In a recent column I told of my frustrations as I tried to help a struggling North Carolina friend with a toothache find a dentist. I shared my surprise at learning about how hard it is for working poor to get emergency dental care in America.

Readers responded. A few told me of some resources in the community that I had not discovered as I tried to help my friend.   Far more told me stories about the issues elderly or handicapped loved ones were having as they tried to access dental care.  

Many of these stories were about people who were poor not because they cannot find work, but because they are very sick or old.  Under these conditions Medicaid is supposed to pay for any eligible medical care that an available dentist can be found to deliver.

There are three things of importance in that last sentence. First, there is a scarcity of dentists in many rural parts of the country.[1]   Second, not all dental needs are on the list of things that Medicaid will pay for. And third,  Medicaid pays dentists a low amount to treat the poor, so few dentists sign up to treat patients. Those that do tend sign up to ration the number of Medicaid patients they can take or else they cannot meet their own payroll.    

In North Carolina, to cite just one example,  there are more than 200,000 people who have an almost impossible job locating a dentist that can come do the equivalent of a house call.[2] They suffer from profound retardation, autism, cerebral palsy, dementia, stroke, head injuries, Multiple Sclerosis and Muscular Dystrophy, cancer and the like. The best numbers I could find showed that of those 200,000 North Carolina souls, comprehensive dental care is available to only 6400 of them- right at 3%.[3] 

How do you feel knowin that 97% of those fragile sick people have very, very limited access to dental care?

One of the interesting things about the economics of a program that could serve this population is that it could save the taxpayer a lot of money, because once a patient's dental problem goes really bad, their primary option is to go to the hospital emergency room. This "solution" costs up to ten times more than a dentist's office visit. Emergency rooms don't have the right equipment, drills, dental x-ray machines or dental staffs so there is often little they can do except prescribe pain killers and tell the patient to go to a dentist.[4]   To add insult to injury, the patient sometimes has to arrive at the emergency room by expensive ambulance ride - big taxpayer money for something easily preventable at a low cost.

One of the major problems getting dental care for this group of patients is that it is very hard (and expensive) to move the patients to the dentist. An alternative is called for.

In 1997, Dr. Bill Milner, located in Greensboro, and Dr. Ford Grant in Charlotte started a North Carolina program to treat this population.  Their group supplemented Medicaid funding with private donations and a few private pay patients who need this unique care.

Access Dental Care, based in Asheboro, N.C. is a national role model often bragged about but seldom replicated close to home. They have developed what amounts to an easily moved dental clinic, complete with dental chairs, lighting, x-ray, sterilization equipment and so forth. Everything is on wheels, and can be unpacked from a 16 foot truck and set up in about 20 minutes.    

Once in place, the bedridden or wheel chair patients are rolled down the hall and treated.   The clinic, with a normal staff of one dentist, a dental hygienist and two assistants can typically see 18 patients in a day - well below what a normal dentist office would do.[5] Add to that the costs of the truck, portable equipment, travel time, and the extra time this special needs group of patients require, and this good investment cannot occur under current medicaid compensation rates unless subsidized by third parties. [6] 

Dr Milner observes that the needs of this special population could served if other organizations were to copy Access Dental Care's model, which could be supported through either significant private charity, or increased support from Medicaid.[7]   Either way, the patient benefits, and so does the taxpayer.  

[1] StateMaster.com Health Statistics Total Dentists per Capita

[2] Dental Care for North Carolina's Special Care Populations, p.1 l

[3] Dental Care for North Carolina's Special Care Populations, p.1 

[4] Medicare Coverage for Adults in North Carolina, North Carolina Medical Journal, vol. 73,

Number 2, May 17,2012

[5] On The Road with Mobile Dentistry - its impact on Our Communities. January 2007, page 21

[6] Personal telephone conversation Dr. Bill Milner March 7 2014

[7] On The Road with Mobile Dentistry - its impact on Our Communities. January 2007, page 23