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High demand drives White River Junction dental clinic to stop taking new patients

  • Daniel Duarte, a student at the University of New England College of Dental Medicine, instructs patient Mark Bacon, of Hartland, Vt., on brushing technique during a visit to the Red Logan Dental Clinic in White River Junction, Vt., Monday, August 23, 2019. Duarte is nearing the end of a 12-week externship at the clinic. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • A July 2017 bequest from Elaine Cook allowed the Red Logan Dental Clinic to purchase a condominium in Wilder, Vt., to house its externs, fourth-year dental students from Boston University, Tufts, or the University of New England. The clinic relies on the students to provide the majority of its dental care year-round, but a gap in their availability around graduation time each May can cause a back up in service. Extern Thais Antunes, left, and Daniel Duarte, right, have breakfast at the condo before going to work at the clinic Thursday, August 22, 2019. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Dental student Daniel Duarte brushes his teeth at the condo in Wilder, Vt., provided for externs before going to work at the Red Logan Dental Clinic, Thursday, August 22, 2019. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Despite a hiatus in admitting new patients due to a backlog of cases, Mark Bacon, of Hartland, is seen for an exam to insure that his mouth is free of infection a week before having a tumor removed from his larynx. Dr. Donald Kalfus, of Rockingham, Vt., left, a supervising dentist, checks in on the work of extern David Duarte, right, at the White River Junction, Vt., office Monday, August 19, 2019. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Sarah Hale, of White River Junction, who said she is ten months sober, has been coming to the Red Logan Dental Clinic over the last eight months and is typical of the approach of seeing patients through long-term improvement and maintenance of dental health that the clinic is moving toward. Extern Thais Antunes, left, who studies at the Tufts University School of Dental Medicine, looks over x-rays with Hale as dental assistant Rebecca Courtemanche, right, prepares instruments during an appointment in White River Junction, Vt., Monday, August 19, 2019. "These people are helping me get my life back together," said Hale. Extern Daniel Duarte talks with another patient at left. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.



Valley News Staff Writer
Saturday, August 24, 2019

Demand for affordable dental care in the Twin States is high.

So high, in fact, that area providers have trouble keeping up with it. Red Logan Dental Clinic — a free clinic in White River Junction for uninsured and underinsured people who live within 30 miles of the clinic — has recently started turning away new patients who are seeking more than immediate relief from pain or infection, referring about 12 to 15 people to providers elsewhere each week.

Sometimes it’s as many as seven in a single day.

“I don’t ever see it (getting) to the point where we don’t have some type of waitlist,” said AnnJane Kemon, Red Logan’s clinic manager.

Red Logan isn’t alone in its struggle to meet the oral health needs of low-income people in the Upper Valley and beyond. A program operated by the Ottauquechee Health Foundation that offered preventive dental screenings in Woodstock and White River Junction had to scale back its effort last year when it grew too big for the small organization to manage. Officials at the Mascoma Community Health Center in Canaan have recently added a new dental assistant and are considering hiring a second dentist and/or starting an externship program to bring in dental students to see more patients.

“It’s unbelievable,” said Scott Berry, the Mascoma clinic’s volunteer director. “Right behind mental health, it’s one of the truly unmet needs.”

There are signs, however, that awareness of these needs is growing. A managed care organization that will begin serving New Hampshire Medicaid enrollees in September, AmeriHealth Caritas New Hampshire, is offering a dental benefit for adults. The other two managed care organizations serving Medicaid enrollees in New Hampshire — NH Healthy Families and the Well Sense Health Plan — do not offer a dental benefit for adults beyond extractions related to pain and infection.

In addition, a new law Republican Gov. Chris Sununu signed last month removed language preventing a mandatory dental benefit for adults in New Hampshire Medicaid and established a committee to develop such a benefit, a goal that public health advocates have been working toward for about two decades.

“This is huge,” said Gail Brown, director of the New Hampshire Oral Health Coalition.

But developing a plan that actually works to expand access to care may be easier said than done. Even in Vermont, where Medicaid covers $510 annually for an adult’s dental expenses, it can be difficult for people to find a dentist willing to see them due to relatively low reimbursement rates and the fact that some procedures aren’t covered. The search can lead people on a winding journey through a patchwork system of providers and can mean that people delay care until they are in severe pain and have an infection. Dental pain can put people in recovery from addiction at risk of relapse, Brown said.

At the clinic

Red Logan has placed the pause on accepting new patients due to a confluence of factors. One is high demand, another is the fact that they sometimes do not have a dental student or supervising dentist available to see patients, and the dental students take longer than a fully certified dentist because each step has to be checked by the supervisor.

Also, the clinic, which has been operating since the mid-1990s, has shifted its focus to working with patients to complete their full treatment plan to restore their mouths to good health, rather than simply addressing the most acute problems and moving on to the next patient.

“That’s a lot more satisfying for us,” said Kemon, who also is a dental hygienist at the clinic.

This isn’t the first time Red Logan has had to stop scheduling appointments for new patients. In the past, staff have collected applications from prospective patients and put them in a stack to return to once they work through their backlog, but this time Kemon said they “didn’t want to give people false hope that they would get in in a timely manner.”

That said, Kemon said she was hopeful that some of the volunteer supervising dentists who have been away due to illness or vacation will come back this fall and allow the clinic to expand its hours to work through some of the current patients’ needs.

The clinic can still fit in some patients who have immediate needs. Mark Bacon, a 61-year-old Hartland resident, was able to be seen last Monday in advance of a surgery coming up to remove a cancerous tumor from his larynx. His doctor wanted Bacon to be seen by a dentist to make sure that there wasn’t any infection in his mouth that could affect the outcome of the cancer surgery, Bacon said.

Fortunately, the Red Logan providers found no infection, Bacon said. They did, however, find some cavities in his six remaining teeth. The rest had been pulled previously. Bacon has not had a regular dentist in his memory.

Bacon — who has health insurance through his work as a housekeeper at the White River Junction VA Medical Center, but does not have dental insurance — had been scheduled for filings at Red Logan last Wednesday, but the clinic called him to reschedule when another patient had a more acute need, he said.

“There are people that are a lot worse off than I am,” he said.

Around the region

Also overwhelmed by demand for oral health care in the region, the Ottauquechee Health Foundation last summer stopped running a program called SMILES that offered free preventive screenings to adults who didn’t have a regular dentist in Woodstock and White River Junction. The program, which began in 2015 to serve seniors, expanded to include all adults and became too expensive and difficult to manage, said Tayo Kirchhof, the foundation’s executive director.

The foundation tried and failed to find another organization to take over the program, she said.

Berry, at the Mascoma clinic, said the SMILES clinics offered people a way to overcome fears that often accompany dental care and a way to receive some education about self-care.

“It was an entry point for people to engage back in dental health,” Berry said. It was a “big service (that’s) unfortunately not happening right now.”

The foundation continues to provide residents of its nine-town catchment area — which includes the Barnard, Bridgewater, Hartland, Killington, Plymouth, Pomfret, Quechee, Reading and Woodstock — with individual grants to those who qualify to help cover the costs of health care. Even though the foundation has stopped running the SMILES program, more than half of these grants still go to cover the costs of dental care, Kirchhof said.

“This is something that is a problem,” she said.

In New Hampshire, oral health advocates say the success of the new benefit in increasing access for patients will be contingent on whether the Medicaid reimbursement rates are sufficient to get enough of the state’s dentists to participate.

The challenge is “this whole issue of creating a sufficient network to meet the patient demand,” said Brown of the New Hampshire Oral Health Coalition.

Due to pent-up demand from patients who haven’t had insurance to help with dental expenses — outside of the treatment of infection and severe pain — for many years, Brown said she expects there will be “a lot of patients to be served when you start.”

The New Hampshire Dental Society’s members are excited about the prospect of the dental benefit. Dr. Lindsey Jackson, the society’s president, said her organization is hoping the state will create a position of a care coordinator to ensure that patients “get to the people they need to see.”

Jackson, who practices in Gorham, N.H., said she’s hopeful the new legislation signals a growing recognition of the relationship of oral health to overall health.

It’s “just as important as medical care,” Jackson said.

She also noted that improving care for people’s oral health may have an economic benefit by helping people stay in the workforce and avoid taking sick days due to dental issues.

It’s unclear exactly when the new committee will finish its work — it hasn’t met yet — and when the new benefit will be mandated, but DHHS spokesman Jake Leon predicted it could be sometime at the end of the biennium in 2021 or early in the next one.

“Timing-wise, we’re just getting started,” Leon said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.