WELLS RIVER — With more than $1.3 million in federal funding and most required permits in hand, Little Rivers Health Care plans to begin construction on a new dental clinic in the fall and to begin caring for patients there early next year.
The clinic aims to fill a long-standing and growing gap in dental care in a rural part of the Upper Valley. Difficulty finding oral health care has increased amid workforce shortages during the COVID-19 pandemic. Those challenges are especially acute for people covered by Medicaid, which reimburses dentists at a lower rate than commercial insurers, and Medicare, which does not have a general dental benefit. Little Rivers, based in Bradford, Vt., is a federally qualified health center and as such cannot turn away people based on their ability to pay.
“We see it on the primary-care side in a dire way,” Andy Barter, Little Rivers’ chief operations officer, said of the current dearth of oral health care in the Bradford, Vt., area where Little Rivers operates. Barter noted that patients come in for care of “other physical ailments that stem from oral health challenges.”
These are “very trying times,” he said.
Access to dental care in nearby northern Grafton County also has become more difficult of late. Ammonoosuc Community Health Services dental clinic in Littleton, N.H., is closed “due to staffing shortages,” according to the federally qualified health center’s website. In addition, Dr. Ralph Faluotico, a Bath, N.H.-based dentist in private practice, recently retired, Barter said.
It became more difficult for patients in the Randolph area, on the other side of Orange County from Wells River, to access oral health care when a dentist accepting Medicaid there retired earlier this year.
Early on in the COVID-19 pandemic, dental offices closed. Afterward, some of the workers never returned, said Stephanie Pagliuca, senior director of workforce development and recruitment at the Bi-State Primary Care Association.
That workforce shortage “has hit Vermont hard, and New Hampshire,” she said.
But the problem goes beyond the Twin States. There’s “not one place in the U.S. that isn’t having an issue,” Pagliuca said. In addition, “rural areas (are) extra challenged.”
In the face of the workforce challenges, Little Rivers is moving forward with its new clinic, which will sit on Route 5, also known as Main Street, at the junction with Route 302 leading to Woodsville. Little Rivers also aims to create a training center for oral health workers at its nearby Newbury, Vt., clinic.
The Newbury Development Review Board, last month, granted site plan approval to Little Rivers to convert a former gas station on Main Street next to its Wells River primary care clinic into a dental office. The approval, dated May 19, also includes adding 855 square feet to the existing 2,500-square-foot building, and rearranging parking and access points on the 0.4-acre site. Still pending at the time of the DRB’s decision was approval from the Agency of Transportation for access and traffic patterns. Exterior lighting and signage will be subject to the town’s regulations.
The facility is slated to have five dental operatory rooms and one consultative/exam room, according to plans filed with the DRB. The clinic is slated to employ 11 people. Barter estimates that the clinic will see 5,720 visits in the first year and eventually see as many as 7,800 annually. Ultimately, the facility is slated to be home to two dentists and serve 3,500 patients.
In support of the project, Little Rivers garnered $1.33 million in congressional directed spending this year through Sen. Bernie Sanders, I-Vt.
Little Rivers was planning to move forward with the new clinic even if the federal money hadn’t come through, but with the debt service that would have been required if the health center had to borrow the money, it “wouldn’t have been able to do as much,” Barter said.
Little Rivers purchased the property in February 2021 from South Burlington, Vt.-based Champlain Oil Co. for $135,000, including a $20,000 donation from the oil company. Due to contamination from the gas station and a previous mechanic shop, the property was listed as a brownfield site. It required three different phases of testing and research, Barter said. A sub-slab depressurization system will prevent any gases coming up from the ground from entering the building and being trapped there, he said. He said he was grateful to Montpelier-based Stone Environmental and the state Department of Environmental Conservation for assisting with the environmental work.
“Those entities made this possible because otherwise there’s no way we would have been able to have gone there,” Barter said.
In addition, Faluotico, the retired Bath dentist, has donated his equipment to Little Rivers, which the health center plans to install at its Newbury, Vt., location. There, Little Rivers plans to offer dental services and train new members of the oral health workforce, Barter said.
It was “extremely kind of him to donate all of his equipment and office setup to us,” Barter said.
Little Rivers aims to establish the training center in coordination with the Vermont Department of Health, Vermont Technical College, River Bend Career and Technical Center, and the University of New England’s dental school, Barter said.
The plan is to offer a place for dental students and recent graduates to undergo externships and residencies, as well as to provide training for VTC’s planned new dental therapist program and for dental assistants at the nearby River Bend. The hope is that such a program would create “more opportunity for people, young adults; even adults, to pursue those careers,” Barter said. In the meantime, the trainees would “help us to provide the services.”
Little Rivers and its partners are seeking federal funds for the training center project, which Barter said he’s hopeful can become a model for other health centers.
“In time, we have a plan that should benefit us and actually a lot more than us,” he said.
Meanwhile, patients across the region are challenged to find the oral health care that they need. Ed Shanshala, Ammonoosuc Community Health Services’ CEO, said the Littleton dental clinic has been closed for about six months. He hopes to reopen it eventually through a partnership with a dental school such as Tufts or New York University, but those conversations are ongoing.
For now, ACHS is offering patients vouchers to use at area dentists who will accept them. It comes out to about $750 per patient per year.
Shanshala is among the patients who lost his dentist when the Littleton clinic closed. He recently found emergency care at Mid-State Health Center, which has locations in Plymouth and Bristol, N.H. But he will have to wait until September for a cleaning. He’s making do with brushing and flossing, and using a mouthwash in the meantime. He may eventually need an implant, which would cost about $5,000.
At the moment, he said, he’s “cobbled together with a little bit of dental duct tape.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.