February 29, 2024

Overcoming Health Disparities: A Kindergartener's Story

For some Iowa children, a tooth cavity means a reminder to brush regularly and a quick fix in the dentist’s chair. For other children with a cavity, health disparities can mean pain, educational losses and a lifelong impact.

Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing and learning. Children who have poor oral health often miss more school and receive lower grades than children who don’t. According to the Centers for Disease Control and Prevention (CDC), an average of 34 million school hours are lost each year because of emergency dental care, and over $45 billion in U.S. productivity is lost each year due to untreated dental disease.

Disparities related to oral health
The CDC estimates 17% of children aged 2 to 5 years from low-income families have untreated cavities in their primary teeth — 3 times the percentage of children from higher-income families. By ages 12 to 19, 23% of children from low-income families have untreated cavities in their permanent teeth — twice that of higher-income households.

Income is one example of health disparities, but other factors like race or ethnicity, gender, transportation access, education or geographic location, such as rural or urban, also play a role in community health. Income, access to affordable health insurance coverage, and location are major causes of health inequity in Iowa.

EveryStep is working to address these inequities through community support services and outreach programs. EveryStep is a partner in the state I-Smile™ program, which connects children and pregnant women living in Iowa with dental, medical and community resources.

School screening catches child’s dental distress
One EveryStep I-Smile™ dental hygienist who serves mostly Warren and Madison counties has seen first-hand how community resources like I-Smile™ are effective. She remembers one child who was seen as part of a kindergarten school screening. The child had multiple cavities and abscesses, and complained to their teacher that their teeth had hurt for a month. The dental hygienist contacted the child’s parent about the seriousness of the child’s situation and offered help from I-Smile™.

The parent shared they had Medicaid for insurance and the EveryStep dental hygienist recognized there were not currently any dental providers in their county that accepted the managed care organization (MCO) the child was enrolled with. She was able to schedule a primary provider dental appointment to have the child’s initial exam and X-rays completed.

“I learned the parent is a single parent to six children and their only vehicle was not running, with the repair was so expensive it was more than the car was worth."

Lack of transportation’s impact
The family’s rural location and lack of transportation meant they had been missing their Women, Infants and Children (WIC) appointments because transportation provided by the family’s MCO was often canceled at the last minute when it didn’t have a driver or large enough vehicle to accommodate the entire family. This presented a major challenge because many dental practices require cancellation 24 hours prior to the appointment or the patient is counted as a no-show or missed appointment, and can be discharged from care.

I-Smile™ assisted in arranging transportation to the child’s pre-surgery appointment through a collaboration EveryStep utilizes with Freedom Taxi Cab Service for these special circumstances. The parent said, “they felt safe because it was always the same driver that showed up for them and not a random driver that would come and go as the appointments were going on.”

Dental surgery in a hospital setting was needed to take care of all the child’s dental abscesses and decay, but the location was 25 miles away from the parent’s home. I-Smile™ was able to set up transportation to the pre-surgery appointment, pre-operation physical and surgery appointments through Freedom Taxi Cab Service.

The child had the surgery completed successfully and the parent says they will be going to the dentist every 6 months.

Powerful example of health disparities
“This story is impactful and important, because it shows all the barriers to living in rural Iowa,” says the EveryStep dental hygienist. “The biggest barriers are the lack of providers who accept Medicaid and the transportation barrier to access care, especially for large families with no local support systems. Sadly, this child had been in severe pain, and it took several months for all services to be completed. Without dental screening, assistance and follow-up, this child would likely still be suffering.”

The I-Smile™ program provides oral health screenings, oral health education, nutrition education relating to oral health, fluoride varnish application, and a referral to a dentist for comprehensive dental needs. The program serves children under the age of 21 and pregnant women by:

Finding a dental home or dental coverage for their child.
Acquiring assistance to set up appointments with the dentist or find dentists who accept Medicaid.
Transporting their child to the dental appointment.
Offering translation services regarding their dental care.

For more information, please contact the I-Smile™ Program at 515-557-9023.

Many people are especially struggling to meet their needs as the cost of living has risen. Rural communities have become further isolated from support systems and families are piecing together services for their kids. You can be part of the community thread that helps prevent children and families like this one from falling in the gaps between our health and social service programs.

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Offering a comprehensive slate of health care and human services, EveryStep helps individuals and families overcome times of crisis and build the foundation for a healthier future. As people become more deeply woven into the community’s social fabric, they are wrapped into a support system that provides stability to move forward with dignity and hope.