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Dental Public Health Activities: Descriptive Summaries

Save A Smile

Practice Number: 49004
Submitted By: Cook Children's Health Care System
Submission Date: December 2013
Last Reviewed: December 2013
Last Updated: December 2013
Best Practice Approach Example -

Save a Smile is an innovative, collaborative partnership designed to address the comprehensive dental care needs of some of our community’s most underserved children. Save a Smile is led by Cook Children’s Health Care System as part of our promise to improve the health status of every child in our region through the prevention and treatment of illness, disease and injury. 

Save a Smile evolved from the American Dental Association’s Give Kids a Smile Day in 2003.  The enthusiasm generated from this event in our community, coupled with the need to fill a gap in services when a local dental program closed, inspired a new initiative for screening and treating children from low-income families on an ongoing basis throughout the year.  The Save a Smile structure is based on three key objectives:

(1)  Improve children’s oral health by reducing the proportion of children who have dental caries experience in their primary or permanent teeth and who have untreated dental decay (U.S. Department of Health and Human Services Healthy People oral health objectives for children).

(2)  Build a strong infrastructure and ensure long-term sustainability with a grassroots, collaborative approach; and

(3)  Identify and address barriers to oral health care faced by families.

Save a Smile is the only non-profit program in our area providing full dental services and preventative care, improving the overall health of children who often would not otherwise receive treatment.  Our target population is pre-kindergarten through third grade in Title 1 schools and we currently serve 16 schools in four school districts. Over the past 10 years, Save a Smile volunteer dentists/specialists have provided screenings (limited oral evaluations) for more than 59,000 children and treatment for 4,092 children, generating more than $6 million in donated services from dental professionals. In FY2013, almost 100 dentists provided screenings for 5,406 children and/or treatment for 223 children identified with the most serious dental disease.  One hundred percent of the children completing treatment are free of pain and dental disease and one hundred percent of children screened received an oral hygiene kit.  This is achieved with an annual budget of $539,000 through civic, corporate and community sponsors. 

Save a Smile evaluation methodology includes (a) extensive tracking of appointments, treatments provided, social service units provided and the ongoing oral health status of children; and (b) surveys of parents, Advisory Committee members, school nurses, and dentists.  Successes include:

  • The proportion of children with the most severe dental disease (Class 1) has declined or remained stable since the inception of Save a Smile in all schools served -- from approximately 14% to between 6-10%.
  • The percent of children missing from 1-5 school days due to dental pain has dropped from 53% to 14% since the inception of Save a Smile.

Save a Smile successes are possible with a large network of dental providers and community organizations to increase access to dental care.  Cook Children’s Health Care System provides management and administrative support (Tonya Fuqua, D.D.S., Director; one advocacy project specialist; one licensed master social worker [LMSW]; and six Community Health Workers). Our volunteer dentist network includes general dentists, pediatric dentists, oral surgeons, a prosthodontist, orthodontists, endodontists, and anesthesiologists.  A community advisory committee provides guidance for the program.  Membership includes representatives from Cook Children’s, John Peter Smith Hospital, Fort Worth District Dental Society, Kohl’s Department Store, Tarrant County College Dental Hygiene Program, school districts, social service organizations and private practicing dentists.  Save a Smile services and community partners include:



Community Partners / Save a Smile

Maintain a network of volunteer oral health professionals.  Staff recruit volunteers to provide free services and maintain a database of the dental specialties, preferred ages, number of children that can be treated, etc.

  • Save a Smile management & administrative staff
  • Save a Smile Advisory Committee
  • Fort Worth District Dental Society

Initial screening.  Screenings (Limited oral evaluations) are conducted at partner schools by volunteer dentists to classify the dental severity and determine what level of treatment is needed.  Dental classifications are Class 1 (Extensive Decay), Class 2 (Minimal/Moderate Decay/ Questionable Areas), and Class 3 (Overall Good Oral Health).  Priority is given to children with the greatest need (Class 1).

  • 16 schools in 4 school districts
  • Volunteer dentists/specialists
  • Children’s Oral Health Coalition (oral health information and resources)

Social Service Assessment & Referrals.  Follow up with parents to communicate screening results, assess resources available to the family for obtaining the needed treatment, and determine the family’s needs for translation, transportation and social services.  Referrals to volunteer dentists are made by matching the dentists’ preferences with each specific child’s dental problem, age, etc. 

Cook Children’s LMSW, Community Health Workers and administrative staff

Case management. Assist families to set appointments, apply for Medicaid/CHIP, obtain emergency food/clothing/financial assistance, transportation to appointments and translation.

  • Cook Children’s LMSW, Community Health Workers
  • Gill Children’s Services and Masonic Home and School of Texas(financial assistance)

Dental Treatment.  Provided in each dentist’s or specialist’s private office using his/her oral health staff and supplies.

      Currently 93 volunteer dentists/specialists

Oral Health Education and Prevention.  Children receive teeth cleaning, fluoride, sealants, oral health education and oral hygiene kits.

  • Tarrant County College (Oral hygiene students)
  • Volunteer dentists/specialists and hygienists

Program Maintenance, Evaluation and Advocacy.  Program funding, oral health data collection and reporting and legislative advocacy.

  • Cook Children’s management & administrative staff
  • Children’s Oral Health Coalition of Tarrant County
  • Civic, corporate and community sponsors

The Save a Smile vision is that families with limited access to health care will be empowered to improve the overall health of their children by using oral health and community resources to create lasting change.  Thanks to the commitment of dental professionals, community partners, and oral health professional organizations, the Save a Smile vision is a reality in Tarrant County, Texas.

Lessons Learned:

The biggest challenge for Save a Smile is keeping families engaged in the process long enough to sustain comprehensive treatment. We believe that a social services component to address emergency needs and provide follow up is key to helping children complete the full course of treatment. Our volunteer dentists report that they appreciate the flexibility to set parameters around their volunteer time and specify their preferences for providing treatment.  There is opportunity for replication of the SAS program and it is a perfect example of how private practicing providers can work in conjunction with public health for the betterment of the community.

Contact Person(s) for Inquiries:

Stacy Shetter, Program Specialist, Save a Smile, Cook Children’s Health Care System
801 Seventh Avenue, Fort Worth, TX 76104-2796, Phone: 682-885-6731, Fax: 682-885-7286, Email:

Tonya K. Fuqua, DDS, Program Director, Save a Smile, Cook Children’s Health Care System, 801 Seventh Avenue, Fort Worth, TX 76104-2796, Phone: 682-885-6731, Fax: 682-885-7286, Email: