Inside Dentistry
June 2009
Volume 5, Issue 6

Kids Smiles is “Building Beautiful Smiles and Brighter Futures”

Lisa Neuman

The bright, cheery rooms are painted in all the colors of the best crayons in the box, and they are filled with children. A little girl wearing bright green, star-shaped sunglasses practices how to brush her teeth by brushing the big fuzzy teeth of a purple and yellow dinosaur. A little boy opens wide and proudly shows off his pearly whites next to an open-mouthed great white shark painted on an under-the-sea wall mural. One preschooler peers out from a gigantic model of the mouth, while another wiggles excitedly in a dental chair, wearing a lead apron bigger than he is and grinning from ear to ear. In the waiting room, children huddle close around a young woman wearing electric blue scrubs, and listen intently while she reads them a story. In another area, children engage in an interactive experience with videos, toys, and puppet shows that teach them why they need to take care of their teeth. Everywhere you look, children are being examined, having their teeth cleaned, getting restorative work done to combat the effects of decay, and learning how to take care of their teeth at home. And they’re having great fun doing it.

This was the vision of Joseph Greenberg, DMD, back in 1998. At the time, Dr. Greenberg was a prosthodontist practicing on the Philadelphia Main Line, a region of affluent suburbs outside of the city. But this children’s dental center is no high-end pediatric practice anywhere in these suburbs, for his vision extended into a part of the city that people seem to want to forget even exists.

Island Avenue in Southwest Philadelphia is a poor neighborhood. With an estimated 85% of its families living below the poverty line, eking out an existence is no easy feat. Mostly African-American, they are either unemployed or underemployed, and so they are also uninsured or underinsured. Getting medical care can be difficult; getting dental care can be all but impossible.

But nestled within this poverty-stricken neighborhood lies a bright spot in the form of Kids Smiles, the innovative non-profit children’s dental center that Dr. Greenberg founded. With its crayon-colored rooms and the dental assistants who read stories out loud, more than 20,000 underserved kids have found a dental home here since the doors opened in 2001. It has done so well that another center opened in 2005 in another distressed neighborhood, the 5800 block of Market Street in West Philadelphia, where another 10,000 kids receive critically needed dental care. Both centers treat an average of 70 to 80 patients every day, from babies to teenagers, with the majority of patients ranging in age from 4 to 9. Most of the patients coming through the doors are on state assistance and/or Medicaid, which Kids Smiles accepts.  

When Dr. Greenberg met Cheryl Janssen, who has been the executive director of Kids Smiles since its inception, they knew they didn’t just want to open up an inner-city safety-net clinic. A grassroots effort in the truest sense, they wanted to create something that would be self-sustaining, reached out into the community, and really made a difference rather than just provide the rushed, impersonal emergency care that underserved populations tend to receive when and if they receive care at all. In addition to providing state-of-the-art preventative and restorative dental care in a child-friendly environment, they set out to really educate both children and their parents on the importance of preventing dental disease and developing positive health behaviors. And they’ve accomplished all of this while emphasizing the dignity of the patients and their parents.

Outreach is a major theme in the Kids Smiles mission. The staff developed an educational program that focused not just on oral healthcare but also on overall nutrition, the dangers of tobacco, and healthy lifestyle choices, and took it to local schools, child advocacy agencies, day care centers, and community health fairs. Coupled with the education is screening. The children attending a Kids Smiles program are given free screenings by the Outreach Team to determine if they have visible decay, and the screening results are discussed with the parents, along with information on treatment and finding a dentist.

The educational component has made such an impact that a new education program was launched in the centers themselves, called the Dental Detectives Academy. Inner-city school teachers who have a unique understanding of the urban environment developed the curriculum, which has the children who are in extended treatment plans complete a series of interactive lessons at each visit. As the children receive positive reinforcement, it motivates them to come back and complete all of the lessons—thereby completing their treatment—because then they “graduate” from the Academy with a certificate and get to walk through the center as the entire Kids Smiles staff congratulates them. “Not only have we cared for their oral health, we’ve also helped them to learn how to be stronger in taking care of their entire well-being,” Janssen says. “We feel that recognizing and affirming that success is a very significant part of our mission here.”

Parents are also actively involved in the Kids Smiles experience. While the child is being examined and treated, the parents are engaged in their own educational experience, so that they understand how critical it is to adopt good oral hygiene habits at home and to have their child complete their dental treatment. This part of the model has had incredible success; Janssen reports that many of the parents respond positively and take the advice they receive very much to heart. The emphasis on educating the parents directly correlates to approximately 70% of the children finishing their full course of treatment within 18 months, with a 50% decline in the occurrence of new or recurrent decay in those children.

Every child receives a toothbrush and a fun sticker at each preventive visit, along with a tube of toothpaste if there’s enough donated supply on hand. Because the philosophy of Kids Smiles is to improve the entire well-being of the child, they are also treated to another great, tangible reward when they complete their care: they get to choose an age-appropriate book from the library that’s growing at each center. As Janssen explains, this new initiative is another example of how the Kids Smiles mission keeps growing and evolving. Many of these children don’t own any books; literacy tends to be a casualty in poor inner-city neighborhoods. So the excitement the children have at being able to pick out a book for their very own acts as another positive motivator.  

There’s also another significant side mission that has developed at Kids Smiles: putting people to work. Over the years, a number of women from the surrounding communities have come on board as front office staff, dental assistants, and dental hygienists. As Kids Smiles has evolved into a fully self-sustaining operation, it has been able to commit to helping its staff—many of whom were previously unskilled—receive continuing education and other professional training that has helped them to build a career. “It builds great trust,” Janssen explains. “If you walk in and see your neighbor, then some of the typical barriers to care, such as judgment and mistrust, can come down.”

That has also happened as children in the community visit the centers and recognize a staff member who has visited their school as part of the outreach program. “The kids will come in and they’ll see one of the hygienists, or the education director, or someone who’s been to their school and they’ll respond, ‘I know you!’ It really builds a friendly, familiar feeling that invites kids into the center and helps them to feel less anxious about being here,” Janssen relates.

The organic dynamics of the neighborhoods also get kids into the centers. According to a market research study done 2 years ago, more than half of the patients had heard about Kids Smiles through word of mouth—from someone else in the neighborhood who was a patient or who had seen one of the educational outreach programs. That word continues to spread: the two centers continue to receive about 400 calls each month from potential new patients.

Janssen has the highest praise for the clinical staff of Kids Smiles. Ruth Fremont, DDS, came on board shortly after the doors opened and only intended to stay for a little while. Eight years later, she is now the clinical director, having left her private practice a few years ago because, as Janssen says, “You can’t help but fall in love with what we’re offering here.” In fact, all of the dentists come from educational and economic backgrounds that could enable them to own lucrative private practices, but they’ve all chosen Kids Smiles as their mission. “They all feel so rewarded by serving that they stay committed because they see how their dentistry is having an impact,” she adds. In a strong testament to how successful Kids Smiles really is, the four original doctors all still practice there.

As Janssen points out, “Over the last 8 years we’ve grown from a staff of four to a staff of 48, from one practice to two centers and two satellites, and from no patients to 34,000 patients. In the beginning it was a matter of making sure the program and the mission could stay intact with such tremendous growth. But now we’re working on positioning the organization to have a more national presence.”

It is certainly not easy. To fully sustain an operation with the reach and success that Kids Smiles has had requires significant funding, which comes primarily from grants and monetary donations. Their clinical expenses are largely covered by Medicaid reimbursements. Janssen and her development staff are working closely with community partners, such as Independence Blue Cross and the Pennsylvania Department of Health, and actively seeking corporate and individual partners in the dental industry as well. Serving as many as 2,000 patients each month, there is always a great need for both equipment and materials. Because they are a large-scale children’s dentistry provider, Kids Smiles always has need for toothbrushes and toothpaste, fluoride varnishes and sealants, as well as restorative materials. With their new incentive program, they are also now undertaking a book drive to collect new or gently used children’s books.

“When we first started, we had no idea about the magnitude of need in the Philadelphia area,” Janssen remembers. “Meeting that need would not be possible without the generosity of our grantors, corporate donors, individual contributors, and volunteers.” To find out how you can help, visit www.kidssmiles.org or call Cheryl Janssen at 215-365-1033.

Kids learn how to properly brush their teeth with a little help from some furry friends. A dental educator helps the children learn about the importance of good oral health. This little boy is all smiles after his examination, and shows off his brand new toothbrush. After participating in the educational activities, getting a dental examination is not an anxiety-filled experience at Kids Smiles.

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