Pediatric Dental Initiative becomes key source of dental care for low-income families

Snug in her pajamas and a favorite blankie, 4-year-old Jansy Lima Luna clutches a doll to her chest as anesthesiologist Mark Escajeda gently places a mask over the girl’s nose and mouth.

“Can you see the monkey? Can you see the giraffe?” nurse Angela Hoffman says in Spanish, pointing to pictures of the animals on the wall.

The girl follows along, her big, brown eyes slowly closing as the medications take hold. Her parents kiss her on the cheek before they are escorted from the surgery bay to the toy-filled waiting room.

The nonprofit Pediatric Dental Initiative of the North Coast, based in Windsor, is an indispensable resource for families who can’t afford specialized dental care. Since 2008, PDI Surgery has treated nearly 23,000 disadvantaged children from nearly half of the counties in California and some from outside the state.

These children suffer such severe tooth decay that they require oral surgery under anesthesia. The age of the clinic’s average patient is 3, and the average number of teeth requiring intervention is 12. A healthy child has 20 teeth.

“In a private office, I may do one filling a day. Here, there are days I restore 70 teeth,” dentist Susie Ryan said on a recent Wednesday morning.

The clinic’s dentists work on a per-diem basis, with most rotating in three or four times a month while maintaining their own practices. The clinic, which employs 50, has an annual budget of $4.68 million. While most dental surgery performed at the clinic is covered by Medi-Cal, other costs, including for medications and prevention education, are underwritten by grants and donations.

Jansy Luna is a typical patient. The girl was referred to the Windsor clinic by another provider who determined her needs required surgical intervention.

Also typical, the true extent of the girl’s tooth decay was not apparent until PDI staff reviewed new X-rays of the 4-year-old’s mouth. Ryan, the dentist assigned to the case, ended up filling 12 cavities and extracting seven teeth.

While unsettling, the case wasn’t nearly the worst clinic staff has seen. Earlier that week, a PDI dentist extracted 15 teeth from a 15-year-old autistic boy and afterward referred him for dentures.

The clinic is the permanent dental home for 265 special needs patients whose families have been unable to find care for them, according to Hazel Whiteoak, a PDI spokeswoman. She said these children require such a sophisticated level of care that it limits how many patients the clinic can see on days when they come in for scheduled appointments.

On that Wednesday morning, Juan Aguilar and Celeste Gaona brought their 3-year-old daughter, Allisson, in for treatment. The married couple lived in Point Arena, about a two-hour drive from Windsor. They had left the home at dawn that morning.

Gaona said the Windsor clinic was the closest to the family’s home with an immediate opening and the ability to treat her daughter’s specialized needs. Seated in the waiting room with her husband and the couple’s infant son, Gaona expressed feeling a sense of comfort she’s not always felt in a dentist’s office.

“Here, I feel like I’m at home,” she said.

Allisson had been referred to the clinic for treatment of four decayed teeth. The girl ended up having 10 cavities filled.

Prior to PDI Surgery opening in 2008, children from low-income families in Northern California had to travel a minimum of 50 miles to San Francisco or Oakland to receive sedated pediatric dental services, Whiteoak said. Children routinely had to wait up to 18 months for an appointment and families often couldn’t afford the time or expense of time off work or traveling to obtain those services.

Ryan, the dentist, expressed empathy and understanding for parents whose children suffer such severe tooth decay, saying “some people don’t know what they don’t know.”

Education is a major component of PDI’s mission. While children are in surgery, parents meet with an oral health educator to go over the causes and dangers of tooth decay, the importance of a healthy diet, good oral habits and the particular risks of sugary beverages.

Parents are given dental health kits, which include a toothbrush timer, toothpaste, floss and a tooth brushing chart, and written instructions in their native language, as well as a bag filled with healthy groceries and recipes.

Through the clinic’s community outreach program, “promotores dentales” (lay health workers) serve as patient advocates, educators and mentors. They encourage families to develop a healthy attitude toward dentist visits, and also make home visits to families of at-risk children who have been forced to return to PDI for follow-up treatment.

About 7% of patients are referred back to the clinic for follow-up care, down from 11% when the clinic first opened its doors, Whiteoak said.

Following her surgery, Jansy Luna was wheeled to the recovery room, where her parents and two nurses observed her return to the waking world. The family then headed home, the girl clutching the doll in her hands.