The Children's Dental Center -- A Community Resource to Meet a Community Need

By Cherilyn G. Sheets, DDS, and
Warren B. Riley, MBA

Growing numbers of children of working poor families in California have limited access to dental care. This article presents a unique solution to this problem: the Children's Dental Center. The center, a nonprofit corporation, emphasizes quality multidisciplinary care, aggressive preventive dental practices, and education programs for parent and child. Through behavioral change, coupled with dental care of urgent problems, the family's immediate needs are addressed while creating a future of diminished dental need and greater self-esteem.

Article copyright 1998 Journal of the California Dental Association.
Photographs copyright of the authors.

Newspaper stories describing dramatic demographic changes in California's major urban centers abound. They describe communities of greater ethnic diversity, multiple foreign languages, working class families struggling to make ends meet, new and different religious organizations, and occasional tensions between neighborhoods. The stories intrigue us as humanitarians and challenge us as health care providers.

Beyond the newspaper stories is the reality that 580,000 children under age 19 in California have limited access to dental care.(1,2) There are dental offices for patients with insurance or money. There are social service programs for families needing dental treatment for their children if they are living at or below poverty level. But, for the working poor, access to dental care is practically non-existent. Consequently, we find children with "significant pain, interference with eating, poor self-image, overuse of emergency rooms, and valuable time lost from school."(3) A recent needs assessment of the oral health of California's children revealed that "dental disease was the most prevalent of health issues affecting children and that dental services were not always available for prevention and treatment."(4) Findings such as this led to the establishment 2 1/2 years ago of the Children's Dental Center. Today, more than 3,000 children have received care at the center. Unfortunately, this has only scratched the surface.

The Children's Dental Center was developed to serve communities of Southern California where ethnic diversity and rates of poverty are especially high: Inglewood, Hawthorne, Compton, and Lennox (Table 1). In the Lennox School District, consisting of six schools with a total enrollment of 6,175, 99 percent of the population is nonwhite and 88 percent qualifies for the free lunch program, thereby indicating the family is living at or below poverty level.(5)

Table 1 Poverty Levels and Ethnic Diversity of Selected Communities of Southern California.(6)
Geographic Area	Total Population	Familes Below Poverty	Children Below Poverty	Black	Hispanic*	Asian	White
Inglewood	113,502	3,508	7,152	49.71%	46.09%	1.85%	12.29%
Hawthorne	71,349	2,015	3,654	35.53%	40.25%	8.93%	29.43%
Compton	90,454	10,680	26,514	44.69%	19.20%	3.27%	15.42%
Lennox	22,757	966	2,351	10.35%	81.57%	1.24%	39.54%
*Note that U.S. Census data for people of Hispanic origin are not mutually exclusive with other races.

Until the founding of the Children's Dental Center in 1995, local efforts to respond to the need for dental care for these underserved populations were limited. Various programs were available at clinics in Long Beach, Venice, East Los Angeles, and Buena Park. These clinics concentrated on urgent needs for restorative care. Because of the large area covered by Los Angeles and Orange counties and the relatively limited capacity of these clinics, only a small portion of children received treatment.

History, Mission, Goals

The Children's Dental Center is in an Inglewood facility that was originally the family private practice of James B. Sheets, DDS. For 40 years, it was an active and successful dental office. But, Dr. Sheets' health declined, and a plan to make a philanthropic gift did not meet expectations. The facility was turned over to the Children's Dental Center, a then-newly formed nonprofit corporation. A plan for renovating the building and launching preventative and restorative services was developed. In January 1996, the doors of the center were opened to the community.

The center represents a bold and exciting vision:

"The Children's Dental Center provides the highest quality multidisciplinary care to meet the needs of children who have no other access to dental care, while enhancing each child's positive self-image."

To realize this vision, the center established six program goals:

• To provide access to multidisciplinary dental care to the children of the working poor who have no other sources for compensated care;
  
  
• To have a comprehensive patient/parent educational program coordinated with a strong preventative dentistry program to minimize children's dental disease in the community;
  
  
• To create an environment of learning for graduate students to gain knowledge in multidisciplinary pediatric care as part of a unique community outreach program;
  
  
• To make a visible difference in an ethnically diverse community, typical of many of the country's inner cities;
  
  
• To encourage minority youth to consider a career in the profession of dentistry; and
  
  
• To provide a model that can be replicated throughout the country.
  

The center had 3,800 child appointments during the first year of operation and 5,100 during the second year. The patient profile is:

Residence: Inglewood/Lennox (32 percent), Inglewood (19 percent), Hawthorne (14 percent), Los Angeles (11 percent), and other neighboring communities.
In addition to its dental care programs, the center is committed to education on several levels. First, there is a strong emphasis on patient/parent responsibility in the prevention and maintenance of dental health. Instruction is given on the importance of plaque control; fluorides and sealants; frequent dental checkups; and nutrition for maintaining optimal general, as well as dental, health.

Second, a plan has been developed for an aggressive community education program to take the center's preventive health messages to local schools and homes. A school-based education and sealant program, health screenings, and there are other community outreach efforts. An adjacent facility is being renovated to become the Toothfairy Cottage to house education programs. Also, a television series is planned, and Project Lift will be launched as a partnership with local religious organization youth groups.

Community Collaborations

The Children's Dental Center has flourished by forming and nurturing collaborations.

The center has successful collaborations with:

• Two local schools of dentistry (the University of Southern California and Loma Linda University);
  
  
• Four local programs in dental hygiene (West Los Angeles, Cerritos, Cypress, and USC);
  
  
• Two local hospitals (Daniel Freeman Memorial Hospital and Centinela Hospital Medical Center);
  
  
• Five school districts (Lennox, Hawthorne, Lawndale, Centinela Valley, and Inglewood);
  
  
• The state and local dental professional community;
  
  
• More than 50 firms in the dental industry;
  
  
• More than a dozen local corporations;
  
  
• Six major local nonprofit agencies; and
  
  
• More than 25 private and family foundations (10 of which have provided support in excess of $75,000 each).

Start-Up and Operating Costs

Capital costs for the Children's Dental Center were significant because of the $1 million renovation necessary to create the state-of-the-art facility. Funding for this renovation was provided by several private foundations. Contributions from dentists have exceeded tens of thousands of dollars. Additionally, hundreds of individuals have provided support for the center, including an anonymous gift of $50,000.

Operating costs for the center have amounted to approximately $500,000 in the first year and $850,000 in the second. One-quarter of the revenue was earned income -- from patient fees at $25 per child, rental income from a few days of private practice dentistry in one operatory, contracts with school districts, professional educational seminars, and the sale of holiday cards. Three-quarters of the revenue was contributed income -- from foundation grants, corporate gifts, and individual gifts developed through various campaigns -- and in-kind donations from the dental industry.

FINANCIAL AND IN-KIND SUPPORT

Foundations
The Ahmanson Foundation Blue Cross of California Weingart Foundation Leavey Foundation The California Endowment A.C. Tyler Perpetual Trust Slipstream Foundation Schuchert Foundation Parsons Foundation California Community Foundation Mattel Foundation Disney Foundation Doheny Foundation	Pacific Mutual Foundation The ARCO Foundation Foundation of the Pierre Fauchard Academy TRW Foundation Pincus Foundation Gillespie Foundation Jewish Community Foundation F.I.B. Foundation McDonnell-Douglas E.C. Foundation Freeman Hospitals Foundation Underwood Foundation
Dental Industry
Kerr Corporation Oral-B 3-M Discus Dental Nobel Biocare American DentalTechnologies Crest Jelenko/Heraeus Kulzer Dentsply International KaVo America Colgate-Palmolive Company Ivoclar North America Patterson Dental	Global Surgical Corporation Block Drug Denatus USA Hu-Friedy Manufacturing Co. Warner Lambert The Bosworth Company Premier Laser Systems, Inc. Van R/Clive Craig/Cadco GC America Ormco Eastman Kodak Company Kreativ, Inc. Pelton & Crane

Words of Wisdom

Untreated dental disease is a leading health problem of children in California. Dentistry has an opportunity to respond with leadership in this time of crisis. As a profession, dentistry knows how to address the problem. To fail to act quickly and effectively when we see the increasing numbers of families in dental distress is to fail to meet our ethical and professional obligations. Additionally, it makes us vulnerable as a profession to legislative solutions for this health problem. The taxpayer cannot be taxed enough to pay for all of the dental disease that currently exists in this segment of the population. Therefore, the only solution is for these families to learn the most cost-effective, least painful and longest lasting treatment -- prevention of dental disease.

It is hoped that communities will use the experience of the Children's Dental Center to help care for families in need by replicating it in their own cities. The goal is to provide dental care and health promotion education in a fun and caring environment. Since the smile of a child is critical to his or her feelings of self-worth, dentistry can be a vehicle to positively change children's lives. In the process, we help them create a much brighter vision for their own future.

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Authors

Cherilyn G. Sheets, DDS, is the founder and president of the Children's Dental Center.
Warren B. Riley, MBA, is the executive director of the center.

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References

1. Marquis J, Neglect blamed for rising tooth decay among state's children. Los Angeles Times Sept 17, 1997.
2. Helping Uninsured Children -- The California Children's Health Plan. Office of Gov. Pete Wilson, Aug 27, 1997.
3. The Oral Health of California's Children -- A Neglected Epidemic. The Dental Health Foundation, San Rafael, 1997.
4. Our Children's Teeth -- Beyond Brushing and Braces. Maternal and Child Health Branch, California Department of Health Services, Sept 1995.
5. Private Communication, Lennox School District.
6. 1990 U.S. Census. Database: C90STF1A, C90STF3A.

To request printed copies of this article, please contact/Warren B. Riley, MBA, The Children's Dental Center, 300 E. Buckthorn St., Inglewood, CA 90301.

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