California Health Care Improvement Projects (CHIPs)

Decreasing Decay Rate in Children under Three by Introducing Early Oral Health Education in Pregnant Mothers in Safety Net Clinics

Dental Decay is the most common chronic disease among school aged children. In fact, dental disease is more common than childhood asthma. By the time children go to school, 50% of them have already experienced tooth decay in California. As a result, children miss school, learn less, are in pain, or end up in the emergency room due to oral infections. Research, and reports support this position (California Children’s Report Card gave a C- for Oral Health Care in 2020). Treating decay in very young children is very challenging. The good news is that decay is a totally preventable disease. Using a multi-disciplinary approach for early education and intervention with expecting parents, I expect children to have a reduced rate of dental decay by the time their children are 3 years old.

Several efforts to decrease dental decay have already been implemented. Safety net clinics, such as Marin Community Clinics have treated children from the moment, they have their first tooth. Expecting parents are referred early on for dental care. Despite all these efforts, we are still seeing dental decay as a chronic disease in very young children. Our population is not completely aware of the etiology of this disease and the lack of understanding and knowledge is producing little effect in preventing tooth decay.

Build a Public Health Infrastructure for Prevention of Oral Health Disease: School-Based Dental Programs

Problem: Currently, more than half of California kindergartners have experienced tooth decay, and by third grade, this number rises to over 70 percent. If left untreated, tooth decay effects children's overall health, social-emotional development, and academic performance.

Current Status: In California, SB 1433, the kindergarten oral health assessment (KOHA) requirement was signed into law in 2006 and requires children enrolled in public school for the first time (at kindergarten or first grade) have an oral health assessment. AB 1433 was amended in 2017 per SB 379 states that each school or school districts are responsible for reporting KOHA data annually. However, the compliance rate is low for schools distributing, collecting. and uploading KOHA data. Once COVID-19 pandemic, the compliance rate plummeted.

Solution: This CHIP project was aimed to conduct an environmental scan of key issues and barriers, identify collaborative partners, and build public health infrastructure for school-based screening programs aimed to create access to oral health screening for families, link them to a dental home, and increase compliance rate of KOHA requirement.

It takes a village – promoting health equity domestically and globally

In recent years, there has been increased focus on health equity, galvanized by events such as Black Lives Matter, and increased awareness of the porosity of borders during the COVID19 pandemic. In my role as faculty lead for DEI efforts within Stanford’s Division of Primary Care and Population Health (PCPH) as well as faculty lead for the division’s global health partnership in western Kenya, I realized that many of the challenges to health equity globally are at play domestically. Our division’s overarching goal is to create a culture of medicine that embraces belonging and mutual respect. My main curricular tasks were to create a DEI curriculum for faculty and staff in our division; as well as to create a curriculum for rotating Kenyan students to Stanford that ensured reciprocal change. I will present the Kenyan student elective curriculum creation to illustrate the complexities and challenges in creating this shared culture, and to highlight the numerous stakeholders involved.