LEBANON — School-based dental clinics in the Upper Valley are ramping up again after hiatuses related to the COVID-19 pandemic and staffing challenges.

Upper Valley Smiles, a program operated by Lebanon’s Alice Peck Day Memorial Hospital, is poised to visit 11 schools across the region this academic year, which is up from just four last year. Meanwhile, the South Royalton-based HealthHub is slated to visit schools in about a dozen towns in the White River valley once this year, and the board president is hopeful the organization will reach more children and adults next year.

School nurses in the region welcome the programs’ resumption, as it remains difficult for people to find dentists in the Upper Valley, especially those who accept Medicaid.

“I’m just really grateful that we have access to that,” Robin Lobb, school nurse at the Enfield Village School, said of the Upper Valley Smiles program. It’s “a great service to the community.”

Through Upper Valley Smiles, which serves students in Lebanon, Enfield, Canaan, Hartford and Hartland, a new part-time hygienist, Asha Clark, offers dental screenings, fluoride varnish, sealants and silver diamine fluoride, which can prevent cavities from growing. Clark, who also works for a Hanover dental practice, previously worked at the Mascoma Community Health Center’s dental clinic before it closed last summer.

“Every three years, APD and (Dartmouth Health) conduct a community health needs assessment, and oral health always pops up as one of the top community needs,” said Liz Swanton, APD’s community health engagement officer and Upper Valley Smiles program coordinator.

As dental offices continue to struggle with staffing and available dental appointments are limited, the program aims to “help fill that gap for kids who don’t have regular dental care,” Swanton said.

Last year, the program served 45 students at the Enfield Village School, about 20% of the student body, and 60 students at Canaan Elementary School, about 25% of the student body, Lobb said. About one-third of those seen had some form of decay, and the program allowed them to get care they might not otherwise have access to. The program also helps families who don’t have a dentist to find one that accepts their insurance, especially for those who have an urgent need.

Poor oral health can have an effect on students’ performance in the classroom.

“It’s very distracting for them if they’re uncomfortable or in pain,” Lobb said. Dental problems also can affect the nutritional quality of the food children eat “if things (that) are crunchy are painful.”

Any child at participating schools can qualify for the program as long as their parents complete the necessary paperwork, but they are targeting children who haven’t seen a dentist for six months and don’t have an appointment scheduled within the next three months, Swanton said. The program is funded by grants and donations, so services are provided at no cost to families, she said.

Upper Valley Smiles’ slow ramp-up following the program’s pandemic pause was due to difficulty in recruiting a hygienist, Swanton said. Last year, the program worked with a retired dentist to get to four schools, she said.

One element of the program that has yet to return are the in-class sessions about oral hygiene that a dental assistant used to offer. Prior to the pandemic, the program had two dental staffers, so the staff capacity still isn’t what it used to be, Swanton said.

Another constraint on the program is space. Swanton and Clark set up in whatever space is available, be it a music classroom or administrative office. They bring a folding dental chair and other supplies.

Space is not the issue for the South Royalton-based HealthHub, which operates out of a mobile trailer and has another that it hopes to make use of beginning next school year. But, like Upper Valley Smiles, Health Hub also has struggled with hiring. Until a few weeks ago, the program was operating with just one part-time hygienist. It now has two hygienists and hopes to add more staff by the fall.

The program aims to “make it through all of our schools once this year,” said Dr. Becky Foulk, a retired pediatrician who was one of HealthHub’s founders and is its current president. That’s about half the visits the program typically does, but given that it started the school year without a hygienist, “we’re happy with that,” she said.

In addition to recruiting staff, Foulk was enthusiastic about the potential of silver diamine fluoride, which can now by applied by hygienists and soon by medical practices, to stop cavities from growing.

The approach is “alleviating the issue of having to find a dentist to take care of a bunch of these kids,” Foulk said.

The treatment, when applied to children’s baby teeth, can “tide them over” until the tooth falls out, Foulk said. In the meantime, the hygienists can teach them how to take better care of their teeth. Avoiding more serious cavities that require drilling can also help reduce children’s anxiety about dental treatment.

For some students, Upper Valley Smiles is their first experience with dental care. In a recent school visit, one student, who had never been to see a dentist, was so scared to see the hygienist that she held the hand of a teacher’s aide. But afterward, Swanton said she walked by the student’s class and overheard the student say, “I went to the dentist for the first time today, and it was awesome.”

Holly Maher, a nurse at Hanover Street School in Lebanon, also said that the program can help reduce anxiety for children who might otherwise be anxious about seeing a dentist.

“We’re grateful for them,” Maher said.

She noted that vision screenings offered by the Lions Club also returned this year. That program covers the cost of an eye appointment and glasses for students who need them and whose families can’t afford them. The school also offers an annual flu clinic in collaboration with Dartmouth Health and the Public Health Council of the Upper Valley.

Still, it remains difficult for families to find a dentist to accept Medicaid and then to find transportation to get to appointments, dental as well as other types.

To eliminate such barriers, Maher said she dreams of having a “one-stop shop,” including a dentist, doctor, eye doctor and social work case managers, set up next to the school.

“Just to help support families that need that extra help,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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