Before the pandemic, it wasn't uncommon for Tiffany Foy and a team of other dental hygienists to visit schools in rural and urban parts of Oregon to treat the teeth of thousands of children each year.
Many of the children studied had cavities, painful abscesses, and "large holes" in their teeth, said Ms. Foy, who works at Advantage Dental, a nonprofit that provides oral health care regardless of a patient's income or insurance.
In March, the program was abruptly suspended after the state stopped personal learning to slow the spread of the coronavirus. Ms. Foy said she and her hygienists have not been to schools since then.
"You could have a mouth full of cavities and the parents aren't even aware," said Ms. Foy. “I'm worried about that. I am concerned about neglect. "
The disproportionate impact of school closings on low-income children who have less access to computers, home internet connections and direct lessons from teachers is well documented. The effects of school closures on children's oral health are less recognized. According to experts, the closings have suspended regular dental health visits to schools from rural Oregon to upstate New York.
Piperlea Chico, dental hygienist and director of the school-based dentist program at Hudson Headwaters Health Network in New York, said that 2,000 to 2,500 children have been treated annually near the Adirondack Mountains since the program began nearly four years ago.
School visits were suspended in April, and although many schools in the area reopened this month, state health officials have not given hygienists permission to return, Ms. Chico said.
"We're a bit at a standstill," she said. "It really is an essential service. We identify many needs for these children and help provide a lot of help and prevent many diseases."
Hygienists usually examine students in classrooms, gyms, or nurses, where they look for cavities, perform fluoride treatments, and apply sealants – thin protective coatings that adhere to the chewing surface of the back teeth. Children get free toothbrushes and toothpaste and get proper dental care, said Myechia Minter-Jordan, president and chief executive officer of the DentaQuest Partnership for Oral Health Advancement and Catalyst Institute, which cares for about 70,000 children across the country annually.
Since the pandemic suspended many of the programs, the organization has reached out to school districts and state health officials for other ways to care for children, including online research.
"We are extremely concerned," said Dr. Minter-Jordan.
Children without access to proper care "could not study because they were in pain or were so ashamed of bad teeth that they would cover their faces," she said.
Ms. Foy, who lives in Bend, Oregon, recalled treating a high school-aged student whose mouth was full of cavities.
"I asked her," Why didn't you come to the dentist? "She told me that her family didn't have gas to drive them to the dentist," she said. "It broke my heart."
Maria Campos, mother of three girls in Houston, said her daughters' school district had stopped face-to-face learning, but the dental program that hygienists sent to students had continued.
All three girls aged 8, 13 and 17 were cleaned regularly last month on a mobile station that hygienists had set up in a school car park.
"Thank goodness for that," said Ms. Campos, a mother who stays home and whose husband drives a grocery truck. In the past, she had to use her credit card to pay for her children's dental care and run into hundreds of dollars in debt.
"It is a great blessing to have these programs in schools because dental care is very expensive here," said Ms. Campos.
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According to teachers, hygienists have discovered painful conditions that prevented students from studying or even eating and sleeping. Abscesses – infections filled with pus – that are not caught can spread to other parts of the body and cause serious, life-threatening problems.
"For children, one of the risks of delayed dental care is abscesses," said Chad Meyerhoefer, professor of economics at Lehigh University in Pennsylvania who researched the economics of health and nutrition. "There were children who died of abscessed teeth."
It's not clear how many children will experience oral health deterioration due to school closings, Professor Meyerhoefer said. But he said students in rural areas, where fluoride is often not added to water, could be hit particularly hard.
Kim Worley, an elementary school teacher in Willow Creek, Oregon, said she saw for herself how a simple exam by a hygienist can change a child's life course.
She remembered a fourth grade student who was notorious for disrupting classes, refused to sit in his seat, and failed his class.
His behavior changed almost immediately after receiving a visit from a hygienist at the school who found severe infections in his mouth.
"He was obviously in pain," said Ms. Worley. After he was treated by a dentist, his demeanor and grades improved almost immediately.
"There was a difference between day and night," she said.
Schools in Willow Creek, a rural community in eastern Oregon near the Idaho border, remain closed and hygienists have not been able to return.
"I'm just worried about these kids," said Ms. Worley. "What will happen to you? And if you have dental problems what will you do? Where are you going?"