It wasn't the fluoride varnish - dabbed on her baby teeth by a medical assistant - that made little Denisha Myrick cry yesterday. It was the jab of immunization needles, part of a medical checkup that brought the tears.
But doctors at the Belair-Edison Family Health Center in Baltimore stressed to the toddler's mother that the varnish - a vital part of early dental care - was just as important to the girl's long-term health.
Denisha, who recovered quickly from the varnish as well as the shots, is one of a growing number of children ages 12 to 27 months who are receiving fluoride treatments from pediatricians or nurses, not a dentist or hygienist, as part of regular medical checkups.
Baltimore is the first city in the nation to provide fluoride varnishes to children at medical clinics and record those results in a registry. City officials yesterday released a report on the pilot program - which has served nearly 1,000 children since November - finding that it was effective in improving dental health, and now the Maryland Health Department is preparing to expand it throughout the state by July 2009.
"We found that everyone involved thought that this was a great thing to do," said Baltimore Health Commissioner Dr. Joshua M. Sharfstein, who got funding from several foundations to launch the pilot program after the death of Deamonte Driver, a 12-year-old Prince George's County boy who died when an infection from a sick tooth spread to his brain.
Of the new program, Sharfstein said, "The doctors were enthusiastic, the nurses were enthusiastic, and the parents really appreciated it."
City health officials launched the fluoride pilot program last fall to reduce dental disease among children who might not otherwise see a dentist. Many families put off dental care until later in a child's development, and not all dentists accept Medicaid patients, in part because the state has been slow to increase reimbursement rates. Since November, nearly 1,000 children at four medical clinics have received the treatment, which costs about a dollar but could have a big pay-off if it keeps children from missing school because of cavities.
State officials said they are enthusiastic about the program. They said they will need about a year to train pediatricians and work out a reimbursement scale.
"Medical clinics are a good place to provide early dental care," said Susan J. Tucker, executive director of the Office of Health Services. "Doctors already do oral checks, but [with fluoride treatments] they are going to be looking at the teeth more carefully than just when the patient says, 'Ahhh.'"
Baltimore officials hope to be able to continue to offer the varnishes at four clinics for at least another year and could eventually expand the treatment to children up to 5 years old.
"This kind of innovative approach is critical to making Baltimore healthier," Mayor Sheila Dixon said in a written statement released yesterday.
It was Deamonte's death early last year that spurred elected officials and public health advocates in Maryland and the U.S. Congress to take action. His mother had a hard time finding a dentist who would accept Deamonte as a Medicaid patient. Besides spotlighting deficiencies in the state's Medicaid network, the boy's death raised concerns that the state, home to the nation's first dental school, didn't have enough pediatric dentists.
Since then, Congress has passed "Deamonte's Law," introduced by U.S. Rep. Elijah E. Cummings, which aims to strengthen the nation's dental system by training more pediatric dentists and encouraging them to open practices in poor or rural areas. In Maryland, a dental action committee released a list of recommendations in August that would improve dental care for many poor children. As a result, the state has agreed to increase reimbursement rates to dentists who treat Medicaid patients.
"We're really looking at our entire system," Tucker said.
Cummings said that the fluoride pilot could do much to end "the unacceptable disparities in oral health and ensure that our children have the healthy smiles they deserve."
But for 15-month-old Denisha, all that mattered yesterday was that the shots were over.
"That's it, that's good," cooed her mother, Audrey Jones.
And then, her tears almost dried and first fluoride varnish nearly forgotten, Denisha smiled.