In 2006, Keri Kilgore was looking for a position as a dental hygienist.  She saw an ad for a position at Chester County Community Dental Services in Coatesville.  In 2014, Community Dental merged with ChesPenn and we acquired a passionate, gifted Public Health Dental Hygiene Practitioner.

Keri found that providing dental care in a community health setting was profoundly different from working in private practice.  In her words, “It was a culture shock.  It took me about three months So many patients have never seen a dentist and come in with severe dental disease.  Many patients have physical or mental disabilities.  “I couldn’t believe the conditions that patients were coming in with – so many problems all at once and in pain and just needing almost a reconstruction.  We would have to start with a palliative approach and transition them to restorative care.  “It’s really satisfying if they’re willing to take the time to let us help them.  When they come through the other side it’s amazing because their confidence is higher their health is better.”

The challenges are often great, but the rewards are even greater.  Geno Henderson is a perfect example.  Geno has been seeing Keri since 2007.  He is a veteran who receives his medical care at the Coatesville Veteran’s Association Hospital.  However, the local VA does not have a dental practice so to receive dental care through his VA benefits, Geno would have to travel to Philadelphia.  That’s inconvenient for any Coatesville resident, but Geno is confined to a wheelchair, making the trip even more difficult.  Like many veterans living in our community, Geno comes to ChesPenn for his dental care and uses our sliding fee discount.

When Geno first came to us, he was able with help to get out of his wheelchair and into the dental chair, but it could take as much as 15 minutes to make the transfer.  Over the years, his disability has progressed and now Keri provides his cleanings directly in his wheelchair.  That requires her to stand and also requires some creativity in taking his x-rays.  But it’s more important than ever because Geno can no longer brush and floss thoroughly as he once did.  He comes for cleanings now every 3 months to compensate.  Geno and Keri have developed a warm relationship over the years and he trusts her to care for him and to make his visits comfortable.  During a recent visit, he told us, “Everyone here is wonderful.  Keri takes great care of me!”

Many of Keri’s patients have severe anxiety during their first visit.  They’re worried that their care will hurt and that they might be judged for not taking better care of their teeth and gums.  Keri’s approach is to praise them for having the courage to come.  She also tells them, “This is going to be the hardest visit.  We’ll get through it together and after that it will be easy.”

Over the years, we have been happy to see more families bringing their children in when they’re very young.  Often the youngest in a family will watch as an older sibling has an exam and cleaning and realize that there is nothing to be afraid of.  We use dental puppets to teach and entertain young children and they get a prize as they leave.  They learn to look forward to their visit instead of being afraid.  One patient who came in for his first visit at 3, later brought Keri a plush Minion for Christmas.

The dental visit can be much more than about comfort and appearance – it can be lifesaving.  Keri has identified cancerous lesions and other critical health issues.  One patient’s x-rays showed an extraordinary loss of bone in her lower jaw.  The woman was only 19, yet her jaw was so fragile that it could easily have shattered.  Keri referred the patient to an oral surgeon and later learned that she had been diagnosed with an ameloblastoma, a rare benign tumor that can completely destroy the jaw.  The patient has since had reconstructive surgery.

Keri’s story demonstrates the critical importance of dental care in public health and the value of offering medical and dental services under one roof.  This kind of quality, integrated care delivered by people who are passionate about their work is a hallmark of community health centers.

One of ChesPenn’s most important health education initiatives is our Smoking Cessation Program.  ChesPenn Community Health Educator Tina Beahm recently sat down with patient John Cornin to talk about his success in overcoming his smoking addiction.  John has been a patient at Upper Darby since we opened in 2009.  Two and a half years ago, he expressed a desire to get help with his smoking and his physician referred him to Tina.  Tina offered him a choice of nicotine replacement methods – gum, patches, or lozenges – and he found that the lozenges helped him most.

John had tried for years to quit smoking before working with Tina.  Stressors that kept coming up in his life and the lack of support made it impossible. ChesPenn’s program takes advantage of the ability of the Community Health Educator to collaborate with the patient and the patient’s physician.  This team approach is a powerful tool to help patients quit.

Tina described her approach to coaching patients as highly individualized.   “I just talk to them as a person.  I get to know them so every session is individualized because everyone has their own story, their own struggles, their own way of living. Getting to know John as a person helped us make a great working relationship and then it was all him.  He was the one that did it.”

John also has wonderful motivation to stop.  Like most patients, he shared that his sense of smell has changed, he feels “100% better” and he feels good about himself.  But his family was his strongest inspiration.  He quit so that he could be here to celebrate his granddaughter’s 17^th birthday, his grandson’s 9^th birthday, and hopefully many birthdays over the coming years as well.  John has been smoke- free for over a year.   He’s set the stage for many years of family celebrations.

Karen Breitmayer, ChesPenn’s Director of Grants, Data, and Special Projects, is a lung cancer survivor.  Karen quit smoking years ago.  For over 12 years, she hadn’t experienced any symptoms that suggested  lung disease, so she assumed she was in the clear.  But she had a conversation with Dr. Letitia O’Kicki, ChesPenn’s Chief Medical Officer, about an initiative to increase the use of low-dose CT scanning for patients at risk of lung cancer and she realized that she was in the high risk group.  She decided to get tested and learned that she had a tumor in her lung.  Fortunately, the tumor was small and self-contained.  Her surgeon was able to remove it and she is completely cancer free.

Karen was lucky.  While lung cancer is the second most common cancer – just behind prostate cancer for men and breast cancer for women – it’s by far the most common cause of cancer death, accounting for more fatalities than colon, breast, and prostate cancer combined.  The American Cancer Society estimates that approximately 127,070 people will die of lung cancer in the United States this year.

In recent years, the low-dose CT (LDCT) scan has emerged as a powerful, cost-effective screening tool for lung cancer, offering hope that we can dramatically lower the mortality rate of this still too common cancer.

But a tool is only effective when we use it.  For years, physicians have routinely recommended mammograms and colonoscopies to screen for breast and colon cancer, dramatically lowering the mortality rate for both diseases.  However, until recently, no such screening tool has been regularly recommended for lung cancer.  According to Dr. Rachelle Lanciano, Chair of Radiation Oncology at Delaware County Memorial Hospital, only 8 – 9% of high-risk patients in Pennsylvania currently receive an LDCT scan.

ChesPenn and Crozer Health have launched an initiative to change that.  Recognizing the need for physician education, in 2023, ChesPenn’s Chief Medical Officer, Dr. Letitia O’Kicki, with Crozer Health Family Medicine Residents Dr. Brandon Twombley and Dr. Paras Shah developed a protocol that primary care providers can use to determine which patients should receive a CT scan.

Drs. Twombley and Shah shared that orders for screening increased by almost 400% in 2023 compared to 2022.  While not everyone follows up, often because of transportation barriers, the actual number has increased by 300%.  This places Crozer and ChesPenn in a leadership position in Pennsylvania for the use of this life-saving tool.

Patients recommended to receive LDCT scans are:

• 50 years and older and
• have quit smoking within the last 15 years and
• smoke or smoked a pack a day for 20 years or longer.

In addition to training primary care providers at Crozer and ChesPenn to screen patients for their risk and refer them for a scan, ChesPenn has secured a grant from Ride Hard Breathe Easy, a Philadelphia-based organization that raises awareness and promotes early lung cancer screening, to cover the cost of LDCT scans for our uninsured patients.  Our hope is that with time, training, and the resources to ensure that everyone who is at risk can get this life-saving test, more people like Karen will have a full recovery and a long, healthy life.

In 2007, after 40 years working as a nurse, Sue Ramberg was ready to retire.  The changes she had seen in the healthcare system had robbed her work of the joy she had once felt.  She shared her plans with the late Dr. Rekha Yagnik, ChesPenn’s founding pediatrician and Medical Director, who immediately replied, “Now you can come to work for me!”  Sue tried to resist.  She felt that she was ready to be done, but Dr. Yagnik had a better idea.  She stopped by Sue’s office every day until Sue finally gave in.  “I said ,‘If I give you a year will you leave me alone,’ and she said yes,” she remembers.  “At the end of my year she came to my desk and said, ‘Can we have one more?’ She was so amazing that I couldn’t say no.”  Eventually Sue let Dr. Yagnik know that she would stay as long as ChesPenn needed her.

“I found something at ChesPenn that I had lost, and that was how to be a nurse again and how to care for people and help them get what they needed to be healthier or even just a little bit happier.”  It gave me the opportunity to be what a nurse should be.  That’s always doing whatever you can to help the person.  Even if it’s not medical, even if they just need you to listen to them for a few minutes.  Every day I still hear Dr. Yagnik say, ‘Take care of my family.’  To her, our patients were family.”

Sue works as a “triage nurse,” evaluating patients’ conditions, resolving problems, and consulting with providers.  Requests vary from help accessing resources to refilling prescriptions to help getting a same-day appointment.  In some cases, she may need to recommend that a patient go directly to the emergency room or to urgent care based on their symptoms.  This is where her training as an RN becomes so important to patients.  She knows what questions to ask, and how to really listen so that she can determine whether a patient can schedule an appointment or needs attention immediately.

Sue’s care for patients doesn’t end there.  Patients call because they’ve lost paperwork for referrals or have some other need that’s not medical.  Her approach is to help patients with what they need in the moment.  Sue commented that sometimes the patient’s need is more psychological than medical. When she sees that need she can connect them to behavioral health or social services. “That’s why ChesPenn is so wonderful and why the vision of Dr. Yagnik was to treat the whole person – not just this disease. ChesPenn helps the entire person, body, mind, and soul.  And that’s why I stay.”

When we go to our dentist’s office, most of us understand the roles the dentist, dental hygienist, and dental assistant play, but there is also one more member of the team whose skill set enhances the dental team’s ability to help their patients.  The Expanded Function Dental Assistant, or EFDA, places fillings, fits dentures, applies fluoride and sealants, and polishes teeth to complete a dental cleaning. By performing these essential services, the EFDA frees the dentist and hygienist to move on to additional patients, ensuring great care for more patients each day while keeping costs under control. A great EFDA contributes to a pleasant dental visit for the patient. That can be especially important with little patients, who learn to feel safe or afraid at the dentist’s office in their early years.

At ChesPenn’s Center for Family Health at Eastside, EFDA Ethiopia Demisse makes sure that patients both young and old enjoy their visit. Ethiopia takes time with each patient to explain each step of their procedure. She also enjoys educating patients during their visits. “When a patient comes in, I take time to answer all their questions and they love it.” Her warmth and reassuring personal style create an atmosphere of calm and safety.

Ethiopia began her dental career as a Dental Assistant in 2006. She and some friends later decided to train as EFDAS. Not long after getting her credential, she took her first job in a community health organization and a year later joined ChesPenn. She shared that she loves dentistry because she can see the benefit of her work immediately and because it makes such a difference in people’s lives. “I had a patient who came in for his final denture fitting. He cried when I handed him the mirror and hugged me.”

ChesPenn’s Dental Practice Manager Latonia McMillan shared that Eastside hasn’t always had an EFDA but now the dentists depend on her. “They’ve gotten used to her taking charge and taking care of the patients. And the patients come in looking for her. She’s definitely an asset to the department.”

February is National Children’s Dental Health Month, a good time to review some “PEARLS” of wisdom about ensuring children have the best dental health because cavities are no fun.  First the good news – while cavities are the most common chronic disease of childhood according to the Centers for Disease Control and Prevention (CDC), they are completely preventable.  The not so good news is that more than 1 in 5 children aged 2 to 5 years has at least one cavity and children from low income families are more than twice as likely to have untreated cavities.  This is why ChesPenn has launched a medical dental integration program that allows the Public Health Dental Hygienist to visit with parents during children’s medical well-child checks to do a quick screening and some dental health education.  The hygienist can even schedule a dental appointment
during her visit with the parents.

Many parents don’t realize how early dental visits should start.  They may also have heard that since baby teeth fall out, it isn’t important for children to see the dentist until the permanent teeth start to come in.  However, the health of the baby teeth can affect the permanent teeth and cavities at any age can hurt.  Small children aren’t always able to communicate what is hurting them, but they may have trouble eating and may not be able to focus or may act out in day care or school.

We recently caught up with Sherri Mills and her children Mai and Sarai Bivens during the children’s dental checkup at our Center for Family Health at Eastside in Chester.  Sherri had been taking them to Children’s Hospital of Philadelphia for dental care but learned that ChesPenn offered dental care right in her community.  She shared that she and the children really like the dental staff and appreciate the convenience.  Mai and Sarai have been coming to the dentist since they were small and they both feel great about getting regular checkups and cleaning.  Mai let us know that he brushes and flosses every day.

Here are some PEARLS of Wisdom from the CDC for ensuring the best dental health for your child:

Protect tiny teeth by caring for your mouth when you’re pregnant. Your child’s future oral health starts with you.

Ensure to wipe your baby’s gums after each meal.

Avoid putting babies to bed with a bottle.

Remember to brush your child’s teeth twice daily with fluoride toothpaste. For children younger than 2 years, consult with your dentist or doctor about when to start using fluoride toothpaste.

Limit drinks and food with added sugars for children. Encourage your child to eat more fruits and vegetables and have fewer fruit drinks, cookies, and candies. This gives your child the best possible start to good oral health.

Schedule your child’s first dental visit by their first birthday or after their first tooth appears. Their tiny teeth matter!

We would add that fluoride varnish and dental sealants are great tools for fighting dental decay.

How does your family focus on children’s dental health?

Kudirat Ariyo and her husband came to the United States from Nigeria to visit family and friends in New York last year. Not long after, they moved to Pennsylvania. Mrs. Ariyo learned about ChesPenn from a friend at church and began her prenatal care at our Chester site. She was surprised but pleased to learn that she was carrying twins, although both families have multiple sets of twins. “I was so happy when I discovered that we were having twins,” she shared. Because the Ariyos were new to the U.S. and needed resources, they were referred to Porsha Harris, one of ChesPenn’s Social Services Coordinators, who connected them with Catholic Social Services, WIC, and the County Assistance Office so they could access the financial, food, and housing they would need for their expanding family.

The twins, Muhammad and Arafat, were delivered by Cesarean section in December. The parents recently brought them in for their 7th week check and their pediatrician, Dr. Stephanie Tanner Walsh related that they are thriving. “They are both growing well on breast and formula supplementation. During our visit many family members from their home country of Nigeria were anxious to see the babies and congratulate the new parents via phone.

This continuity of care is virtually unique to community health centers, where adult and pediatric medical care, OB/GYN services, dental and behavioral care, as well as social service coordination are all available at the same location. The family became comfortable coming into our health center and getting to know staff through the course of the pregnancy, received support accessing vital benefits, and then were given a true warm hand-off from their obstetrician to their pediatrician, whose office is just down the hall. This benefits mothers and babies as providers are able to share information freely and the family develops a high comfort level with the entire staff at the site. In a few months, our Public Health Dental Hygienist will stop in at a well-baby visit to talk to mom about early steps in dental hygiene and will offer to schedule a first dental visit for the twins. We are looking forward to watching the twins grow up and to continuing to care for the whole family.

Robert D’Agostino is a carpenter.  He belongs to the local carpenters’ union and receives great benefits – when he is able to work a specific number of hours each year.  Unfortunately, over the past couple of years work has been scarce and he lost his benefits, including his health insurance.  Robert learned about ChesPenn’s dental services and came in for an exam and cleaning.  He returned later to have two cavities filled.  He was impressed with the quality of care he received.   “I can trust the dentists here,” he said.  “They’re very effective and professional, very down to earth.”

During his first visit, Robert discovered that we also offer medical care and he made an appointment with Josemi Josef, our Nurse Practitioner.  He shared that before coming to ChesPenn he hadn’t really seen a physician for many years.  His philosophy was that good health meant eating right, getting good exercise including cardio and strength training, meditating, and having an interest in life.  He’s since added seeing his family medicine physician regularly.  He was anxious at first about seeing a new provider, but over his first few visits he and Josemi built a rapport and he was comfortable following her recommendations for managing his hypertension.

“Dr. Josie is kind.  She cares.  She’s the kind of person you want to hug. I’m really glad these people are here.”

Making New Year’s resolutions is a time-honored practice.  We’ve all done it.  We promise ourselves to get fit, lose weight, stop procrastinating, or do whatever we think will make us more attractive, healthier, or successful.  Too often, we lose steam within weeks and then the guilt sets in.  There’s even a day to celebrate it – Quitters’ Day is the second Friday of January!  The anxiety and depression that come with abandoning our resolutions can be real and even debilitating. Here are some tips from the Substance Abuse and Mental Health Services Administration (SAMSHA) for developing resolutions that you can keep, and feel good about:

• Pick a Goal that Motivates You: You are more likely to stick to your goal if it motivates you or if it is influenced by others, such as a spouse, a workout partner, or a medical professional. If your goal is to exercise more, but you know going to a gym is not a motivation for you, then pick another exercise you can do outside of the gym.
• Break Down Your Big Goals into Smaller, More Manageable Goals: By doing this you’ll be much less likely to feel overwhelmed. If your ultimate goal is to run a 5K race, but you have not yet run a lap around the track, start with walking a shorter distance and gradually begin to jog once you feel you’re ready. It may just be a few yards or a lap around the track. Sometimes just signing up for that race is just the motivation you need to get started.
• Focus on Progress, Not Perfection and Stay Positive: Emphasize the journey and strive for progress rather than aiming for perfection. And reward yourself for the progress you made. For instance, if your goal is to lose 10 pounds, but you only lost five pounds, acknowledge the five pounds you lost were five more than before you started trying to lose weight. The way we talk to ourselves can foster a positive and realistic outlook and contribute to a healthier approach to both mental health and success in meeting our New Year’s resolutions.
• Lean on Others for Support and Motivation: Achieving goals can be easier when done with others. Consider joining groups or communities with similar goals to connect with people who can provide encouragement and accountability.
• Set a New Date: You do not need to commit to a resolution on January 1. Feel free to delay implementing your New Year’s resolutions until the time is right. You can make them at any time you want. Under stress now? Why not resolve to make that change beginning in March or by another preferred date.
• Don’t Compare Yourself to Others: Don’t get too caught up in the New Year’s resolutions of others. Set goals with only you in mind.
• Practice Self-Compassion: Be easy on yourself. Acknowledge that setbacks will happen and that’s okay. Just pick back up where you left off.
• Know When to Ask for Help: You are not alone. SAMHSA has behavioral health resources to help. Visit SAMHSA.gov, Find Help.

Make your New Year’s resolutions about self-care, not extra pressure.  And have a happy, healthy 2024!