Nimo Mohamed calmly leaned back as an assistant painted her teeth with a fluoride varnish. "It didn't feel like anything," Nimo said of the quick cherry-flavored coating she got last week.
While the procedure was uneventful, the location was newsworthy. Nimo, a sophomore at Minneapolis' Heritage Academy, wasn't at the dentist. She was visiting her pediatrician, Charles Rogers, one of a growing number of doctors adding fluoride varnishing to the list of preventive efforts benefitting low-income children and teens.
Fluoride varnishing is one of the quickest, easiest and cheapest ways to keep children's teeth strong and cavity-free from the time the first tooth erupts. It takes less than three minutes, costs about a buck per fluoride packet, and is reimbursable for providers.
It's also out of reach for an alarming number of Minnesota's poorest children who don't have regular access to a dentist.
In Minnesota, 80 percent of tooth decay is found in just 25 percent of children, most of them low-income. The pediatrician or family practitioner may be the only contact these children have with the health-care system. That makes fluoride varnishing in the doctor's office a small effort with big health implications.
The protective coating is painted on the surfaces of the teeth, much like painting fingernails, to prevent new cavities and help stop cavities that have already started. Because it's painted on, the chance of ingestion is minimal. Coating should be repeated every three to four months.
The majority of Rogers' patients are on Medicaid or other forms of medical assistance. "I see lots and lots of cavities," he said. "Anything we can do to try and prevent that is good."
The effort is the result of tireless work by University of Minnesota pediatrician Amos Deinard, who observed similar outreach in North Carolina. Since about 2007, Deinard has trained doctors, nurses, nurse practitioners, clinic support staff and others in about 150 medical clinics statewide. "I want to make the public hungry, so they go to their doctors and demand it," Deinard said. He's happy to be a thorn in the side of his professional peers who haven't yet jumped in, including Allina Hospitals and Clinics, HealthEast and Fairview Health Services.
"The Mayo Clinic said they're not interested," Deinard said in frustration. "They don't necessarily see the problem because it's not as pressing to them." (The Mayo didn't respond to an interview request.)
Other efforts buoy him. Twenty-two HealthPartners clinics, from Andover to Woodbury, offer fluoride varnishing. In the first quarter of this year, that translated into more than 2,000 children. "If we can intervene with children at a particularly vulnerable time in their life, we can give them a head start," said HealthPartners Medical Director Dr. Brian Rank.
Fridley Children's and Teenagers' Medical Clinic and most Partners in Pediatrics sites offer varnishing, too. Deinard has heard no rumbling from the dental establishment, "since we're not doing drilling, filling, pulling or applying sealants. Doctors and dentists," he said, "must work together."
'Dentists listen to him'
Last Thursday, Deinard was in Cloquet to fire up stakeholders, including parents, school nurses and preschool teachers. "Dental health is a very controversial issue, and it's been a challenge," said Julie Myhre, a public health nurse who is working with Deinard to expand varnishing to doctors' clinics in Carlton and nearby counties. "He has incredible credibility," Myhre said. "Dentists listen to him."
Rogers' walk-in Pediatric and Adolescent Services Clinic in south Minneapolis, which he runs with Dr. Linda Nygren, added fluoride varnishing about two years ago. "It's been a piece of cake," Rogers said.
By 10:30 a.m. last Wednesday, medical assistant Bridget Geng had painted varnish on five children, ranging in age from 2 to 15-year-old Nimo. "Nothing to eat for two hours," she tells parents, many of whom get an explanatory handout in Somali and the names of dentists accepting medical assistance. "They're already in for their physicals," she said. "This is just one more component."
But with a mind-boggling checklist -- vaccinations, bike helmets, car seats, mental health questionnaires -- couldn't one more component push a good doctor over the edge?
Deinard calls that concern "very legitimate," just not legitimate enough to turn needy kids away. "We are licensed to take care of our patients, and the mouth is part of the body," he said. "We have an obligation to do something. And this something takes less than three minutes."
Gail Rosenblum • 612-673-7350 firstname.lastname@example.org