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Tooth Truth - The Untold Connection Between Your Teeth & Your Daily Life | Let’s Talk Kids

• Lets Talk Kids @ ACNJ • Season 2 • Episode 2

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Nicole McGrath-Barnes DDS FACD, Founder and CEO of KinderSmile Foundation, discusses why dental care for babies and young children is more critical than most parents realize—and why the system is failing them. She shares the story behind building KinderSmile, how the foundation operates, and why its model deserves to be adopted more widely. The conversation digs into the overlooked connection between oral health and whole-body health, the financial and social repercussions of untreated dental disease in kids, and the crisis of chronic absenteeism linked to tooth pain. She also covers practical tips for parents, student loan forgiveness for dentists, and her 10-year wishlist for transforming children's dental care in America.


Learn more about KinderSmile Foundation below!

KinderSmile Foundation - https://www.kindersmile.org/

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SPEAKER_01

Welcome to Let's Talk Kids. I'm Mary Coogan, president and CEO of Advocates for Children of New Jersey, and the host of Let's Talk Kids, featuring conversations with community organizations, experts, and policymakers about issues impacting children and youth. Joining me today is Nicole McGrath Barnes, founder and CEO of Kinder Smile Foundation, and also a dentist or a pediatric dentist, right? A general dentist with an affinity for children. Okay. Welcome. So glad you could join me today. Thank you for inviting me.

SPEAKER_00

Thank you so much. So, what is the Kinder Smile Foundation? So, Kinder Smile Foundation is a 501c3 nonprofit organization, and we advocate for children and families here in marginalized communities. Our mission is to increase oral health care access, and we focus on children and perinatal mothers. And our vision is to see a world where oral disease is eradicated because oral disease is the number one preventable disease. And we want to make sure that all of our children in marginalized and rural communities have access to comprehensive oral health care.

SPEAKER_01

And that's a wonderful thing that you do. I guess the service is definitely needed. What made you start this foundation and this whole operation of providing oral health care?

SPEAKER_00

Well, Mary, this journey, I call it, started in 2007. The first 15 years of my career as a dentist, I was in private practice. I was a private practitioner, practicing dentistry in Montclair, New Jersey. Everyone's familiar with Montclair, New Jersey, income per capita, and so forth. First 15 years, I wasn't very happy as a dentist, believe it or not. I checked all of the boxes of being a black health professional. And that wasn't enough. There was something in my soul that was missing. And I realized that there's a difference with providing a service and serving your community. And what I was doing as a private practitioner was providing a service. That's what we do as dentists. But that wasn't enough. And so what I decided to do, I decided to become a program dentist at the local Head Start, Montclair Child Development in Montclair. And my Wednesdays off, I would go there and I would provide oral education to the children, the teachers, and the parents. And it was wonderful. My soul was starting to fill because I realized that oral education is so needed. You know, we need to meet our children and families where they are and really explain why oral hygiene is so very important. Because as I mentioned before, oral disease is the number one preventable disease. So every Wednesday, when I would do this, I realized and I saw children when I was down on their level with mutilated dentition or black teeth or uh broken teeth. And I'm scratching my head because I did not grow up in New Jersey, Montclair, New Jersey. I did not, you know. And so I found out that in Montclair, there's an area in Montclair, the fourth ward. And the Head Start program service or educate children at or below poverty level. And so that made sense why I was seeing these children with mutilated dentitions. So I went to the executive director and I said, you know what? I want to do a little more than just oral education. If you can get permission or consent from the parents to have children who are in need of access to care bus to my private office, which was less than a mile away, I will do these services free of charge. And so that's what I did. And children were being busted to my office, consent form, free of charge. No cleanings, fillings, extractions, everything that they needed. So that was going well. And I realized my soul was being filled. I realized now I'm providing service for a community that's in such need. So then one Wednesday, later on in the evening, I get a phone call from my receptionist. She said, We have a little girl here. And I said, But I'm off today. And she was like, Well, she says she knows you. And so we went through the charts, and she wasn't a patient of ours. She was from a local Head Start. Long story short, my home in Montclair was in close proximity to my office. So I stopped what I was doing and I went there. And here was a little five-year-old girl. When I saw her, Mary, she had an abscess the size of a golf ball. Literally. But she was asymptomatic, meaning she wasn't get having any experiencing any pain. So she leaped into my arms and she was so excited to see me. And I felt this pit in my stomach. Here I am leaving my son, who's almost the same age as little Z we'll call her. And I brought her into the uh operator and I spoke to the grand aunt and I said, you know, this is a pretty deadly infection. How long has she had this? And she said, three months. And I said, Why didn't she go to a dentist? And she said, Well, we live in Union County and we could not find a dentist to accept her Medicaid insurance. And um I said, Okay, she's gotta be on antibiotics. And unfortunately, this tooth has to be extracted. Do you have funds for to pro you know to fill the prescription? She said yes. Um and I said, She has to be back in 10 days. And I said, If you don't come back, I'm gonna come knocking on your door. So I go home that night and I literally could not sleep. I tossed and I turned and I I tell the story just like it all the time. I fell to my niece and I had a long conversation with God, and I said, What am I doing? And that night, Kindra Smile Foundation was born. And I felt compelled to be the voice and the advocate because the grand aunt didn't know how to advocate. This little girl was walking around with an abscess the size of a golf ball, expecting to learn in school, expecting to eat, expecting to carry on her life as a five-year-old, but had this oral health impediment, you know, that could potentially kill her. So the next morning, I said to myself, I said, All right, Nicole, are you doing this because you're led to do this and there's a need? Why are you doing like I was questioning myself because once again, I was a private practitioner. I had my own practice, I had three kids, uh, mom, I'm married and all of this, and yet taken. And I said, I need confirmation that this is what I'm supposed to do. And literally, lunchtime the next morning, my assistant walked in with the quarterly American Dental Association newsletter. And on the front cover, Mary, was a 12-year-old Diamante driver, a black boy from Prince George's County, Maryland. I remember that story. Who died from that same infection. And that's when it was confirmed that this is the journey that I need to take. So here we are, almost 20 years later. Wow.

SPEAKER_01

Yes. Wow. Thank God you took that story. Yes, right? Literally.

SPEAKER_00

Literally.

SPEAKER_01

Literally. Yes. Yeah. Wow. It to me, it's so amazing because I have seen young children now. As you know, we're both involved in certain organizations that talk about oral health. Anyway, you do the practice. I have been at meetings where they talk about it. And it was always amazing to me how young children really need the oral health care. Yet when I was growing up, you didn't go to the dentist to you were in kindergarten, first grade. Right. Why is it that young kids need to see the dentist?

SPEAKER_00

Oral health is the gateway to total health. And if you want to prevent oral disease, the younger the better. And probably when you and I were growing up, there was fluoride in the water. There's fluoridated water. Now things have changed drastically. Um, and just the foods, the overabundance of the processed foods that break down the enamel and cause tooth decay. So, very important. According to the American Dental Association, children should be seen by a dentist by age one. But in our dental homes, we implore that the mothers or the families bring their children in when they see the first tooth erupting for a plethora of reasons. Number one, it's getting the child familiar with the dental environment. And we do a lat visit. Um, so that's number one, and just habitual. That is habit. And when we talk about children and families in marginalized communities, we have to take into consideration the educational level, the comprehension. You know, we deal with like undocumented and immigrants, and we we want to meet them where they are. We don't want to talk down to them. We don't want them to feel uncomfortable if, you know, they're haven't brought their child into the dentist. So very important that we encourage them the minute you see a tooth erupting, bring your child in. Bring the child in. Very important.

SPEAKER_01

But what are you gonna see when there's just a little bit of a tooth popping out?

SPEAKER_00

Great question. Very good question. So your body makes plaque. So from breastfeeding to drinking formula to feeding a child, all of that, the plaque that's built up, you have bacteria. And if the parent isn't providing proper oral hygiene instruction, that plaque, those processed food, from even from the breast milk, from can break down that enamel and expose that child at a very young age to cavities. And we've seen it. We've seen children under a year with eight teeth, and they have decay because the parents aren't understanding the precautions or the measures to take to prevent that. They think that, oh, they don't have a full complement of teeth. I'm breastfeeding, oh, that's okay. You still have to implement good oral hygiene habits at a very young age, even if it's that one tooth, or even if it's a tooth that's partially erupted.

SPEAKER_01

So I always hear people saying, what does it matter? You're gonna lose your baby teeth anyway, right? And I'm sure you're gonna disagree. It does matter. Why does it matter?

SPEAKER_00

Oh, it absolutely matters 100%. We get two sets of teeth. So the primary teeth or the deciduous or baby teeth are crucially important. How will our children speak if they don't have teeth? How will they masticate or eat food if they don't have a healthy complement of teeth? So, a quick story. When we started out with the journey with Kindersmile Foundation, Montclair Child Development Head Start was our first school where we would provide oral education. And now, instead of the children being busted to the dental home, we would go on the premises of the school, provide education and preventative and diagnostic services. There was a two-year-old boy who had a full complement of teeth. 20 teeth, baby teeth, right? At two years old, they should have 20 teeth. He had his 20 teeth. Out of the 20 teeth, 18 of them had cavities. So tell me, how is he eating properly if he's experiencing pain? How is he articulating to his parents that he's in pain?

SPEAKER_01

Well, he might not even realize it's not what he should be feeling, right? Absolutely.

SPEAKER_00

Because he doesn't know anything different. He doesn't know anything different. But so he's living with that discomfort. So what we had to do, we had to s do serious, comprehensive services and extract his top six teeth, his anterior teeth. Now each tooth has a purpose in your mouth. The anterior teeth incise the food. They hear the food, and the molars and the premolars in the back masticate and chew the food so that we can digest it properly. So we had to extract four of his anterior teeth. He's two years old. We extract those teeth, and then he is now a year later, two years later, in a speech impediment class. A speech specialist is now coming to the school to help him with his speech. So I say to the teacher, why is little Jay in that class? They said, Well, he's having problems enunciating and pronunciating. I said, he doesn't have a speech impediment. He has his anterior teeth were extracted. Those are the teeth that are needed for the tongue to go on the backs of the teeth so they can start enunciating and pronunciating.

SPEAKER_01

So it was causing him a problem. Yes.

SPEAKER_00

Wow. And that's what happens in our marginalized communities. They're displaced and they're tracked. So that's why it's so important to educate on oral health, oral hygiene, to understand, let the teachers and the caregivers know if you extract these teeth, he's going to have a problem. He's going to have problems speaking. There's nothing wrong. His permanent teeth will come in and he'll be able to speak and, you know, pronounce, but there's not a problem. So that's why deciduous or baby teeth are crucially important. Very, very important.

SPEAKER_01

So you're talking about kids, low-income kids in the urban areas, but I would think you're gonna have similar problems with kids even in the suburbs, because I'm not thinking typically dentists, because you, I think, are an exception to the rule. I don't think your typical dentist is as comfortable seeing a two-year-old or an infant or a five-year-old. So do dentists typically take very young patients, or is that becoming more common now?

SPEAKER_00

So I am a general dentist with an affinity for children. They are pedodontist or pediatric dentists that see children from ages zero up to 18. So there's there's a special specialty. Absolutely. You do have general dentists like me who love children, who's the the majority of the patients that they treat are children. Um I don't know if it's becoming a trend with general dentists only because general dentists do a plethora of services, right? There's no specific specialty. They can do PETO, they can do endo, they can do oral surgery. I don't know that there's a trend of them wanting to see children because we have specialists specifically for dentists, but I know that in FQHCs, there's some FQHs that are federally qualified health centers that do have like a pedodontist and some do not. And so those general dentists and FQHCs that don't have a specialist, they normally tell the family, bring the child back when they're six or seven, when they're not so ornery. So And that you would say is a problem. That's a huge problem because it contradicts the American Dental Association, right? And good care. And good care, which is key.

SPEAKER_01

Which is absolute key. Because I know I still hear parents say that. Yes. Right? That my dentist said I don't need to be here. Right. Yes. So let's go back um, because we got sidetracked it because I appreciate the story. I think it's a wonderful story. And thank God, I mean, it's horrible what happened to that little girl, but to me, because of her, you now have really helped so many other children and families. So Kinder Smile. So you have how many locations?

SPEAKER_00

How does that operation work? Absolutely. So, Kinder Smile Foundation, the nonprofit, we have three dental homes, and we specifically call them dental homes because we're culturally sensitive. We want our children and families to walk into a place where it's professional, it's clean, the equipment's up to date. We don't call them dental clinics or centers because that always had a negative connotation in the urban or marginalized communities. So we have three. The first one is in Bloomfield, New Jersey, and uh we service East Orange, Irvington, North Newark, Belleville, Bloomfield, you know, that area there. And then the second one, we partner with the Boys and Girls Club of Newark on Avon Street. We have a dental home in their brick and mortar there. And then our third one is in Trenton, New Jersey.

unknown

Yes.

SPEAKER_01

I think I've been to the Boys and Girls Club. Yes, you have. Right? Yes. When that first opened. Yes. I mean, it's years ago now, but there's four or five chairs. There's three chairs. There are three chairs. Yes. So how does that work? Do you just come afternoons or so great question?

SPEAKER_00

So um it I believe it was in 2012 or 13, I may be off with a year or two. Uh, a Dr. Michael Gruber, who is a dentist here in New Jersey and a board member of the Boys and Girls Club of Newark, had this great idea of putting a dental center in the brick and mortar. And he started that. And then he heard so much about Kindra Smile Foundation and what we were doing. He reached out to me and he says, I want you to take this over. And so there are three chairs there. We have a dental home director there, Dr. Park. We have a hygienist there, Monique. We have a full supporting staff. So we treat all of the members of the Boys and Girls Club, um, and we've opened the doors to the community. So anyone can literally walk in and get services there. So it's three days a week Monday, Wednesdays, and Fridays, yes.

SPEAKER_01

And is that a good model for other organizations to do something similar?

SPEAKER_00

100%, because you're creating community partnership, which is key because the more community partners you have, the more awareness you're spreading, absolutely. Um, I think the Boys and Girls Club of Newark is one of the only Boys and Girls Club that has a dental facility in. And it's a wonderful uh uh partnership because when the children are bus there after school, they go right to the and get their services right there. The parents don't have to take off time from work or travel afar for the dentist. It's literally right there, just long as we have the consent. Children are seen and they get comprehensive services there.

SPEAKER_01

And they realize going to the dentist isn't so bad. It's a lot of fun when you come to Kindersmall Community Oral Health Center. It's fun. No, I mean, most people, and no offense, to your commitment to oral health care, that going to the dentist is not their favorite thing. Absolutely. By the time they go, they're happy they went, but it's not their favorite thing to do.

SPEAKER_00

Absolutely. And that's why we make it fun. All of our dental homes are colorful and inviting. We have pictures of our actual kids on the wall, and there's a toothbrush station. We want them to remember their visit there and know that oral health is not a side of fries. It's the gateway to total health and it's fun.

SPEAKER_01

So let's talk a little bit about the gateway. Yes. And I've heard that often. I think Dr. Sarah, who is a Kindersmile, used to say that to me all the time. What is it about nutrition, food we shouldn't eat, food we do eat, the time of day we eat it, that impacts oral health? Right.

SPEAKER_00

All of that impacts oral health. So the types of food that we eat, right? So complex carbohydrates, processed food, if it's not brushed off the teeth properly, they break down into sugar. Eats at the enamel, causes these little micro holes, bacteria gets in there, and starts a cavity, pain, discomfort can lead to an abscess. Abscess can lead to a brain infection, and that can lead to death. Right? So what we've noticed in our environments and in our community is that we're not here to tell our parents, don't eat rice and beans, don't eat meat, don't drink that, don't we? That's who are we to say that, right? Because this is what they can afford. We need to be empathetic and compassionate, and that's part of our culture. So what we will say is if you are going to eat this, this is what happens if you don't remove it at a in a timely fashion. So make sure after all meals you brush your child's teeth. And this is the proper way of brushing your teeth because there is a right way and a wrong way to brush your teeth. So, yes, the foods that you eat can impact your oral health and can lead to fatal situations, and we want to prevent that. So it's not when you should eat it. Okay. Yeah, if that makes any sense.

SPEAKER_01

Well, I always heard kids are not supposed to go to bed with sugar water or milk, right? And so I guess the point you just made, it doesn't mean they can't have it, but you should be cleaning their teeth or their mouth after they do, before they go to sleep.

SPEAKER_00

Absolutely. Right. So you did make a good point. So if a mother is breastfeeding her child or giving a bottle to sue that child before they go to bed, after that milk or that feeding of breast milk, give them a cup of water because that water will wash away the milk and the substance that could potentially sit on the teeth overnight to break down and initiate cavities. So, yes. So it's all about educating and meeting them where they are and say, what can we do differently and how can we help you think differently to prevent decay?

SPEAKER_01

But I'm sure most people would say stay away from the sugar. Yes.

SPEAKER_00

Yes. It's hard to say stay away from the sugar because, you know, I have to confess, I love candy. You know. So I mean, that would be a little hypocritical if I tell stay away from sugar when, you know.

SPEAKER_01

I know. Yeah. Besides the cavities, can improper oral health impact other parts of your body?

SPEAKER_00

Yes, absolutely. So oral, poor oral health or oral disease is linked to cardiovascular, diabetes, even Alzheimer's. Everyone at 100%. That's that's probably has been around for a long time, but it's become getting more um uh publicity when in the nursing homes, their teeth are not being taken care of as well due to lack of manual dexterity and and things of that nature. And even maternal health. Uh systemically, if there's some sort of oral disease, that bacteria travels through the blood and can uh affect the unborn child 100%. That's one of the reasons that we have one of our programs, a perinatal health and wellness program, because we educate the moms. You're the matriarch. We want your mouth to be so healthy and that you really understand why you're doing what you're doing. Just don't take our instructions, but really understand so that you can prevent your child from staying long time in the NICU, or when they're born, you know exactly what to do immediately. So, yes. Yes.

SPEAKER_01

Why does poor oral health lead to Alzheimer's?

SPEAKER_00

It's the amount of plaque, the amount, the the accumulation of the plaque on their teeth and the bacteria, the sub the kind of bacteria uh that that sort of stays on their teeth for a long time without me getting into like term terminologies that are uh that amount of plaque, they said, spreads and creates uh dementia or contributes to. It doesn't initiate, but it contribute contributes to uh dementia. Mm-hmm and and and Alzheimer's disease, yes. And so if you think about uh people as as we age, like I said earlier, there's a right and a wrong way to brush your teeth. But as we age, our dexterity is not as acute as it was when we were younger. So we might put that toothbrush in there, but we're not removing that plaque. And, you know, it can exacerbate diseases. Yeah.

SPEAKER_01

So is that why we all should get battery-operated toothbrushes, takes care of it for us? Wow. That's a good conversation.

SPEAKER_00

I've got an opinion on that one. Okay. I have never, in the 35 years of my profession being a dentist, I've never used an electric toothbrush. Never. And I'm not a big proponent because I think the old-fashioned way of angling your bristles towards your gum line is always the best way.

SPEAKER_01

Interesting. Yes. Interesting. Well, I have to confess, I do use, but maybe I ought to switch it. But that's okay. That's okay. How many dentists are part of your operation?

SPEAKER_00

So we have three dental homes, and on the average, we have about uh two to four dentists per dental home and supporting staff. Um, very difficult to retain dentists to work in the public health sector. What we do as a nonprofit, we call this public health. Um very difficult because we're in marginalized communities. And, you know, it's not the same as being in a private sector or corporate dentistry when it comes to pay scales and things of that nature. So our turnover is a little high. But to answer your question, we have about 10 to 12 dentists. And I could be off a little bit. Are there any dentists who volunteer? Oh, we have a plethora of dentists who volunteer, and that's part of our Give Back a Smile program or G Bass. Matter of fact, I every colleague that I run into, I'm like, do you, you know, instead of golfing or playing tennis on that Wednesday, can you give us a couple of hours? We do. We have specialists, we have prostodontists and pedodontists and general dentists who do come into our dental homes and volunteer their time, which helps us tremendously to defray the cost as well as to treat the uninsured population. But we also have oral surgeons and endodontists and orthodontists that we can refer our patients out to for pro bono care. That's wonderful. It's so wonderful.

SPEAKER_01

I mean, I remember the Give Kids a Smile, which was always that first Friday in February. You got it. And dentists always did volunteer. I think what I remember hearing is they were happy to do the work. It was handling all the logistics, right? Of making sure the kids got there, somebody to take them home, the consent form. So I'm assuming your dental homes take care of all that. So a colleague can just come in and say, where are the three kids I'm treating today?

SPEAKER_00

Right. You've got it. Absolutely. That is our job to make sure that everything's in order for our volunteer dentist and hygienist to come in and provide the best services for our children. We pride ourselves on, you know, dotting the eyes and crossing the teeth. So they're they're comfortable. And it also fills their soul because now they're being a part, they're being a part of the solution with Kinder Smile Foundation by increasing access to care because there's a huge problem in our marginalized en-rural communities with access to care, because they're just not enough dentists in the community to serve the community.

SPEAKER_01

Yeah. And they can just do what they do well. That's that's that's absolutely. Okay. So here's the tougher question, which I know some of the answer to. How do you pay for all this?

SPEAKER_00

Okay. So yes. So our sustainable model is insurance reimbursement, where we have about 80 plus, 85% of our population are on Medicaid. That's state insurance. And we know that our New Jersey state Medicaid fees have not been increased in over 20 plus years. So we're getting pennies on a dollar, right? So even though inflation, cost of living has cre increased, expenses have increased, we're still getting very it's minimal. Minimal, right? Exactly, reimbursement. The second part of our sustainable model are are grants. We get, we have to apply for grants. We're not an FQH, a federally qualified health center, so we don't get state or federal funding at all. Okay. And then our donors. Our donors, um, we rely on our donors. Um, and so that's our sustainable model insurance reimbursement, uh, grants, donors, and we are trying to convert some of our community partners into sponsored alliances. The service that we provide for them, we are asking for some honorarium or some cost. Um, and so that's also added uh into our sustainable model. Oh, that's smart. Yeah, right. Absolutely. You got to be smart because with Medicaid, we wouldn't be able to survive.

SPEAKER_01

Absolutely. So, just as a clarification for anyone listening or watching, Medicaid in New Jersey for kids anyway, and for low-income parents is the New Jersey family care, our public health insurance, right? So we need to talk about that for Medicaid. I guess some of your, if you if you were taking care of elderly patients, they would be strictly Medicare or Medicaid. That's correct. The reimbursement is family care. Yes. Which does have a dental benefit. But from listening to Dr. Nicole the Advocate, my sense is it doesn't cover everything.

SPEAKER_00

Absolutely, positively correct. Does not cover everything. There's some services that it doesn't cover, and it's just not equivalent. It's not on par with the increase of cost of living and so forth. And I think we're one, the state of New Jersey's is is really, really behind with that. And but also remember with the New Jersey family care, you also have the five MCOs, right? So you're only on New Jersey family care or Medicaid for 30 days before you have to select an MCO, which is United Healthcare, Horizon, NJ Health, Liberty. Well, you know, the managed care. The managed care program.

SPEAKER_01

But that's sort of, you know, some people refer to as an HMO, but that means you have to use their network providers. You have to use their network provides right, exactly.

SPEAKER_00

So is Kindersmile in the networks? 100 percent. That's the only way that we can offer the services to all of our patients in the community. So the Medicaid reimbursement or fee for service is a little higher than the managed care. Once you select the managed care, even though the managed care they vary in reimbursement rates, it's still lower than the New Jersey family care, which is lower than some of the other states. That's why, hence, after COVID, a lot of dentists who were accepting New Jersey family care dropped because box PPE was in increasing, boxes of gloves, masks, and so forth were astronomical, and they could not afford to pay because lack of reimbursement from New Jersey family care. So hence we have very, once again, very few dentists in marginalized and rural communities here in the state of New Jersey.

SPEAKER_01

Interesting. Because I always remember people making the argument that we had plenty of dentists. It was just they were concentrated in certain areas. But you're saying a lot of dentists have retired or just dropped out of the practice or taking the low income. I think the not necessarily taking the New Jersey family care clients. Right.

SPEAKER_00

Absolutely. Okay. So remember, so there are five MCOs, and some MCOs pay reimburse more than others. So dentists that are accepting Medicaid or NJ family care are only seeing those patients that with the MCOs that are reimbursing higher. Right? So if there are two MCOs out of the five that are reimbursing much higher, they're only taking those patients, leaving the other population of those MCOs left on the side. Yes. So what do you think the answer is to that problem? So what I think is the answer is that the state of New Jersey has to put oral health as a top priority. We don't want what happened in the state of Maryland to happen here in the state of New Jersey before we do anything. And that's why I've been advocating for change in policy, oral health line item in the state budget, um, speaking to legislators, converting our legislators into oral health champions so that they can advocate. We first have to recognize that oral health is not a side of fries. It's just as important as primary health. It's just as important as going to the physician. And that's one of the reasons, too, or one of the main reasons that we're starting to do medical-dental integration. Because we want to show the state and our community partners that it's one and it's not two separate. So, first starting to understand that oral health is a priority. And what can we do to invest in our children and families to make a difference so we don't have a Diamante driver?

SPEAKER_01

So that integration, the medical dental integration, what would that look like?

SPEAKER_00

Okay. That will look like for us what we started. We uh mobile uh mobile tech, uh, which is an organization um uh with the proprietor Winston Meikle, who's a nurse practitioner, comes into our dental homes uh once per quarter. Now we are getting funding or grant, a grant from the state to do this, which we're grateful for our partnership with the Department of Health. And he performs A1C testing and high blood pressure testing on our patients so that we're showing the correlation that if your A1C is high, you might have diabetes, go to a medical dent uh a medical doctor, therefore, that's why your teeth are loose. You understand? Trying to educate the population that your teeth may be loose because you're pre-diabetic or you're you're diabetic. Just educating them and showing them that that correlation. Therefore, what we're doing is medicine is not here and dentistry is not here. We're showing that connection. Exactly. And with our perinatal mothers, we want when they come for education, we want a mammogram mobile unit so that the moms can go and get mammogram testing, which they don't really do that in our community because it's costly. And sometimes they're uninsured or the insurance doesn't pay for that. So any time of any type of medical dental integration that we can the partnership make happen, we want that to happen so that we can educate our community and show that it's there's a connection.

SPEAKER_01

That makes sense. I do think it's still in people's minds it's separate.

SPEAKER_00

And it has been for centuries. Yeah. Yeah.

SPEAKER_01

What do you think the biggest challenges are to making that integration happen?

SPEAKER_00

Just what you said prior. You said it's in people's minds, it's separate. Right? You know, you have to first change the mindset of the the community, right? And so when you get medical health, that's totally separate from dental health. You know, that's this this this mindset. A few dental schools and medical schools are combining their first two years of dental students and medical students together. I believe Case Western universities won. The first two years for a medical student, four years of medical school, dental, four years of dental school, their first two years are being combined. So they're learning. With dentistry, you learn your head and neck, right? With uh medical students, you learn your head and neck and extremities, your entire body. So I think that's a very good start. I think more dental schools and medical schools need to take that path, you know, to dispel this myth or fallacy that the mouth is here and the body's here. You couldn't live without your teeth in your mouth or digest your food, right? And even when we talk about sometimes colon cancer, when if you're not masticating your food well, those boluses or those big chunks, or they're just hanging around in your small or large intestine. I mean, I don't mean to get a little spite of visible. Exactly. But that's what can predispose people to cell dysplasure or, you know, colon cancer and things of that nature. So starting medical and dental schools, other dentists and organizations really partnering with Obi-Gains or uh pediatricians and uh medical doctors. That's what we we try to bring our medical doctors in to educate. We would like to go now into their environment and educate. So it's going to be a long process, but we'd have to start somewhere. Yes.

SPEAKER_01

Well, I guess even the fact that they're meeting together, because I can remember back in the day, very separate. They have separate associations, separate meetings, separate conferences. Absolutely. But when I think about it, your whole appearance in terms of people's smiles, when you first meet somebody, going on a job interview, being able to talk, that people can understand you, it is all about your mouth and your teeth. That's right. Right? So when you think about it that way, it does make sense. It should be a priority if we want people to be functioning adults socially and also working and being productive.

SPEAKER_00

100%, Mir. You can work out, you can eat so well and so clean and have the best uh blood outcomes, uh, you know, results and in medical results. But if you have oral disease, if you have untreated tooth decay and abscesses in your mouth, you're not healthy. And people have to realize that you are not healthy. Healthy starts the mouth and the entire body. Right. Yes.

SPEAKER_01

And kids who are in pain aren't gonna learn because they can't focus or concentrate.

SPEAKER_00

That contributes to the high absenteeism rate in school. How much do you think that that's a cause of that absenteeism? Fifty-three million hours of school are missed due to oral disease nationally? Nationally. Okay. So I have some schools or schools have me on speed dial. I literally just received a text from a head nurse in school in Trenton with a picture of a seven year old boy with an abscess, and she said, I need your help. And we got him right into the office. This is a school nurse. So how is he focused in school with how is he even eating? He's not. He's not. He's not. Definitely not able to focus. Not able to focus. Interesting. So big con big contributing factor.

SPEAKER_01

So it appears we probably need some more dentists. We definitely need more dentists who can are who can and are also comfortable treating young children. Right. What role do the dental hygienists play in all this? Great.

SPEAKER_00

So we need more public health dentists. We need public health is a mindset. It's a sp specialty in the profession. Um, it's those dentists going into the marginalized community and providing the services. Hygienists are wonderful. Hygienists, we need more hygienists to come into our community. You know, we have struggled with finding a hygienist to stay at our Trenton dental home over the last five, six years. Why? Well, there's a shortage of hygienists. Um I'm not gonna say the number because I don't know the exact number, but I think there's maybe four hygiene schools in the state of New Jersey. I'm not quite sure. Um, but only about 200 hygienists are graduate per year. And they go out into the private sector or the corporate dentistry sector. Usually the marginalized communities are the last on on their list. But hygienists are crucial in in providing services. They do the cleanings, um, and though they're the first to really come in contact with our children and our families. So they're very important. And we need more hygienists here in the state of New Jersey willing to work, come into the marginalized. We've been struggling.

SPEAKER_01

Well, and they need to have your passion. Yeah. And the passion of your colleagues who maintain these dental homes. But I could understand if you're fresh out of school and you might have some loans, et cetera. I'm sure those in private industry probably can pay a higher higher salary than you might be able to pay at the dental home. That is correct.

SPEAKER_00

And that is the um that's the problem. That's the problem. That's the problem.

SPEAKER_01

What would you like to see change over the next 10 years? Oh, wow. In terms of oral health. Okay. Let's limit it to oral health.

SPEAKER_00

Do you have two hours though? Okay. I would love to see oral health policies implemented in the state of New Jersey. Right? Let's start from the top. Because I think when we start from the top, it really trickles down very nicely to the bottom. Understanding that oral health is a priority, but when looking at the budget, really trying to implement or allocate or reallocate funds to oral health. I would love our Medicaid fees to be increased. Uh some sort of accountability for MCOs with increase in their reimbursement rate. But all of these things will attract more providers back into back into our community. And I would really love to see more dentists being a part of public health. Kinder Small Foundation, we promote public health dentistry. Um, more dentists realizing that there is a problem. You cannot escape the problem that we're having here in the state of New Jersey, lack of access for oral health care and marginalized community. Whether you're a private dentist or a corporate dentist, be part of that solution by whether you volunteer your time or you give back somehow, because it's still a part of our profession. Whether you're private or corporate, it's still part of our profession. We can't allow our children in marginalized communities slip through the crack when it comes to oral health. We have enough dentists here in the state of New Jersey in private and corporate to help be part of that solution.

SPEAKER_01

Is there any um discussion or any way to get loan forgiveness if people donate a certain amount of years?

SPEAKER_00

Absolutely. The great question. And that we we participate in the New Jersey state loan repayment program. Most of our students graduating from dental school, uh half a million dollars on the low end, a half a million dollars in debt. So we are a part of the state loan repayment program. So hence, then now you see why a student graduating from dental school may want to go into corporate dentistry or private practice, because the pay scale is much higher. But we try to create these incentives. And there's also the public service program. Uh, if you work for a nonprofit uh for 10 years and make 120 consecutive payments, the balance of your loans are forgiven. But we don't know what this the current administration is doing to defunct or to remove that program. As you know that there's a cap on federal loans now that they can take. So that puts our dental students in a very precarious situation, not being able to take out as many federal student loans as previous, now taking out a lot of private loans with potentially higher interest rates and so forth. But we do participate in the state loan repayment program.

SPEAKER_01

Okay. So a couple of things. So even though the salary is lower, if you can figure out a way to continue to make your payments, people could work at the lower salary. I think you said you have to make 120 payments, and then the remainder of your loan is forgiven. That's correct. So that's that's good. That's a good thing. I think that's a really good opportunity. Absolutely. But I can understand why people, once they get out of school, want to just kind of knock it out and have a little extra money to maybe pay the rent or go to the movies or do something, whatever, right? Totally understanding. That is tough. So I what I'm hearing you say really is the whole infrastructure which supports the public health system, at least for oral health, really needs to be uplifted. Absolutely. Right? So, because even having loan forgiveness is not the same as maybe increasing the reimbursement rates. You got it. Absolutely.

SPEAKER_00

What made you become a dentist? I knew I wanted to become a dentist when I was 15 years old. Oh. Believe it or not. I grew up in Brooklyn, New York, and I watched my mother. My mother, an immigrant from Jamaica, West Indies, and I'm a gr immigrant as well. I was born in Jamaica, West Indies. Parents were divorced, and I watched my mother struggle. She was a legal secretary, my role model who worked tirelessly to put food on our table and to fight to give us all an education. My mother didn't go to college. And uh, she supported my father. My father had a dual career. He was a pharmacist in Jamaica and he became a dentist when he came to the state. So she supported his higher education. And so when they divorced, I watched her and I said, I have to find a way to help my mom. And this is, I don't want to repeat this, so to speak. And since I was a young child, I was always very spiritual and very faith-oriented. And um a little different than the average, you know, which I like being different. I embrace my, you know, me being different. And at a very young age, I started to say, what kind of career would I want to get into? And um, in high school, I thought I wanted to become a pediatrician because I had a strong affinity for kids, even as a young girl. I started, I started working at eight years old, and I have not stopped. There's never been a year that I did, I did not work. And so loved kids. I thought I wanted to become a pediatrician. So in New York City, there's the candy stripe where you volunteer. And I was at Kings County Hospital in Brooklyn, and it was the most devastating. I was traumatized because I didn't realize at a young age King's County Hospital was, you know, such a not a not so good hospital, drug-addicted mothers and you know, lots of violence around that area. So that's what I saw in the pediatric ward. You know, mothers would deliver and leave their kids there. And so when I would get home, I would say, I don't want to do that. Knowing me, I would end up adopting 20 kids at the age of 20, you know. So I said, no pediatrician. And then my mother really uh stressed education and music while we were growing up for my siblings and I. And so I was a piano player. So I was always good with my hands, and she signed us up for BAM, the Brooklyn Art Museum, and we were always sculpting, and I was just always so comfortable using. So that's when I said, maybe a dentist. So I got on my 10-speed bike and I went for a job interview to be a dental assistant. And I was 15. And I remember knocking on the door, and it was uh Dr. Sendroff, and he opened the door and he was like, Can I help you? And uh, I'm like, I'm here for the dental assistant job. And he's like, uh, come upstairs. Let me have a talk with you. And he was like, Are you credentialed? I'm like, No, I'm in high school. What do you want? And he became my mentor and I shadowed him. And it was at 15, he showed me that dentistry is such an art. Don't look at the mouth and the yucky stuff. It's an art. You can take a mutilated teeth and build it and make a smile beautiful and really edify and encourage that patient. And since 15 years old, I knew that I wanted to become a dentist and I never veered.

SPEAKER_01

That's a wonderful story. Yes. Thank you for telling us that. Thank you. I don't know. Is there anything I don't think we can top that? Is there anything else that you think people should know about Kinder Smile or the importance of oral health or the the work you do?

SPEAKER_00

Well, I I say this. Uh Kinder Smile Foundation, um, very passionate. We're we're leading with um advancing uh public health dentistry and increasing access to oral health care uh for our children and families in the community. Um we we need help. We cannot do this without our community partners, ACNJ, Department of Health, all of our partners. We need to create that platform, to elevate that platform to really promote public health dentistry and say, let's put the state of New Jersey back on track with access to oral health care for our children and family that need how let's come together. So I just I thank you for this opportunity, this wonderful. Um I know we could probably go on for hours. But um I just want everyone to just take a look at who we are. I implore everyone to, when you're in Bloomfield, Newark, or Trenton, stop by one of our dental homes, talk talk to our family, our staff, and however you can be a part of the solution, I welcome each and every one of you. So I thank you for this opportunity. And I have such a strong affinity for ACNJ. I love it. It's, I mean, I was just looking through my Facebook pictures and I found a picture at one of the first breakfasts. Yes, in 2017, I think it was, or one of the early. Well, we just had our 10th annual breakfast last year. Yes, yes, yes.

SPEAKER_01

So I thank you so much for this opportunity. And as a former board member, as I should say, in the interest of full disclosure, we really did appreciate your time on the board. But I thank you so much for all that you do through Kindersmile, for your commitment to oral health, and for your passion in really trying to help as many children as you can, and for all your colleagues who donate their time and would encourage anyone listening today to check out the Kindersmile Foundation and make a donation.

SPEAKER_00

Oh, thank you. That would be wonderful. Thank you, Mary. Thank you so much. We appreciate you so much.

SPEAKER_01

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