San Francisco provides dental care for Latinx children at a rate greater than the national average, suggesting a roadmap that can increase access across the U.S.

[by Jack Davies; courtesy photo]

[Editor’s Note: The following story is part of a collaboration between journalism students at San Francisco State and El Tecolote, and is supported by a grant from the National Institutes of Health’s National Library of Medicine.]

The Magic Tooth Bus drives through San Francisco, providing children with dental services at schools and dental fairs. It’s like Santa’s sleigh, only the present is a cavity-free mouth instead of a new bike. 

Dental care is a challenge for BIPOC (Black, Indigenous, People of Color) children across the country. 

Lack of education, dental deserts, financial restraints, language barriers and a child’s diet, are all contributing factors hindering access to dental care. 

Cavities for Latinx youth between the ages of 2–19 are at a high rate of 52 percent. When compared to other ethnicities, this is a stark contrast. Black youth see a rate of 44 percent, for Asian youth it’s 42 percent, and for White youth, it’s a rate of just 39 percent

San Francisco has made significant strides in recent years in reducing cavities in BIPOC children. The City has found innovative ways to bring dental care to children who need it, such as the Magic Tooth Bus. 

Elaine Musselman, Director of Pediatrics at San Francisco State University, found success in bringing dental care to kids who can’t otherwise get access, whether due to dental deserts, lack of income, or an inability for their parents to take them during work hours.

Musselman works with CavityFree SF, a non-profit organization dedicated to providing dental care for children in San Francisco. CavityFree SF partners with the Head Start program and Unified School District in San Francisco to bring dental care to kids up to fifth grade. In doing this, the parents don’t have to worry about scheduling time for a dentist appointment.

“That’s one thing we found that works really well,” Musselman said. “It’s very effective to bring those services there. We bring dental hygienists in, that do dental exams, we do fluoride varnishes at the schools.”

She added that they recently expanded the age range up to grades 2–5 since children with a lack of access in kindergarten will likely have those same access issues when they are older. 

CavityFree SF also provides the Magic Tooth Bus at health fairs throughout the city. There are dentists and hygienists who speak multiple languages so that parents and children of different ethnicities can understand what is going on in the child’s mouth.

“We’re bringing that care to the kids where they’re at,” Musselman said. “We’re meeting them at the preschools in San Francisco, we’re meeting them in their school districts. If we’re not bringing it to them, they’re not going to have it. That’s the unfortunate reality.”

Solutions like this help reduce many of the problems for Latinx children. CavityFree SF has currently cared for 5,000 of the 15,000 children ages 0–5 who are Medi-Cal recipients. For children between the ages of 3–5, cavities have decreased from 41 percent in the 2013–14 school year to 26 percent in the 2017-18 school year, the last year of available data for CavityFree SF due to COVID-19 interrupting things. 

Additionally, there was a 55 percent increase in fluoride varnishes applied to preschoolers between 2016 and 2017 in the most recent data available from CavityFreeSF. 

While progress has been made, there’s still more that can be done locally and nationally. 

Martha Ortiz, a dental assistant at Bay Area Dental Office in Redwood City, said that the main reason for the discrepancy in dental care for Latinx children is a lack of education about oral care, whether from schools or parents. 

Ortiz suggested that the best way to educate parents and children is for schools to offer a day where parents and their children go to a dental office or dental school to learn about the importance of dental care. Ortiz has provided visual demonstrations in the past and finds those to be very helpful. 

“Parents will learn and they will take action,” Ortiz said. “When I used to go to schools, I will take a Coke and I will ask the children, ‘Do you know how much sugar this has?’ I will put the amount of sugar in a Ziploc bag and tell them, ‘If you don’t brush, this is what stays on your teeth.’ And visually they see and they will tell their parents.” 

Ortiz also said that many parents aren’t aware that cavities are contagious and can be transmitted from kissing your child on the mouth or sharing food and drinks with them.  

An additional issue is the language barrier. English speakers visit the dentist more often than Spanish-speaking children and as a result, Spanish-speaking children are less likely to receive adequate dental care. “Hispanic” dentists only compose 5.6 percent of the active dentists in the country.

“I think it’s frustrating for the family and the parents to go in there,” Musselman said. “Because they don’t understand what’s going on. So that is where a lot of our work is, is finding those dentists in the area who do speak the other languages, whether it’s Cantonese or Spanish, that are willing to work with the low-income families.” 

Another issue is that many dentists do not like to take in children because they can be difficult to deal with as opposed to adults. Additionally, many dentists don’t make as much money for taking in Medi-Cal patients as they do for patients with more expensive medical plans. 

“In order to try and bridge a little bit of that gap with oral health with children, pediatricians now actually check teeth,” Musselman said. “Pediatricians are referring children to dentists. One thing that’s really important, especially for the younger ages, is getting fluoride varnish put on their teeth to protect the enamel. If you protect that enamel, you’re preventing cavities. Pediatricians’ offices are now applying fluoride varnish.” 

Pre-Licensure Clinical Placement Coordinator at San Francisco State University, Larry Vitale, has seen the impact that diet can have on the teeth of Latinx children in his 38 years of experience in the field. 

Vitale said that immigrants coming to the Bay Area don’t trust the water because the water they had in their native land wasn’t suitable to drink. Instead, the families will opt for cheap alternatives. 

“They end up giving children what they like and what they can afford now, because it’s cheap,” Vitale said. “And that’s the sugar drinks. This ends up being a problem, not only for teeth, but for weight and all sorts of other things. So part of that is the targeting of low-income immigrant communities, which is structural racism, and the lack of appropriate resources for better choices.” 

The nation has an issue with making sure dental care is accessible to everyone who needs it. But San Francisco is making significant efforts toward making this less of an issue for the Bay Area. The rest of the country will likely follow, but it’s a matter of taking action to help those who desperately need it.