Addressing the shortage of oral health care in Northern NH

Oral Health Program Manager/Certified Public Health Dental Hygienist Annette Cole examines a child in a school room using her portable office

Innovative program brings dental care directly to children

A “portable” dental program operated by a nonprofit organization has innovated the delivery of preventive dental care to vulnerable children in the least populated and most remote region of the Granite State.

Dubbed the “Molar Express,” the program has been providing oral health care to North Country residents since 2004. The Molar Express currently serves 20 K-12 schools in addition to serving newly added childcare, pre-school and Head Start sites funded by the New Hampshire Children’s Health Foundation.

The Molar Express is operated by the North Country Health Consortium, a nonprofit public health organization based in Littleton that collaborates with health and human services providers serving northern New Hampshire.

Barriers to care

Families in New Hampshire’s rural North Country not only face challenges in making a living, but also in finding health care services in or nearby to the towns in which they live.

It is particularly difficult for low-income families in this part of the state to find dentists to treat their children.

The availability of transportation is a barrier to many families and the time it takes to get from one end of the North Country to another adds to the problem.

North of Lancaster in Coos County, there is only one dentist that accepts Medicaid patients, and he soon plans to retire. There’s a pediatric dental practice in Littleton, but that means a two-hour drive for some families to get to a dentist appointment.

What this adds up to is a lot of children who are not seeing a dentist unless it’s an emergency. And that’s not sound public health policy, nor the most cost effective way to ensure that kids have a chance to reduce their risk for dental disease and subsequent health risks.

A Foundation priority

According to the Centers for Disease Control and Prevention, untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Children who have poor oral health often miss more school and receive lower grades than children who don’t.

The New Hampshire Children’s Health Foundation has been a long-time supporter of the Molar Express. One of the Foundation’s five funding priorities is promoting oral health for children through age five.

The Foundation has awarded the Consortium several grants to expand oral health services to under-insured or uninsured children in its service area, conduct oral health education and awareness campaigns in schools and to connect children to dental providers.

“Our funding in early childhood oral health in the northern New Hampshire is informed by statewide data collected and analyzed since 2004,” says New Hampshire Children’s Health Foundation Program Director Patti Baum.

“The Foundation had to be strategic with our investment and focused on the region with the highest need. We’re seeing the benefits over time, as demonstrated by the data,” Baum added.

Providing services to children where they are

The Molar Express travels to schools throughout the region bringing the services of a certified public health dental hygienist to children who would not receive preventive dental services any other way.

Working with school nurses and other staff members to identify and schedule children, the Molar Express arrives on-site at schools with portable state-of-the-art dental equipment.

The Molar Express’ Annette Cole instructs students about the importance of good oral health


A dental hygienist provides preventive services to children—including screenings, fluoride varnish, and decay-stopping fluoride treatment—and referrals to dental homes for continued care

“Despite the fact that it’s almost entirely preventable, tooth decay is the most common chronic disease in children,” said Molar Express Certified Public Health Dental Hygienist Annette Cole. “It can begin as soon as a child gets his or her first tooth.”

With support from the Foundation, the project is expanding its focus to conduct education and outreach to childcare centers and schools to provide them with the tools needed to educate children about oral health, connect them with dental providers and also to encourage dental providers to provide dental screenings to children as soon as they have a tooth.

Changing a three-year-old’s life

One participating Head Start, for example, includes students who live as far north as the Canadian border and as far south as Stratford (40 miles apart).

This Head Start has a home-based component that enhances the development of infant and toddlers while engaging families through its staff’s home visits.

A Head Start family worker in Pittsburg encouraged her home-based students to come to another Head Start site on the day of the Molar Express’ visit.

The family worker ambitiously coordinated student registration and arranged transportation so that these children could be seen by the Molar Express hygienist.

One of these students, a three-year-old, had never had dental care. He had rampant caries and was promptly referred to a pediatric dental provider.

The Head Start family worker knew the child needed dental care, and said the family knew it as well.  The family had been dealing with a series of challenges relating to unemployment and issues with access to reliable transportation.

The family worker reported that having the child seen by a dental professional and obtaining a written referral to a pediatric dentist was the missing piece that helped her and the family move the child’s dental care to the next stage.

Improving children’s oral health

The Molar Express addresses the challenging oral health environment in the North Country by providing a solution that changes the traditional dental service delivery model and provides better service for low-income families.

The program promotes the benefits of good oral health, not only to children, but also to their caregivers and their teachers by going to them, instead of requiring them to come to it. It has traditionally provided dental services, but is now expanding its approach to include more education and outreach to create systemic change.

“We have a long-standing relationship with the Foundation,” says Francine Morgan, a director and the project lead at North Country Health Consortium. “Its most recent support is not only allowing us to see the most vulnerable children in the region but also to reach them at an earlier age.”

For more information about the Molar Express visit: