Archive for the ‘Featured’ Category

Oral Health Facts for Happy Hartford Teeth

Saturday, June 29th, 2013

Nearly 1 in 5 kids in VT
haven’t seen a dentist — even for a checkup— because they can’t afford it.

FACT # 2
Fluoride Mouth Rinse Program has been available to Hartford children through schools for over 30 years.

FACT # 3
34% of all Vermont children in grades 1-3 have a history of dental decay.

Vermont’s School-Linked Tooth Tutor Program connects children to a full range of dental care through local Dental Homes.

There are about 35 hygienists working as tooth tutors in 120 elementary schools throughout the state as well as all Vermont head start programs.

344 children in grades K-3 were screened through the Upper Valley Smiles Program, and 28% had untreated tooth decay.

Community water fluoridation effectively prevents tooth decay, which gives significant cost savings to communities.

Oral health is an important part of overall health.

Vermont has been ranked as the nation’s healthiest state since 2008.  However, the burden of oral disease continues to silently affect Vermonters. The Upper Valley Oral Health Coalition is working to get our teeth healthy!

 Learn what you can do to have Happy Hartford Teeth.

Tips for Children
Tips for Adult

News From Vt. State Dental Society

Thursday, October 11th, 2012

Thanks to member, Toby Kravitz, DDS, Upper Valley Oral Health Coalition is please to post this release from the Vermont State Dental Society on our website.

Subject: The Importance of Oral Health during Pregnancy and Early Childhood
Dear Vermont State Dental Society Members:
Below is the web link to Dr. Steve Arthur’s May 24th Vermont Department of Health’s Public Health Grand Rounds presentation, “Two is Too Late”, which is about the importance of oral health during pregnancy and early childhood.
It does not include an audio recording, but does include a link to the video portion of the presentation.  A link to the presentation is listed under Presentation Recordings and Slides, near the bottom of the page.
The take away message includes that oral health care is safe during pregnancy, and should not be delayed until the baby is born.  Bacteria that cause early childhood caries (ECC) are transferred from mom to infant by things like pretesting food and kissing on the mouth.  If babies are infected before their second birthday, they are set up for a lifetime of more severe decay.  ECC is a real problem in Vermont.  In FY 2009 over 400 Vermont children had to be treated under general anesthesia in a hospital setting, at a total cost of over $2.5 million dollars to treat this preventable disease.  Many of these children will grow up, and pass the decay onto their own children if this cycle is not broken. 
ECC is a complex problem, involving many aspects, and needs to be addressed at all levels of the Vermont Prevention Model.  Ideally, the importance of oral health would be addressed at a woman’s first prenatal visit; she would be given information about how pregnancy may put her at an increased risk for oral disease, how her oral health can affect gestational diabetes and preeclampsia, and how her oral health may affect that of her child.  She would be encouraged to have all needed preventive and restorative dental work done before her baby is born (even if that means needed x-rays and local anesthesia), and to decrease the bacterial count in her mouth by using mouth rinse and xylitol gum.  Appreciating their potential to positively affect this woman’s birth outcomes, and her oral health as well as her child’s, the local dental team would welcome this woman into their practice, and look forward to seeing her child on his or her first birthday.  At the women’s Head Start program and WIC, she would be getting consistent messages about the importance of prioritizing preventive oral health care (showing up for appointments and following through with homecare), limiting sugar sweetened beverages, and establishing a dental home for her child by age one (“Two is Too Late”).   
The California Dental Association Foundation (CDAF) has excellent resources on this topic that are being promoted by VDH:
CDAF’s “Oral Health in Pregnancy and Early Childhood: Evidenced Based Guidelines for Health Professionals” shared with OBGYNs, midwives, pediatricians, WIC, and Vermont dental practices in collaboration with the Dental Society, and patient/parent materials, “Cavity Keep Away.”
I’ve also attached the ADA recommendations outlined in “Baby’s First Tooth”, published in JADA (February 2002).
Please review these materials and share them with your practice team.  It is important that we deliver a consistent message to patients.  We expect to continue working with Dr. Arthur, Robin Miller RDH, and the VDH team on this important topic.

Fluoridation Update from the ADA

Monday, August 6th, 2012

July 16, 2012
The state of fluoridation
After 67 years, challenges continue across nation
By Stacie Crozier, ADA News staff
For 67 years, community water fluoridation has been part of the landscape in the United States public health arena. Hundreds of studies have confirmed its safety and effectiveness in reducing caries rates since 1945, when Grand Rapids, Mich., became the first community to adjust the fluoride levels in its water supply to lower tooth decay rates in children.

 According to the latest statistics from the Centers for Disease Control and Prevention, fluoridated water now reaches more than 204 million U.S. residents—just under 74 percent of the population on public water systems. In 1999, the CDC proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century.

Dental professionals might think policymakers and the public understand that community water fluoridation is a safe, effective and cost-effective measure to prevent dental decay, but the latest information compiled by the ADA indicates that 43 states have experienced activity to initiate, retain or defeat fluoridation programs—or a combination of these—from January 2011 through May 2012. While in some cases the activity didn’t end in an official vote, some communities were involved with challenges that required action on the part of dentist members and dental societies.

Although a handful of states have mandatory fluoridation laws, the vast majority of the debate happens at the local level, where many city councils, boards of health or water district officials have authority to make fluoridation decisions.

“A fluoridation debate might be happening in your community right now,” said Dr. John Hanck, chair of the National Fluoridation Advisory Committee and member of the ADA Council on Access, Prevention and Interprofessional Relations. “And you are not alone. Communities that have been fluoridated—even for decades—are facing challenges. However the question is raised, it can lead to high emotions.”
The ADA’s policy on fluoridation, added Dr. Hanck, calls for “individual dentists and dental societies to exercise leadership in all phases of activity which lead to the initiation and continuation of community water fluoridation, including making scientific knowledge and resources available to the community and collaborating with state and local agencies” and “encourages individual dentists and dental societies to utilize Association materials on the community organization and public education aspects of fluoridation.”

“We have a vast amount of resources available to our members for use in educating the decision-makers and the residents of their communities about the safety, benefits and cost-effectiveness of fluoridation as well as strategies that can help them initiate or face a challenge to fluoridation,” Dr. Hanck said.

Form a coalition
In the city of Bozeman, Mont., where residents have had fluoridated water for 60 years, health professionals, public health groups and others joined together earlier this year to educate and advocate for fluoridation with city commissioners and the public, said Dr. Jane Gillette, a Bozeman dentist and member of the ADA Council on Access, Prevention and Interprofessional Relations.
Dr. Gillette
“A few months ago a local college student came to a regular Monday night city commission meeting to speak in an open mike forum which started a chain of events,” she said. “The student said he wouldn’t drink or bathe in Bozeman’s tap water because it was fluoridated.”  

The result, she said, was that a vocal minority of people against fluoridation appeared every Monday for weeks to speak at commission meetings.

Bozeman dentists, hygienists, physicians, nurses, health department officials, public health advocates and groups like the local Head Start program responded by working in collaboration to show the city commissioners not only that they support fluoridation, but why.

“We had about 120 health professionals and other advocates sign on to a letter of support,” said Dr. Gillette. “Our supporters included not only most of Bozeman’s dentists, but pediatricians, water scientists and the dean of Montana State University College of Nursing.”

The coalition, she added, held many early morning conference calls to solidify its messages and plan for the city commission’s final hearing on fluoridation on April 23.

“Our message is that fluoridation is safe, effective and cost-effective and we developed talking points,” said Dr. Gillette. “We also planned to have as many coalition supporters as possible attend the meeting. We virtually flooded the meeting room and the coalition members who spoke at the meeting were articulate and persuasive.”

Dr. Gillette said the coalition wanted to give city commissioners a visual cue that the coalition was large and broad-based, so they developed 4-inch diameter buttons to wear to the meeting that said “Yes! Fluoride for a Healthy Bozeman.”

At the meeting, the commissioners unanimously decided to continue fluoridation, but antifluoridationists have started a petition drive, gathering signatures from Bozeman voters to bring the question to a ballot in November. The group has until mid-July to collect 4,041 signatures—one quarter of the voters in Bozeman—to get fluoridation on the ballot.

“Our main objective now is to encourage local health professionals and advocates to inform and educate their patients and clients about the benefits of fluoridation,” she said. “The community support I’ve personally gotten from this is amazing. Lots of people I hardly know have offered me their thanks for supporting fluoridation. The truth is our community is pretty well informed about its benefits and they appreciate our work. I’m proud of our community, and especially of all of our health professionals who worked together to advocate for fluoridation.” 

Get involved before challenges happen
Florida has been the site of a number of fluoridation changes in the past 18 months. Six communities have voted to retain their fluoridation programs following a challenge; two communities have voted to initiate fluoridation; two have discussed fluoridation in public forums without any action to date; and Pinellas County, which provides water to some 700,000 residents, voted to discontinue its fluoridation program by a county board vote of 4-3.

While the Pinellas County Board of County Commissioners opted to stop fluoridating the water supplied to some county residents at the end of 2011, several communities within the county have their own water systems and may not be affected by the decision. A few of the affected communities in the county are actively working to bring fluoridation back to their residents.

Dr. Johnson
Tarpon Springs recently held a city commission meeting to discuss fluoridating its water supply when the city’s desalination plant is completed in two years. A previous commission had voted not to fluoridate it. Dr. Johnny Johnson, a pediatric dentist in Palm Harbor, said that local dentists and other profluoridation activists have been working hard to educate the Tarpon Springs City Commission about the benefits of fluoridation and provided references and answers to questions from an antifluoridation group. Currently, the city depends on Pinellas County for most of its water.

“We worked hard to reach out to each commission member and make sure they had all the scientific information they needed to make a sound decision,” said Dr. Johnson. “We provided each member with an ADA Fluoridation Facts booklet; plus Internet links to websites like the ADA, CDC, the American Water Works Association and others; and the table of contents to a 500-page binder filled with information on the science and history of fluoridation.

“We also asked local dentists, pediatricians and other health professionals as well as local residents to send emails to commissioners supporting fluoridation and to attend the hearing on fluoridation,” Dr. Johnson said.

“The email contacts were huge,” he said. “Politicians depend on emails from experts and citizens to gauge public opinion, and even though it may not be scientific, it definitely influences their decisions.”
On April 17, the Tarpon Springs city commission cast a unanimous vote to fluoridate when the water system goes on line.

“I am so proud of everyone who got involved in this effort. The key is to stay involved,” he said. “Be involved even when things are going well. It’s good to have a personal relationship with your policymakers before you need to ask for their support. Your elected officials may or may not know the science behind fluoridation, and it’s easier to touch base with them when you are already involved with them.”

The issues are changing
In Milwaukee, Ald. Jim Bohl in May proposed that the city immediately stop fluoridating its water because he said fluoridated water is not safe. His proposal set off a firestorm in Wisconsin’s largest city, which has been fluoridated for 59 years and prompted a contentious seven-hour Common Council Steering and Rules Committee hearing May 31. The committee voted 5-2 to hold his proposal in committee and schedule an additional hearing on the issue. As of late June, no follow-up hearing date had been scheduled.

Dr. Donohoo
Photo by Emily Bultman, WDA Communications Coordinator/Managing Editor.
“It has become apparent that the fight is no longer over fluoride’s effectiveness (even the opposition acknowledges that the topical application is beneficial in fighting decay), but whether or not it is ever safe to add fluoride to the water supply for ingestion,” said Mark Paget, Wisconsin Dental Association executive director. “Organized dentistry and advocates of water fluoridation must have the research and evidence to show that fluoride is not only effective in preventing cavities but is also safe for consumption/ingestion.”

The WDA has long worked to address community fluoridation issues as part of a coalition, he added, teaming up with the Wisconsin Department of Health Services Division of Public Health, Marquette University School of Dentistry, grassroots member dentists and local public health departments.

Wisconsin’s coalition reacted swiftly to reach out to all Milwaukee City Council members in advance of the hearing with factual information. WDA member Dr. Mike Donohoo of Milwaukee was one of several dentists who testified.

Sound strategies to help protect fluoridation

Dr. Hanck
There are a few simple steps individual dentists, dental societies and oral health coalitions can take to help protect fluoridation for residents in their communities, said Dr. John Hanck, chair of the National Fluoridation Advisory Committee and member of the ADA Council on Access, Prevention and Interprofessional Relations:

• Read your annual Water Quality Report—Water systems are required to provide their customers with this report, sometimes called the Consumer Confidence Report, by July 1 of each year. The reports, which detail quality and content of water, may be mailed to consumers’ homes (often with the water bill), published in local newspapers or posted online. Dental professionals should review the report to check the level of fluoride in the water.

• Know your policymakers—It’s easier to meet a fluoridation challenge head on when you are familiar with those who make decisions in your community and have already established a relationship of trust and mutual respect.

• Work with the local or state oral health coalition—Dentists who work with dental hygienists and dental assistants, physicians, nurses, public health officials and other individuals and groups in the community can show policymakers and the public that fluoridation has broad-based support and endorsement.

• Tour your local water plant—Seeing how the water plant operates and getting to know its personnel builds bridges and opens lines of communication and education with the water system, policymakers and the public.

• Use ADA and other fluoridation resources—From the ADA’s comprehensive Fluoridation Facts booklet (available at, to links for information from dozens of other respected organizations on fluoridation, visit The ADA also offers personalized help for communities facing hearings, ballot initiatives or other measures where fluoridation is an issue. The ADA Councils on Communications and Access, Prevention and Interprofessional Relations have created a new resource kit for dental societies. Fluoridation: Tap In To Your Health, will be available in late July. Watch upcoming issues of the ADA News for more information. For more information, contact Jane McGinley, manager, Fluoridation and Preventive Health Activities for the ADA Council on Access, Prevention and Interprofessional Relations, at mcginleyj©ada•org  (mcginleyj©ada•org)   or call toll free, Ext. 2862.
“I attended the city fluoride hearing, and it was disheartening to see out-of-state antifluoride activists attack local dentists who serve local children, adults, seniors and families,” said Dr. Donohoo in a letter to the Milwaukee Journal Sentinel. “Wisconsin’s dentists donate tens of millions of dollars in charitable care through various programs annually. We work with federal, state and local officials to expand access to oral health care, and we support numerous preventive education programs.”
Dr. Donohoo, who has practiced dentistry in Milwaukee for 32 years, said he had many conversations about fluoridation with his late father, Dr. Stanley Donohoo, who practiced in Milwaukee for 57 years. The elder Dr. Donohoo’s career began before fluoridation was implemented in Milwaukee.

“He and I often discussed the dramatic, positive health changes he witnessed as Milwaukee transitioned from nonfluoridated to fluoridated water,” said Dr. Donohoo. “As someone dedicated to serving low-income and Medicaid patients, I love that water fluoridation makes cavity prevention so much easier for everyone. It’s accessible for even the poorest of families. When I see a patient—and sadly, I see this kind of patient weekly—who’s never learned how to brush and can’t always afford fluoride toothpaste, mouthwashes and rinses, I say a silent prayer of thanks that safe, fluoridated water provides them with at least some barrier to extreme dental decay.

“Wisconsin’s dentists want what’s best for our patients. And science shows that what’s best for our patients today is optimally fluoridated water.”

You’re not alone
Help is as close as the ADA’s Fluoridation Facts booklet and resources available to ADA members, said Dr. Mark Peppard, president of the Capital Area Dental Society, which serves the Austin, Texas, metropolitan area.

“The best advice I can give anyone or any group of dentists in a community is to be prepared,” said Dr. Peppard. “Read Fluoridation Facts cover to cover several times. Read The Journal of the American Dental Association scientific articles on fluoridation, on baby formulas, on the valid epidemiological studies on the benefits of water fluoridation and the reason why the recommendations have evolved. Immerse yourself in the concepts of the scientific method and the principals of peer review and why a study has authenticity and validity. Understand how a controlled study is validated epidemiologically. Know the history of fluoridation in the United States. Know the variables of European fluoridation policies.”

For more than a year now, Texas Dental Association members and others in Austin (Texas) have been working to stop fluoridation challenges. The end result is that the Austin City Council last December decided to continue fluoridation of its water system that serves more than 736,000 residents and nearby Water District 17, which serves another 16,000 local residents also reaffirmed fluoridation in April.

“Without question, our members were well prepared thanks to the support of ADA and TDA staff and the resources they provided for us,” Dr. Peppard added. “Our team consisted of general dentists, specialists and dental hygienists and we enlisted the support of the state’s fluoridation engineer for expertise in the chemical engineering of water fluoridation science. We received the support of the medical director for the city of Austin, who presented medical testimony.”

Dr. Peppard said the Texas coalition’s sharing of scientific knowledge and background gave policymakers the confidence to make the decision to continue fluoridating.

“We are the professionals they look to,” he said. “We are the educated and experienced individuals in the trenches they can trust. We have the scientific background and clinical experience necessary to help them make the decision.”

“This is not a walk in the park confrontation. The Fluoridation Facts booklet is organized to help users to address specific claims commonly used by antifluoridationists. Prepare your group and trust your knowledge that in the world of public health, what we strive for is the best method of providing the greatest benefit to those most in need.”

Dr. Peppard

PBS – FRONTLINE June 26, 2012

Monday, June 18th, 2012

On June 26, 2012, Frontline and the Center for Public Integrity investigates the Dental Care Crisis in the US.

“Dental care can be a matter of life or death. Yet more than 100 million Americans either
don’t have dental insurance or simply can’t afford to see a dentist. The result? Severe pain, preventable disease, humiliation, bankruptcy and sometimes even death. In Dollars and Dentists, airing Tuesday, June 26, 2012, at 10 P.M ET on PBS (check local listings) a joint investigation by FRONTLINE and the Center for Public Integrity, correspondent Miles
O’Brien uncovers the shocking consequences of a broken dental care system.”

Dartmouth Students Simple Design for Big Impact – Improving Oral Health during Pregnancy

Friday, June 1st, 2012

This year a group of Dartmouth College undergraduates including Lucas Yamamura, Karl Schutz, Melissa Saphier, Winnie Yoe, Hannah Kim worked with Tom Roberts and Good Beginnings to improve oral health for pregnant mothers.  They are part of the group Design for America (, a national organization from Chicago that has established studios at colleges in the US to use design thinking as a way to solve local social issues.  Lucas and his colleagues learned that gum disease is a common problem for pregnant women, and poor dental health is usually correlated to negative birth outcomes.  Brushing teeth twice a day is the recommendation of most dentists – a simple strategy for healthy teeth and gum.  In order to tackle this issue, the group asked the following question: How to encourage pregnant moms to promote their own oral health?  The group’s answer is a tooth brush holder in the form of a simple, low cost cup and lid that holds the brush.  The cup is decorated in honor of the coming baby and and can include a copy of the baby’s ultrasound or any other picture or drawing the mom and family apply. That way, they intend to elicit a personal connection between the parents and the upcoming child, reminding future mothers that brushing teeth is part of the  Not yet in production, but the group will be suggesting this idea to a group of pregnant moms for their input.  Great work and let’s hope it works.

Free Dental Care for Adults – May 5, 2012

Monday, April 30th, 2012

Free Dental Care. The Vermont State Dental Society is sponsoring  statewide free dental care on May 5, 2012.  Vermont is the first state to offer this event with dentists across the state participating.  Here in the Upper Valley, Drs. Kraitz, Gold and Blicher have reach across the river and enlisted New Hampshire dentists to make this an Upper Valley event.     The participating dentists are Drs. Baker, Blicher, Denk, Gold, Governo, Kravitz, Meyers, Petrescu-Boboc, Santavicca and Willette.  Along with these dentists, hygienists and dental assistants are also voluntering their time for patient care.  In preparation for May 5th, 46 patients have had oral health screenings and xrays at the Red Logan Clinic in White River Junction, and will have follow up care at Red Logan, as needed, after May 5th.  The range of services include hygiene, restoration, root canals and extractions.   Partners in the Upper Valley include the Vermont State Dental Society, Grafton Sullivan County Dental Society, the Red Logan Dental Clinic and the Community Oral Health Initiative of the Upper Valley.

A Personal Story: Insurance Issues – Melinda & Dave, Orford

Wednesday, April 4th, 2012

Melinda and Dave live in Orford, New Hampshire and have four children. Dave’s job offers dental insurance, but the rates are high. “We do have dental insurance available to us but. . . the family rate is so much higher than the individual rate, that unless you are going to have a lot of work done it doesn’t make sense financially to have the insurance for your kids. It’s cheaper to pay for expensive stuff out of pocket than to pay the higher rate for kids to be on our plan. . . We also have a dentist who we love that is not on the preferred provider list, and so it’s more expensive than if we had found somebody else. We’ve chosen to stay with her because we like her, we think she does good quality work, and we have a connection there. But it costs us more money.” Melinda explains that although the recommendation for cleanings is every six months, she tends to schedule cleanings for every eight months or so, in order to save money.

One of Melinda and Dave’s children, Angela, has special needs and is eligible for Medicaid. Because of her special needs she goes to a different dentist than the rest of the family, one who specializes in pediatric dentistry. Melinda feels that New Hampshire Medicaid is very good about dental care. They send regular reminders to go to the dentist, and they cover everything fully. Angela needed extensive sedated dental work done and it was all covered by Medicaid. Melinda’s one concern is that she feels that Angela’s dentist may have been able to catch some of her dental problems earlier if Melinda had started taking Angela to the dentist at a younger age. “I do think it’s kind of crazy how medical care and dental care are so separate. Even though we feel like we are getting really good medical care for her, her primary pediatrician was not saying, you need to take her to the dentist this year, even though she’s only one year old, just to see what’s going on. Somebody should have been telling us that. It wasn’t until it was to a crisis point that we took her to be seen and realized that there was all this horrible decay. I think that that’s not an uncommon story. I know that the pediatric dentist feels . . . that he’s seeing all these cases that should have been referred to him much sooner, and never were. I know he feels that the time line for checking out children’s teeth is too late. By the time they’re seen at age five, all their baby teeth have been in there for all this time and you could have seen decay happening but nobody ever looked.”

Illustration by Dennis Pacheco.

A Personal Story: NH Medicaid is Crippling – Jason, Lebanon

Monday, April 2nd, 2012

Jason is 34, with four children, and lives in Lebanon, New Hampshire. Jason’s daughter was born with Spina Bifida, which means, among other things, that her teeth are softer than most people’s and they are more susceptible to decay. At four or five years old she needed some extensive work done. Jason explains: “We had a dentist in Claremont, and with a busy schedule (my wife and I both work) and we have four kids we’re chasing around and bringing back and forth to different appointments. One of the appointments slipped our mind. When we realized we had missed the appointment, we called in to reschedule, and they told us that we couldn’t be seen there ever again.”

Jason couldn’t find any other dentist in the Upper Valley who would accept his NH State Medicaid. After looking around, Jason was referred to a pediatric dentist in Concord, New Hampshire. Jason traveled an hour and a half to get his daughter an exam, and then, a few weeks later, back for the surgery she needed. She needed a couple of teeth pulled, spacers put in, and caps on her molars. Jason feels lucky that the work was all covered by insurance. Still, “That’s a three hour trip. We were down there all day for the surgery, had to pull the rest of the kids out of school, so it’s definitely an inconvenience having to travel that far.”

Fortunately, Jason and his family have since found a dentist that accepts his insurance closer to home.


A Personal Story: No Need to Pull Teeth – Nathan, Woodstock

Friday, March 30th, 2012

Nathan lives in Woodstock, Vermont. This is his story:

Twenty-five years ago I went to a local dentist. He stated I needed to have all my teeth pulled and replace with dentures. I was only in my 50′s; this was not an acceptable treatment plan, regardless of my financial situation. I obtained a second opinion. The second dentist told me that most of my teeth would be lost within five years. The most cost-effective treatment would be to pull all the teeth and be fitted for dentures. I was outraged.

Instead, I went to Boston for treatment. It was successful. I have only had to have one tooth pulled in these last twenty-five years.

Why would a dentist’s first course of action be to pull all the teeth? Was income a factor?

Illustration by Dennis Pacheco (click here for Dennis Pacheco’s website).

A Personal Story: No Phone, No Gas, No Dentist – Leslie, Lebanon

Thursday, March 29th, 2012

Leslie has spent 2 years out of work due to health issues and has been living on $500 a month for the past year. Nutritional deficiencies over the last few years have weakened her teeth so that now many of them have nerve damage and are falling out. She has no insurance for herself and so has been unable to address any of these issues. She has no income to cover the phone minutes to call dentists or the gas to drive to visit them in person.

A year and a half ago, Leslie’s daughter had an accident in school where she was hit in the face by a basketball and chipped her new adult tooth. Her daughter is covered by a dental insurance plan through her father, who lives further south in New Hampshire, as well as by Medicaid, but many of the prescriptions she needed for this accident weren’t covered and the root canal she needed meant that they still owed $450. “Even with insurance you can’t get in anywhere to get dental care…There are a couple of different children’s dentists around the Upper Valley but they aren’t taking new patients…” Or they don’t take Medicaid. Now her daughter needs orthodontia work, but she doesn’t have the money to start looking into addressing it.

Illustration by Dennis Pacheco.