All Smiles

When you don’t know what to do, it’s best to clear your plate. After college, I finally began cooking wholesome food for pleasure, reading health magazines, researching do-it-yourself cleaners, and even utilizing the materials in my old arts and craft bin I tucked away in the closet. I took an internship at an organic, sustainable farm where I harvested during the day; by night, I led fitness activities for high school students as a camp counselor for the University of Michigan. In hindsight, health was at the center of everything I did.

It was at Michigan, on my last evening counselor shift, that I knew I was ready to join the mission of Community HealthCorps: to promote health care for America’s underserved while developing tomorrow’s health care workforce.  Members of Community HealthCorps, which was founded in 1995 by the National Association of Community Health Centers, are placed in over 200 health care centers to increase their patients’ knowledge of preventive care, financial-health literacy, and independent living

As a HealthCorps member within the Mendocino Community Health Clinic, I found out that I would be providing age-appropriate health education through the Smiles Program to more than 2,000 preschool and elementary school students in Ukiah, Willits, Potter Valley, and Clearlake—schools where at least one-half of the student population is on free or reduced lunch programs. In the years before my arrival, the Smiles Program was developed to decrease fear of going to the dentist. To achieve this, my lessons were going to have some added support from Daisy, a dinosaur puppet. Daisy featured a full set of human teeth, and she was going to need an examination in each classroom presentation. I would also put on all the garb a dentist wears because that made students more at ease about people dressed the same way. For older students, the program focused on the sugar in soda and the chemical process that occurs on teeth when sugar isn’t removed. The take-home message in both age-groups was responsibility: learning to brush their teeth regularly. Flash-forward to today. I’ve had the liberty to take Smiles in a subtle, yet entirely new health direction. Its focus is now nutrition.

It wasn’t until I entered the first pre-school classroom a month later when I really understood what I was up against. What I faced was the number one chronic disease affecting children (aged 6 to 11) and adolescents (aged 12-19) today:  Dental caries, more commonly known as cavities, caused by a breakdown of tooth enamel. The main culprit damaging tooth enamel is the plethora of bacteria in our mouths that break down the food we eat. These bacteria excrete the acid that destroys tooth enamel and allows cavities to form. Nationally, roughly half of children age 6-15 are affected by cavities; but within the classrooms I visited, that percentage seemed too low. After researching Mendocino dental statistics, I learned that my observation was correct:  Tooth decay in my site is almost 20 percent higher than the national average. The baby teeth I saw (those that remained) were silver-coated—or more accurately put, mercury-filled (silver fillings are not entirely silver; rather, by weight, half of a dental filling is actually elemental mercury).

Looking out into my audience, I sensed this intense urge to change my tactic. Clearly, with all these cavities, something must be missing if year after year of HealthCorps members saw the same thing I did. I must have appeared lost in thought. Halfway through the middle of my very first classroom presentation, I took off my dental gown, cap, gloves and booties, and told them, “Now, to be a great doctor, we have to be an even better patient. We all want to be great doctors and great patients, right?” I asked fervently. They always cheered in agreement when you were enthusiastic about anything. I was going rogue, centering in on the source of the problem: sugar.

Children with healthy teeth are spared the pain and developmental setbacks that dental disease can bring. Hence, instead of trying to convince the younger students to brush and (hopefully) floss twice a day, I changed my whole approach to address the root cause—the substances we put in our bodies. No doctor would argue that there isn’t a direct correlation between cavities and food consumed, so how about starting from there? I thought. The brushing-and-flossing method is clearly not enough.

I frantically looked down at my Smiles-box contents. A dental mold of the upper and lower jaw, a tartar scraper kit, an oversized toothbrush, a Nemo-esque fish with perfect little teeth, stickers, and a container of plastic food—all endless entertainment for a child. I grabbed the container of imitation grub and held up a piece of broccoli. “Is broccoli healthy for us?” I probed. Yes! was the unanimous response. “What about oranges?” Yes! “And beans with carrots?” Yes! These questions were too easy. I surmised that the students needed a bigger challenge, a harder question.

“Do broccoli, oranges, beans and carrots have sugar?” No! I was still, and puzzled faces sprung up left and right. “Do broccoli, oranges, beans and carrots have sugar?” I questioned again, slowly scrutinizing worried eyes. No? Everything the children thought they knew about food was in question.

Fruits have sugar. Vegetables have sugar. Grains have sugar. Proteins have sugar. Dairy products have sugar. And sweets and candy have the most sugar of all. I made the children repeat these simple statements until they knew for sure everything they eat has some amount of sugar in it—which isn’t a bad thing. If food didn’t have sugar, we wouldn’t have energy to do everything we need to do. Still, the fact remains, everything has sugar. Repeat. Everything has sugar.

For me, the best part of my service in the classrooms was redefining food. The hard part was trying to explain why too much sugar was bad if we want lots of energy. For younger children, because they were still learning the difference between an actual question of the content and a story related to the content, I mostly focused on their dental hygiene. Not one student liked the fact that millions of bacteria were eating that same sugar and “going poop” in their mouth and on their teeth when they didn’t brush or floss. Even the older children were uncomfortable learning that if you only brush (and not floss) you only clean little more than half the surface area of all teeth; the “poop” remains trapped in between the not-so-hidden spaces. There was no substitute for flossing, no matter how hard they tried to come up with creative solutions to avoid doing it. These “bacterial restaurants” open up in the vacant lots provided to them. Flossing kicks out the rest of these unwanted guests—or zombies, as one youngster clarified—at the unlimited buffet. “We don’t want our guests eating all night, do we? We can’t afford that. No business can afford that.”

For older children, I also explained the geometry behind this, and why too much sugar can lead to heart disease, diabetes, and obesity in uncomplicated terms. As time went on and my lesson plan grew more compact, I began explaining how sugar can upset the mineral relationships in the body and interfere with the body’s absorption of calcium and magnesium, overload the liver, affect the development of the eyes, and ultimately trick our brain into thinking we want more sugar than we do. All my research as a Community HealthCorps member has led me to firmly support that the addictiveness of sugar, especially in its omnipresent processed form, is a serious, cyclical threat to the health of our nation when faced with heart disease, diabetes, obesity, and a host of other unknown complications yet to be found from sugar. Our mouth is a definitive reflection of our general health and well-being. So what does it mean that nearly 9 out of every 10 adults over the age of 20 have some degree of tooth-root decay?

The impact was evident by how quickly the time passed, how engrossed we all were in the content. The more information I researched and time I spent on classroom presentations, the more I wanted to share. I watched as the little ones scrambled to find their water bottles to prove they only had water (and no sugar). They drank. They then pointed to their bellies as if to show evidence of their active effort at staying hydrated. Competitions arose in which the “winner” was defined as the one who brushed and flossed their teeth the most. However, this winner would be immediately trumped by anyone who never had a cavity in their whole life. When my allotted time ran out and went over, kids stayed inside from recess to reflect and gain a better understanding of what questions were on their mind. As I packed up my materials, the questions ranged from, “What if a good food makes you feel bad?” to “Is it okay if I floss three times a day?” Some kids were quite interested in an aside I made about oven-baking your own “candy” (in the form of plantain balls). No health topic was off the discussion table. Their gears were rapidly spinning. When I absolutely had to go, I encouraged children to continue conversations with their peers, family, friends and teachers.

To my surprise, there was even a hint of scorn among those who didn’t drink sugary beverages towards those who did. As I felt the ostracizing begin, I would always try to placate the disdained with affirmations that we all need to make the best health choices for us. Once we know better, we have to do better.

If I had been a child in those classes, I would have needed to hear that. I would have been one of the disdained: At one point, I had a record seven cavities. And I remember being afraid to smile. In my family, it was natural to eat sugary snacks and candy at home. They were staple items. It was common to have a soda at dinner. That’s what my elders did. The thought that food and beverages provided at meals might not be the best substance for me did not cross my mind, because I was eating in the comfort of those I loved the most. I knew they would protect me from anything. But I realize now they were just as addicted as I was. I told some of my classes that I wished I had known everything as a child that I was telling them on the day of their lesson. I explained clearly that it’s never too late to make the right choices for our health. We just have to be disciplined.

I was moved when parents came up to me and said that their child had completely changed―not only their brushing routines, but their demands at the dinner table (half the plate should be fruits and veggies!). Anytime I was recognized outside of the classroom, I was the “Smiles guy. I see you everywhere.” I felt comforted by the community I served and sensed a strong connection to my hometown 2,321 miles away. Two stories encapsulate my experience within the schools. I had just finished demonstrating what could happen to the body over years of poor breakfasts (waffle with syrup, banana and artificial fruit juice) and lunches (peanut butter and jelly sandwich on white bread, chips, crackers and soda) when one student grimaced. Since the students now knew that sugar was in everything, I had to make another very important connection for them: too much sugar can make us very sick, overweight, and make our heart hurt by pumping harder. This lesson was in the aftermath of Halloween, when kids were running out of their perfectly sanctioned candy—candy that might not be as safe as they originally thought. This student, very troubled, raised her hand and asked, crestfallen, “If these things can hurt us like that,” she paused and struggled for the words, “then why are they even allowed?”  For me, this was one of the most heart-rending questions my education provoked—the underlying inquiry felt among all students, and the one they struggled most to put into words. I, too, struggled to find words to answer that question. Why are chewing tobacco and cigarettes still on the market? My attempt at a simple answer was that sugar is the new tobacco, hooking kids when they’re young; but how do you begin to explain that to a child?

Another student brought forth a question that I still think about every day. She was visibly distraught, arms crossed, when I walked into the classroom with my Smiles collared t-shirt on. I didn’t even have to ask when she looked up from her homework and questioned aloud, “Why do I have to learn about things I already know?” I cheerfully promised her the material would be different, and she seemed appeased for the time being. At the end of the renovated Smiles presentation, my vow rang with veracity. She approached me as the other children were grabbing their items for gym. She explained to me she felt bad because it is not fair that her classmates’ parents do not know how to help their child’s dental health. I went quiet, then reassured her that we’re all learning together, parents included. Once we know better, we have to do better.

“And we can do more,” I professed. “It’s our turn to educate our parents and relatives—anyone who will listen. We have to make our demands heard.” Doing the right thing is often easy and affordable; debunking the myth that sweet treats and fast food are easy and affordable is not so easy, however. I’m so incredibly fortunate I can make the best decisions for me, but realize my students don’t have that liberty. At least I can say I’ve planted the seed for their growth in understanding of health. I know I gave them a great head start. They have a voice and I dared them to use it.

Fighting the high rates of tooth decay (and the host of other health illnesses associated with sugar) can be won, and education is key in winning this battle. I saw it with my own eyes. The tobacco industry lost its fight. Now it’s sugar’s turn to fold. Rewiring the brains and taste buds of children and adults alike will take time and patience, but I believe this will be a successful crusade for anyone who wants to do better.

###