BRATTLEBORO — On Saturday, 40 dentists from around Vermont offered their services freely to those who needed them most.
What's become known as Free Adult Dental Care Day has grown each year since its inception in 2008, and this year's event was the biggest yet.
“It's about giving back,” said Dr. Robert S. Ruhl, of Wilmington, one of the founders of the event. He said that the day was created as a way of reaching out to the community and caring for those that lack the insurance coverage, or personal means, to afford their own dental care.
“Vermonters are well known for being willing to help neighbors in need,” he said. “It's a compliment to the dental providers that they are setting aside all this time. We all do a lot of work for a lot of people every day to help them out, but this is more organized.”
The first Dental Care Day involved only eight dentists in one county, according to Ruhl. This year, clinics were set up in Windham, Bennington, and Rutland counties, and according to event organizers, about $230,000 in free dental care was provided this year.
At one of those sites, the Elks Club in Brattleboro, a makeshift exam area was set up to do assessments, and patients were then sent to other areas for fillings and extractions.
The dental care workers were prepared to see 150 patients over the course of the day. By noon, that number had been exceeded. This growth represents both increased participation in the event by the dental community as well as an increasing need for their services.
“We have been seeing increased emergency room visits that have to do with dentistry,” said Ruhl.
Priorities for care
The very need for this event reflects a pressing issue in Vermont communities, where many lower-income families are left with inadequate dental insurance, or none at all.
“There are patients with good jobs and insurance that do avail themselves of regular care, and then there are patients in the lower income spectrum who have Medicaid et cetera, and then there are the groups in the middle,” Ruhl said.
Steve Voorhees of Putney is one such patient. He attended the Free Adult Dental Care Day to be treated after an accident knocked out one of his teeth. A friend told him about the event and he came to have the old injury treated, a procedure he could not afford without help.
“The economy is such that paying for a dentist has been very low on my list of things to worry about,” he said.
Carmen Derby, executive director of the United Way of Windham County, explained that the problem is one of priorities.
“People are making decisions based on keeping a roof over their head and food on the table,” she said.
The United Way became involved with the Free Adult Dental Care Day for the first time this year.
“They came to us a few months ago; they've been doing it for a little bit and they needed to bump it up to the next level,” said Derby. “We've been gathering specific data on who needs help with this and why and making connections with local businesses and the community.”
Ruhl said the United Way was crucial in organizing and coordinating the event. “We can't thank the United Way enough,” he said. “They are coming in to handle everything from logistics, to transportation, and so many more things.”
Dr. John-Michael Stewart, of Bennington, is the original founder of the Free Dental Health Day, which is a product of the The International Team for Implantology's Project-31. The organization advocates for the 31 million people in the United States without access to dental care.
Stewart said that the importance of dental care to a community is often overlooked.
“A healthy mouth is the beginning to a healthy body. Periodontal disease [gum disease] has been linked to numerous health problems, such as heart disease, pre-term labor, diabetes, kidney disease, etc.,” he said.
“Without teeth, a person's nutrition worsens. This, in turn, leads to a detriment in vitamins and, therefore, health,” Stewart said. “Besides health, socially people are more confident with teeth. We have patients that struggle to find jobs without a full smile.”
However, the state Medicaid program does not offer enough help to individuals or families without steady employment. According to the Vermont State Dental Society's website, adult Medicaid programs for dental work have a yearly cap of $495.
Ruhl said that figure has not changed since 1985, even though the cost of dental procedures has greatly increased since that time.
Solutions sought
Statewide groups are also aware of the need for more obtainable dental care in the community, and some seek to improve access for those who need it.
The Department of Vermont Health Access (DVHA), along with the Vermont Department of Health (VDH), attempted to implement the “Dental Dozen” initiative, 12 proposals intended to provide increased access to dental services among low-income Vermont families.
The first 2011 DVHA quarterly newsletter states, “Many Vermonters face challenges in receiving appropriate oral health care due to the limited number of practicing professionals, the affordability of services and a lack of emphasis on the importance of oral health care. Challenges frequently are more acute for low-income Vermonters, including those Vermonters participating in the State's public health care programs. The Dental Dozen recognizes oral health as a fundamental component of overall health and moves toward creating parity between oral health and other health care services.”
However, according to a position statement released by the Vermont State Dental Society (VSDS), the Dental Dozen plan has the support of the dental community but “was not funded in 2009, the third and most critical year of funding.”
VSDS Executive Director Peter Taylor said that while Vermonters have excellent oral health in comparison to other states, there are many opportunities for improvement.
“It's a challenge between recognizing where we're lacking, and recognizing the great strides we've made compared to the rest of the country,” he said.
While hundreds of people across the state received free dental care - thanks to the donated time and resources of local oral health professionals - the organizers of the event know a more permanent solution must be found.
Ruhl said that the state Medicaid system needs a major overhaul. He specifically suggested raising the $495 annual cap on dental procedures and the reimbursement rate, which he says makes it difficult for his colleagues to afford to treat Medicare patients.
“People with Medicaid don't understand that when a person comes to my office, we have a certain overhead to pay our for our employees, supplies, facilities, and so on,” he said.
Typically, that overhead accounts for 70 to 75 percent of the total cost of the operation. but in Medicaid, Ruhl said, the reimbursement rate is only 55 to 60 percent of the cost.
“Every time we perform work for a Medicaid recipient, we aren't even meeting our costs,” he said. “While we try hard to see as many patients as we can, with the reality of that, it's hard to see all the patients that need help.”
Ruhl added that this situation “is very frustrating to us as dental practitioners, because we're able to provide less and less care. Certain things aren't even covered at all. It's a terrible thing. We try to help out as best we can, but our hands are tied.”
Taylor said that multi-year programs, such as the Dental Dozen, are an excellent idea, but they need to receive full funding to be effective in the future.
As an example, he pointed out that the loan repayment system, one of the 12 programs, was reduced from $195,000 in 2010, to $125,000 in 2011.
Derby added that while raising the Medicaid cap and funding state programs are both important, reaching out to the community and keeping an open dialogue is also essential.
“We need to start having some conversations regarding increasing the amount people are allowed under the state allowance as well as keep talking to dentists about how the process could be improved,” she said. “One of my goals is to continue the dialogue with dentists and the community, and work out a more sustainable solution.”
Although he acknowledges the shortcomings in the state Medicaid system, Stewart said that ultimately awareness and preventative measures are key to improving dental care for low-income families.
“These free days allow everyone a chance to be seen by a dentist at least once a year. This, however, is not enough,” Stewart said, noting that it is “human nature to wait until symptoms develop to seek care.”
“Dental care should not be separate from medical care,” Stewart said. “Once people see the importance of a healthy mouth, I think they will take it more seriously. Right now, people do not consider teeth necessary. That attitude must change.”