LEBANON — At her desk in the corner of Ms. Matthews’ classroom, Norma Sharp let out a squeal.
“Now I don’t have a cavity anymore!” she exclaimed to the room, holding up the tooth she had just pulled out of her mouth. Her third-grade classmates looked over in awe, amazed at Norma’s timing: Moreen Ng, a second-year medical student at Dartmouth’s Geisel School of Medicine, was in the middle of a lesson about teeth.
Ng visited Hanover Street School in Lebanon last week to teach a class of third-graders about oral health, something she has been doing at elementary schools across the Upper Valley. She started her education initiative as part of her Albert Sweitzer Fellowship, a program available to graduate students in Vermont and New Hampshire that requires fellows to address health disparities by engaging in their communities.
“I think oral health has been one of the most persistent and top unmet needs in our community,” Ng said Oct. 27.
She based this on the Upper Valley Community Health Needs Assessment, an evaluation of health issues in the region conducted in partnership between Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital. Ng worked closely with Beth O’Donnell, director of the community health program at Alice Peck Day, to develop her project.
Indeed, the 2025 report demonstrated a serious need for dental care access in the community, with respondents indicating they could not afford dental care and that appointments were difficult to find and schedule. Thirty-nine percent of community survey respondents listed “dental care for adults” as a service they had a hard time accessing.
For people on Medicaid in the Upper Valley, affording dental care has been particularly difficult. There are not many dentists to begin with in rural areas, and the pediatric offices that do exist rarely accept Medicaid. Dentists, O’Donnell said, often believe they will have low reimbursement rates through Medicaid and take on so many administrative burdens that accepting it as a form of insurance isn’t worth it. But these things aren’t necessarily true, O’Donnell pointed out: they’re more like myths, used to discredit people in underserved communities.
Further, Medicaid recipients often struggle with other day-to-day barriers to dental access, like getting to an office during work or school hours.
When the needs assessment survey asked respondents to indicate “one thing that […] would improve health in your community,” 25% of them indicated the affordability and availability of dental services.
To Ng, it made sense to educate Upper Valley residents while they were already in a learning environment, so she decided to take her initiative to schools.
“Today, I want to talk about how to keep your smiles healthy and bright,” she told the classroom.
Her lesson involved a series of slides with pictures of decaying teeth and some quiz questions for the kids, like “What is the sticky layer of germs that builds up on our teeth?”
“Ooh, my mom told me this once,” said Jason Mangani from the back of the classroom, the word on the tip of his tongue.
It took a while for the class to come up with “plaque.” They got it eventually.
When Ng asked if anyone had ever gotten cavities, Norma and Miryam Pacht raised their hands with pride. Elinor Barnacle walked to the front of the room in her flowery pink cardigan and pointed to a picture of a gaping hole in a tooth.
“I had a cavity like that one once,” she announced.
After talking through her slideshow, Ng brought out a series of cups filled with various liquids and, in each one, an egg. With help from teachers, she carried the cups around the classroom. The shells, soaked in soda and lemonade, showed the class the damage sugar can do to teeth. Gentle cracks webbed around a neon-orange one, dyed by Fanta. The egg soaked in water, however, was pristine.
While Ng wants her oral health lessons for children to be fun, the impetus for her project came from a rather shocking experience. Shadowing a doctor at DHMC once, she witnessed a patient whose whole body had been racked by infection. It had started in the person’s mouth.
The experience got Ng thinking about some of the root causes of poor health. In White River Junction, the Red Logan Dental Clinic offers free dental care, something Ng called “a great resource.” But Red Logan limits its services to adults.
Alice Peck Day’s community health program tries to supplement the limited dental care available to children in the region. Through Upper Valley Smiles, a free project from the hospital, children can receive in-class and chair-side education about oral health. Hygienists go into local schools to conduct simple cleanings and screenings and to apply fluoride varnish and dental sealants. When they find students in need of dentists or with serious oral health problems, they try to facilitate connections.
“Getting to kids when they’re younger, seeing them, bringing them services, and then educating them on good habits is the best way to have them be healthy adults,” O’Donnell said.
O’Donnell and her colleagues also work with the few pediatric dentists’ offices that do accept Medicaid, like Mascoma Community Health Center in Canaan and Montshire Pediatric Dentistry in Claremont.
Ng hopes her in-school instruction can instill “good habits life-long.” In the short term, though, her visit certainly caused some excitement. As her classmates studied the eggs, Norma rushed down the hall and returned with her tooth in a small pink box. She held it up with a triumphant air, proud of her tiny trophy.
