Transforming Moments

Smiling Siblings

Not many children get excited to visit the dentist, but for five local siblings, excited and enthusiastic are exactly what they are for their bi-annual check-ups with Elizabeth Bortell, DDS, Director of Pediatric Dentistry at Children’s Hospital. In fact, 10-year-old Rachel said, “when mom says we have to get up early to go see Dr. Bortell, I say ‘yeah.’”

Sherri, mother of the children ages five to 14, brought her kids to Dr. Bortell in 2001, shortly after Dr. Bortell joined the hospital’s medical staff. Sherri, who has been bringing her children to the dentist every six months since they were toddlers, was dissatisfied with her existing dentist because he wanted to restrain then three-year-old Brenna while treating her seven cavities. Sherri said the dentist’s cold bedside manner – he told Sherri’s oldest daughter to stop crying after he pulled seven impacted teeth at once - also was cause for concern. When she saw an article in TidBits, Children’s Hospital’s family newsletter, announcing Dr. Bortell’s arrival, she verified that the hospital participated in her insurance plan and made appointments for everyone.

“She talked to me and explained everything,” Sherri recalled of her first visit with Dr. Bortell. “And when Brenna had seven cavities [caused by drinking too much juice], she did not make me feel bad about that.”

Growing the Practice

Prior to Dr. Bortell’s arrival, Children’s Hospital’s Pediatric Dental Program only treated patients up to age 13 unless the child had cerebral palsy, Down’s Syndrome, autism or some other medical issue that required special dental care. Today the program treats children through age 21 and in January added a second dentist, Deepa Simon, DDS, to focus on the pre-adolescent and adolescent population, a group Dr. Bortell refers to as “the most underserved population in Richmond.” Working in the clinic four days a week, Dr. Simon will focus on everything from basic cleanings to more complex procedures such as root canals, bridges, crowns and partial dentures.

Children’s Hospital’s Pediatric Dental Program provides comprehensive services ranging from standard pediatric practices (regular checkups, cleanings and x-rays) to complex procedures such as dental surgery. Services are available for the well-child as well as the child with special needs. With a two-dentist practice, Children’s Hospital expects to double its patient volume and treat up to 3,000 patients in clinic and 620 patients in surgery each year. For children with special medical needs, surgery is often the only way to conduct a bi-annual cleaning. In other cases, surgery can be the best way to pull teeth or complete extensive dental work for an otherwise anxious child.

Easing the Pain

Because Brenna’s anxiety over having an impacted tooth pulled made her sick to her stomach, Dr. Bortell chose to pull Brenna’s tooth in the operating room. Today, eight-year-old Brenna jumps around when she talks about the dentist and exclaims that Dr. Bortell’s singing of Dora the Explorer is the best thing about her visits. She said the room full of Beanie Babies is a close second.

Sister Rachel agrees. “I feel comfortable there. I’m not afraid.” She also likes that “they let you pick the [fluoride and polishing paste] flavors.”
Fourteen-year-old Sierra is more reserved in her remarks but said that when Dr. Bortell pulled an impacted tooth, she didn’t feel it. Although she doesn’t share her sisters’ enthusiasm for dental visits, she likes Dr. Bortell and calls her staff “sweet.”

Gaining a child’s and parent’s trust and making the child feel comfortable are priorities for Dr. Bortell. With the alarming rise of baby bottle decay (caused by baby bottles, sippy cups and juice boxes), Dr. Bortell estimates that many patients will have 12-14 decayed teeth by the time they are four years old.

The American Academy of Pediatric Dentistry recommends that children be seen by a dentist by the time the first tooth erupts or no later than age one. After that first visit, children should return for check ups every six months. For a young child, treatment involves a dental exam, toothbrush cleaning and fluoride treatment. As a child gets older, he or she can expect a more extensive examination including everything completed during a young child’s visit as well as a dental cleaning with the electric polisher and x-rays.

Serving an Underserved Population

As one of the few dental programs in Central Virginia that accepts children eligible for Dental Medicaid, approximately half of Children’s Hospital’s clinic visits and 78 percent of dental surgeries are Medicaid children. To accommodate the needs of all patients, Children’s Hospital will expand and refurbish its dental clinic this year including adding new chairs with x-ray stations and renovating the dental lab, quiet treatment room, office space and reception space. The program also recently hired a dental care coordinator, Connie Condrey-Reynolds, who will coordinate patient care, help with reimbursements and assist in community outreach efforts.

This is great news for Sherri, who said she “would never go anywhere else now.” When daughter Sierra had a tooth pulled, Sherri said Sierra “trusted Dr. Bortell and knew Dr. Bortell would do everything to make her comfortable.” Sherri, whose family also includes five-year-old Jared and 13-year-old Kristen, also appreciates that when she makes the 30-minute-drive from her farm in Montpelier, Va., Children’s Hospital can accommodate all five children at once. “We’re usually in and out in 30 minutes.”

As Children’s Hospital’s Dental Program continues to expand, Dr. Bortell hopes to increase access to dental care for more children. A 2001 report (the most recent year for which statistics are available) from Virginia KIDS COUNT on Dental Health estimated that fewer than 40 percent of Virginia’s approximately 1.8 million children under the age of 19 had a preventive dental visit that year. The shortage of dental providers, especially in Virginia’s rural areas, is a major barrier to this access.

“We provide access to care for so many patients who can’t get care anywhere else,” said Dr. Bortell, one of the few pediatric dentists in the area.

Despite her busy schedule, Dr. Bortell remains committed to her patients and passionate about pediatric dental health. “[These children] are model patients,” she said. “The children are so excited to see the dentist and show me their teeth.”

The family is quick to return the compliment. “We just think Dr. Bortell’s awesome,” said Sherri.

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