Most people don't have an audience when they go to the dentist's office.
But at Minnehaha Elementary School in Two Harbors on Friday, Stacey Anderson's young patients not only had to open wide, they had to do so with their classmates waiting and watching nearby.
Anderson brought her free "Just Kids" dental health service to the school for the first time. She and her staff were scheduled to see 26 students throughout the day -- an exhausting schedule, but each tiny mouth was a tiny victory in Anderson's eyes.
"In my small way, I'm providing preventative services for children in my community," Anderson said. She's been a licensed dental hygienist for 15 years, but two years ago she decided to branch out and take her services straight to the kids.
In 2001, Minnesota began allowing dental hygienists to perform some dental care on their own, outside of a dental office. It's called a collaborative dental agreement, and the idea is catching on throughout the state.
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"I realized there was a need, and I've put my heart and soul into this," Anderson said.
She focuses on children covered by Minnesota's Medical Assistance program because it's particularly hard for low-income children to get good dental care, Anderson said.
Working parents aren't always able to take their children to regular appointments, and there is an areawide shortage of dentists, Anderson said. Some dentists are reluctant to take on new Medical Assistance patients because of the low reimbursement rates, which are sometimes less than 50 cents on the dollar, Anderson said.
The goodies Anderson brings, however, don't reflect those low reimbursement rates. Kids go home with bubblegum-flavored toothpaste, new toothbrushes, sugar-free gum and Superballs, among other choices.
"Bribery is a great tool," Anderson said.
Anderson formerly worked with Dr. Robert Horoshak in Silver Bay. She no longer works under Horoshak's direct supervision, but as part of their collaborative agreement he has some responsibility for Just Kids and is available if questions arise. Anderson is reimbursed by the state of Minnesota for her work, though she also has invested much of her own money into Just Kids.
She emphasizes that she is not a dentist, and her visits are not a substitute for regular visits to a dental office. She does not do fillings or scrape tartar, and she doesn't diagnose problems. But, she says, the sealants and fluoride treatments she can apply are good front-line defenses against tooth decay.
Richard Diercks, executive director of the Minnesota Dentists Association, believes there will be more collaborative dental agreements like Anderson's in the years to come.
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Anderson estimated she was one of only a dozen or so hygienists working under such an arrangement in the state, and the only one in Northeastern Minnesota.
Though solid data is lacking on how many active collaborative agreements exist in Minnesota, "the trend is on the increase," Diercks said. "There is a lot of interest and need for alternative settings, where care under collaborative agreements can be done."
Just like flu shot clinics that take place outside of a typical health-care setting, the kind of dental care Anderson provides can be done almost anywhere, including nursing homes, schools and physician's offices.
Anderson sets up shop at Kundel Pediatric Associates twice a month, seeing patients as young as 9 months old.
She teaches parents how to brush their baby's teeth and applies sealants and gives fluoride treatments to older children.
"We had no idea it was available," Dr. Maria Kundel said when Anderson approached the clinic last winter about creating a partnership. The arrangement has worked very well, Kundel said.
During her school visits, Anderson and two dental assistants quickly and efficiently move children in and out of the portable dental chair.
There are a few moments for get-to-know-you conversation, then it's time to open wide as Anderson examines the mix of baby teeth and permanent teeth most children have in their mouths.
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"Open big, bigbigbig, big as you can," Anderson tells6-year-old Mason Thompson. Mason is one of the eager patients, wanting to tell about his loose tooth and enthusiastically slapping a high-five with Anderson and dental assistant Wendy Lund as he got up.
Sitting on a chair nearby, though, was 6-year-old Navah Swoverland; at that moment she probably was the glummest little girl in the elementary school. Her eyes were glued to Mason's mouth as clinic coordinator Sally Murphy tried to make conversation.
"You have such beautiful hair," Anderson told Navah. No response.
"What are you going to be for Halloween?" Murphy asked. Nothing.
But when Navah was finally settled in the chair and Anderson asked her if she had any pets, Navah finally opened up and began talking about her dog, Basil. After that, she was fine, even as Anderson and Lund poked in and out of her mouth with various instruments.
Anderson has learned a lot of tricks to help children overcome their dental apprehension, and she tries to keep everything fun and positive. Handing out Cha Cha Chocolate-brand toothpaste helps, as does showing kids good brushing and flossing techniques on a purple dinosaur puppet equipped with a big set of choppers.
"The most rewarding part of this is making this a very fun, upbeat experience for the children," Anderson said. "There should be no fear of dentistry."
JANNA GOERDT covers the communities surrounding Duluth. She can be reached weekdays at (218) 279-5527 or by e-mail at jgoerdt@duluthnews.com .
