Kevin Donly, D.D.S., M.S., professor and chair of pediatric dentistry, and James Tysinger, Ph.D., associate professor of family and community medicine, led team that developed Project Smile, an online curriculum that teaches pediatric and family medicine residents how to detect tooth decay in children in its earliest stages.
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Contact: Will Sansom
Phone: (210) 567-2579

SAN ANTONIO (Nov. 27, 2007) ― Children’s teeth are in more danger of tooth decay today than they were just 20 years ago, according to a report released this year by the U.S. Centers for Disease Control and Prevention (CDC). Local experts say that children in San Antonio are among the most vulnerable.

Early childhood caries, or tooth decay, is the most common chronic disease in children. It is five times more common than asthma and seven times more common than hay fever.

New curriculum helps dentists and medical doctors work together
In an effort to curb this dangerous trend, faculty members from the Dental School and the Department of Family and Community Medicine at The University of Texas Health Science Center at San Antonio have created an innovative resource to help prevent and detect tooth decay in children before it becomes a problem.

James Tysinger, Ph.D., associate professor of family and community medicine, Kevin Donly, D.D.S., M.S., professor and chair of pediatric dentistry, a team of dentists and family medicine and pediatrics faculty members at the UT Health Science Center, have developed a curriculum that teaches pediatric and family medicine residents how to detect tooth decay in children in its earliest stages.

With the help of a parent, a pediatrician performs the “knee-to-knee” oral exam on a toddler. The exam can be performed in the doctor’s office and takes just one minute to complete.

Project Smile teaches techniques that can be used at medical check-ups to detect tooth decay
The curriculum, called Project Smile, consists of four digital learning modules that cover the prevalence, risks and causes of early childhood caries, and detail simple detection techniques that pediatricians and family physicians can implement during a doctor’s visit. The curriculum can be accessed from the UT Health Science Center’s Family and Community Medicine Web site.

The modules are presented in an easy-to-follow format of sections of information, photos, charts and video. One of the videos for example, demonstrates the “knee-to-knee” oral exam that a family physician or pediatrician can conduct on a toddler with the help of a caregiver. The exam takes just one minute in the doctor’s office, and is just one tool that can help save a child from years of painful dental repair as well as the costs involved, which can be in the range of between $2,000 and $5,000.

A report released this year by the CDC indicates that tooth decay in primary teeth increased in the U.S. from 24 percent in the 1988 to 1994 time period to 28 percent in the 1999 to 2004 time period. William R. Maas, D.D.S., director of the CDC’s Division of Oral Health, said that economic barriers contribute to the disparities.

Impoverished children stand to benefit most
“Although preventive measures, such as dental sealants, have been widely available for years, we need to focus our efforts on reaching children living in poverty who stand to benefit the most from them,” Dr. Maas said. “This report challenges us to increase our efforts to reach those most in need with effective preventive measures, and to provide guidance and health education to others.”

Health Science Center experts said the study’s findings are consistent with the problems they are seeing in the teeth of children in Bexar County.

“There has been an increase in this country of caries in children ages 2 to 5,” Dr. Donly said. “In San Antonio, the numbers are higher than the national average with almost one-third of children in this age group experiencing dental caries.” Dr. Donly agrees that lower educational levels and lower economic status usually play a role in limited access to care. “Some parents don’t realize how much of an impact oral health has on the overall well-being of a child. Tooth pain accounts for numerous missed school days and hours spent in emergency departments.”

Dr. Donly said Project Smile is an excellent way to teach family physicians and pediatricians to help children before it’s too late. The modules provide resources for family physicians so they can detect decay early, educate the caregivers about good oral health for the child and refer the patient to a dentist.

“If we can intervene through the child’s first point-of-contact for health care – the family physician or pediatrician – then we can perhaps save that child’s teeth,” Dr. Donly said.

The first online curriculum of its kind, Project Smile took two years to complete and was funded by a $402,189 grant from the U.S. Department of Health and Human Services Health Resources and Services Administration.

Society of Teachers of Family Medicine has included parts of curriculum in Smiles for Life program
Dr. Tysinger said the curriculum has been so successful in classrooms at the UT Health Science Center that it gained attention from the Society of Teachers of Family Medicine (STFM), the national organization for family medicine educators. The organization included some of Project Smile’s resources in its national oral health curriculum called Smiles for Life and made them available on its Family Medicine Digital Resources Library (FMDRL) Web site. The materials can be downloaded from anywhere in the world and include patient education resources in English and Spanish. The materials have already been downloaded more than 20,000 times, and earned the STFM’s Group on Oral Health 2007 Innovative Program Award.

“Developing the Project Smile and Smiles for Life materials was truly a team effort and an excellent collaboration between our Dental School and School of Medicine faculty,” Dr. Tysinger said. “The idea for Smiles for Life emerged after a national STFM meeting, and individuals from institutions across the country partnered to produce materials. These resources have been so well received that they are the No. 1 downloaded materials from the FMDRL. This shows that family physicians and pediatricians can successfully work hand-in-hand with dentists to address significant and preventable health problems that affect children.”


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The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $576 million, the Health Science Center is the chief catalyst for the $15.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 22,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields.