How can children carry the oral health habits they learn from their dentist into their adult lives? Every child learns the value of brushing and flossing. Far too few practice good oral health habits in their adult lives. Fewer learn the link between good oral health and overall physical health.

Community Voices El Paso has initiated a pilot project, known as Sonrisa Familiar, that seeks to determine if children learn more consistent oral health practices if their parents undergo the education process with them. The project will provide oral health care and education to qualifying uninsured or underinsured families.

Sonrisa Familiar does not seek only to educate parents and children, it seeks to "involve family units in the oral health education process," according to former Project Director Jose Moreno.

It is hoped that parents and children will reinforce good oral health habits in each other, and that both will incorporate these practices into their family life. The project, which will occur in two phases, is also seeking to provide information that policymakers can utilize to establish better programs for oral health and family health care.

Phase I is a process of evaluation and education. Families consisting of one or two parents and children see a dentist for an initial evaluation. Both children and parents receive a dental check-up and cleaning. The results of the initial evaluation will create baseline measurements of two oral health characteristics, bleeding gums and plaque. These will be used to chart the progress of each family.

Two to three educational contacts will occur over a period of four to six weeks following the initial evaluation. These not only include lessons on proper techniques for brushing and flossing, which are the foundation of good dental care, but broader education on good oral care. The connection between nutrition and oral health is explained, as are the links between oral health and continuing physical health.

Following the educational contacts, each family member will receive diagnostic x-rays and cleaning. Families who exhibit a marked improvement in their dental health will graduate to Phase II of the program.

In Phase II, families receive treatment and restorative care, including fillings and crowns. "The purpose is to see if families can internalize the information and improve their overall health," says Moreno. The program will track the families to determine if they maintain their baseline level of dental health or, hopefully, improve.

Sonrisa Familiar hopes to enroll all children who enter the program in SCHIP or Medicaid. By using these services to fund the dental care of children, the program can maximize the number of uninsured adults who can participate. Community Voices El Paso can also help these children access the full range of care available through the programs.

Approximately eighty-five families will participate in the program, depending on average family size. The program would like to cap enrollment near 200 people. Since the program seeks to study the effects of preventive care on long-term family health, parents selected must be under age 45 years. After age 45, people begin to develop chronic oral diseases that could skew the data on long-term preventive care.

The program also prefers to track women of childbearing years to determine the long-term effects of oral education on family health.

The project should have enough dentists at Centro de Salud Familiar La Fe, a federally funded oral health clinic, to treat every patient in the projected caseload for Sonrisa Familiar, but that is not the case in the El Paso community.

"El Paso has fewer dentists per capita than most other communities," according to Mary Helen Mays of Community Voices El Paso, who continued, "If we had to go out to the community, we would have problems."

Many poor and working poor are forced to cross the border to Juarez, Mexico, which has twice the number of dentists El Paso has, but this causes as many problems as cures.

"Local dentists are very concerned," says Mays. "They receive a number of patients presenting with damage caused by inadequate care received across the border. But there is no mechanism to get care for these people in the U.S." Often poor patients without insurance will seek medical care at hospitals, but there are no health care facilities where people can go to find dental care. "Local hospitals will only extract teeth or provide emergency dental care to indigent patients," says Mays.

"This is especially distressing because of the reports linking oral health to diabetes and cardiovascular disease," according to Mays. "We have a high percentages of both illnesses in our population."

Some maintain that permitting hygienists to conduct basic exams and pass their findings to a dentist for diagnosis could alleviate the problems caused by the lack of dentists in remote communities, such as El Paso. Currently, a licensed dentist must examine a patient before any care can begin.

Community Voices El Paso is also collecting information to inform the public of the need to develop a preventive oral health program for underserved adults. "There is no preventive care for adults," says Mays. "A child is covered under CHIP and Medicaid, but there is nothing for adults."

Unfortunately, this project faces an uphill climb. "There was no data on dental care usage in Texas, so we had to get data from similar states to frame the costs and language of the proposal," says Mays. The site hopes the data it collects will explain the need to dedicate resources to adult oral health services.