Until he retired, Paul Nelson never thought twice about dental care because he always had it. But when the businessman joined the board of the North Shore Health Care Foundation, a nonprofit in Cook County that provides health care funding, he had an awakening: Families in his community were limiting, or forgoing, oral health care to pay for groceries and housing. Now chairman of the Oral Health Task Force, a program that began with the North Shore Health Care Foundation and is now part of the Sawtooth Mountain Clinic, Nelson champions comprehensive and early dental care for everybody. He talks about the pilot's promising early successes with kids and plans for a dental equity pilot for seniors.

Q: What were concerns that led to the task force 10 years ago?

A: Cook County is a relatively poor county, with median incomes well below the state average. Our Grand Marais dentist, Dr. Alyssa Hedstrom, and I were concerned that the children of many of our younger families, for various reasons, were not able to receive good oral health care. Most of these families work in the hospitality industry, the primary industry in Cook County. Even with both parents working multiple jobs, they simply couldn't afford dental care for their children.

Q: And the fallout of that lack of dental care?

A: Our school nurses and emergency room doctors reported that quite a few children were missing school or coming to the ER because of oral health issues and pain. But we needed to learn the extent of the problem, which children needed to see a dentist and how to provide financial assistance to those families who needed it. We realized that we couldn't just keep fixing cavities. That's not fair to the kids, plus no one can afford to do that. Rather, we had to get ahead of the problem and prevent the issues from happening in the first place. So we concentrated heavily on prevention through education and constant outreach not just to children, but to their parents who, because of inexperience or lack of knowledge, might not understand the need for children's oral health care.

Q: How have results been?

A: Very good. Since we started in 2012, we've cut the incidence and severity of children's oral health issues substantially. For example, looking at our largest school system, ISD 166, in 2014, 26% of the children we saw had cavities or other issues. In 2019, heading into the pandemic, only 9% of the children had oral health issues.

Q: To that point, how did COVID-19 affect your outreach?

A: Pre-pandemic, we were very successful in improving prevention and reducing oral health issues, with children receiving regular checkups and early intervention. That was seriously affected by the schools being closed, since we regularly provided checkups to every schoolchild right in the schools. Normally, if we detected oral health issues during the checkup, we would notify the child's caregiver immediately that the child needed to see a dentist for further care and if financial assistance was necessary, we could help with that. That all stopped.

Q: So you had to, as we now say, pivot?

A: We switched to sending oral health care kits and information to every child and their parents at their homes. We ran informational ads in the news media. And it seemed to help because, during the pandemic, parents began to bring their children in to see the dentist without the checkup prompts from us. The downside is that prevention took the hit and cavities increased. To counter that and get back on track, we are stepping up our efforts to hold more checkups in schools once the kids are back in class.

Q: Do you find that families with a positive early relationship with a dentist continue to seek regular dental care throughout their lives?

A: Absolutely. To help parents ensure it's a positive relationship for their children, we take preschool children on fun field trips to visit the dentist and remove the fear. The kids love it. Once parents understand how easy it is to take care of their children's oral health and how great the rewards are, it becomes second nature.

Q: And now you're looking at the other end of the age spectrum. Tell us about that.

A: While we were working on our oral health care project for children, we were often asked whether we could provide such preventive and restorative care for adults and seniors. Because all of our resources were being devoted to children, we simply couldn't expand our program. Now, due to the generosity of our granters, we have some additional resources to prepare a limited pilot project to reach out to seniors. We know anecdotally that many of our seniors who are living on Social Security and not much else do not have dental insurance. So we will offer a "Free Day at the Dentist" to approximately 40 or 50 folks with the same care as we offer to children: complete exams, X-rays, cleanings, fluoride treatments. Then we will evaluate the extent of their oral health issues and determine how much financial assistance we can provide for them. This is truly a pilot project, a learning experience, just as we did with the kids when we first started. And because it is just starting, we expect to see a lot of need for restorative procedures. But the secret again is prevention. We hope, over time, to be able to create a preventive process for seniors, just like for the kids, and reduce the pain and expense of restoration.