This story is part five of Accounted For, an ongoing project of St. Louis Public Radio that explores the connection between chronic absenteeism -- defined as missing three and a half weeks or more of school -- and classroom success. One reason students miss school or do poorly in class is health. For more on the academic effects of chronic absenteeism, watch the video at the bottom of the page.
Tiffany Myers is a soft-spoken seventh grader at Valley Middle School in House Springs with dreams of becoming a veterinarian when she grows up.
Even though she loves science and math, Tiffany sometimes was hesitant to raise her hand in class. Her mouth hurt, sometimes really bad.
This past fall she made her way toward some old science classrooms at the far end of her school in rural Jefferson County. In them, an experiment was underway. Since November, cabinets that once stored lab kits became home to equipment for a full-service dental clinic operated under a partnership between Comtrea, a nonprofit community health organization, and the Northwest School District.
“When I sat down, all they did was clean my teeth,” Tiffany said. “But the second and third visits, they were doing work on my teeth.”
And it ended up being a lot of work.
After six visits, the clinic’s staff has done roughly $9,000 worth of dentistry. Even though it will take four more visits before all of the work is completed, Tiffany isn’t so shy anymore about answering questions in class.
“I wasn’t a big smile-er,” she said. “But now I’m really happy to smile and show my teeth.”
Like 91 percent of the clinic’s users, Tiffany qualifies for Medicaid. Only 1 percent of the students using the clinic have dental insurance.
Nicole Johnson is the senior director of Elev8 Baltimore, a nonprofit that runs three school clinics in partnership with Baltimore Medical System. In her experience, she said, dental health can also be a challenge, especially for low-income students.
“As students get older, in the middle grades, they have really serious dental needs,” Johnson said. “They need root canals or they have cavities, or they’ve gone a long time without proper dental care. So, how do you find the right partners who can work with the schools?”
Nathan Suter, who was fresh out of dental school last spring, headed back home to Jefferson County to run the clinic in this rural area about 40 miles southwest of St. Louis.
When he arrived, Suter quickly found that more than one in three children had untreated tooth decay and almost 90 percent didn’t have proper sealants on their teeth. That’s especially problematic in a part of the state where residents often drink well water and don’t get the fluoride used in larger water systems.
“If they’re having dental abscesses or tooth aches, they might not know how to tell somebody this is what they’re experiencing,” Suter said. “Being able to screen for these things and offer services right in their area can address a lot more than their oral health.”
Like many rural areas in Missouri, a trip to the dentist can be an hour or more each way. That’s hard on poor families who lack transportation and the ability to take time off from work to see a dentist who accepts Medicaid.
Northwest’s Superintendent Paul Ziegler saw the dental clinic as an opportunity to help his students.
“Having a tooth ache is not something that’s going to lend itself real well to paying attention and focusing in school,” Ziegler said.
A little more than 10 percent of students in Northwest’s schools missed enough class time last year to be considered chronically absent; that’s significantly less than many urban and suburban districts. But Ziegler said students in this category tend to be absent for an extended period of time.
“When our students are missing, they’re missing a lot,” Ziegler said. “How much of that goes to mental health, physical health, or dental health? It’s hard to say. But we do know that there’s a strong correlation between those areas of poverty where they’re lacking some of those services or support to make sure those areas are identified and addressed.”
There's limited research on the connection between access to dental care and attendance, but a survey of students by the UCLA Center for Health Policy Research found that children in California miss an estimated total of 874,000 school days due to dental problems. They concluded that access to dental care is the key difference between kids who do and do not miss school because of an oral health issue.
Though the clinic has only been open for short time, its popularity has rapidly grown. In November, 39 patients received dental care. In contrast, 300 patients were seen in February.
Comtrea also opened a substance abuse and behavioral health center next to the dental clinic, and it hopes to expand health-care services at the school in the near future. Because it was located in unused classrooms, Comtrea could cut back on its overhead costs, spending roughly $300,000 to get the service off the ground.
It also sees parents of students during the day, and anyone in the community can come to the clinic in the evening for dental services.
As with many rural districts, Northwest’s schools are a big part of the connective tissue that holds together residents sprawled out over larger areas. While it’s too early to quantify the clinic's impact on attendance and ultimately classroom performance, Ziegler said positioning the school as a community resource is a benefit in and of itself.
“All those things create a sense of belonging and security within a school,” Ziegler said. “The more we can get families and students engaged the more can achieve that academic success that ultimately we’re charged with.”