With the hum of the bus' engine in the background, Doctor Maria Pardo looks at 2-year-old Isabella Rodriquez's teeth. The toddler is nervous, and keeps closing her mouth. To help distract her, Pardo counts Isabella's teeth out loud as she inspects them with a dental mirror.
"Here we go,” Pardo said. “Let’s count. Ready? Let’s count. One...two...three…big girl!"
A Florida Department of Health study says the state ranked 11th highest in the country in the percentage of third-graders with untreated tooth decay.
Some groups in Manatee County got together to take on the problem themselves.
Today, the mobile dental unit, called the “dental bus” is parked in the parking lot of Morton Clark Head Start preschool in Bradenton, but it's driven where it's needed. The bus is an extension of MCR Health Services, a federally-supported group of clinics that treat low-income patients in Manatee, DeSoto and Sarasota counties.
Toni Rosier, the mobile health coordinator, said transportation is a major barrier to health care for many parents.
"The mobile health clinic actually goes out to the locations that is most convenient to those patients,” Rosier said. “So it's at the schools, Head Starts, day cares, sometimes churches. They’re having outreach events and sometimes community events as well."
More than 600 Manatee County preschool children see a dentist at least once a year through the program, which is run through Head Start, a federally subsidized program for preschool children living in poverty.
Another 10,000 Manatee County preschoolers who have Medicaid coverage typically go without dental care. Their parents often can't find a dentist who takes their insurance.
"Those kids have great health disparities when it comes to oral care,” Rosier said.
Tooth decay is the most common childhood disease in the United States, and especially affects low-income children.
It’s also the leading cause of school absence for students all across the country. According to a 2008 study of more than 2,100 North Carolina students, those with dental pain miss more school days and have lower academic performance than children without dental problems.
“Brush, brush, brush your teeth, brush them nice and clean!” the children sing during a story time session at Morton Clark Head Start preschool.
Willona Milton, a teacher, reads a book to her pre-k students before they board the dental bus. She said it helps the kids who are scared on their first visit.
"This book depicts a lot of the actual pictures of things they'll actually see on the bus,” Milton said.
"Where's Shayari?” Milton called out to a group of students sitting on the floor by her feet. “Shayari! Remember you had a visit on the dental bus? Did you have to go by yourself? Yeah? Was it a little bit scary for you? Yeah. But did they hurt you? No. Were they really nice and friendly, too?"
The mobile dental unit started helping students in Manatee County in 2013. The bus, staffed with a pediatric dentist and two hygienists, started at a Head Start preschool but now includes elementary schools in underserved areas.
Rosier said that without the program, many students would end up in the hospital needing emergency oral surgery.
"The bill is enormous, and tax payers are paying for it, and still, same issue,” Rosier said. “It's not addressed."
Preventative care, Rosier said, prevents expensive dental work down the road.
She also said that while the mobile dental clinic only treats little children, the lessons they take home about oral hygiene educate the whole family.
“Up and down, and round and round, until they’re nice and clean!”
This story was produced in partnership with the Sarasota Herald-Tribune's Maggie Clark and Rachel O'Hara. To see their story and the rest of Clark’s series on Medicaid, click here.