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CELEBRATING 40 YEARS • QUALITY HEALTHCARE • ACCESS for ALL

OPEN DOOR

Community Health Centers

THERE IS NO TOOTH FAIRY Carter Wright, DDS ODCHC Dental Director A few weeks ago I had the honor of cutting the ribbon on a brand-new dental van to be used for children in Del Norte County. That was a great day. More access, more service, more healthy kids. I was really excited and relieved that we were doing the right thing. The next day, "Jake" came to the Burre Dental Center in Eureka. He is a young man of 15. He had never been to a dentist before. He was scared, angry and embarrassed, but he was in pain. Jake’s dental disease was so severe that I could only recommend dentures – dentures for a teenager. Jake faces a future of health problems, oral and otherwise. Dentures are not a good solution, even when they are the only solution. Jake hadn’t learned how important or how easy basic oral hygiene can be. Unfortunately, Jake’s situation is not rare. I see young people with severe dental decay and disease almost every day. Most of the continued on page 8 ➤

OPEN DOOR DENTAL

Congressman Mike Thompson with the children of Smith River Elementary School celebrate the new dental van by showing their teeth to the camera.

SMILES IN THE SCHOOLS n October 2nd Open Door “cut the ribbon” on its newest service, a sparkling mobile dental van fresh from the factory. This van, and a newly hired staff, will serve children in Del Norte County exclusively. This new van was funded by The California Endowment as part of its Building Healthy Communities: Del Norte County and Adjacent Tribal Lands initiative. The van will visit schools throughout Del Norte County, providing comprehensive dental screening and treatment for children. According to Barbara Davis, Dental Sites Administrator and Mobile Dental Service Coordinator, “We can do almost everything on the van that we can do in the clinic. We schedule several schools to visit during the school year. In this, our first year, we’re starting at Smith River School. We’ll stay there until all of the children who need dental care, and have parental consent, are screened and treated. We won’t leave until all of the kids are taken care of. Then we move on to the next school and do the same thing. This means we may only get to 3 or 4 schools during a year.” States Laura Olson, Program Manager for The California Endowment Building Healthy Communities initiative, “At the ribbon cutting, someone came up to me and said, ‘So this is really ours?’ referring to

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Every child qualifies for services; all we need is parental consent. Being at the school works to get the children the dental care they need. - Barbara Davis

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the new van and the idea that it will be in Del Norte and not leave the area. It was so gratifying to be able to say, ‘Yes!’ This is a major step forward in creating the infrastructure of access and services so needed if we are to address the pressing health needs in our community.” During the extended school holidays and over the summer, the van will be located at the Del Norte Community Health Center and serve as extra treatment space. “We’re excited to be able to open up more access to dental services all year, whether at schools or here at the clinic,” notes Hilda Yepes Contreras, site administrator of the Del Norte Community Health Center. “Access to care; that’s our priority.” This sentiment is echoed by Robert Chiang, DDS, a dentist recruited specifically to work on the new Del Norte dental van. “It is wonderful to be able to provide a high level of service for so many kids. We’re still working out some of the kinks, this is only our second week, but I’m impressed with the van, the staff, the schools and the kids. This is a very exciting project.” Dr. Chiang works with registered dental assistants

Linda Inman-Bourne and Laura Johnson. “We’re rapidly becoming a good team.” The Del Norte mobile dental van is not a first for Open Door. Open Door has been providing mobile dental services at schools in Humboldt County since 1991. While not using a vehicle quite as shiny as the new van in Del Norte County, Diane Patkowski, DDS and registered dental assistants Claudia Wells and Mindy Ferreria have been “on the road” providing a full array of dental services to children throughout Humboldt County. During a typical year, the van visits 4 or 5 schools, staying at each school as long as it takes to provide dental screening and treatment to all children who have received parental consent for such services. Explains Barbara Davis, “We couldn’t finish up at South Fortuna Elementary School last spring, so that was the school we started with this fall. In all, we completed treatment for 120 children. We hope to get to four more schools this year, but we have to

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ABOVE: Open Door’s Mobile Dental Van serves Humboldt County children

remain flexible based on the kid’s needs.” The schedule permits the van to return to a school every 3 years. The van is now at Grant Elementary School in Eureka and 86 children are lined up for screening and treatment. “In both Del Norte and Humboldt,” explains Barbara, “we are treating children who might go without dental care due to limited access, lack of transportation or other family hardships. With the vans at the schools, parents don’t have to take time off from work and children actually miss less school time because our van is right here on campus.” Barbara emphasizes, “Every child qualifies for services; all we need is parental consent. Being at the school works

to get the children the dental care they need." “In addition to treating children’s dental needs, we work with them to improve their self-care. We provide instruction and education about oral health care and talk with parents whenever possible. A person’s smile has a big impact on their self-esteem. For children, their health, happiness and wellbeing are particularly linked to how they feel about themselves. After treatment we see how kids develop greater confidence as they begin to smile more,” explains Barbara. “We focus on education and proper care at home, including how to brush and floss properly. We teach the children how to have fun with their dental care and to be proud

LEFT: Front Desk staff at Burre Dental Center (from left) Jarrett Nicholson,Stefanie Delgado, Nayelli Tejeda, Stacey Celest (office manager), Daisy Barrios BELOW LEFT: Some of the Burre Dental Center staff BELOW: Robert Chiang, DDS, dental provider for the new Del Norte Mobile Dental Van

ABOVE: Stephanie Nelson, RDA shows patient Kalliyanne Palmer how to brush and make healthy food choices during a monthly Well Child Dental Exam at Burre Dental Center

relaxed. Children are less fearful the second or third time they come in. Because it is designed to be kidfriendly, children have a good experience coming to the van. There is less waiting and less anticipation and they see their peers going to the van too.”

MEDI-CAL: WHAT IS COVERED NOW

In 2009, the California Medi-Cal program eliminated most dental

benefits for adults; children’s services are still a covered benefit. A court challenge briefly returned adult dental care to the Medi-Cal program, but a final ruling in May upheld the elimination of adult benefits. “This has been a real blow to services for many of our patients,” states Carter Wright. “We still offer services to adults,

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of their efforts. We understand that kids all have different experiences and life situations. For children who are frightened we first give them a “Happy Visit” just to get them used to visiting the dentist. With full dental services offered on the van, starting with a comprehensive exam, the experience is the same as going to any dental office.” Dr. Chiang notes, “When kids come in with pain it can be difficult to treat them because they are fearful of dentistry, particularly if this is their first visit. I remember one child who needed to have a tooth pulled, it had been bothering him for a long time and was totally decayed. It was scary for him. The next time he came in, he was more

It is wonderful to be able to provide a high level of service for so many kids ... this is only our second week, but I’m impressed with the van, the staff, the schools and the kids. This is a very exciting project. - Robert Chiang, DDS

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for children and teenagers. We’ll fast-track pregnant women and coordinate our care with prenatal providers as necessary.” Samantha continues, “Though most dental services for adults are no longer covered by MediCal, we still offer comprehensive dental care to the community. We accept CMSP and private insurance and we’ll work out a payment plan for folks who don’t have any dental insurance. The demand for care has increased and it’s hard to get an appointment, but keep trying. Our staff is doing their best to help you get the quality care you need.”

HEALTHY INFANTS, HEALTHY CHILDREN

LEFT: UCSF Resident Zach Castiglione, DDS and dental assistant Amber McCleary with Burre patient and former dental assistant for Open Door, Sandra Ballard. ABOVE: Dr. Carter Wright gives patient Clara a fluoride treatment at her well-child dental exam.

and we work out discounts and payment plans, but a lot of people still choose not to get the treatment they need.” This ruling cut most dental benefits for adults throughout California. “Virtually all adults were affected by these cuts,” says Dr. Wright. “For adults, Medi-Cal pays for treatment that relieves pain and infection. It doesn’t cover work that saves teeth. The Medi-Cal cuts certainly weren’t our choice, but we’re stuck with the regulations,”

explains Dr. Wright. “Medi-Cal pays for extraction, not restoration.” Current law requires that Medi-Cal pay for treatment related to the relief of pain, infection and trauma; however, the treatment option is tooth removal. “We will work with patients to find ways to treat the problem without removing teeth that can be saved, but many patients just can’t afford the work,” notes Dr. Wright. Medi-Cal eliminated what were termed optional benefits. Medi-Cal will no longer pay for most oral examinations, fluoride treatments, fillings for cavities, root canals and crowns, treatment of gum disease,

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complete or partial dentures and bridges or repairs to existing dentures, partials or bridges – virtually all procedures that save teeth or restore function. On a positive note, Medi-Cal covers most dental services for anyone under the age of 21, and some services for women who are pregnant and adults who live in skilled nursing facilities or care homes. “We really encourage parents to bring their children in for a routine exam as soon as the child’s teeth start coming in,” says Samantha Hani, lead registered dental assistant at Burre Dental Center. “Starting a routine of good oral health right from the start will prevent most problems later on. We always find a way to make room

“Education is essential, and our team is dedicated to oral hygiene education,” says Kathy Dilling, assistant to the director of the Burre Dental Center. “For parents and children, it makes a big difference, in health, time and money.” Kathy, a registered dental assistant, has been with Open Door for more than 18 years. “We believe that education will help set up the kids for a healthy lifestyle.” Open Door dental centers work to educate children and families. Well Child Dental Exams, otherwise known as “Smile Days” are offered once a month at the Burre Dental Center in Eureka and the Del Norte Community Health Center in Crescent City. These are free walk-in clinics for infants and children up to age five. Kathy Dilling explains, “We offer simple examinations and education in a relaxed and kidfriendly environment. The whole

clinic is geared toward kids on cate parents and children togeththese days. We want children to be er. Oral health care needs to start comfortable coming to see a denat an early age, so the parents tist, starting at a young age. We need to be involved. Our wellhelp kids and child checks families learn (Smile Days) about proper are for childental care, dren up to For adults, Medi-Cal pays for brushing, diet age 5. Latetreatment that relieves pain and and safety. We ly, we have infection. It doesn’t cover work want kids to be been seeing that saves teeth. The Medi-Cal cuts proud of taking a lot of chilcertainly weren’t our choice, but we’re care of their dren return teeth. There once or stuck with the regulations. are usually twice a year - Dr. Wright lots of other for a checkkids around, up. This is so it can be a great.” The little hectic, dental staff but a lot of is seeing the fun too.” At both the Burre and results of their efforts to educate Del Norte clinics, dental assistants the community about prevention go through a basic dental checkup and good oral health routines, with young children and talk to the particularly in the youngest kids and parents about oral health. generation. “Things seem to be Every child is seen by a dentist and getting a lot better,” Samantha if problems are identified, appointstates. ments for follow-up care are made “Maintaining oral health is a daily on the spot. Every patient receives activity. You can’t wait until somea goodie bag filled with tooththing goes wrong. It only takes a brushes, toothpaste and other supfew minutes and doesn’t cost very plies for preventive care as well as much,” says Susan Wellman, DMD, a healthy, tooth-friendly snack. of the Del Norte Community Health I’ve seen a real decrease in the Center. “Our dental assistants and number of children with cavities, dentists encourage parents to take but I still see way too much decay. care of their teeth and to model And I often see serious decay in good oral health for their children. an entire family, across multiple Most of the time, parents just generations. If your parents didn’t don’t know what to do, and if know about oral hygiene, you probthey can’t help, children will probably didn’t learn how important it ably develop problems.” The Open is, and you probably aren’t helpDoor dentists offer the following ing your children establish good recommendations: habits,” explains Dr. Wright. But the cycle can be broken. Samantha • For infants, try to stop using Hani emphasizes, “We need to edubottles after the first year and

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DNCHS

Suzanna Torres, RDA shows patient Aimee Rogers how all of the dental instruments work.

encourage the use of an open cup as soon as possible; limit the use of ‘sippy’ cups as much as possible; • To prevent ‘baby bottle tooth decay’ never put your baby to sleep with a bottle. At night, only put water in the bottle. Milk and juice pool around the child’s teeth as they sleep, causing tooth decay.

Babies can develop tooth decay as soon as their teeth start coming in. • Start brushing your baby’s teeth as soon as they start to come in, gently using only water and a soft toothbrush. Around age 2, your child will be able to follow simple instructions, such as spitting out toothpaste foam and you can begin to use a “pea-sized” amount continued on next page ➤

At the Del Norte Community Health Center, these kid-friendly clinics are held the first Friday of every month from 9:00am to 11:00am; call ahead or walk-in. The events are held at the Burre Dental Center on the first Wednesday of every month from 9:00am to noon. Calling ahead is recommended. Visit www.opendoorhealth.com for more information.

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of toothpaste. Letting your child watch you brush your teeth will create a good example, one they are likely to copy.

• Talk with your dentist. They will be happy to answer your questions about caring for your and your family's teeth.

• Children – and adults – should brush their teeth twice a day. Brushing should last 4 minutes each time. An inexpensive eggtimer can be helpful.

Brandy Boone works in the newly created position of case manager at the Burre Dental Center. She works to help find treatment solutions for extreme or immediate situations, including cases of neglect. “I mostly manage cases for little kids with high risks, most are under six years old. We usually have to send them to specialists. After specialized treatment, it is important for the child to return to the clinic for followup. We don’t want them getting lost in the shuffle and we don’t want a repeat of what caused the severe problems in the first place.” Brandy’s usual cases involve severe tooth decay, sometimes related to neglect, poor habits or poor diet. “Most of the cases I see are the result of parents who don’t know what to do or don’t know that we are here to treat young children. No one wants their child to suffer now or in the future. We can help prevent these problems if parents bring their children in for a check-up and then follow-through with the treatment plan.”

• At any age, fruit is better than fruit juice, which typically has a lot of sugar (natural or added). Don’t use bottles or sippy cups for juice. • See your dentist for a regular check-up at least annually, twice a year if possible. If there is any tooth or mouth complaint or problem, bring your child to the dentist. It is much easier to fix little problems. • Children should wear mouth guards during all sports activities. Many broken or missing teeth could have been prevented by the child wearing a mouth guard. This applies to bike riding and skateboarding as well, particularly when trying out tricks. • It is never too late to start taking care of your teeth. Whatever the age of your child, whatever your age, starting to brush regularly, floss and reduce sugary snacks will make a difference. For young children, you are preventing future problems. For older children and adults with dental problems, you are slowing the disease process and making it easier for your dentist to correct the existing problems.

ORAL HEALTH AND PREGNANCY

“Not only is it okay and safe to see your dentist during pregnancy, it is important for the health of your unborn baby,” says Karen Severn, RN Clinic Coordinator at Open Door’s Northcountry Prenatal Services. The American Dental As-

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sociation (ADA) recommends that pregnant women eat a balanced diet, brush their teeth thoroughly with ADA-approved fluoride toothpaste twice a day, and floss daily. It is also recommended that pregnant women see their dentist for preventive dental cleanings and evaluation. During pregnancy, increased acidity in the mouth increases the risk of tooth decay. Vomiting during pregnancy can aggravate the problem by exposing the teeth to more gastric acid. The bacterium that is associated with tooth decay could be carried over to a newborn child, possibly passing the bacteria to the baby. Pregnant women go through hormonal changes during pregnancy that can lead to gingivitis and inflammation of the gum tissue. Both can lead to a pre-term birth or low birth weight. Ideally, if a woman is

planning a pregnancy, she should schedule an exam ahead of time to treat any dental problems. Certainly upon becoming pregnant, a woman should schedule an exam with her dentist right away. Dr Jung of the Willow Creek Community Health Center, explains, “Dental care during pregnancy should be a normal part of prenatal care. The woman’s body is changing and that affects her oral health and the future health of her child. Preventive and maintenance exams and cleanings are recommended for all pregnant women.”

A PARTNERSHIP FOR LEARNING

One of the unique aspects of the Burre Dental Center is its connection to the School of Dentistry at the University of California, San Francisco. Fourth-year students

LEFT TO RIGHT: UCSF Resident Grayson Palmer, DDS. Some of the dental staff at DNCHC. Johanna Chung, UCSF Dental Intern. Paul Jung, DDS examines Willow Creek resident Jan Joki at WCCHC.

and post-graduate residents rotate through the clinic, bringing their training to the clinic and getting a “real-world” experience in providing community dentistry. According to Tram Vu, fourth-year intern, “Our experience at Burre has provided confidence with both our clinical and patient relations skills. We have become more efficient with our time while still providing quality care and education. After our rotations, we definitely notice an improvement in speed and skills. We work with wonderful dental assistants, which is something that we do not have at UCSF. The dental assistants have exposed us to the effectiveness of four-handed dentistry. We see an amazing range of dental needs at Burre. We try to see an average of 10 a day here; at school, we average 3. As future dentists, our time at Burre has

taught us the importance of taking an active role in providing for the community.” Grayson Palmer, DDS Resident, explains, “We apply to be placed at a site and Burre is a very popular site because of the quality of our experience. I have done much more hands-on dentistry here than many of my classmates at other sites. This has been an amazing learning opportunity. I really enjoy working as a team with my assistant. I am now interested in continuing to work in a community health center. I’m hoping to continue on as a provider at Burre once my residency obligation is completed. My wife, daughter and I enjoy living in this community." Johanna Chung just completed her second internship rotation at Burre. “I love working with the children, and I now recognize the

importance of screening and education. This has been an incredibly challenging and inspiring experience. The lectures and clinics at school were mere shadows in comparison to what I’ve experienced and learned here. I have gained so much that only this kind of handson experience could give me. And I

feel confident, with the great team around me, that we are providing patients with the best care possible. We are not compromising quality. I am grateful to train at a site where advancements in treatment alternatives are being used on a regular basis. The environment itself motivates me every day.” According to Dr. Wright, “Our partnership with UCSF creates access to care that we wouldn’t have any other way. These students are not only skilled and eager to learn, they are committed to the highest standards of quality and care. They are learning valuable lessons while contributing to our knowledge, bringing with them the latest training and advancements in dentistry. It is a great association for the students, for our staff, and for our patients.” •

WHERE TO GO

The Burre Dental Center is open Mondays through Saturdays from 7:00am to 5:00pm. Call 707-442-7078. The dental department at the Del Norte Community Health Center is open Mondays through Fridays from 8:00am to 5:00pm (Saturday hours to start soon). Call 707-465-4636. The dental department at the Willow Creek Community Health Center is open Mondays through Wednesdays from 9:00am to 5:00pm. This clinic is accepting new patients who live in the Willow Creek area. Call 530-629-1941.

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time I can treat the problems and save the teeth, but not in Jake’s case. When I finished with Jake for the day, I wasn’t excited or relieved, I was heartbroken. Jake’s pain and suffering – now and in the future – is absolutely unnecessary. We have decided to make children and teenagers our priority for dental care. If you call, we are going to make the appointment and get the youngster into care – emergency or not. We are going to provide treatment and education. We want to prevent the problems Jake is going to face the rest of his life. Unfortunately for adults, it is not the same situation. The demand for care is staggering and our resources are limited. Financial support for adult dental care is minimal – Medicare and Medi-Cal do not pay for most adult dental services and not many folks have private dental insurance. Regardless of your insurance, unless you are an established patient at one of our clinics, we’ll be able to treat your pain or infection, but we simply do not have the personnel or space to take on new adult patients wanting or requiring more than emergency services. For that I apologize. We see adults for emergency care on a stand-by basis. We ask you to come to clinic and wait. I know this is not pleasant, particularly if you are in pain. We honor existing appointments (we're usually booked three months in advance, but intentionally leave space in our day for emergencies. Our providers will do their best to see you as quickly as possible. Some days are busier than others. We now offer Saturday hours and some evening clinics. Within the resources we have, we offer as much access to care as we possibly can. In our area, the demand for dental services outstrips the supply of care. I know people are frustrated that they can’t get an appointment with us. We share that frustration, but that doesn’t solve the problem. This set of articles attempts to answer some of the common questions we hear. We’ll keep working to meet your needs and expand access. We ask for your patience and understanding. •

OPEN DOOR COMMUNITY HEALTH CENTERS

Administrative Offices: 670 Ninth Street, Suite 203 • Arcata, CA 95521 • 707-826-8633 www.opendoorhealth.com • Arcata HUMBOLDT OPEN DOOR CLINIC 770 Tenth Street, Arcata, CA 95521 707-826-8610 NORTHCOUNTRY CLINIC 785 18th Street, Arcata, CA 95521 707-822-2481 NORTHCOUNTRY PRENATAL SERVICES 3800 Janes Road, Suite 101, Arcata, CA 95521 (in the Shaw Pavilion of Mad River Community Hospital) 707-822-1385 • Crescent City DEL NORTE COMMUNITY HEALTH CENTER 550 East Washington Blvd, Crescent City, CA 95531 707-465-6925 - Medical 707-465-4636 - Dental • Eureka BURRE DENTAL CENTER 959 Myrtle Avenue, Eureka, CA 95501 707-442-7078 EUREKA COMMUNITY HEALTH CENTER 2412 Buhne Street, Eureka, CA 95501 707-441-1624 TELEHEALTH & VISITING SPECIALIST CENTER 2426 Buhne Street, Eureka, CA 95501 707-442-4038

➤ Visit www.opendoorhealth.com for e panded versions of these articles and to learn more about Open Door Community Health Centers

• Willow Creek WILLOW CREEK COMMUNITY HEALTH CENTER 38883 Route 299, Willow Creek, CA 95573 530-629-3111 - Medical 530-629-1941 - Dental All clinics will do their best to accommodate your immediate needs; however, there may be a waiting list at some clinics to establish care for new patients at this time. Open Door clinics offer either family practice/primary care medical services or dental services for children and adults. Several clinics offer both medical and dental services. While not available at all sites, other services provided to patients of Open Door Community Health Centers include: • • • • • • • • • • • •

Behavioral Health and Counseling Services Evening and Saturday Hours HIV/AIDS and Hepatitis C Care Nutritional Counseling Opiate Dependency Treatment Pediatric Services Psychiatry Specialty Medical Care Teen Health Clinics Transgender Health Clinic Urgent Care (Walk-In Services) Wellness and Health Maintenance

Articles by Breanne Sorrells, Development Associate, and Julianne Barnum, Advancement Assistant, Open Door Community Health Centers; editorial contributions by Christopher Peters, Chief Advancement Officer, Open Door Community Health Centers Most Photography by Paul Swenson Photography, www.paulphoto.com Layout and graphic design by Siobhan Calderwood, North Coast Journal Please visit www.opendoorhealth.com to read expanded versions of these stories and discover more about Open Door. Comments may be addressed to: editor@opendoorhealth.com.

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➤ Visit northcoast journal.com/specialpublications to view past editions of Open Door Special Sections

• McKinleyville McKINLEYVILLE COMMUNITY HEALTH CENTER 1644 Central Avenue, McKinleyville, CA 95519 707-839-3068 - Medical 707-839-2677 - Pediatrics

This health center is a Health Center Program grantee under 42 U.S.C. 254(b), and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n)


Open Door Community Health Centers