Since 2012, Creighton dental students and faculty have volunteered at the St. Francis Mission Dental Clinic on the Rosebud Indian Reservation in South Dakota. Read more about the much-needed care provided to the Rosebud Reservation residents.
The soft-spoken, diminutive mother and daughter showed up early for the girl’s follow-up dental procedure at the School of Dentistry pediatric clinic on a snowy winter morning.
The mother, Mu Hki, had taken off work from her six-day-a-week factory job outside of Omaha to accompany her daughter. Creighton dental care coordinator Margo Forsythe helped the family arrange transportation to the appointment because the family doesn’t own a car.
The girl, 12-year-old Paw Klay, had been experiencing tooth pain strong enough to wake her during the night. An earlier appointment to the clinic had confirmed that she had a severe abscess, requiring antibiotics. On this particular day, the tooth would be extracted.
Karen refugees from Burma who had been living in a camp in Thailand, the family had arrived in Omaha six years earlier. In fact, Mu Hki, 32, had lived in refugee camps most of her life, since she was about 12. Paw Klay and one of her three siblings were born in the camp, where the family lived in the bamboo structure they built themselves. Frequent rains necessitated rebuilding portions of the house regularly.
There was no dental care in the Umphium camp, which houses some 10,000 refugees in a mountainous region.
“We had to walk down the mountain to the city, to the hospital,” Mu Hki said, speaking through an interpreter. “We had to sit all day and hope to be seen.”
Toothpaste was always in short supply in the camp, so Mu Hki used salt to clean her own teeth, saving the toothpaste for her children.
For drinking and cooking, the family would dig a hole as deep as necessary to reach water. They would then boil the water over a campfire, which was also used to cook their food.
“There was not enough work. And there was not enough food for the children,” Mu Hki said. “Only rice and beans and oil.”
In search of a better life for their family, Mu Hki and her former husband applied for United Nations refugee resettlement, and eventually joined a Karen population of several thousand in Omaha.
Paw Klay’s elementary school is among 10 low-income public schools in northeast Omaha served by a Creighton dental outreach program, and that was how the family learned of the Creighton Dental Clinic. More than 90 percent of the students in those schools are eligible for the free or reduced-price federal lunch program.
“I know I have to take my children to the dentist, but it is difficult because I have to work,” said Mu Hki. “I am very glad the dental students come to her school.”
On the day of her follow-up appointment, Paw Klay, who speaks English, broke into a big smile when asked about the care she receives from Creighton. “I really like the dental students. They are amazing. They help us kids a lot and teach us how to clean our teeth.”
“I was very sad that Paw Klay got the tooth infection. I want her to take care of her teeth,” her mother said, “but I can’t always make sure she does it. I am happy that she got treated. It is so important for the kids to have care so they can be healthy.”
Paw Klay is just one of the 5,000 children seen annually through the schools-based program, which is called Healthy Smiles. Last year, 31 percent of the children screened had untreated tooth decay (the national average is 21.5 percent, according to the Centers for Disease Control and Prevention) and 11 percent had urgent dental needs.
Treating children’s oral health addresses a critical need. According to the CDC, dental disease is the most common chronic illness for children in the U.S., with 68 percent of youth experiencing tooth decay in permanent teeth by age 19. Data from 2014 show that more than 18 million of the nation’s low-income children went without dental care.
Through Healthy Smiles, Creighton students under the supervision of faculty provide fluoride varnish, dental sealants, screening and oral health education twice a year at each school. If they see a child with untreated tooth decay who needs to see a dentist, the dental care coordinator contacts the family and assists them in getting a dental appointment at the provider of their choice. Many of them choose the Creighton dental clinic.
Funding for the dental care coordinator position and the Healthy Smiles program is through Building Healthy Futures, which is part of the Children’s Oral Health Collaborative. The collaborative creates a continuum of oral health care and education for underserved children in the Omaha area.
On a recent Healthy Smiles visit at Martin Luther King Jr. School in Omaha, four dental students and four dental hygiene students (through a cooperative program with Iowa Western Community College) provided services to 120 first- through sixth-graders.
“Some of the students have lots of damage,” said the school’s principal, Stephanie Black. “This program is amazing. We love it. It’s serving kids who often don’t get dental care and it’s a way to get them some help. We ask our teachers to encourage the students to bring the parent permission forms back that allow them to be treated.” Black said sometimes the lack of dental care is due to a family’s financial situation or sometimes a parent has a fear of the dentist.
“Students all over our school talk about brushing their teeth now. Some students ask for permission to brush their teeth after lunch so we have gotten toothbrushes donated to our classrooms.”
As if on cue, a first-grader proudly walks up to dental school faculty member Linda Woodruff following his dental treatment. Woodruff plants a Creighton Bluejays sticker on him and hands him a packet containing an electric toothbrush, toothpaste and dental floss. “Have a great day, bud,” she says, and Principal Black chimes in, “Have a good day now, and make good choices.”
The schools program is just one facet of the many ways the School of Dentistry shapes future dentists to be community-service minded, not only in dental school but in their dental practices.
The school is formed by the University’s Jesuit, Catholic identity and its students come to Creighton expecting more than excellent academics and proficiency in dentistry (Creighton dental graduates consistently score above the national average on national and regional licensing exams). As the school’s mission states, students will be challenged “to reflect on transcendent values” and “instill caring, ethical and moral components in their professional lives.”
They learn these values firsthand as the dental school provides care through its clinics and outreach programs to about 27,000 patients annually, including approximately 12,000 people at the on-campus Creighton pediatric and adult dental clinics. Students and faculty additionally provide care to underprivileged adults and children and volunteer hundreds of hours through a variety of programs (see sidebar articles).
“For more than a century, the students, faculty and staff of the School of Dentistry have taken community service to heart, providing for the oral health needs of the underserved in Omaha and the surrounding areas,” the Rev. Daniel Hendrickson, S.J., Creighton president, said. “In particular, our dental students learn how to be compassionate professionals who serve their patients as well as their communities.”
Mark Latta, DMD, dean of the School of Dentistry, is proud of the community work the school does in addition to training competent, ethical general dentists. “This is not only an educational program,” Latta said. “We deliver care to an enormous number of people in need.”
“The mission of the dental school is the mission of Creighton University — to help transform our students into women and men for others,” said James Howard, DDS, senior associate dean for clinical and external affairs. “You get immediate gratification when you help other people, and you become someone who wants to keep getting that good feeling.
“Service is such a huge part of their clinical training,” Howard said, “and it is important to society — that type of dentist is different.”
There are only three Catholic dental schools in the United States and Creighton is the farthest west. Creighton is also the only one that chooses not to offer graduate programs so CU dental students get more hands-on clinical experience. “Our students are very clinically oriented,” said Howard. “Here, they get to do it all. There are no graduate students who get to do the majority of care.”
Howard, who has lectured internationally, joined Creighton in 1995 following career service in the U.S. Air Force Dental Corps. He said when he was an Air Force colonel, long before he ever worked at Creighton, “I needed dentists who could do it all. I worked with dentists who graduated from every school and few prepared young dentists who could do dentistry the way Creighton students did. So when I was offered a position here at Creighton, I was thrilled for the opportunity.”
Creighton’s well-rounded training and its emphasis on mission have led many graduates to choose rural dentistry, helping fill a critical shortage of dentists in rural America. In fact, Creighton is the top private dental school in the nation for percentage of graduates (2005-2014) practicing in rural communities, according to a report published in The Journal of the American Dental Association.
One alumna who has been doubly formed in the Jesuit tradition and gone on to a distinguished career in public health dentistry is Kim Wieckert McFarland, BA’83, DDS’87, chair of the Department of Community and Preventive Dentistry. McFarland graduated from Creighton with her bachelor’s degree as well as her DDS.
She is past president of the American Association of Public Health Dentistry; the first woman to chair the American Dental Association’s Council on Access, Prevention and Interprofessional Relations; and the former dental director for the state of Nebraska. She joined Creighton last year and currently teaches dental public health, ethics and professionalism.
“It has been an incredible journey,” McFarland said. “If you had told me 30 years ago that I would be back at Creighton, helping the underserved, I would never have believed it. It just shows you that God has a plan.”
McFarland decided in third grade that she wanted to be a dentist and shortly thereafter that Creighton was the place for her. “I grew up in Colorado and at age 9 I was thinking that I wanted to be an oceanographer, archaeologist or dentist. I asked my dentist, if he could do it all over again, would he choose the same profession? I got a big smile and he said, ‘In a heartbeat.’ I asked him where he went to dental school and he said Creighton, so I decided right then and there that’s what I wanted to do.”
She came to Creighton for undergrad with her sights set on dental school. But she majored in theology because she found it “so rich in thought.
“Of course, I took all the sciences,” McFarland said, “and a lot of people thought I should major in one of the sciences, but majoring in theology gave me good balance.”
When McFarland was in dental school, she participated routinely in the Thursday night student-run volunteer clinic that Terry Wilwerding, DDS’77, MS’00, MS’08, professor of prosthodontics, coordinated (and still does) for low-income and uninsured and underinsured patients.
“I remember one night my little patient fell asleep while I was treating him and I asked Dr. Wilwerding what I should do. He said, ‘Don’t worry about it. It’s probably the first time he’s gotten to rest all day.’ We also went into the schools to talk to them about oral health, and it gave me glimpses of what was possible.”
McFarland said it was the work she did on an American Indian reservation one year out of dental school that gave her insight into the importance of public health. “Public health was a nebulous term to me at that time. I just thought, ‘Of course the public should be healthy.’ I was doing private practice but I wanted to have more of an impact. The Omaha tribe at the Omaha Indian Reservation in Macy, Neb., needed someone part time one day a week, and then two.”
McFarland went to work at the reservation full time for five years, becoming the only dentist for 5,000 Native American patients. She said one-third of the tribe was diabetic with another possible 25 percent undiagnosed diabetic, adding that diabetes leads to periodontal disease and poor wound healing. “I saw at least one broken jaw a month, and there were drug and alcohol struggles, so it was multifaceted care. I found out not everyone has insurance and not everyone is healthy.”
McFarland saw 18 to 20 patients a day. “They said ‘the big white woman’ is our dentist,” she laughed. One of the procedures she initiated was providing dental sealants, which has been shown to reduce tooth decay by 30 to 40 percent.
“Community-based programs are so important,” McFarland said. “You have to bring it to them. It is so very beneficial to families.”
Many others — including Paw Klay and her mother — apparently agree with her, and are glad that Creighton is taking such a leading role in providing these services.
“Children need to be healthy in order to learn,” said Jeanne Weiss, chief executive officer of the nonprofit Building Healthy Futures, which seeks to improve the health of underserved children and youth in Omaha through collaboration and advocacy.
“Creighton and the School of Dentistry have been great partners with Building Healthy Futures from early on. They stepped up to the plate and understood the importance of connecting with the community.”
Charles “Fritz” Craft, DDS, dental health director in Nebraska’s Division of Public Health, said thousands of Nebraskans lack the personal resources to receive professional dental services on a regular basis due to “economic, geographic, educational or even cultural obstacles.”
Craft said, “Creighton is committed to making an important impact on the overall dental health status of underserved populations in our state,” noting that, at the same time, the University is “allowing their dental students to gain valuable clinical experience in the career field of public health dentistry.”
Third-year dental students Nick Samuelson of Omaha and Devon Rasmussen of Grace, Idaho, both participants in the recent Healthy Smiles program at King Elementary School, view Creighton’s role in the community personally.
“Working at the school opened my eyes to the fact that some of the kids have no support at home for oral hygiene,” Samuelson said.
“But I was really impressed with how enthusiastic they were about learning about oral health. They asked a lot of questions and they really wanted to be there. It made me glad that we were able to provide this service, and I know I will be able to apply what I learned about motivating kids to have better oral hygiene in my future practice.”
Rasmussen, who has four children of his own, said he now has an appreciation for the complexity of community service. “I never imagined the work, organization and thoughtfulness that is given to a simple community event. These experiences expose me to a model of community dentistry and provide a small infrastructure to build upon in my future practice.”
He said he sees the benefits for all involved. “The patients are provided with a service and learn that ‘going to the dentist’ is not as frightening as they may have assumed. We students, on the other hand, learn the importance of delivering care to the community and how to better communicate with patients. And we have the opportunity to perform service for those who otherwise may have been devoid of such opportunities. It is a win-win relationship.”