Second-grader Anurag Das was nervous walking into Mary Davis’s makeshift dental office last Wednesday.
He put the hood of his dark blue sweatshirt over his head and crossed his arms over his chest.
“Is it going to hurt?” he asked, sitting on a recliner next to Davis’s chair. “I’m scared.”
“It’s not going to hurt, buddy,” Davis said. “Lie down and put your hands on your belly. It will help your breathing.”
Davis is a certified public health hygienist working with the Concord Dental Sealant Coalition led by Concord dentist Dr. Ray Orzechowski. For years, she has been working with Orzechowski to go into schools and provide free care to students who might otherwise not get a dental visit.
On Wednesday, she was at Penacook Elementary School wearing blue scrubs, her instruments and a pile of Disney-themed stickers displayed on a table in a room off of the school’s main office.
The coalition typically provides students fluoride treatments and dental sealants once a year, funded by Medicaid and grant money. The nonprofit’s focus has always been cavity prevention, Orzechowski said. Research suggests that fluoride treatments and dental sealants reduce students’ risk for cavities by two-thirds.
But this school year, they are part of a new program pioneered by Dr. Richard Niederman at New York University College of Dentistry that may make them able to provide prevention that is just as effective – at a fraction of the cost and the time.
Last fall, NYU College of Dentistry received a five-year, $3.6 million grant from the National Institutes of Health to provide dental care to children across New Hampshire. Orzechowski and Davis are delivering the prevention twice a year to children in 10 schools in the Capital region, including in Penacook, Loudon, Concord and Boscawen.
Niederman’s study is monitoring the effectiveness of two cavity-prevention techniques: a “simple” treatment of silver diamine fluoride and fluoride varnish, and a “complex” treatment of traditional sealants and fluoride varnish.
The simple method is cheaper and a lot faster. Davis said she can treat about 25 students in a school day using the sealants and fluoride technique, which takes 15 minutes. She can treat 35 a day with the other method, which takes five to eight minutes.
The silver diamine fluoride and fluoride varnish method is also a lot less invasive and easier for children who have anxiety about dental work or children who have special needs, Davis said.
“You can provide a lot of prevention to all types of children. The big piece of this, the passion, is social equity,” she said. “We want everyone to have access to evidence-based prevention.”
Nearly 30% of school-age children in the U.S. have untreated cavities, according to the NYU College of Dentistry. For children in rural areas, this number is even higher: more than 35% have untreated cavities. For rural populations, the primary barrier to care is the distance required to travel to dentists.
Niederman said tooth decay is the most prevalent global and national disease. Cavities are five times more prevalent than asthma, he said. Americans spend a lot of money on it, too.
“We spend, after cardiac disease and cancer, the most amount of money on cavities,” Niederman said.
Children with cavities and associated toothaches face multiple disadvantages, including reduced quality of life, school absences, difficulty paying attention in school and lower standardized test scores.
“Bringing care to children instead of children to care eliminates these barriers,” Niederman said.