A new documentary created by three Maryville professors is highlighting dental health disparities for children in rural Missouri — and what can be done to provide access to care for this vulnerable population.
A new documentary created by three Maryville professors is highlighting dental health disparities for children in rural Missouri — and what can be done to provide access to care for this vulnerable population.
A campus collaboration is helping a Maryville nursing professor promote a decade-long passion: helping underserved children in rural Missouri keep their teeth.
In her doctoral research, Carol Berger, DNP, APRN, FNP-C, assistant professor of nursing, found that a simple, inexpensive process can prevent tooth decay. But the red tape of public health insurance and a bifurcated medical system make implementation difficult.
While conducting her research, Berger attended Maryville’s 2019 REAL Week, a weeklong teaching and learning convention for faculty. It was there that Berger met Scott Angus, MFA, director of the photography and digital art programs and associate professor of art and digital photography. As Berger talked about her findings, Angus reflected on his 20 years documenting dental mission work in the Philippines, Malaysia and Indonesia. “Here I had traveled all over the world, and I was shocked to find out similar problems existed in my own backyard,” Angus said. “And I told Carol, ‘We should make a documentary.’”
The pair teamed up with Maryville digital art instructor Lilli Kayes, MFA, ’12, and the Missouri Office of Dental Health to create “Rural Children in Crisis: Access to Missouri Oral Care.” Berger explained that the film “puts a face on all the statistics; it humanizes the problem and brings it to life.”
Berger found that many children who have Medicaid still face pressing dental issues. One problem is access. Only four dental providers in the state’s rural areas accept Medicaid. And while the water in many areas contains fluoride, a mineral that protects teeth, it may not make it into children’s mouths.
“In some places, the water is brown — who wants to drink that?” Berger said. “So the kids drink bottled water, which has no fluoride.” When parents can’t take kids to a dentist, decay goes undetected, often until the child is in pain. By the time they’re in a dentist’s chair, the only remedy may be extracting multiple teeth.
“Rural Children in Crisis” opens with a closeup of the mouth of a two-year-old Lincoln County boy in foster care. The viewer hears project editor and videographer Kayes ask him to make a “grrr” sound. “I can’t, because I don’t have teeth up here,” the boy tells her, pointing to bare gums where four front baby teeth should be. “For me, that was the whole message: ‘I can’t,’” Kayes said. “These children just can’t do anything about this.”
Berger said speech problems, eating issues and social ostracization are common in children with missing teeth. Many suffer impairment for five years or more until their adult teeth grow in. But in her research, Berger found an easy way to prevent this debilitating decay: fluoride varnish. Applied at least twice a year, the varnish goes a long way toward saving baby teeth. But it’s only available at dental offices.
Berger wondered: Why not have medical doctors apply fluoride varnish to children’s teeth during checkups, or bring dental professionals into their offices for that purpose? “Many people who don’t take kids to the dentist will take them to the doctor for their well visits, for their shots,” Berger said. “And fluoride varnish is cheap — about $1.50 for each application — and Medicaid reimburses ten times that.”
When the three filmmakers began working on the documentary two years ago, an early priority was finding interview subjects. Berger took to Facebook to locate a parent. “And a former patient wrote, ‘I know just the person,’” Berger said. “She said, ‘It’s been such a nightmare for her to get dental care for her kids who’ve been in the foster system.’”
By March 2020, they’d completed several interviews and other video portions. Then the COVID-19 pandemic hit. “We had to shut down filming for almost a year,” Angus said. “So we spent time putting together what we had already done.” Because of the pandemic, they had to shelve a shoot that would have let viewers watch a doctor apply fluoride varnish to a child’s teeth. Instead, Berger conducted the on-camera interview behind a Plexiglas shield. Still, the trio, who did all the work themselves, is happy with the end result. Angus and Kayes found satisfaction in the fact that Berger’s work, and therefore the film, presents a solution as well as a problem.
“You don’t normally get that in documentaries,” Kayes said. “They tell you facts and they scare you a little bit but then you’re left with this sort of chasm, like ‘It’s my responsibility,’ and there’s nothing you can do about it.”
Even solutions pose problems. The United States’ health care system considers medical and dental care separate entities, and medical doctors are reluctant to begin examining children’s teeth, Berger said. Many doctors aren’t aware that fluoride varnish is inexpensive, and they’re not set up to bill for Medicaid reimbursement.
Another concern is what medical doctors should do if their young patients need dental work beyond fluoride varnish. If doctors partnered with dental offices, they could send that office images of children’s teeth, and bill it under Telehealth, Berger said. But it’s not an easy fix. “You need a whole team of people to come in and put all of that in place,” Berger said.
Building that team requires education and exposure, something the 18-minute “Rural Children in Crisis: Access to Missouri Oral Care” provides. The documentary boasts more than 1,000 views on social media. Berger now hopes to share it with decision-makers at Barnes-Jewish, Mercy and Saint Louis University hospitals to put in motion the idea of doctors checking and varnishing children’s teeth.
Additionally, the documentary is now part of the Maryville nursing curriculum. But its educational value goes far beyond the field of health care. Angus uses it in his filmmaking classes “to show students how a film is put together,” Angus said. “We have all the raw pieces so we can demonstrate things like how you develop a thesis or figure out a storyline.”
The documentary also assists Angus in teaching students about legal issues in filmmaking. There’s a reason the documentary’s opening scene shows only the boy’s mouth and not his full face: foster care authorities and the foster parent weren’t authorized to grant permission. “When you’re a photographer or filmmaker, you have to make sure you’re not breaking the law,” Angus said. “It’s not like something for TikTok; you can’t just go on private property and start filming or photographing people.”
Kayes called the documentary project “one of the best experiences I’ve had in my professional career.” The successful interdisciplinary collaboration is emblematic of the overall Maryville experience, according to the filmmakers.
Angus has previously worked with faculty and students from other disciplines including biology and music therapy. He and his photography and videography students accompanied music therapy students to Costa Rica to document their work with older people with disabilities. Berger’s past collaborations include a project with app development students, which ultimately resulted in a dozen medical apps to explain conditions including asthma, atrial fibrillation and back pain.
Overall, the filmmakers believe Maryville does a good job supporting and encouraging cooperation among the various disciplines, all with student outcomes in mind. “Maryville promotes an active learning ecosystem where students actively participate in the learning process by doing, making and interacting with each other and the environment around them,” Berger said. “We’re better when we’re all learning from each other.”