Co-Operative Inquiry and Children’s Dental Health

TeethFirst celebrates co-operative inquiry during National Children’s Dental Health Month with a summary of all that we have done since our humble beginnings. Our focus has always been health and healing in a dynamic approach based on Hippocrates’ “The greatest medicine of all is teaching people how not to need it”. Our style: co-operative inquiry.

How do we rediscover this Hippocrates wisdom long ago replaced with the “cures” of modern medicine? What does it take to make it work?

It started almost 5 years when I joined the People’s Health Clinic as a volunteer. After close to 40 years of clinical dentistry, this transition opened my eyes to the overwhelming oral health inequities that exist across the country. That new awareness prompted me to do something.

At the Clinic, I saw (and still do) uninsured residents of Utah’s Summit and Wasatch Counties. They are mostly Hispanic immigrants working very hard to make ends meet at low paid jobs with no benefits. Many have more than one job, supporting the main industry of our region: tourism. The status of their oral health is generally poor. Their risk level for dental disease, high. Why? Not because they don’t care, but rather because of a lack of knowledge, lack of affordable care and limiting or even damaging cultural beliefs.

In schools we can teach children how to not need fillings

As I conducted risk assessments and offered bits of valuable knowledge to the women and children I saw at the Clinic, I kept thinking of the need for a more impactful, larger scale approach. Then it struck me: all children are in school, even the children of parents who can not afford the most basic of dental services. In schools we can teach children how not to need drilling and fillings.

With a vision of a cavity-free future, in January 2015, TeethFirst was officially incorporated as a Social Impact Enterprise. In co-operative inquiry style, we met with teachers, school principals, nurses, counselors, students, parents, janitors and cafeteria personnel, looking for possibilities in creating a better future for oral health, starting in elementary schools. What surprised me was the amazing willingness to participate in this inquiry and the high level of awareness of the problem. What inspired me were the teachers willing to do something about the problems despite their very full schedule.

Many ideas died early, like putting a toothbrush on each cafeteria tray or school wide supervised programs. But others took hold and after many iterations, some are gaining traction.

Here is what we have accomplished since January 2015

Our Co-Operative Inquiry beginnings

16 Stakeholders Meetings
28 Teachers Interviews
4 Community Surveys
World Oral Health Day awareness campaign: 1000+ Summit County participants
Oh’Pal prototype design & feedback loop
Alpha/ beta test with 104 kindergartners
10 Meetings with school nurses, counsellors & public health officials
48 Workshops with Grade 2 Students

Concurrent actions

2015: Partnering with PandoLabs directors & 150+ advisors
2016: Semi-finalist, Global Health & Innovation Conference Prize
2017: Designed manufactured and delivered 100,000 Oh’Pals. Disposable and recyclable flossing toothbrushes to be used in school programs. Oh is for oral health and Pal is for best friend.
2017: Applied for and received a Grant from the Park City Community Foundation
TeethFirst's co-operative inquiry as presented at the APHA annual meeting 20172017: Presentation at the American Public Health Association’s Annual Meeting
2017-2018: Design of Curriculum for the Integration of Oral Health Education in Kindergarten
2017-2018: Baseline oral health assessments of 279 children on a shoe string budget. Thank you to the doctors, hygienists, teachers, principals, counselors and everyone who contribute their time to make it happen.

First Data 2017

46 to 80% of the 5 year old children we examined have past or present evidence of tooth decay
2.17 to 4.6 Teeth Average number of teeth in the mouths of the 5 year old children we examined affected by this almost totally preventable disease
0% children have skills to floss at the launch of each program
                                   3.3% children are proficient at brushing at the launch of each program
96 to 98% of the 5 year old children we examined have 2 or more risk factors for tooth decay

What we learned

By bringing the oral health assessments into the classrooms, we triggered curiosity. We also raised awareness about the amplitude of the tooth decay problem. From that came a more confirmed desire to make a difference. I had no idea this was going to happen. When I realized the impact of our work, my eyes filled with tears. Bringing the dental examination in the classroom is magical!


Learning from and with kids flossing and brushing with Oh'Pal in the classroom, co-operative inquiry styleDaily oral health education program in 1 school
7 Supervised Flossing & Brushing Programs
More than 1,400 children reached
Weekly Bites of oral health knowledge shared in classrooms
78,712 Oh’Pals distributed for the benefit of elementary school children
3 School Districts TeethFirst has a daily presence in classrooms in 3 school Districts

We are still in the early stages and will not have official confirmation that our inquiry has the impact we have projected until we collect a second set of data.

Projected SHORT TERM Outcomes

On the week of May 21st, we will conduct new assessments and compare to the results mentioned above. We expect to find:

An improvement in brushing and flossing skills of 25 to 50%
A 25 to 50%  reduction in plaque indexes
A reduction in gingival inflammation of 25 to 50%

At the end of the year, kindergarten children will be able to answer the following


Why are you brushing your teeth?5 year old boy demonstrates how the quadrants on a piece of paper relate to the quadrants in his mouth
When do you brush your teeth?
How long do you need to brush each quadrant?
What are 3 types of teeth?
What are the functions of teeth? “Incisors, canines and molar”
Where do sugar bugs live?
How do you get rid of sugar bugs?
Who is the BIG HERO for your teeth?
Name a healthy food choice.
How long do you need to wait between snacks and meals?

Honoring people’s capacity to solve problems

Unlike traditional research, the process of co-operative inquiry we use connects TeethFirst’s thinking with the experiences / concerns of the people involved. What we know is that this approach honors the capacity of ordinary people to develop their own ideas to solve a problem and can work together on ideas that make sense in their environment and work in practice. In co-operative inquiry, as described by John Heron and Peter Reason, research is conducted with people rather than on people.

Will this approach work? We don’t know yet until after the week of May 21st when we will be conducting a second oral health assessment. Are we overly optimistic with our projected short term outcomes? We will find out and if those projections happen to be right, then the long term outcomes will be a significant reduction of tooth decay not only now but for generations to come.

Our hope is to obtain funding for a long term longitudinal study to follow the 5 year old children learning the lessons and practices for good oral health today. How will those daily lessons and practices affect them in their teens? As young adults? As they become parents?

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