At 8:30 a.m. on a Wednesday in late November, UT Health San Antonio dentists and staffers were busy providing care across seven patient rooms at the pediatric dental clinic on the West Side.
In room three, Raquel Ricart reassured her nervous 7-year-old son, José David Vargas Ricart, who sat in the dentist’s chair for a tooth extraction after an infected cavity had spread to his gums.
“You can squeeze my hand if you need to, and that way you’ll feel better,” Ricart said as she leaned over José David, holding his hand and running her other hand over his curly hair.
First grader José David needed a two-part procedure, the first one that day and the second one scheduled for Dec. 29.
It’s a common issue locally. In fact, one in four children is likely to have tooth decay by the time they go to kindergarten in San Antonio, according to UT Health San Antonio.
But preventative education and on-the-ground efforts like the clinic where José David was being treated are slowly improving outcomes in the community, pediatric dentistry experts told the San Antonio Report.
The Pediatric Dental Clinic at the Ricardo Salinas Health Center is a low-cost clinic for economically disadvantaged families with children from 6 months to 17 years old, supported by a partnership between the San Antonio Metropolitan Health District and UT Health San Antonio’s Advanced Education in Pediatric Dentistry program.
The nonprofit clinic opened 20 years ago as a temporary pilot program, but became permanent after oral health doctors saw the extent of the need in San Antonio. It relies on local foundations and grants for its funding, and reduces or eliminates costs for low-income families through a federal-state partnership Title V block grant, which covers dental services for children not eligible for Medicaid, CHIP or other programs.
The Ricarts moved to San Antonio from the Dominican Republic 11 months ago and are still adapting to their new life in the U.S. They got word of the affordable clinic through a flyer tucked inside a folder belonging to the first-grader, who attends Eduardo Villarreal Elementary School in the Northside Independent School District.
Because the family does not have dental insurance, Ricart contacted the clinic to get help for her three young sons.
The price tag for José David’s extractions and other work totaled $1,771, Ricart said, an impossible sum for the family, between paying for the residency process and not being able to legally work.
“It hurt me so much knowing my child would need to go through that process and that I wouldn’t be able to cover the costs to help him,” Ricart said.
Just then, a UT Health School of Dentistry resident walked into the room wearing pink scrubs and a smile, holding a small cup of “strawberry juice” for José David, who was about to undergo treatment.
“When we came here, they told us about the program and we saw the difference,” Ricart said.
Through the clinic, the family’s total out-of-pocket costs for the treatment was $154 — about 25% of the cost of oral sedation.
“We’re so grateful to receive this help,” she said.
‘It was a cycle’
When the Pediatric Dental Clinic opened 20 years ago, “it wasn’t like this,” said Virginia Salazar, a clinical supervisor of 19 years.
Salazar described how when the clinic opened, parents were often shrugging off their children’s oral health care. Now, education, outreach and resources create ways for parents to address their children’s oral health, like cavities and infections.
“It was a cycle, it wouldn’t change,” Salazar said.
Dental issues like untreated cavities can have serious long-term effects on children’s overall health and quality of life, she added.
To better understand those connections, UT Health Science Center San Antonio launched the Center for Global and Community Oral Health at its School of Dentistry, bringing together several programs focused oral health. The center will fund new research into how oral health affects systemic health in South Texas, including diseases like diabetes, neurological issues and heart and lung disease — which all have a high prevalence among Hispanic populations.
“The common link here is that abnormal oral bacteria leads to systemic inflammation, which may be the root cause of these diseases,” said Brij B. Singh, associate dean of research for the dental school.
The goal is that evidence-based research will pinpoint links between those diseases and oral health — to emphasize the importance of oral health even at an early age.
Salazar said simple things the Ricardo Salinas clinic is doing, like making follow-up calls after six months, work — giving parents an “aha!” moment when they hear their child has no cavities.
In addition to the clinic’s work and the studies, elementary schools across eight school districts participate in a weekly school-based sealant program led by Metro Health to help prevent cavities by placing a thin coat sealant, or protectant, on molars to avoid tooth decay for free.
School districts that participate in the program include Edgewood ISD, Harlandale ISD, Northside ISD, Northeast ISD, San Antonio ISD, South San Antonio ISD, Southside ISD and Southwest ISD.
Other local organizations are working on the issue, too: The San Antonio Oral Health Coalition is developing an online School District Dental Education Resource Guide for teachers and nurses with information on oral hygiene and trauma, and to help recruit oral health professionals for the field.
And if school nurses see a serious case of tooth decay or infection, they’ll call the Ricardo Salinas clinic directly, Salazar said. The health department’s Miles of Smiles program also does oral health screenings by partnering with local school districts and head start programs.
In 2022, the Miles of Smiles program visited 117 schools across eight school districts and gave 8,261 elementary students limited oral exams and sealants or fluoride varnish if they needed it.
A total of 6,476 children enrolled across 80 Head Start and Early Head Start early childhood education centers in San Antonio also got oral exams and treatment if needed, Metro Health said.
In 2022, Metro Health said it participated in 10 health fairs and distributed more than 12,000 oral health kits that included toothbrush and toothpaste.
Serving underserved areas
San Antonio needs more nonprofit clinics for low-income families, Salazar said, but it takes funding. For now, outreach efforts and the clinic are “doing something” in the community, even if the problems persist, she said.
“They’re coming in with rampant decay, just all over,” Salazar said. “In fact, that’s why they come, I’m seeing black spots on their teeth.”
It takes about 10 days to get an appointment at the Ricardo Salinas clinic, Salazar said, but if the child’s need is urgent, the clinic will see them right away.
The clinic charges patients according to their income, she added: A majority of patients at the clinic get 75% of their services covered and only pay the 25%. For families who don’t have health insurance, like the Ricart family, it’s a big help.
“I’ve seen parents come to the window and look through their envelope [of money] and say, ‘Well this is for my water bill, for my light bill, but my child needs it, he’s in pain,'” Salazar said. “It hurts to see that, but we’re in the right place.”
For families living in poverty, other household costs are barriers to getting needed treatment, said Juanita Lozano-Pineda, associate dean of external affairs for the UT Health San Antonio School of Dentistry and director of the Hispanic Center of Excellence at the dental school.
“A lot of the areas where we have our partnerships in our affiliated programs with are in underserved areas of the city,” Lozano-Pineda said. “And in San Antonio, part of the area that’s more underserved is the South Side — southwest and West Side.”
San Antonio’s boots-on-the-ground pediatric dentistry efforts respond to a greater need: 84% of Texas children in Pre-K are economically disadvantaged. Texas still ranks lowest in the nation for children’s health insurance, with 12% of children under 19 uninsured, according to Every Texan.
It’s all connected, Lozano-Pineda added: Oral health is an issue in San Antonio especially in areas that are burdened by poverty and food deserts, meaning where you live determines how well you eat.
When living in neighborhoods where grocery stores are a long drive away, families living below the federal poverty level are often forced to turn to “dollar menus, fast food, soda, chips and convenient snacks,” said Eric Cooper, CEO of the San Antonio Food Bank.
Other families may turn to starchy or carbohydrate-heavy foods, like bread, pasta, rice, potatoes and beans — and when carbs stay stuck in between teeth, they break down into sugars, causing cavities, Lozano-Pineda said.
Dental care can have hefty price tag for low-income veterans and seniors in San Antonio, too.
How to improve your child’s oral health
Lozano-Pineda says parents should prioritize taking their children to cleanings every six months, as well as drinking more water and eating more fruits and vegetables.
Salazar said waiting too long to address an oral infection can be dangerous.
“If it gets infected, infection goes to their head. It could be bad,” she said. “Once you see something in their mouth, seek care. Let us check.”
The San Antonio Food Bank helps families enroll into Medicaid and the Children’s Health Insurance Program (CHIP), which can be used to cover costs at the dentist. To get help, click here.
The Ricardo Salinas Pediatric Dental Clinic helps parents apply for Children’s Medicaid and CHIP. To apply for those programs online, click here. If you aren’t eligible for these programs and your income level is 185% lower than the federal poverty level, you may be eligible for the Title V Maternal and Child Health Fee-for-Service Program.
If you have Medicaid, see a list of local pediatric dental providers here. For a list of adult community dental health clinics, click here.
“If we really want to make lives better, we need to focus on oral health,” Singh said.
