By Garry Millard, DDS
SMILES Project Leader
Dental Director, Mountain Family Health Centers
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| Former Navy dentist Dr. Millard and his family, including two adopted daughters who helped drive home for Dr. Millard the needs of kids in foster care - among other vulnerable populations who lack consistent access to oral health care. |
As a participant in the SMILES Dental Project, the Mountain Family Health Center – in partnership with the Garfield and Eagle County school districts and Grand River Health – is providing oral health services to underserved populations in Colorado’s western mountain region by placing dental hygienists at medical and community sites.
We’re thrilled about the SMILES project because it addresses the main barriers to accessing dental care among low-income families: cost, transportation, language and culture. One of the biggest related issues is the lack of oral health providers in this area who are willing to see Medicaid or uninsured patients.
The Mountain Family Health Center is currently the only clinic that sees Medicaid and uninsured patients at a discount in the 86-mile area between Glenwood Springs and Grand Junction. That’s a big area with a real shortage of providers for lower-income individuals and families. As a result, some of our patients drive a great distance to see us – from Steamboat Springs, Vail and elsewhere in the vicinity. We have three full-time dentists, and currently more than 50% of our patients are on Medicaid; that means we’re booked two months out and – at 2,800 total patients – we’re at capacity.
That’s why the SMILES project is crucial. One of our most significant limitations is a lack of capital to build new bricks-and-mortar clinics – through SMILES, we’re transcending that challenge by placing dental hygienists in community settings, thereby expanding our reach without bearing the expense of establishing new facilities.
Trickier to overcome are culture-based barriers. The fact that some recent immigrants don’t prioritize dental care for young children, for example – believing that primary teeth don’t matter because they’re “temporary” – is a major contributing factor to dental caries. Oral health education also varies widely in schools.
At the Mountain Family Health Center, we have the distinct advantage of a bilingual dental supervisor – originally from Bogota, Columbia – who understands Latino culture, and how to address culture-based misinformation in a respectful and compassionate way. Through SMILES, we’ll be able to expand our oral health education efforts at three locations in the coming year.
What sets SMILES apart is that it aims to transform an entire system of care through evidence-based best practices, thereby providing the best care for the most people. I’m disappointed how few dental providers are willing to see low-income patients, also contributing to the silent epidemic that is childhood caries. For too long, we’ve heard the excuse that Medicaid is too cumbersome and reimbursements are too low – so most providers won’t see any Medicaid patients at all.
But if you compare dentistry with, say, pediatrics, there’s a disconnect: low-income children are cared for seamlessly by most pediatricians. But very few dental schools emphasize the moral imperative of providers being willing to see at least some low-income patients – perhaps just one day a week. It’s an inaccurate perception that if you open your doors to a few Medicaid families, for example, they’ll “take over” your entire practice.
And for providers concerned about making less money by welcoming even a token number of patients from vulnerable communities, it’s worth remembering that every dollar spent in preventing dental disease saves $33-55 downstream in more costly treatments. Early intervention and prevention is very cost efficient.
As a paraprofessional in a low-income public school, my wife has shared with me countless stories of children with untreated tooth decay. The result is missed school days due to toothaches – and worse. When the pain gets really bad, children often seek treatment in the Emergency Department, and costs can run into the thousands.
As a developed country, we can do better. A good starting place is to recognize oral health as a basic human right.
