 24-48 hours. An additional 22% of screenings (5,434) found students with oral health problems requiring care within the next few weeks.

• Between 2014 and 2020, $3.9 million was invested in improving children’s dental health through the Children’s Dental Health Initiative, including $2.2 million in OCF discretionary resources and $1.7 million from funding partners and donors. While most of this funding supported school-based prevention programs, it also supported parenting education, dental supplies, advocacy, communications, evaluation, research, and building awareness and networks.

• A significantly higher percentage of children on the Oregon Health Plan received preventive dental services in 2019 than in 2015. Just 48% of OHP-enrolled children ages 6–14 received preventive dental care in 2015.35 In 2019, that figure rose to 64%.

• A 2014 report found that dental problems were among the most common reasons that Oregonians (particularly those without dental insurance) visit emergency rooms. Since then, nontraumatic dental-related visits to Oregon’s emergency rooms have consistently declined, dropping from almost 20,000 in 2016 to about 16,000 in 2019.

• Lack of access to optimally fluoridated water remains a persistent challenge for most Oregonians. Although 73% of Americans are served by fluoridated water systems, only 26% of Oregonians are. Oregon ranks 49th out of 50 states on this measure.

Going statewide

In 2008 — about the same time that Ready to Smile was making an impact on the South Coast — Freeman started working for the Oregon Community Foundation, and she couldn’t help but notice the impact that Ready to Smile had created.

“What was most exciting was when we brought the community together in the South Coast,” she said, “and we had dentists, public health professionals, educators, community leaders, school boards, superintendents, and they all had hands in, like, ‘Yes, thank you, this would be great, we will work with you.’”

The success of Ready to Smile and a handful of similar programs around the state sent a message to the foundation’s board.

“We were learning that this was a topic that we could wrap our hands around,” Freeman said. “This is a preventable disease. It’s something where we could really dive in and make an impact. … We were hearing stories of kids not having their own toothbrushes, never having been to the dentist. Not going to kindergarten or first grade, because they’re in pain, their mouths are in pain. So, it was really one of those things where it was a hidden epidemic.”

In 2012, the foundation’s board declared children’s oral health one of its strategic priorities. In 2014, the foundation launched the Children’s Dental Health Initiative, intended to identify – and remove – systemic barriers preventing Oregon children from accessing timely, age-appropriate dental services. In addition to funding prevention and education efforts throughout the state, the initiative worked to provide statewide leadership and advocacy on the issue.

That statewide advocacy inevitably led the foundation and its partners to the halls of the state Capitol.

In 2018, Freeman reached out to Tom Holt, a lobbyist who represents health care providers and associations, for assistance. Holt and Freeman knew they wanted to do additional homework.

“Over the course of 2019, we started spending a lot of time talking through the issues and gathering data,” said Holt, who now lobbies on behalf of the Healthy Teeth Bright Futures coalition, which includes the foundation and more than two dozen other partners. “What rose to the top by the end of the year was, well, we have a kids’ health curriculum where there’s no requirement that they be taught anything about oral health.”

A bill to that effect was introduced in the 2020 Legislature, but despite broad support, it foundered in that short COVID-infused session. Holt and colleagues returned to the 2021 session, where a similar measure passed.

Since then, Holt said, he and his colleagues have taken on much of the work of implementing the measure and are working with the state Department of Education and the Oregon Health Authority.

Holt also is working to shepherd two bills through the 2023 session: One, House Bill 3007, directs the Health Authority to establish an oral health advisory committee and an Office of Oral Health; the bill would require an annual report to the Legislature on oral health issues. The other bill, Senate Bill 487, calls on the Health Authority to establish a grant program to support certified dental sealant programs and directs the Office of Rural Health to provide scholarship and tuition assistance grants to people enrolled in community dental health coordinator programs.

Both bills remain in legislative committees.

The Oregon Community Foundation still is deeply involved in pushing for better oral health for children, but it’s working now hand-in-hand with dozens of partners.

“I feel like we built some good relationships and collaborative networks that will likely live on beyond any OCF funding,” Freeman said.

But she added: “At the same time, this problem is not going away. There are new kindergartners coming into school every year. And every year, school nurses are finding massive loads of decay in kids’ mouths. So an effort to educate, screen, provide sealants, all of that has to continue and has to be part of a statewide preventive health system.”

The challenges remain. But Penny Allen’s experience with Ready to Smile tells her that consistent community engagement (and funding from OCF and other donors) can make it possible for children throughout Oregon to smile.

“It took a lot of people who were engaged in the local community,” Allen said, “folks who believed in what we were doing, and we just moved it along and kept growing and growing and growing. … And so, it turned out to be a full community effort.”