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Ezekiel Asuega can’t take his eyes off the TV monitor on the ceiling above him. “Despicable Me” is on and it’s one of his favorites.
But on this day, it’s not all movies for Asuega, as there is important business to be conducted during his visit to the Healthy Smiles for Kids of Orange County clinic in Garden Grove. The 8-year-old’s attention is needed.
“We’re going to clean your teeth today,” Luz Partida, a registered dental assistant, tells him.
He claps his hands to his face. “I remember this,” he says, opening his eyes wide.
One-year-old Journi Hampton is given a new toothbrush by Angie Nieblas, a registered dental assistant, at Healthy Smiles for Kids in Garden Grove on Tuesday, October 26, 2021. It was Journi’s first visit to the dentist. (Photo by Mindy Schauer, Orange County Register/SCNG)
Eight-year-old Ezekiel Asuega watches as his teeth are cleaned at the Healthy Smiles for Kids nonprofit dental clinic in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
Jessica Moran high-fives Evan Hampton, 6, after cleaning his teeth at the Healthy Smiles for Kids nonprofit dental clinic in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
Pediatric dentist Julie Nguyen shows off a Waterlase machine, one of several donated by the medical equipment company BIOLASE. The device can be used for procedures without dentists having to use a needle to numb the mouths of the young patients at the Healthy Smiles for Kids dental clinic in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
Pediatric dentist Amy Huh gives 8-year-old Ezekiel Asuega a thumbs-up after examining his teeth at Healthy Smiles for Kids in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
One-year-old Journi Hampton waits for her first dental exam at Healthy Smiles for Kids in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
One-year-old Journi Hampton gets her first dental exam at Healthy Smiles for Kids in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
Pediatric dentist Sara Khoshbin chats with Tienika Manning after Manning’s 1-year-old daughter had a checkup at Healthy Smiles for Kids in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
The Healthy Smiles for Kids nonprofit dental clinic in Garden Grove has a display showing how many packets of sugar are in each drink in hopes of teaching children to make healthier choices. (Photo by Mindy Schauer, Orange County Register/SCNG)
Tienika Manning fills out paperwork at the Healthy Smiles for Kids nonprofit dental clinic in Garden Grove on Tuesday, October 26, 2021 while her son Evan, 6, gets his teeth cleaned. Her daughter Journi, 1, had an earlier checkup. (Photo by Mindy Schauer, Orange County Register/SCNG)
Jessica Moran, a registered dental assistant, cleans 6-year-old Evan Hardy’s teeth at the Healthy Smiles for Kids nonprofit dental clinic in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
Tienika Manning fills out paperwork at the Healthy Smiles for Kids nonprofit dental clinic in Garden Grove on Tuesday, October 26, 2021 while her son Evan, 6, gets his teeth cleaned. Her daughter Journi, 1, had an earlier checkup. (Photo by Mindy Schauer, Orange County Register/SCNG)
Eight-year-old Ezekiel Asuega gets his teeth cleaned at the Healthy Smiles for Kids nonprofit dental clinic in Garden Grove on Tuesday, October 26, 2021. (Photo by Mindy Schauer, Orange County Register/SCNG)
Luz Partida, a registered dental assistant at Healthy Smiles for Kids in Garden Grove, folds dental gowns on Tuesday, October 26, 2021. The clinic switch from disposable uniforms after the pandemic when products were in short supply. They sometimes do more than four loads of laundry a day. (Photo by Mindy Schauer, Orange County Register/SCNG)
The Healthy Smiles for Kids nonprofit dental clinic in Garden Grove also uses mobile units for outreach at lower income schools. (Photo by Mindy Schauer, Orange County Register/SCNG)
Partida has a question for him: How many times a day does he brush?
Partida reminds him he needs to brush at least twice a day, in the morning and at night. “Without Mommy telling you,” she adds, also showing him how to floss his teeth.
Now, more than ever, that routine is crucial to the oral health of children. Along with everything else it touched, the coronavirus pandemic has left its mark on their teeth.
Dentists are seeing the consequences of disrupted dental routines and stressful family circumstances that prompted anxious, tooth-unfriendly eating when schools were closed and students were stuck at home.
“Since they were home all day, kids were eating and snacking more,” says Dr. Lydia Park, one of the full-time dentists at the clinic, shuttling between patients on a bustling Tuesday morning the week of Halloween.
Kids also stayed up later, and snacked before sleep, often without brushing their teeth.
That combination — of excessive snacking and a pause on preventive care — has translated into more cavities, more infections and more abscesses in a county where 1 in 3 kindergartners already suffer from poor dental health.
At the beginning of the COVID-19 shutdown, dental offices around the country closed, unable to guarantee the safety of patients and workers. When they reopened, many operated at reduced capacity, making it harder for parents to get kids to a dentist for routine cleanings or for crucial early visits when first teeth came in.
Those dynamics were particularly difficult for families with no dental insurance, who often rely on programs such as Denti-Cal, the dental insurance offered through Medi-Cal. That population has been the focus for Healthy Smiles for Kids since its formation in 2002 — 98% of its patients get Denti-Cal.
The Smile Center dental clinic in Garden Grove opened in 2004 and another operates at Children’s Health Center of Orange County (the CHOC children’s hospital in Orange). About nine in 10 patients are at high-risk of developing cavities, and dentists at non-profit Healthy Smiles for Kids say they treat at least 15 children a week who have as many as a dozen cavities.
“That’s unfortunate,” said Dr. Norman Chen, a deputy dental director at Healthy Smiles for Kids.
Determined to continue its mission, Healthy Smiles for Kids was among 5% of dental clinics nationwide that remained in operation during the COVID-19 lockdown.
“This clinic was kind of like a safety net,” Chen says.
During the nine weeks of California’s full shutdown, a skeleton crew at the Smile Center held twice a week clinics to handle up to 20 emergency cases — many of them children with special needs or who were immunocompromised.
Routine dental services — checkups, cleanings and other non-emergency treatments — were delayed until Healthy Smiles for Kids could procure enough personal protective equipment, reconfigure its open bay area, and add air purifiers. Appointments slowly started to ramp up around June of last year and were at full pace by the end of the year.
To lower the costs of churning through disposable gear, dental assistants now launder four loads a day of cotton gowns and caps at a new washing machine set up in a break room at the Garden Grove clinic.
The nonprofit also provides satellite services, from a trailer parked outside the North Orange County ROP site in Anaheim. In all, it has four mobile clinics (known as “Smile Mobiles”) that travel to 200 schools and community sites or bring dental staff to classrooms that have been set aside for patient visits at school campuses.
The scramble to help kids didn’t start with COVID. Before the pandemic, Healthy Smiles had a waiting list of 300 patients in need of treatment that requires anesthesia. Now, the wait time for those children has been reduced from about 6 months to two weeks at the Garden Grove clinic, and from 18 months to two months at CHOC, according to the most recent Healthy Smiles for Kids annual report.
More than 100,000 children and parents visit the various sites yearly.
One of the younger patients, Journi Hampton, 1, sits calmly in a dental chair as Dr. Sara Khoshbin checks her tiny white teeth — all eight of them, four on the bottom and four on the top.
Journi’s mother, Tienika Manning, watches nearby and laughs along with the dentist and her assistant when Journi shrugs and complies after Khoshbin asks the child to open her mouth.
Her mom calls Journi, born in September 2020, a “pandemic baby.”
But she is not a pandemic-tooth baby; her teeth show early signs of being strong.
“So, Mommy,” Khoshbin says, “everything looks amazing.”
Manning, a mother of two from Tustin, has been coming to Healthy Smiles for Kids since her son, Evan Hardy, 6, was a baby. And on this day, while Journi entertains everyone, Evan gets his teeth checked and cleaned in another bay down the hallway. Khoshbin has a few questions for Manning, who bottle feeds her daughter.
Too many young children, the dentist notes, end up with cavities because they fall asleep with a bottle in their mouth.
“Does she go to bed with a bottle?”
No, Manning says, but she does wake up at night wanting to be fed.
“I don’t want you to give her a bottle at night,” Khoshbin says. And if Manning does, the dentist adds, only put water in it.
Manning learns that her son has a tiny cavity starting on a back tooth. It’s not yet big enough for Dr. Park to treat, and his adult teeth are starting to come in. Park tells Manning to make sure she helps him brush, something he doesn’t like to do.
Manning concedes, “I have to do it for him.”
Meanwhile, Ezekiel, a third-grader from Fountain Valley, leaves the dentist in good shape. He didn’t get to finish “Despicable Me” but he’s walking out with zero cavities.
Part of the reason is because his mom, Filiata Asuega, sets a tooth-friendly policy.
“The only time of the year they actually have candy is at Halloween.”
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