The most common chronic childhood disease is one you'd never guess: tooth decay. It's also one of the most preventable. Yet many low-income children in Illinois never see a dentist—an omission that can lead not only to cavities and toothaches but serious health problems as well. One way to change that picture is by bringing dental care to schools.

Trips to the dentist are a standard entry on the busy calendars of middle-class children, scheduled right along with soccer practice and sleepovers. But poor children are much less likely to see a dentist regularly. Most Illinois dentists don't accept Medicaid because payment rates are so low (among the lowest in the country), and there aren't nearly enough communitybased dental facilities to handle the need. The Illinois State Dental Society estimates that lowincome residents in 60 percent of Illinois counties lack access to dental care, including parts of Cook County. So it's hardly surprising that 38 percent of Cook County third-graders have untreated cavities. But it's still disheartening. Tooth decay can be substantially prevented through childhood dental care, including education, fluoride treatments, and sealants. And neglect of dental problems can threaten overall health, as demonstrated not long ago when an untreated cavity resulted in an infection that spread to the brain of a homeless child and caused his death.

With Fry Foundation funding, Heartland International Health Center is tackling the problem. It is bringing oral health education and dental care to its school-based health centers at Senn and Roosevelt High Schools, which serve broadly diverse neighborhoods on Chicago's North Side. Students can schedule visits to fit with their class schedules. The dentist works out a treatment plan for each student, and staff make sure they follow through on appointments and adopting a dental regimen. As a result, a higher percentage (70% to 80%) of dental patient students complete their treatment plans in comparison to those in community facilities (40% to 60%). Services are available throughout the school year and during most of the summer. Over 250 students took advantage of the services through 1,000 visits in the last school year.

"A substantial percentage of these kids have never seen a dentist," says Heartland's Kimberly Tester, noting that that's especially true for immigrant students who make up a big part of Senn's student body. "About half of the procedures are restorative, fixing things that could have been prevented—things that are not as prevalent among kids who've had dental care for most of their lives and have received sealants. Once those are addressed, we focus on preventive care going forward." Services run the gamut from fillings and crowns to providing dental guards for athletes and keeping mouth and tongue piercings healthy. Follow-up visits show a substantial reduction in standard measurements of risk for periodontal disease.

The school-based centers also help sign families up for state-sponsored child health insurance (SCHIP), provide referrals for specialty services, and offer some services to community members as well, especially pregnant women and young children.

Heartland Health Center's overall mission is to improve the well-being of communities by providing accessible, high-quality care, including a wide range of primary care and mental health services. Its commitment to dental care stands out; of the 49 school-based health facilities in Illinois, only four others provide dental care. "Oral health often falls to the bottom of the list for low-income people," says Tester, when there are so many other problems to worry about. But oral health is essential to overall health. Oral cancers, for example, are especially high among African-American men, and late diagnosis, a consequence of lack of access to care, puts the death rate from the disease over 40 percent.

That's why starting young and including oral health education along with services are so critical, says Tester: "It's important to reach kids where they are, at a time when we can make a difference, and help them set up new health habits that may be different from what their parents did."

Supporting dental care is an important element of the Fry Foundation commitment to making sure that low-income Chicagoans have access to quality primary care, including health education and preventive programs. No child's life should be threatened—and for that matter, no child should be experiencing tooth disease and decay—for lack of decent, regular dental care.