WHITE RIVER JUNCTION — Earl Parker left a free dental clinic in White River Junction on Friday having received fluoride treatment, and toting advice to seek out further medical attention.

A flier advertising the clinic caught his eye during a visit to the White River Junction VA Medical Center— pain from a tooth damaged while he was serving in the Air Force had cropped up again. Parker, 64, leaped at the opportunity for no-cost care.

Asked how regularly he makes it to a dentist, his answer: “I don’t, really.”

Parker, who lives in Windsor, is priced out by his fixed income.

The clinic, held in the Hartford office of the Vermont Agency of Human Services, was the first of its kind hosted by the Upper Valley Oral Health Working Group. It was open to all ages, and all types of insurance coverage. Attendees could get their teeth cleaned, referrals to providers for other dental care that were beyond the limits of the pop-up, and a toothbrush and floss to boot.

By 1 p.m., 25 people had shown up, with the biggest rush between 8 and 9 a.m. said Lyrica Stelle, a chronic disease program specialist with the Vermont Department of Health who convened the working group.

“Oral health is a pretty significant need in the Upper Valley,” Stelle said.

In all, 33 people came through the clinic on Friday. Of those who completed an optional exit survey, 19 reported zip codes from Vermont, and five from New Hampshire.

It was one of a pair of dental pop-up clinics in the Upper Valley on Friday. In West Lebanon, a mobile clinic set up shop in the parking lot of Walmart, taking patients 21 and over who are enrolled in Medicaid by appointment only.

The West Lebanon clinic, hosted by DentaQuest, a New Hampshire dental insurance provider, was fully booked when it opened its doors Friday morning, said Jonathan Wenck, program director for Solvere Health, a mobile care provider contracted by DentaQuest.

Last April, New Hampshire expanded the state’s Medicaid to cover basic dental care, including X-rays, preventative cleanings and extractions. But by this past December, only around 20% of the state’s dentists were accepting Medicaid patients.

“It can be very difficult for patients with Medicaid to get appointments in private practice,” Wenck said. “There’s just not a lot of coverage.”

The group has plans to head to Newport, and to return to Lebanon, Wenck said. Exact dates are yet to be set.

Access and affordability are the two greatest stumbling blocks for rural dental care, said John Echternach, a retired dentist from South Strafford who was volunteering at the White River Junction clinic. He cited a study from the American Dental Association: “If someone must travel more than 30 miles to attend a dentist appointment, they’re far less likely to go,” he said.

At single-day clinics like the one on Friday, “people come in, do an exam, we tell them what’s wrong and try to find a clinic that will give them what they need,” Echternach said.

But he hyped up the real-time care that it actually can provide. “That’s the story I want to tell,” he said.

At the Vermont clinic, silver diamine fluoride and glass ionomer cement were used to fill cavities without a drill. By 1 p.m., Echternach had filled three already.

Still, medical attention beyond what the clinic can offer comes down to a game of referrals. A February list from the Vermont Department of Health identifies only two providers in the Upper Valley that take the state’s Medicaid and are accepting new patients: Dr. Robert Munson in Bradford, and HealthHub, which is mobile but also has office in Chelsea. Montshire Pediatric Dentistry is accepting new patients under the age of 18, and takes Vermont and New Hampshire Medicaid.

Beth Robinson, a health care grants coordinator helping out at the White River Junction clinic, recast Echternach’s description of the possibilities of that kind of pop-up, free health care. She wasn’t tight-lipped about the restricted limits of care the dental clinic can offer, or even then the limits of dental care available beyond that.

She described it more like: “We took a look, and then say ‘here’s a list of dentists that may or may not see you, and that you may not be able to afford,’ ” Robinson said.

In Vermont, dentists accepting new Medicaid patients have been in steady decline for more than a decade. In 2022, the Department of Vermont Health Access found that of the 260 dental providers participating in Medicaid, most weren’t accepting new patients.

Robinson works at the Ottauquechee Health Foundation in Woodstock. Half of the organization’s grants go to dental care, she said, an indicator of both the volume — and the expense — of dental need in the region.

In the years after the height of the COVID-19 pandemic, the Upper Valley found itself drained of dental care providers. When restrictions started to lift, for the providers that remained, a backlog of their regulars meant most largely shut their doors to new patients.

“Here’s $1,000, but there aren’t any providers and you can only use it for this, this and this,” Robinson said of the cash benefit those enrolled in Vermont Medicaid receive each year for dental care.

She mentioned a patient who had been at the clinic earlier in the morning. Almost all of his teeth were decaying. The work the clinic can do stops there. They sent him on his way, with advice, and hope that he can find another provider.

Echternach recommended an X-ray for the tooth bothering Parker, the veteran. He’s planning on heading to a practice in Chester, Vt. as soon as he can afford it.

Frances Mize is a Report for America corps member. She can be reached at fmize@vnews.com or 603-727-3242.