Getting dental care can be a hassle, but for Armani Manzanares, a student at Denver’s Florence Crittenton High School, it’s relatively pain-free: She can pick up her son Nathan from nursery school, walk less than a football field away and knock out both their appointments at once.
Manzanares, 17, said she appreciates being able to get care for herself and her son, 1, without having to worry about transportation.
“It’s on campus. I can do it myself, so I feel like it’s making me more independent,” she said.
Florence Crittenton, an alternative high school serving pregnant and parenting teens, recently added dental services to its health clinic, which already offered pediatric and gynecological care to students and their children. It’s the fourth building in Denver Public Schools to add dental care for routine needs over the last four years, said Kathrine Hale, the district’s nursing manager.
Clinics in partnership with Denver Health are available in 18 of DPS’s more than 200 schools, though most offer primary and mental health care without dental services. The district hasn’t studied whether school-based health services reduce absenteeism or improve grades, but it is clear that students who are dealing with tooth pain or another health problem are going to have a harder time focusing on their lessons, Hale said. Ideally, all students would have access to a range of health services, but schools have space and financial constraints, she said.
“It’s a benefit on many levels” to offer health care, she said. “We would love to see it expand.”
Suzanne Banning, president and CEO of Florence Crittenton Services, said wraparound services at the high school contribute to a graduation rate about twice the national average for teen mothers, with about 75% of students getting a diploma by age 21. The students do tend to take longer than four years to graduate high school, but in some cases that’s by design, so they can continue to take advantage of concurrent enrollment and free child care, she said.
DPS provides teachers for the school, and the nonprofit provides services like parenting classes, art therapy and a store where students can spend “baby bucks” they earned in school on diapers, used clothing and toys, Banning said. Some take multiple RTD buses to get to school every day, so it’s important to remove barriers to both health care and education, she said.
“These girls are very determined,” she said. “They are looking for a better future, like any parent.”
The health center has helped improve attendance at Florence Crittenton while reducing the odds that young moms will put off necessary care, Banning said.
“Prior to the health center being on site, our moms might put off going to get something taken care of because of the challenge of getting to a clinic. If they did go to the doctor or dentist, often urgent care, they would end up missing school that day,” she said.
Terrill Graden, a dental hygienist at the Florence Crittenton clinic, said they can offer routine care like dental exams, cleanings and X-rays. A dentist comes once a week and will start offering more involved work like fillings and extractions in January, he said.
Carmen Rivera, a pediatric patient navigator at the clinic, said they try to schedule the mother and child for the same time, if possible. She works with the mothers to help them set up with a regular medical and dental provider when they graduate, and to coordinate any care that can’t be done in the clinic, like removing wisdom teeth. Most mothers have health insurance through Medicaid or Child Health Plan Plus, but there’s no charge for uninsured moms and kids, she said. The Delta Dental of Colorado Foundation contributed $300,000 over three years to start the clinic.
Some of the students had never been to a dentist before, so they were excited for the chance to get their teeth checked, Banning said. Others need more coaxing, either because they’ve heard myths like dental care isn’t safe during pregnancy, or just because many people don’t like going to the dentist, Graden said.
Pregnant women are vulnerable to dental problems because the stomach acid from morning sickness damages enamel, the hard cover that protects the tooth itself, Graden said. Women who develop infected gums are at a higher risk of delivering too early or having a low-birth-weight baby, though the biological mechanism isn’t well understood.
At Manzanares’ appointment on a Thursday in September, Graden asked if she if she was brushing Nathan’s tiny teeth twice a day, if he used a sippy cup and if anyone in the house had cavities, because the bacteria can spread from person to person.
With Nathan in the comfort of his mom’s arms, Graden managed to sneak a look in his mouth and establish that there was no cause for concern. Then they switched, with Manzanares lying in the chair while Nathan sat on her stomach, distracted by a Baby Shark video long enough for Graden to check Manzanares’ mouth and determine she wouldn’t need anything beyond a routine cleaning.
In addition to letting moms and kids get care they need now, the clinic can help kids develop positive ideas about the dentist, Graden said.
“If (Nathan) has a bad visit, he probably won’t remember it now, but if he has a bad visit at 6 … it can start a cycle,” he said.
Updated 2 p.m. Oct. 2, 2019 Due to incorrect information provided by Denver Public Schools, this story has been corrected to report that the health centers are in 18 schools and include both mental health care and primary care.
