Joann McManis stood in front of a group of smiling second- and third-graders, grasping a foot-long toothbrush and a giant tooth she calls Charlie.

"What do you have to do to keep your teeth clean and strong?" she asked the group at Modesto's Marshall School.

"Brush them," the children called out.

"What happens if you forget?" McManis asked.

"They get smelly," 8-year-old Gabriel Lopez said.

That may seem simple, but many children don't know how to care for their teeth, said McManis, known as the "Tooth Lady" to thousands of children throughout Stanislaus County.

Hoping to help, the state recently gave the county's Health Services Agency $163,429 so the agency can continue its dental education program for the next three years. The county contributed an additional $4,050.

San Joaquin, Merced and Tuolumne counties have similar programs in which workers visit classrooms and teach preschool and elementary school children to brush and floss. Also included in the lessons: how to care for a toothbrush, which foods promote healthy teeth, and the importance of brushing before school and before bed.

"When I first started this, I asked, 'Isn't this something that happens at home?'" said McManis, a dental educator with the Health Services Agency since 1989.

"Then I started getting into the schools, and I realized it's just not part of their routine."

The program started in Stanislaus County and most other counties in the state in 1980, when education officials brought the poor condition of children's teeth to the attention of legislators.

Today, McManis finds that some children have never been to a dentist. Some don't know how to brush correctly. A few have never seen a toothbrush.

That's why she starts with the basics. Lessons begin with brushing, move on to reasons not to drink soda (it erodes tooth enamel), and what to do if your family runs out of toothpaste (brush using water only).

McManis also teaches dental health to preschool children and their parents. She gives toothbrushes, toothbrush caps and floss to elementary students for them to keep at school.

She gives fluoride tablets to teachers, who dole them out to children who have parent permission.

This year, for the first time, the program will pay for dentists to screen 100 second-graders to determine if they would benefit from sealant on their molars. Only children without cavities can receive the treatment, designed to prevent tooth decay.

"We're trying to stop it before it starts," McManis said.

Modesto's Dr. Toshi Cruz-Hart likes the idea. She specializes in treating children, and said many youngsters don't know enough about caring for their teeth.

"Most kids know about brushing, but the younger ones don't know about flossing," she said. "I think any education is a good idea."

Marshall fourth-grade teacher Brad Hallinan estimates that, before McManis' first lesson of the year, about half his students brush their teeth before school. By the end of the year, he finds that many more children brush and floss at home.

Because there's not enough money to bring the dental program to every school, officials choose schools where at least 48 percent of the students receive free- and reduced-price lunches.

And not every class gets visits from the Tooth Lady. Teachers who believe their students will benefit sign up for the lessons. About 5,400 students at 42 schools throughout Stanislaus County hear McManis' message each year.

Back in the classroom, McManis packed up Charlie, her giant tooth, along with her oversized toothbrush.

"What happens if you forget to brush your teeth?" she asked again. "If you forget, there's going to be a party in your mouth and your teeth will pay."

Bee staff writer Kerry McCray can be reached at 578-2358 or kmccray@modbee.com.

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HEALTHY TEETH TIPS

To help keep your child's teeth healthy:

• GOING TO THE DENTIST -- Take your child to see a dentist regularly, scheduling a visit to the dentist within six months of the eruption of the first tooth, and no later than the child's first birthday.
• DRINK FROM A CUP -- Encourage children to drink from a cup by their first birthday.
• BRUSHING -- Start brushing the child's teeth with water as soon as the first tooth appears.
• FLOSSING -- Start flossing when two of the child's teeth begin to touch.
• BRUSH AND FLOSS -- Brush and floss your child's teeth daily until the child can be taught to do this alone.
• FLUORIDE -- Make certain your child gets the right amount of fluoride needed for decay-resistant teeth. Ask your dentist how this can be done.
• DENTAL SEALANT -- Ask your dentist about dental sealant, a thin, protective barrier that shields the chewing surface of back teeth against tooth decay.

Source: American Dental Association

TALE OF THE TEETH

Tooth decay remains one of the most common diseases of childhood, five times as common as asthma and seven times as common as hay fever.

More than half of children ages 5 to 9 have had at least one cavity or filling; 78 percent of 17-year-olds have experienced tooth decay.

By age 17, more than 7 percent of children have lost at least one permanent tooth to decay.

For every child without medical insurance, there are 2.6 who lack dental insurance.

Source: U.S. Centers for Disease Control and Prevention

Reprinted by permission of the Modesto Bee.