Oral Health Initiative takes big leap forward in LAUSD schools

The L.A. Trust Oral Health Program Manager Nancy Ripoly at Willow Elementary School with kindergartners.

At the onset of the 2023/24 school year, The Los Angeles Trust for Children's Health (The L.A. Trust) witnessed a remarkable surge in the number of kindergarten students receiving oral health screenings with one school alone accommodating 94 screenings in a single day. This is in stark contrast to the previous average of only 35 across select schools within L.A. Unified (LAUSD).

The increase in screenings is being attributed to the change from opt-in consent forms to opt-out forms. With the implementation of opt-out screenings, all students are included by default unless parents specifically decline participation. The new forms eliminated the need for individual parental signatures and streamlined the process. Opt-out consent represents a significant departure from traditional consent-based systems.

The change underscores the efficacy of opt-out screenings in reaching a larger portion of the student population and ensuring more children receive essential dental care. The new approach resulted in a significant increase in the number of students receiving dental screenings, with only a fraction of parents opting out compared to the previous consent-based model.

The idea of providing dental screening at school is part of a groundbreaking Oral Health Initiative led by The L.A. Trust with the Oral Health Advisory Board, a group of public healthcare leaders and private providers. The initiative aims to enhance children's oral health throughout Los Angeles County.

Dental screening of a kindergartner student

“We’ve been advocating for this change for years and we are excited about what this means moving forward,” said Maryjane Puffer, Executive Director of The L.A. Trust. “The success of opt-out screenings extends beyond mere numbers; it represents a significant milestone in the broader effort to enhance children's oral health across Los Angeles County.”

LAUSD provided essential data to support the transition to opt-out screenings, further solidifying the collaborative effort behind this initiative. With improved data collection facilitated by onsite screenings, officials can now better measure the effectiveness of oral health prevention and intervention programs, paving the way for more targeted initiatives in the future.

The implementation of opt-out screenings aligns with the broader legislative efforts to address oral health disparities in California. Assembly Bill 1433, enacted in 2005, laid the groundwork for the Kindergarten Oral Health Assessment, which aims to mitigate tooth decay among young children. The subsequent amendment through Senate Bill 379 in 2018, allowed for onsite screenings with an opt-out consent option. This marked a significant stride towards achieving this goal. Since then, The L.A. Trust and its partners have been working with state, county and local health officials on creating and implementing a system of excellent oral care for students that is transparent, accountable, and able to track results.

The urgency of addressing oral health disparities in Los Angeles County cannot be overstated. Surveys have revealed alarming rates of tooth decay among kindergarten students, highlighting the critical need for early intervention and preventive measures. By providing accessible dental screenings in schools, particularly to children at greatest risk, Los Angeles County is taking proactive steps towards ensuring every child receives the necessary dental care for a healthy smile and a brighter future.

This endeavor was made possible with a grant from the Los Angeles County Department of Public Health Oral Health Program (LACDPH), which aims to provide oral health screenings, preventive care, and treatment to 77 schools across the county. This ambitious initiative has the potential to impact thousands by ensuring access to essential dental services for children in need.

The transition to opt-out dental screenings represents a paradigm shift in children's oral health initiatives in Los Angeles County. Through collaborative efforts and innovative approaches, The L.A. Trust and its partners are paving the way for a healthier, happier future for the county's youngest residents. With continued commitment and investment in preventive measures, we can strive towards a community where every child can smile with confidence.

A special Thank You to the LAUSD team for their advocacy and persistence:

Smita Malhotra, MD
Chief Medical Director

Dr. Ron Tanimura
Director of Student Health Services

Dr. Kevon Tucker-Seeley
Director, Data Privacy, Analysis, & Reporting Branch

Brush It Up! The L.A. Trust launches online fundraiser for children's oral health

Brush It Up! is a peer-to-peer awareness and fundraiser to be held through videos, fun challenges, and social media February 21 – 24, 2023.

Kicking off National Children’s Dental Health Month, The Los Angeles Trust for Children’s Health is proud to announce Brush It Up!, an online fundraising campaign to be held from February 21 to 24. The online event will feature daily videos with The L.A. Trust staff and oral health puppets Billy and Friends, highlighting surprising facts and fun challenges about children’s oral health. The goals of the campaign are to raise awareness of children’s oral health and funds to increase access to high quality oral health care, education, and resources to students in need in Los Angeles.

Since the start of the pandemic, children’s oral health has been on a rapid decline, particularly among high-need populations. To address this issue, The L.A. Trust has committed to dissolving barriers to oral health care by raising awareness, increasing access to dental care, and addressing the shortage of oral health providers in low-income communities.

“Good oral health is an essential part of overall health and wellness, and we are proud to host this online fundraiser to support our mission,” said Maryjane Puffer, Executive Director of The L.A. Trust. “We are committed to promoting oral health and improving the lives of those in our community, and we need everyone’s support to make that happen.”

Brush It Up! will bring together The L.A. Trust board, staff, and friends to spread the word about the importance of oral health and raise funds for this critical cause. Supporters can donate money online and spread the word among their social networks. Our headline sponsors are Liberty Dental Plan and DentaQuest. Additional supporting sponsor is Big Smiles Dental.

Join The L.A. Trust in its mission to improve children’s oral health and Brush It Up! For more information about Brush It Up! and The L.A. Trust, or to make a donation, please visit here or contact Julie Eden, J.Edens@thelatrust.org.

Celebrating National Children's Dental Health Month: A call to action for healthy smiles

A kindergarten student at an LAUSD dental screening.

February is National Children's Dental Health Month, a time to emphasize the significance of oral health in children's overall wellbeing. Sadly, many underserved communities face numerous barriers that make dental care for children challenging, including lack of oral health education and financial limitations. During this month and all year round, it's crucial to focus on expanding access to dental care for all children, especially those from underserved communities.

Educating Children on Oral Hygiene

The initial step in celebrating National Children's Dental Health Month is to educate children on the importance of maintaining oral health. Parents can lead by example by teaching their children to brush twice a day with fluoride toothpaste and floss daily. They should also explain why oral hygiene is vital and how poor habits can lead to serious health problems such as cavities and gum disease.

Schools Can Make a Difference

Schools play an integral role in this cause by providing basic oral health education and screenings, just like LA Unified is doing in its elementary schools. This kind of programming ensures that each student receives dental care during the academic year and helps connect families with dentists who accept Medicaid or other forms of insurance. Schools can also provide resources such as toothbrushes, toothpaste, and floss, so students can take responsibility for their oral health at home.

Maryjane Puffer, Executive Director of The L.A. Trust speaking at the Oral Health Advisory Board meeting this month.

The L.A. Trust Oral Health Initiative

The L.A. Trust's Oral Health Initiative has been a driving force in oral health since 2012. The initiative has formed partnerships with providers and partners to bring free oral health education, screenings, and referrals to children without dental care. The L.A. Trust works annually with Los Angeles Unified and providers to screen and educate over 1,700 kindergartners and third graders. The initiative also supports the broader community by bringing together public health officials and private dental providers through its Oral Health Advisory Board meetings.

“Good oral health is essential for a healthy life, and it's our responsibility to ensure that all children, especially those in underserved communities, have access to the dental care and education they need for a healthy smile,” says Maryjane Puffer, Executive Director of The L.A. Trust. “Let us celebrate National Children's Dental Health Month by committing to oral health as a priority for all children.”

In conclusion, National Children's Dental Health Month is a call to action to prioritize the dental health of our children. By educating children on oral hygiene and increasing awareness among school administrators and healthcare providers, we can help ensure that all children have access to the dental care they need and deserve. Let us work towards a future where every child has a healthy smile, regardless of their background or financial status. National Children's Dental Health Month is an opportunity to celebrate and advocate for our children's dental health today and every day.

Fall season dental screenings for kids

Esther Yepez and Maryjane Puffer at 116th Street Elementary School providing oral health education.

Throughout the month of October, The L.A. Trust partnered with Big Smiles Dental to increase the number of dental screening consent forms collected from 22 LAUSD elementary schools (grades K-5). The L.A. Trust is currently working with LAUSD to phase out the consent forms. However, the forms are still being used today.

The L.A. Trust oral health team served as “boots on the ground,” in a two-step process. First, they visited all 22 schools classroom by classroom to provide oral health education. Billy and friends good oral health puppets, led demonstrations on how to brush properly and played interactive games where the students learned about healthy and not-so-healthy snacks to avoid cavities. At the end of the screenings, students received a wrist band that reminded their parents to return the consent forms for their dental screenings which were scheduled to take place on school premises two weeks after the oral health presentations.

For the second step, The L.A. Trust team returned to the 22 school sites with Billy the puppet and friends to do a short 10- minute presentation for the students as they waited their turn to see the dentist. The presentation consisted of a short Sesame Street video that talked about oral health and another video called “No More Nasties,” which talked about brushing and flossing. The dental screenings are free of charge for students, as are the dental services provided to them. Anything the child needs that day can be serviced if the parents fill out the consent form and opt for any of the services provided.

Jasmine Cisneros at South Park Elementary School.

Tooth decay is the most common chronic disease of childhood, and yet it is also the most preventable. Early and consistent oral health care is critical to preventing dental caries (tooth decay) in children. The American Academy of Pediatric Dentistry (AAPD) recommends that children visit the dentist at the time of first tooth eruption and no later than at one year old and every six months after that. Unfortunately, this need for oral health care often goes unmet, leaving our youth vulnerable to advancing decay. Barriers to accessing oral health care include a lack of awareness about the importance of routine oral health care; lack of dental insurance; and a shortage of oral health providers to treat low-income children in their communities.

The L.A. Trust Oral Health Initiative

Since 2012 The L.A. Trust’s Oral Health Initiative has been forging partnerships with providers and partners to bring free oral health education, screenings and referrals to children who lack dental care. We work with Los Angeles Unified and providers to facilitate screenings and education for more than 1,700 kindergartners and third graders. The L.A. Trust also supports the broader community by convening public health officials and private dental providers through our Oral Health Advisory Board meetings. During the lockdown period of COVID-19, The L.A. Trust also launched Operation Tooth Fairy, raising oral health awareness and distributing more than 50,000 toothbrushes.

The Kindergarten Oral Health Assessment and district survey results

A kindergarten student at a school dental screening.

In 2005 California legislators passed Assembly Bill (AB) 1433 to create the Kindergarten Oral Health Assessment (KOHA) to help improve student health and strengthen efforts to reduce absenteeism. However, the assembly bill needed additional funding and infrastructure to realize a successful implementation. Then in 2018, KOHA was amended with the passage of Senate Bill (SB) 379, which allowed for onsite screening with an opt-out consent option for parents with the goal to screen more children and identify which children need urgent care and find them a dental home. With oral screenings made available at the schools, officials can now improve data collection to measure the success of oral health prevention and intervention programs.

Why California Needs the KOHA

A 2020 Smile Survey found that by the time Los Angeles County’s children enter kindergarten, almost half have experienced tooth decay. In addition, almost 20% or 43,500 kindergartners and 3rd graders experience severe tooth decay. On any given day more than 4,500 Los Angeles County kindergarten and third-grade children need urgent dental care, which means they may be experiencing mouth pain or a serious infection. If left untreated, tooth decay can affect essential aspects of daily living, including eating, speaking, and performing at home, school, or work. Children with poor oral health miss more school and receive lower grades than those with better oral health. Early dental care plus regular and consistent prevention are key to improving the oral health and overall health of children in Los Angeles County. This highlights the need for ongoing screening, referral, and case management services in schools that serve children at greatest risk.  

The L.A. Trust and the KOHA District Survey Project

Last year The L.A. Trust partnered with the Los Angeles County Department of Public Oral Health Program to survey how 28 school districts with the largest elementary enrollments in L.A. County are reporting and collecting KOHA project. The culmination of that research was shared by The L.A. Trust in person and via Zoom on May 16, 2022, at the Endowment Center in Los Angeles with L.A. Unified, L.A. County and Smile California. The L.A. Trust shared key findings from the survey that highlighted best practices, challenges of gathering the necessary data, and recommendations on how to improve reporting to capture accurate and timely data.

This study analyzed the implementation of KOHA in 28 of the largest school districts in Los Angeles County, including the 574,570 students enrolled in LAUSD. This is the total number of students enrolled in LAUSD, not just the kindergartners. This information will be used to improve reporting, and support districts and families to receive more oral health care as the effort progresses.  Understanding the reporting mechanism will help schools focus on how to efficiently streamline reporting data to the state and use it to improve children’s oral health. The L.A. Trust also looked at the reporting mechanisms and promotion strategies of the 28 school districts.

There are layers of complexity when it comes to optimizing the implementation of KOHA in Los Angeles County.  L.A. County is the largest county in the United States, with 88 cities and 80 school districts, including the second largest city in the nation, and the second largest school district. The county is also one of the most diverse regions of the country where one third of the residents are immigrants and an estimated 185 languages and dialects are spoken. In addition, the need is critical: surveys show that 47 percent of the county’s children may have experienced tooth decay by kindergarten.

Challenges with the System for California Oral Health Reporting

KOHA data should be entered into and managed by the System for California Oral Health Reporting (SCOHR). Today data is collected via paper forms distributed to parents through various channels. While many districts distribute the forms in enrollment packets, survey results indicate that the best results come after an in-person consultation or a presentation.

Most school districts surveyed reported that their student oral health data is housed in either paper forms or in spreadsheets. If KOHA data is uploaded in the system, it is entered manually and not automated. Many districts reported that SCOHR does not work as advertised and that the system displays severe undercounts that do not reflect the data put into the system. A majority of districts also reported that school staff lack the training on how to use the system properly.

Recommendations for Improvement

Below are the recommendations unveiled by The L.A. Trust in the KOHA convening on May 16.

1.       Update the SCOHR reporting system.

2.       Improve and standardize the Oral Health Reporting form. A scannable form matched to a state scanning system would obviate the issues with the SCOHR reporting system.

3.       Increase the Los Angeles County Office of Education’s support of KOHA data submission. 

4.       Until other reporting system improvements are made, train and assist districts to submit summary information from their data systems into the SCOHR system.   

5.       Provide materials and training to districts and schools to improve oral health support to families. 

6.       Provide training and support to assist school districts in utilizing dental partnerships to screen students and assist them in obtaining a dental home.

School readiness is much more than attending to children’s early learning and cognitive development. 2021 marked the inaugural launch of the district survey on KOHA data collection, and we look forward to working with our partners to ensure that we gather the most accurate and comprehensive information available. The L.A. Trust will continue to create opportunities to partner with communities, local schools, and health officials to improve data collection systems and processes. Children’s oral health is a pillar issue that impacts the overall health of the student as well as their performance in school. Ultimately it affects family finances as well as school and community economics. Through schools and local health advocates working together, we can promote oral health and put children on a path to wellness and academic success. There is no better investment in the future than supporting the health and well-being of our children.

Project Leader: Casey Balverde, Data and Research Analyst at The L.A. Trust

Oral Health Advisory Board focuses on dental high-risk priority schools

Esther Yepez and her friend Billy show little ones how to brush their teeth.

Oral health leaders from the healthcare industry, nonprofits, academia, and the government met online at The L.A. Trust’s Oral Health Advisory Board quarterly meeting on June 7. Representatives from about 20 organizations discussed ways to help students in dental high-risk priority schools to access oral health services, how to improve screening assessments, and developed a roadmap for future meetings.

Dr. Smita Malhotra, Los Angeles Unified School District (LAUSD), Medical Director provided an update from the new Superintendent for LAUSD, Alberto M. Carvalho, who has identified 68 priority schools as dental high-risk schools. LAUSD aims to bring mobile dental services to all the priority schools in the upcoming school year. They hope to provide toothbrushes and other resources in these schools and to boost The Kindergarten Oral Health Assessment (KOHA) participation in communities where dental care resources are lacking or what health officials call “dental desert communities.” 

Assessments and screenings

Casey Balverde, Data and Research Analyst with The L.A. Trust, gave a brief overview of the KOHA Survey Project, an online survey conducted in 28 districts to see how each district is distributing, collecting, and reporting KOHA data. The L.A. Trust is finalizing a full report in collaboration with the L.A. County Health Department detailing best practices, challenges and recommendations that should be ready later this month.

Elizabeth Brummel, Oral Health Community Liaison at the UCLA School of Dentistry, gave a brief update on the findings of their own Oral Health Collaborative Consortium of five elementary schools in South L.A. She outlined what UCLA Dentistry is doing to advance school-based oral health, including updates on their assessment, education, and outreach programs.

Esther Yepez from The L.A. Trust provided updates on the Big Smiles screenings small pilot project at the nine schools in the Local South District which provided oral health education to 781 students. The pilot project was able to screen 162 students and is aiming next year to increase the impact on children with more education and screenings.

Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, added that there was likely growth in dental emergencies due to the pandemic. In the last 10 years, the average has been 4-6% and now it is at 9%. The dramatic increase in cavities, or “covidties” as Dr. Francisco Ramos called them, can be seen as a result of the pandemic with the closure of dental clinics, social distancing, staying indoors, and fear of visiting unfamiliar places.

Moving forward

The L.A. Trust’s Oral Health Advisory Board ended with a focus on next convening’s agenda. The agenda includes reporting findings and recommendations on referral systems for the city, the county and the state. The Board seeks to align LAUSD priority schools with the LA County priority schools to make sure those students get first access to dental screenings and referrals to dental homes. The Board also aims to ensure that water fountains at the 68 priority schools are properly fluoridated to supplement ongoing oral health initiatives.

Health educators from The L.A. Trust go back to school

The L.A. Trust and Beyond the Bell have distributed more than 100,000 toothbrushes and other donated oral healthcare items to students and family members as part of Operation Tooth Fairy.

Los Angeles Unified School students are back on campus — and so are oral healthcare educators from The L.A. Trust. 

Program Manager Esther Yepez and her kid-friendly puppet Billy visited Logan Street Elementary School in the Echo Park section of Los Angeles May 5. It’s the first of nine such trainings sponsored by a grant from QueensCare. 

“Students were extremely excited to learn about the importance of why we brush our teeth and how cavities are formed,” Yepez said. “They learned about the germ called plaque that causes cavities.” 

Good to be back 

Yepez and Billy addressed four classes — one transitional kindergarten class, two kindergarten classes and one first-grade class. A total of 78 students received the instruction along with oral healthcare kits containing toothbrushes and Sesame Street brochures.  

Executive Director Maryjane Puffer of The L.A. Trust said, “It’s good to be back in the classroom, teaching good oral healthcare habits to our kids.”  

The L.A. Trust’s oral healthcare mission has continued during the pandemic, Puffer noted.  Operation Tooth Fairy distributed more than $455,000 in supplies; The L.A. Trust’s kid-friendly oral health campaign on KLCS and social media reached an audience of more than 1.5 million. 

The campaign has made celebrities out of Yepez and Billy. One student in the hallway recognized the pair from their appearances on KLCS. They appeared on the L.A. Unified TV station 150 times during the pandemic. 

Dental disease starts young, so should oral healthcare

Brushter, Gumster and Toothster are the spokes-characters of L.A. County’s “Love Your Baby’s Teeth” campaign, which launched on multiple media outlets last month.

Oral health advocates from public agencies, private foundations, community groups and L.A. Unified explored how to improve children’s dental care starting at an early age at The L.A. Trust’s quarterly Oral Health Advisory Board meeting March 16.

Dr. Abrey Daniel of the Los Angeles County Department of Public Health introduced the county’s extensive new Love Your Baby’s Teeth education campaign, launched during Children’s Dental Health Month in February. The campaign features TV, radio, PR and social media.

Daniel said one-quarter of L.A. children age 2 to 4 have tooth decay, and 55% of all lower-income children have dental disease, which is more prevalent in Black and Latinx communities.

“Families where Spanish is (mainly) spoken are at the greatest risk” in L.A. County, Daniel said.

The county’s multilingual campaign includes heavy use of Spanish-language media, and features such elements as dental office posters, bus shelter ads, exam table paper with campaign messages, and giveaway mirror clings to remind kids to floss and brush. The campaign has already reached hundreds of thousands.

Smile, California

Dr. Puja Shah, Medi-Cal outreach consultant, reviewed the California Department of Health Care Services’ “Smile, California” campaign, designed to build awareness and use of the benefits available from Medi-Cal Dental.

The tagline of the campaign is “Medi-Cal Has Dental Covered.” Key messages include getting a child’s first check up by their first birthday; seal today to prevent decay; and Medi-Cal covers dental during pregnancy. The comprehensive outreach includes robust websites in Spanish and English connecting patients and providers, a partner program enlisting community groups and a toolkit with materials for children and family members.

 Shah also noted that the agency was improving its online complaint system so patients can report providers who refuse them care.

More outreach and updates

Cynthia Cervantes, Oral Health Collaborative Consortium liaison from the UCLA School of Dentistry, gave an update on the consortium, which is funded the California Department of Public Health’s Office of Oral Health.

Cervantes stated that the mission of the OHCC is to “support and facilitate the implementation of the L.A. County Community Oral Health Strategic Plan (COHIP) throughout L.A. County through community outreach and leadership in each of four Mega Service Planning Areas. She gave examples of outreach at faith-based organizations, Los Angeles Public Library branches, medical clinics and daycare centers. The consortium will host Oral Health Summits in 2021 and 2022.

Susan Flores, senior policy coordinator from the California Pan-Ethnic Health Network, updated OHAB members on Medi-Cal dental appointments during the pandemic. The decreases in monthly appointments ranged from 437,898 in April 2020 to 129,114 last August, the most recent numbers available.

Flores also urged support for two California Assembly bills under consideration. AB526 would allow dentists to vaccinate for Covid and flu, potentially increasing healthcare equity.  AB733 would help expand access to oral healthcare for children and those pregnant enrolled in Medi-Cal by allowing registered dental hygienists to partner with medical professionals to provide fluoride treatments and oral health education and coordinate dental care. It is similar to a bill signed last year (AB890) that allowed physician assistants to perform more oral healthcare.

Gloria Velasquez, organization facilitator for L.A. Unified’s Student Health and Human Services, gave a briefing on school re-openings, including health and testing protocols and the hybrid teaching model.

Maryjane Puffer, executive director of The L.A. Trust, sounded an optimistic note at the close of the meeting. “The important thing is that nobody stopped working.” She pointed to expanded outreach on social media, TV and video, and events like The L.A. Trust’s ongoing Operation Tooth Fairy, which has distributed more than 58,000 toothbrushes to date. The next meeting of The L.A. Trust’s Oral Health Advisory Board will be held in person or online June 15 in accordance with health directives.

The L.A. Trust takes action in Children’s Dental Health Month

Los Angeles School Board Member Scott Schmerelson and The L.A. Trust’s Tooth Fairy  Maryjane Puffer brought brushes, toothpaste and healthcare info to Columbus Middle School February 10.

The Los Angeles Trust for Children’s Health launched a public oral health awareness campaign and distributed 58,000 toothbrushes plus other oral care items in observance of National Children’s Dental Health Month in February.

“Poor oral health is the number one cause of school absenteeism – and it’s entirely preventable,” said Maryjane Puffer, executive director of The L.A. Trust. Screenings of 3,399 elementary school students in Los Angeles found that 66% of children had active dental disease, 27% had visible tooth decay and 6% required emergency care.

Puffer said The L.A. Trust is working closely with its partners in the oral health community, including L.A. Unified Student Health and Human Services, LAUSD’s Beyond the Bell division, UCLA’s More LA Smiles, the L.A. County Department of Public Health and other agencies, foundations and dental care providers. Puffer gave special thanks to Crest, which provided toothpaste to go with the thousand of brushes being distributed.

Prevention campaign

Los Angeles School Board member Scott Schmerelson took The L.A. Trust’s Brushing with Billy campaign direct to kids during an online Local District “Twinkle Time” February 3, using the puppet to show young students how to brush, floss and eat right.

“Improving the health and lives of all L.A Unified students and providing access to oral healthcare is a critical element to ensuring student achievement and success,” Schmerelson said. “As we celebrate National Children’s Dental Health Month, we are grateful for our partnership with The L.A. Trust and will continue to support their oral health awareness initiative so our students can stay healthy and benefit from a wealth of resources.”

ORAL HEALTH RESOURCES FROM THE L.A. TRUST

The L.A. Trust is releasing three oral health videos on social media this month. The “Brushing with Billy” videos feature Program Manager Esther Yepez and the kid-friendly puppet. The spots, which focus on brushing, flossing and healthy eating, have been aired 150 times on KLCS-TV, reaching an estimated viewership of more than 1.1 million.

The L.A. Trust also facilitated the broadcast of UCLA More LA Smiles oral health TV spots starring Sesame Street characters, which will be shown on KLCS remote learning channels through February. 

“People don’t understand the disease process when it comes to cavities – it’s insidious,” said Dr. Jim Crall, project director of More LA Smiles. Simple changes in student behavior can make a big difference and education is key, he said.

“Prevention is key to oral health and that includes screenings and education,” Puffer said. “The pandemic has transformed our oral health education activities but not our commitment. We will continue to use every means at our disposal to ensure that kids and teens enjoy the best possible oral health during this pandemic.”

SHHS Organization Facilitator Gloria Velasquez noted that seven Wellness Centers and school-based health clinics are currently providing partial or full oral health services for students and community members: El Sereno Middle School (Western Dental); Hart Street Elementary School (Dr. Samoha); Jefferson Wellness Center (South Central Family Health Center); Maclay and Sun Valley Middle Schools (NEVHC); Monroe (Valley Community Health, appointment only); and Washington Prep Wellness Center (St. John’s Family and Wellness Center). Call ahead for an appointment.

Oral Health Advisory Board focuses on prevention education

Dr. Jim Crall of UCLA More LA Smiles (and friend) discussed public oral health campaigns during the final Oral Health Advisory Board meeting of 2020.

Representatives of the L.A.’s student oral health community met online December 15 at the fourth and final 2020 meeting of The L.A. Trust’s Oral Health Advisory Board.  

More than three dozen oral health providers and stakeholders attended the event, which focused on public health campaigns and best practices for student oral healthcare in the midst of the coronavirus pandemic. 

Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, discussed The L.A. Trust’s oral health education campaign on KLCS featuring Program Manager Esther Yepez and her kid-friendly puppet, Billy. The campaign has generated up to 1.5 million views to date.  

Puffer thanked QueensCare for funding upcoming student oral healthcare education by The L.A. Trust at nine LAUSD sites and introduced The L.A. Trust’s new Oral Health Toolkit, providing useful resources for student and community dental care providers.  

Dr. Maritza Cabezas, dental director for L.A. County Department of Public Health, and Dr. Abrey Daniel, walked attendees through the development of a County oral health education campaign. She outlined the campaign development process, including: determining the need; selecting the audience; developing the message; and crafting the final creative with the help of focus groups. The County’s campaign’s goals are to increase awareness among caregivers of children under 5, demonstrating the importance and ease of at-home oral health habits.  

“People don’t understand the disease process when it comes to cavities – it’s insidious,” said Dr. Jim Crall, project director of UCLA More LA Smiles. He said “there are a lot of disconnects in oral health treatment” for children. Simple changes in student behavior can make a big difference and education is key. He previewed a series of TV spots featuring Sesame Street characters, which will be shown on KLCS remote learning channels through February. The L.A. Trust helped facilitate the broadcast of the Sesame Street spots.  

Doors still open 

Gloria Velasquez, organization facilitator for LAUSD Health and Human Services, said  seven Wellness Centers and school-based health clinics were still providing partial or full oral health services for students and community members: El Sereno Middle School (Western Dental); Hart Street Elementary School (Dr. Samoha); Jefferson Wellness Center (South Central Family Health Center); Maclay and Sun Valley Middle Schools (NEVHC); Monroe (Valley Community Health, appointment only); and Washington Prep Wellness Center (St. John’s Family and Wellness Center). 

Crall noted that the Medi-Cal Dental Transformation Initiative would continue but local DTI pilot programs would not. UCLA’s More LA Smiles LADRRS program (Los Angeles Dental Registry & Referral System) would be sustained for now and potentially integrated into the Department of Health Care Services.

Oral Health Toolkit puts resources at providers’ fingertips

The L.A. Trust Oral Health Toolkit includes links to our new “Brush with Billy” video series as seen on KLCS TV.  Billy is pictured with Esther Yepez of The L.A. Trust.

The L.A. Trust has released a new multimedia Oral Health Toolkit featuring links to kids’ oral health videos, local dental services referrals, state oral health assistance programs and more. 

The Toolkit was created by Eddie Hu, oral health program manager for The L.A. Trust, and Esther Yepez, program manager, as part of the organization’s Oral Health Initiative.  

Hu said, “The purpose of this toolkit is to address the barriers to oral health access being experienced by many L.A. students — barriers that have been worsened by the COVID-19 pandemic. During this pandemic, many children and families are not receiving information regarding their oral health. Many school-based clinics are closed; students are not on campus; and they have additional priorities when it comes to health issues.” 

He noted that “oral health is critical component of overall health. It is extremely important to take care of our oral health and teeth to prevent disease and illness,” he said. 

The L.A. Trust and its allies tackle student oral health

Beyond the Bell employees helped The L.A. Trust distribute more than 50,000 toothbrushes during Operation Tooth Fairy in June.

Oral health leaders from government, academia, nonprofits and the healthcare industry met online at The L.A. Trust’s Oral Health Advisory Board quarterly convening June 2. Representatives from more than a dozen organizations discussed ways to help students and their families access oral health services during the COVID-19 crisis.

Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, presented an update on how the COVID-19 crisis was impacting dental care for students and communities. She outlined steps The L.A. Trust is taking during the current school closures, including the development of virtual education with upcoming videos, new referral cards for LAUSD local districts, and Operation Tooth Fairy, which raised oral health awareness and distributed more than 50,000 toothbrushes at 16 Grab and Go Food Centers in June.

Gloria E. Velasquez, organization facilitator for Los Angeles Unified’s Student Health and Human Services, outlined steps for re-opening LAUSD campuses under several models released by the Los Angeles County of Education. The models include face-to-face, distance and hybrid learning, depending on health conditions.

Budget cuts and telehealth

COVID-19 has had a major impact on state funding. Fatima Clark, senior policy and outreach associate for Children Now, noted there would be a staggering $54.3 billion budget deficit over the next two years. Among the budget changes: Delayed implementation of the CalAIM initiative; $300 million in cuts to Community Schools Grants; shift of $1.2 billion in Prop. 56 funds to support Medi-Cal; reduction of Adult Dental Benefit; and transitioning all Medi-Cal dental services to the fee-for-delivery system, eliminating voluntary dental managed care in L.A. County.

Dental care providers statewide are getting support from Sacramento as they grapple with COVID-19, according to a presentation by Stephanie Thornton, a fellow with the California Children’s Partnership. California has eased restrictions on telehealth, she noted, but the “digital divide” needs to be closed before these options can be accessed by everyone who needs them.

Ambitious agendas

Lisa Nguyen, associate director, community-based clinical education at the UCLA School of Dentistry, outlined what her institution is doing to advance school-based oral health, including updates on their assessment, education and outreach programs. Nguyen also provided an update on More LA Smiles and discussed the impact of COVID-19.

The meeting ended with a recap of a proposed 2020 policy agenda for The L.A. Trust’s Oral Health Advisory Board. The agenda includes achieving 100% compliance with the Kindergarten Oral Health Assessment Mandate throughout L.A. Unified; ensuring the highest standards of care and case management; integrating teledentistry and alternative practice providers; supporting robust funding for school-based oral health; creating a centralized resource repository; and promoting the use of fluoridated water by Los Angeles Unified families.

The L.A. Trust and L.A. Unified put focus on student oral health

Program Manager Esther Yepez, Executive Director Maryjane Puffer and Associate Program Director Stella Kim distributed hundreds of free toothbrushes at Los Angeles Unified’s Grab & Go Food Center at Manual Arts Senior High School June 9. 

The Los Angeles Trust for Children’s Health has joined forces with America’s Tooth Fairy, the University of Southern California and the Los Angeles Unified School District to raise oral health awareness and distribute more than 50,000 toothbrushes at Los Angeles Unified Grab & Go Food Centers.

“Healthy children are ready to learn, and The L.A. Trust has worked with us for years to promote the health and wellbeing of our students,” Superintendent Austin Beutner said. “Children may find it difficult to visit a dentist, so making sure kids practice good oral health habits like brushing their teeth is more important now than ever.”

L.A. Tooth Fairy Maryjane Puffer, executive director of The L.A. Trust, thanked Los Angeles Unified and sponsors of Operation Tooth Fairy, including America’s Tooth Fairy and USC. “We even got an anonymous donation of 1,500 wrapped toothbrushes – every little bit helps.”

Puffer noted that “children with poor oral health are nearly three times more likely to miss school and perform poorly.” Past screenings of elementary school students in Los Angeles found that 66% of children had active dental disease, 27% had visible tooth decay and 6% required emergency care.

Since 2013, The L.A. Trust has worked to improve student oral health by coordinating free Kindergarten Oral Health Assessments in Los Angeles Unified schools.

Puffer said replacing toothbrushes frequently and not sharing brushes is especially important during this pandemic. Children should floss daily and brush twice a day. They should also keep wearing their braces and dental appliances.

“Many dentists and dental clinics are re-opening, and you should always see a dentist if it’s an emergency,” Puffer said. This includes oral pain, infection, trauma or damage. Many Student Health and Wellness Centers are open for restorative care, and you can also ask if your dentist offers tele-dentistry to get a remote assessment.  

Thanks from Board

School Board members thanked The L.A. Trust for supporting students while school facilities are closed.

“I am grateful to The L.A. Trust for helping us fulfill our commitment to support the whole child,” Board Vice President Jackie Goldberg said.

“I salute The L.A. Trust and their continued commitment to promoting and educating our children on the importance of oral health,” Board Member Dr. George J. McKenna III said.

“Thanks to The L.A. Trust, America’s Tooth Fairy and the University of Southern California for your partnership and support for our students and families,” Board Member Mónica García said. “The health of our students is a strong indicator of their ability to achieve academically. I am grateful for all those involved in the effort to bridge the gap between education and health.”

“As a retired teacher and principal, I know that our children’s health and wellbeing are critical for effective teaching and learning,” Board Member Scott M. Schmerelson said. “Unfortunately, due to the pandemic, many parents have lost jobs and cannot afford to buy the necessary supplies or pay for dental treatments. Now more than ever, we must continue to provide needed support so our students can remain healthy. I thank The L.A. Trust and our community partners for their generous contributions and continued support.”

“We are grateful to The L.A. Trust and all the partners working to mitigate the unfortunate side effects of our current public health crisis and the existing crises that our kids face every day by not having adequate access to basic health care,” Board Member Nick Melvoin said. “That’s why I brought, and the Board passed, a resolution earlier this year to make it easier for partners like The L.A. Trust to provide these basic health services to our students, and why it’s so important that we uphold this commitment to meet the needs of our kids and families.”

“Along with our partner, The L.A. Trust, we are dedicated to promoting our students’ health,” Board Member Kelly Gonez said. “This latest distribution of toothbrushes at our Grab & Go Food Centers will support student wellbeing and allow them to focus on their learning.”

Puffer thanked the School Board, Los Angeles Unified and Operation Tooth Fairy partners, and urged other organizations and individual to join the effort. She said Operation Tooth Fairy is seeking donations of wrapped children’s and adult toothbrushes plus items like toothpaste and dental floss. “These may seem like small things,” she said, “but they can make a big difference in the oral health of a child or adolescent in this quarantine and recession.”

The L.A. Trust OHAB meeting opens with good news on dental screenings

Dr. Maritza Cabezas, dental director of the Los Angeles County Department of Public Health, discussed “dental deserts” at The L.A. Trust’s oral health convene.

Representatives from private and public oral health organizations discussed the state of children’s oral health at The L.A. Trust’s Oral Health Advisory Board Meeting, March 11, 2020 in at the California Community Foundation in downtown Los Angeles.

The meeting was convened by Associate Program Director Stella Kim, The L.A. Trust’s oral health lead. She introduced Executive Director Maryjane Puffer, who opened the meeting with good news: The Los Angeles Unified School Board approved a resolution the day before expanding dental and vision screenings for K-12 students. The resolution permits no-cost dental health screenings for every LAUSD student whose parents do not opt out, and requires a plan to be developed for the 2020-21 school year. Previously, prior parental approval was required for the non-invasive assessments.

The L.A. Trust’s Oral Health Advisory Board is a prime convener in the Los Angeles Country’s dental care community for school-based oral health. Its quarterly OHAB meetings attract dozens of participants from the public and private sectors.  Puffer provided an update on The L.A. Trust’s Oral Health Initiative, including The L.A. Trust Tooth Fairy Event, which provided free dental screenings for 205 students and community members and attracted a record number of attendees February 22. 

She announced The L.A. Trust is working with UCLA’s More LA Smiles on a Local District Pilot Project funded by the California
Dental Transformation Initiative (DTI). The pilot project will expand The L.A Trust’s Oral Health Initiative to 85 schools in LAUSD Local District South. The L.A. Trust will also participate in a 2020 Universal Kindergarten Screening pilot program with 141 potential school sites this year. 

California gets C-minus

Fatima Clark of Children Now gave a statewide update on children’s oral health from the 2020 California Children’s Report Card.  The report card gave the state’s oral health policies and resources a C-minus. 

“Too few children enrolled in Medi-Cal receive preventative services,” Clark said.  Nearly 4 in 10 California kindergartners (39%) did not complete oral health assessments due to financial burden or lack of funds; of those who did, 20% had untreated dental decay. But the report was cautiously optimistic about the improvements in student oral health, stating that “recent efforts to improve utilization look promising.” 

Read more on the California Dental Association website

Dr. Maritza Cabezas, dental director of the Los Angeles County Department of Public Health, outlined a recent survey of “dental deserts” in the county. Dental deserts were mapped using three criteria: high population density; low income (Medi-Cal income cut-off); and one dental provider or less for every 4,000 patients.

The map identified numerous high-need, low-resource areas, many along the CA-110 corridor in Central and South Los Angeles. The survey identified 15 publicly funded medical clinics where dental services could be added and six dental clinics where oral healthcare could be expanded.

The morning session ended with a briefing from the UCLA-led More LA Smiles Consortium on a new pilot program designed to help Medi-Cal beneficiaries age 0 to 20. Associate Director Bonnie Shook and Technical Product Manager Joshua Norton introduced the LA Dental Registry and Referral System (LADRRS), which will allow medical and dental providers to “close the referral loop” and help thousands of patients get the oral healthcare they need. The presentations were followed by a working lunch and four breakout discussions on top systems change drivers: policy, financing, care and community.

Threatening weather doesn’t dampen The L.A. Trust Tooth Fairy Event

The L.A. Trust Tooth Fairy Event February 22 included fun, prizes, education and free dental screenings from The L.A. Trust’s allies and partners.

A record number of Angelenos ignored impending rain to attend The L.A. Trust Tooth Fairy Event, February 22, 2020, part of the Los Angeles Unified School District’s annual Health and Wellness Festival & 5K at Dodger Stadium.

The L.A. Trust event was presented with the UCLA-led consortium More LA Smiles and supported by silver sponsors Big Smiles Dental, Delta Dental, Liberty Dental Plan Companies and the office of L.A. County Supervisor Mark Ridley-Thomas. Also sponsoring the event were Access Dental, America’s ToothFairy (NCOHF), Cedars-Sinai COACH for Kids Dental, East West Bank and Patterson Dental.

Hundreds of Festival attendees participated in The L.A. Trust Tooth Fairy Event, which included fun, prizes, free dental screenings and information booths hosted by L.A.’s leading oral healthcare organizations. In partnership with Sesame Street in Communities, the event also included a special appearance by Cookie Monster from Sesame Street. “Potter the Otter” (Nina Nguyen and Lillian Orta of The L.A. Trust) entertained dozens of small children by reading a storybook about the benefits of drinking water.

On the main stage

Executive Director Maryjane Puffer of The L.A. Trust reprised her role as L.A.’s unofficial Tooth Fairy, appearing on the Health and Wellness Festival main stage along with Program Manager Esther Yepez, who helped organize the Tooth Fairy Event.

“The sun really shone on this event,” said Yepez . “Not only did we have a record number of partners and visitors, we helped provide dental screenings to LAUSD students and parents and spread the word about the importance of early oral healthcare,” she said. “Even the weather cooperated.”

The L.A. Trust Tooth Fairy event, now in its fifth year, is one of the biggest public oral health awareness events in Los Angeles, noted Stella Kim, associate program director. “The L.A. Trust is committed to improving the dental health of our kids and proud to stage this event bringing the public and the dental healthcare community together.”

Students find a healthcare home at LAUSD Wellness Centers

LAUSD’s network of Wellness Centers, like this one operated by South Central Family Health Center, are on the front lines of student and community health.

When a Delta 777 passenger plane dumped a load of aviation fuel over the Cudahy area last month, students at six LAUSD schools were affected—and the Wellness Center at Elizabeth Learning Center sprung into action.

The clinic, operated by South Central Family Health Center, offered free screenings to everyone in the community, regardless of insurance, immigration status or ability to pay. The clinic is part of Los Angeles Unified School District’s network of Student and Family Wellness Centers, which provide a healthcare home for students and community members in the district’s most underserved neighborhoods. Tens of thousands of students and community members rely on the clinics each year.

“When there’s an environmental emergency, a flu outbreak or a spike in STDs, the Wellness Centers often see it first,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health. “They are on the front lines of student and community health, and the services they provide are indispensable. Nothing is more important to The L.A. Trust than supporting these clinics.”

Partners in health

The L.A. Trust provided direct financial support to the six original LAUSD school-based health clinics between 1994 and 2002. Since then it has worked closely with LAUSD Health and Human Services to support the development of 15 (soon to be 19) new school-based Wellness Centers, focusing on strategies to make them self-sufficient and sustainable. 

“Our Wellness Center support mission today includes a broad range of prevention programs, best practices and research,” Puffer said. She cited The L.A. Trust’s groundbreaking Data xChange initiative, student engagement efforts and Wellness Network Learning Collaborative workshops as examples of how The L.A. Trust supports the clinics.

The Wellness Center Network is overseen by LAUSD Health and Human Services, headed by Executive Director Pia V. Escudero. Professional services are provided by these Federally qualified health centers: Asian Pacific Healthcare Venture at Belmont; Eisner Health at Santee Education Complex; Kaiser Permanente, LAUSD Student Medical Services and Planned Parenthood Los Angeles at Hollywood High; Mission City Community Network at Maywood Center for Enriched Studies; Northeast Community Clinics at Gage Middle School; St. John’s Well Child and Family Center at Manual Arts High and Washington Prep; South Central Family Health Center at Elizabeth Learning Center and Jefferson High; South Bay Family Health Center at Carson High; T.H.E. (To Help Everyone) Health and Wellness Centers at Crenshaw High; UMMA Community Clinic at Fremont High; Valley Community Healthcare at North Hills-Monroe High; Via Care at Garfield High; and Watts Health at Jordan High and Locke Early Education Center. 

Primary care plus

In addition to primary and dental care, most LAUSD Wellness Centers provide mental health services to students and community members. LAUSD School Mental Health provides intervention, care and referral at the Belmont, Carson, Crenshaw, Elizabeth, Gage, Locke, Maywood and Washington Prep Wellness Centers.

Other mental health services providers include Aviva Family and Children’s Services at Hollywood High; Child and Family Guidance Center at North Hills-Monroe; Children’s Institute at Jordan; Los Angeles Child Guidance Clinic at Manual Arts; and Weber Community Center at Fremont.

“Our kids hold all the promise in the world,” Puffer said. “Helping support them with access to care—whether it’s asthma, anxiety, depression or substance use—is part of the holistic wellness mission of The L.A. Trust. ”

The L.A. Trust Tooth Fairy Event will help kids brush up on oral health

Who flosses after every meal? The L.A. Trust Tooth Fairy Event will advance oral health Saturday, February 22 at Dodger Stadium.

Students and their families will join oral health providers and Los Angeles Tooth Fairy Maryjane Puffer at The L.A. Trust Tooth Fairy Event, Saturday, February 22 at Dodger Stadium from 8 a.m. to 1 p.m. The fifth annual event is part of the Los Angeles Unified School District’s annual “Move It!” Health and Wellness Festival and 5K, attracting more than 5,000 kids and family members. 

In addition to the 5K walk/run course, the Festival will include live entertainment, food trucks, fitness and dance classes, celebrity appearances, free stadium parking, booths from health providers and an interactive Kids Zone featuring games, face painting, an obstacle course, sports clinics and more. 

The L.A. Trust Tooth Fairy Event will be a key component of this high-profile community event, featuring free dental screenings, prizes and giveaways, photo opps and character appearances by Sesame Street’s Cookie Monster and others.

It’s fun-ucational

The Tooth Fairy Event will spotlight oral health information and booths hosted by L.A.’s leading oral healthcare organizations, including the Title Sponsor, UCLA-led consortium More LA Smiles. Other event sponsors include Big Smiles Dental, Liberty Dental Plan, the office of L.A. County Supervisor Mark Ridley-Thomas, America’s Toothfairy, Cedars-Sinai, East West Bank, Patterson Dental and Premier Access Dental.

Sponsorship opportunities for The L.A. Tooth Fairy Event are still available; please contact Anna Baum of The L.A. Trust by Friday, January 31.  

Registration is not required for the Festival—pre-registration is required for entering the race.

“February is National Children’s Dental Health Month,” said Maryjane Puffer, L.A.’s top Tooth Fairy and executive director of The L.A. Trust. “There’s no better time — and no better place — to promote the lifelong benefits of good oral health to children, adults, and caregivers than The L.A. Trust Tooth Fairy Event!”

“We have a lot of fun surprises planned for this year’s event,” said Stella Kim, associate program director at The L.A. Trust. “Program Manager Esther Yepez and I will be on hand with every member of The L.A. Trust staff to ensure everyone has a great time and learns more about oral health.”

Preventing cavities on Halloween (and all year long)

No one wants to take the treats out of Trick or Treat this Halloween. Least of all Maryjane Puffer, executive director of the L.A. Trust for Children’s Health and L.A.’s own “Tooth Fairy.” Puffer and her team at The L.A. Trust are dedicated to preserving the oral health of nearly 600,000 students in the L.A. Unified School District. “We see the damage that candy and sugary drinks can do. But there are ways to reduce cavities and still have fun.”

Puffer cites the American Pediatric Dental Association, which said that adults should limit what they give out (and kids should limit what they consume). Sticky, chewy and acidic candies are especially bad. Chocolate, pretzels, chips and sugar-free gum are better. And non-edible treats like temporary tattoos, stickers and toothbrushes are best.

The sky should not be the limit, according to The L.A. Tooth Fairy and the APDA. You can screen your child’s bag and trade up to a toy, or give excess candy to the Halloween Fairy to share with someone else.

The L.A. Trust has an entire team devoted to oral health in the sprawling Los Angeles Unified community and works in full partnership with LAUSD Student Health and Human Services staff along with university and community providers. The L.A. Trust team, spearheaded by Associate Program Director Stella Kim and Program Manager Esther Yepez, focuses on underserved areas, conducting events at dozens of elementary schools and screening thousands of kids.

Oral health a social justice issue

“The need is great,” Kim says. “About 50% of children screened have evidence of decay – a significant number have emergencies like abscesses or broken teeth.” Kim and Yepez use puppets with teeth and oversize toothbrushes to demonstrate proper brushing to the kids, but oral health is not all fun and games. “Oral health is essential to learning,” Kim said. “It is the most chronic disease in children, and it’s entirely preventable.” It’s estimated that an average of 2.2 school days per student per year could be saved by better oral health treatment.

DentaQuest, one of the nation’s largest dental benefits organizations, is the lead funder of The L.A. Trust’s oral health initiative. “Without their generous assistance we could not make a difference in the lives of so children,” Puffer said.

The L.A. Trust is looking forward to its annual Tooth Fairy Event at LAUSD’s 5K and Health & Wellness Festival, February 22 at Dodger Stadium. The festival attracts thousands of students and their families each year — top healthcare providers from Los Angeles and the nation will attend this premier outreach event.