Tribe's dental team plays prevent defense

If you are the mother of a 3-year-old child or younger, Tribal Dental Hygienist Sheila Blacketer wants to visit your home and sit across from you knee-to-knee to safely deliver dental services to young patients while they are held and comforted.

“I bring my loupes and I have my container of fluoride varnish and toothbrushes and gauze,” Blacketer says of her home visit routine. “I put my loupes on and sit knee-to-knee with the mom and the baby’s head is on my lap and I can see if there is any cavities starting.”

Dental loupes are small magnification devices used to look closely at a patient’s teeth.

Blacketer’s home visits were still dreams on paper in 2012, but those dreams started becoming reality in 2013 with the first of what are now regular and welcomed home visits aimed at improving the dental health of Tribal members of all ages.

By 2014, the visits were a regular offering and now they are part of the overall strategy of the clinic’s dental staff. It’s all about building trust and establishing relationships that will hopefully lead to lifelong improved dental health, she says.

“There are some new techniques out there where a quick look in the mouth and they (dental staff) can see if there are issues going on,” Health Services Executive Director Kelly Rowe says. “There is a lot of time and attention paid to building a relationship when they are out in the field or they are at the school. All of the outreach events and opportunities are just building the relationship and it really is a model of public health.”

The Health & Wellness Center’s dental programs are working to improve the membership’s overall oral health by offering quality dental services like emergency and comprehensive exams, preventive and periodontal services, crown and bridgework, silver and tooth-colored fillings, root canals, extractions, deep cleanings, restoration of implants and providing dentures.

In 2016, the dental program added orthodontics to its services by request of the membership and the program has an open-door policy for children up to the age of 5 so they can be seen by a dentist or hygienist with no appointment needed.

Initial visits include a review of the member’s medical history, soft tissue exam, charting of teeth, oral cancer examination and X-rays.

The Health & Wellness Center provides comprehensive out-patient medical and dental care to Tribal members, other Native Americans, non-Native employees of the Tribe and casino, and surrounding community members.

Home visits are one of the many helpful and informative programs the Health & Wellness Center offers for Tribal members regarding dental care aimed at improving overall health.

Home visits catch decay early when there is still something that can be done and, in some cases, visits detect decay before it becomes an issue.

“I knew about putting fluoride on teeth and I knew that we could reverse decay and that getting toothpaste into homes is important,” Blacketer says. “But what I didn’t realize was that there would be all these positive side effects and what it has done is it has connected us at the dental clinic with our young families in the community.

“We saw all these barriers go away and we’re building relationships with other departments and that makes our department strong. When you’re sitting on their couch and you’re holding their babies and you are talking to them, it’s just more open and it has been amazing.”

Blacketer, who is part of a team of three dentists, two dental hygienists and five dental assistants, also works with Head Start program staff members to visit homes on a quarterly basis to conduct risk assessments on Tribal youth. Blacketer said Head Start staff members perform weekly home visits and that she accompanies them four times a year to conduct assessments.

The Tribe’s dentists are Drs. Eric Webster, Erin Lange and Ryan Davis. Hygienists are Blacketer and Erin Muchmore, and the assistants are Donnette Spaulding, Shelby Hoyt, Rachel Clark and Tammy Baird. Carrie Brooks and Whitney VanArsdale are the dental receptionists.

“Partnering with Head Start has been huge,” Blacketer says. “We have had a long history with Head Start and that goes back since I have been here 19 years in July. They know that we are a resource and it allows us to connect with other departments, and I think that is huge.”

Rowe says she is pleased with the work being done by the dental program and she supports it by providing the best people the center can hire and by giving employees the tools they need to do the job well.

“There is a lot of time and attention paid to building a relationship when they (dental staff) are out in the field or they are at the school or Adult Foster Care or the Elders Activity Center,” Rowe says. “By being able to do the outreach that they do they are connecting with people on a level outside of the clinical setting and building relationships with trust that reduce anxiety.”

Blacketer says she has developed a dental health curriculum that educates children by teaching them proper brushing habits, nutrition and how it plays a part in overall dental health, and combatting decay-causing germs.

Blacketer visits Tribal classrooms monthly for a circle time presentation during which she explains proper brushing techniques and those sessions are followed with a letter to the child’s parents explaining the activities their children participated in and how they, as parents, can emphasize healthy dental habits and proper techniques to achieve it.

Blacketer and Webster coordinate with Adult Foster Care Director Peggy Shaver on client visits at the Tribe’s facilities in Grand Ronde every three months.

“We go in and we see all the residents there,” Blacketer says. “We check for decay. It makes a big difference.”

Blacketer says a grant from the American Dental Association helps the dental team participate in local events like the annual “Give Kids a Smile Day” in Willamina schools.

Rowe says the dental team provides screenings and a fluoride varnish.

“All of these outreach events and opportunities are just building relationships and it really is a model of public health,” Rowe says. “It’s taking the care to the person where they are at and engaging them, and it builds that engagement so they come to us. With the kids it’s about developing that relationship early on so that they are not instantly fearful. If we can have as much contact along the way to show them that we’re not scary and we’re here to help then we can make sure things go good.”

Blacketer says the Tribal dental staff used American Dental Association sponsorships to see 89 students in 2016 (and as many as 211 one year) at Willamina’s “Smile” day and performed $10,000 worth of dental care.

One of the tools used when assessing children is silver diammine fluoride, which is a topical medicament used to treat and prevent cavities. Silver diammine fluoride, a light-sensitive clear liquid, stains areas of concern black when applied to teeth as a way to identify cavities.

“We use that to arrest decay,” Blacketer says. “It will completely arrest the cavity and stop it before it becomes an issue. It stops future cavities.”

The fluoride treatment replaced silver nitrates that were used to prevent cavities from 1920 through 1960. Its use began in 1960 in China, Japan, Mexico, New Zealand and Australia, and was approved for use in the United States in 2014.

“This technique has saved the Tribe money in Contract Health dollars and has provided a safe, non-invasive way to deal with cavities,” she says.

Blacketer and Rowe say they are both proud that the Health & Wellness Center has the latest equipment and uses the most current dental techniques.

“I will say for our dental clinic I am proud because we are on the cutting edge of dentistry – we are using procedures that are very conservative, but very preventative,” Blacketer says.

“We have very up-to-date equipment and techniques that they are using,” Rowe says. “There are a lot of preventative things they can do. Our staff is really good. They have been here for a long time and they have been here for the community and they have been able to get to know people.”

Blacketer says she is driven by her ability to perform ongoing home visits that keep her on top of the preventive side of dental care.

“I feel good about what we do at the clinic and what we do out of the clinic,” Blacketer says. “I think for me I just have a passion for public health dentistry because it is more targeted at prevention and how do we prevent disease. You can’t drill your way out of a disease – you have to prevent it.”

Emergency hours for the Tribe’s dental program start at 8 a.m. Monday, Tuesday, Wednesday and Friday and 9:30 a.m. Thursday. Scheduled visit hours are 8 a.m. through 5:30 p.m. Monday through Friday.