New program helps get emergency dental care to low-income adults

When Meagan Daniels lost her footing and fell on a rainy November night, her jaw slammed into the pavement, breaking off part of a tooth.

The Spokane Falls Community College student lived with a debilitating toothache and infection for four months. Daniels didn’t have dental insurance, and the $1,500 cost of a root canal and a crown was beyond her reach.

“By the end of December, I was crying like a baby whenever I opened my mouth,” Daniels said. “I couldn’t chew, I couldn’t drink hot liquids. I felt sick and I was losing weight.”

Daniels debated whether to get the tooth pulled, or whether to use her student loan money to get the tooth fixed. The aspiring photographer knew a gap in her smile would detract from the professional image she wanted to convey. But she needed the loan money to pay for school supplies.

A referral got her into DENT, a local program that helps adults get treatment for dental emergencies. Daniels had the root canal and crown done in February at a community health clinic for $250.

“They saved my tooth,” she said. “It meant the world to me.”

DENT stands for “Dental Emergencies Needing Treatment.” The program is a cooperative effort among Providence Sacred Heart Medical Center and Holy Family Hospital, Washington Dental Service Foundation and Better Health Together, a subsidiary of Empire Health Foundation.

Since the program started in July 2014, more than 3,100 dental appointments have been made for low-income adults. Many of the referrals come from hospital emergency departments or urgent care centers, where people with toothaches often end up.

“As we know, there are no dentists in the ER,” said Alison Carl White, Better Health Together’s executive director.

People with toothaches were leaving emergency departments with antibiotics, painkillers and referrals to dentists. But many couldn’t get dental appointments, and they kept cycling through the emergency department.

“If the abscess wasn’t taken care of, they would be back in the emergency room,” Carl White said.

At Providence’s Spokane hospitals, dental problems were one of the top reasons homeless and low-income patients were visiting emergency rooms.

“We realized there was more we needed to do for this population,” said Sara Clements-Sampson, Providence Health Care’s community benefits manager.

DENT locates dentists willing to treat low-income patients. Karen Davis, the program’s manager, works to make the appointments successful for both the dentists and the patients.

She meets with dentists and their staffs every few months to get feedback on the program. She also counsels patients to get them ready for the visit, making sure they have transportation and telling them to give at least 24 hours’ notice if they have to cancel.

In the case of fearful patients, Davis has accompanied them to the dentist and held their hands. One man kept a white-knuckle grip on her fingers for 90 minutes while he had two teeth pulled.

“A lot of people haven’t been to the dentist, or they haven’t been to the dentist in 15 to 20 years,” Davis said.

The program is getting good reviews from health professionals, dentists and clients. Next year, Providence will have more information about potential cost-savings from fewer emergency department visits.

The pre-appointment counseling is a valuable part of the program, said Dr. Brian Macall, a dentist at Unify Community Health, whose patients include DENT referrals.

“It really helps prepare a patient prior to seeing us,” he said. “They get coached on what to expect.”

In addition to working with several community health centers, DENT has been expanding the number of private dentists willing to see low-income patients.

More than 60 dentists now participate in the DENT program, each accepting a few patients at a time. Davis hopes to keep participation rates for private dentists growing.

Washington has one of the lowest dental reimbursement rates for adult Medicaid patients, which is a barrier for getting those patients treatment, said Diane Oakes, president and CEO of the Washington Dental Service Foundation.

Medicaid’s dental reimbursement for adults is about 29 percent of what private dental insurance pays. Coupled with historically high no-show rates, private dentists have been reluctant to take Medicaid patients.

“It’s hard to run a business that way,” Carl White said.

Davis built rapport with local dentists through her previous job at the Spokane Regional Health District, where she worked to get children from low-income families into dental appointments. After private dentists have treated the first DENT patient, they’re often willing to take a few more, she said.

Daniels had her root canal and crown done at Unify Community Health in Spokane, which is part of the Yakima Valley Farm Workers Clinic.

“I just knew it was important for my self-esteem to have my teeth,” said Daniels, 50, who is back in school for a midlife career change.

She’d always taken care of her teeth, and she worried that people would judge her by a missing tooth. She also knew that a healthy mouth was important to her overall health.

Daniels approached seven different dental offices, trying to work out an arrangement for saving the tooth, before DENT sent her to Unify Community Health.

“I had been so discouraged from all those ‘no, no, nos,’ from other dentists. They treated me so well,” Daniels said of Unify. “It was humanity, goodness, kindness and a hand up.”