Providing Restorative Care for People In Need

Providing Restorative Care for People in Need. Image credit: © InsideCreativeHouse - stock.adobe.com

As the surgeon general said in 2000, you can't be healthy without good oral health. Nevertheless, many patients try to do just that for various reasons. However, some patients would like to get the oral healthcare they need but don't have access to care, again, for a variety of reasons.

We look at what the industry believes about access to care, why some patients don't have access to care, the problems that can lead to, and some successful programs that get patients the care they need.

Oral Health Care is Essential to Overall Health

The research established links between oral health and other systemic conditions. So, 3 years ago, the American Dental Association (ADA) passed Resolution 84H-2020, emphasizing dentistry's essential role in public health, particularly during the COVID-19 pandemic. The World Dental Federation (FDI) echoed this message in 2021, advocating for oral health's recognition as an integral part of overall well-being.¹

The surgeon general agrees. The 2021 update to the Surgeon General's report builds on the original 2000 report, emphasizing social and behavioral disparities that limit access to oral care. It calls for collaborative efforts among policymakers, health care professionals, and communities to integrate oral, medical, and behavioral healthcare and address systemic inequities affecting oral health behaviors and access to care.¹

Low-Income Adult Patients Don't Have Access, But Do Have Consequences

One of the reasons patients who want oral health care but don't have access to it is affordability. Medicaid, the primary healthcare program for low-income individuals, offers an extensive and mandatory benefit package for children, which covers oral health screening, diagnosis, and treatment services. Over the last decade, through combined efforts at the federal and state levels, Medicaid and the Children's Health Insurance Program (CHIP) have significantly improved access to dental care for low-income children, increasing their utilization of preventive and primary dental services.²

In addition, the American Dental Association (ADA) has its charitable branch called the ADA Foundation. It manages programs like Give Kids A Smile® (GKAS), along with associated programs such as Tiny Smiles and Give Veterans A Smile. Since 2003, GKAS has given free oral health care to children. Every year, around 6500 dentists and 30,000 dental teams volunteer at GKAS events, providing screenings, preventative and restorative treatment, and oral health care education to over 300,000 kids.³

However, fewer programs exist for low-income adults. Without dental benefits, there is a significant cost barrier for these patients. Also, a long-term lack of access to dental care or connection with providers can lead to low-income adults having low expectations regarding oral health or delaying seeking dental care until something hurts.²

Unfortunately, not getting care when they need it can have a lot of adverse effects on these patients' lives, including:

• Changes in appetite and the ability to eat
• Tooth loss, which can cause nutrition problems
• Chronic pain impacting speaking and sleeping
• Work-related problems: i.e., employed adults lose over 164 million work hours annually due to oral health problems or dental visits, and people who do not have professional positions lose more of those than those who do
• Negative effects on job prospects due to damaged teeth or tooth loss.²

Some states have responded to these needs. For example, the California Department of Health Care Services (DHCS) has Medi-Cal Dental. They encourage their members to call them for help finding a provider and for dentists to register their practices with the program. The program treats patients for things like:

• Exams, x-rays, and cleanings
• Emergency treatment for painful problems
• Extractions
• Fillings, Root canals, Crowns
• Periodontal maintenance, scaling, and root planing
• Complete and partial dentures
• Orthodontics for kids who qualify for it.⁴

People with Special Needs Also Struggle with Access to Care

Another patient population that suffers from access to care is those patients who have special needs. People with developmental disabilities like autism, cerebral palsy, Down syndrome, or other conditions face challenges in taking care of themselves, especially their oral health. For example, the following can interfere with their ability to take care of their teeth:⁵

• Mental capabilities might make it difficult to understand and follow instructions at the dentist or home.
• Behavior problems contribute to patients feeling anxious, making dental treatment uncomfortable.
• Mobility problems make getting in and out of the dental chair harder, and appointments might take longer.
• Neuromuscular problems can interfere with the patient's ability to eat or swallow.
• Uncontrolled body movements can make it challenging to get dental care safely.
• Cardiac disorders might require antibiotics before the patients receive dental treatment.
• Gastroesophageal reflux can have symptoms that affect their teeth.
• Seizures can happen, which can harm their teeth or mouth.
• Visual or hearing problems can make it hard to communicate during dental visits.
• Latex allergies are more common in these populations, too.⁵

This population often has problems with their oral health, like tooth decay and gum disease, because of problems with their home care. They also sometimes have harmful habits, like bruxism, food pouching, mouth breathing, and tongue thrusting. In some cases, children with developmental disabilities experience late tooth growth. Other people can suffer mouth injuries from falls, accidents, or seizures. Sometimes, the medication these patients take for their conditions can cause dry mouth or other issues that lead to problems with oral health care.⁵

Penn Dental Medicine Care Center for People with Disabilities at the University of Pennsylvania treats people with disabilities who don't get proper dental care. They're also training students, dentists, and caregivers worldwide to improve the care for people with disabilities.⁶

The Care Center has been running for 2 years, and it's getting busier. From September 2021 to September 2022, they had 1793 patients and almost 9000 appointments. The dental school also uses telemedicine to help patients, sharing their knowledge at conferences, teaching practicing dentists, and opening new places to treat people with disabilities and others in the community^.6

DSOs Help Provide Restorative Care for People in Need in Many Ways

Despite the challenges, some patients who need (and want) access to care get it from dental professionals. Dental Support Organizations (DSOs) have many organized programs that give back to their communities.

For example, Aspen Dental opened the TAG Oral Care Center for Excellence (OCC) to treat low-income patients in the Chicago area, free of charge. The 25,000 sq. ft. clinic opened in July 2022 and has 16 dental care rooms, including 14 operatories and 2 surgical suites. The TAG OCC is a global center of excellence for continuing dental education while providing comprehensive quality care to those in need, including veterans and other underserved populations. The TAG OCC has donated over $4 million in free dental care to over 500 patients, with another 500 on a waitlist.

Julie Frantsve-Hawley, PhD, CAE, Executive Director of the TAG Oral Care Center for Excellence, describes it as the next evolution of the charitable giving Aspen calls the Healthy Mouth Movement, which they started in 2014. The TAG OCC is the year-round program serving Aspen's overall mission to break down barriers to quality care and bring better care to more people.

"We developed a strong partnership with the state of Illinois to help us provide this free dental care. A team of dentists and support staff provide care at the TAG Oral Care Center for Excellence who are wonderful, compassionate people who think and live our mission," Frantsve-Hawley says.

Aspen also uses the TAG OCC to train their team on their technology for 3D printed dentures and advances in implant placements. During this training, their teams provide access to care with the latest technology, which can give patients a new outlook on life, Frantsve-Hawley says.

"It's been inspiring and touching when we see many of our patients come to us in a state of despair and fear and shame and leave with a new smile and courage and a great outlook on life," Frantsve-Hawley says. "It's not just changing their teeth and smile, but it's changing their lives."

The combination of the efforts on behalf of the Healthy Mouth Movement, which also includes Aspen Dental’s Dental Service Day, where many of the practices nationwide provide free dental care to Veterans and their families, and the Overseas Outreach Program, which Frantsve-Hawley also leads, have led to over $23 Million in donated dentistry since 2017.

Heartland Dental established the Heartland Dental Foundation in 2018 with the vision to “give supported doctors, team members, support professionals and the communities they serve more reasons to smile through passionate, thoughtful, and generous assistance.” The Foundation raises money through various fundraising efforts and applies those funds to individuals in the Heartland support network experiencing hardship.

Heartland Dental also partners with the Heartland Dental Foundation on programs that reach outside the United States borders. Over the last 2 years, Heartland Dental has partnered with Mission Lazarus in several areas of Honduras to provide much needed dental care to the communities. This population, through no fault of their own, has zero access to the level of care that the Heartland supported team can provide, he says. David Foster, DDS, practices near Nashville at Gallatin Dental Care as a Heartland-supported doctor has participated in mission trips with the Heartland Dental Foundation.

"We have had 3 groups travel down to provide care, including our CEO, Pat Bauer," Dr Foster says. "Our goal is to provide more than extractions, which is the typical model of humanitarian work. We want to save teeth and provide consistent care so that our patients in Honduras can keep their teeth and their dignity long-term. So, in addition to extractions, we are placing fillings, providing cleanings, and even performing root canal therapy. The results are better than expected so far."

In 2023, 25 Heartland Dental supported doctors, delivered over $230,000 in dental care across two trips to Mission Lazarus. The teams provided 325 exams, 399 extractions, 170 fillings, and 18 root canals. These treatments likely would not have happened otherwise, Dr Foster says.

"Remember, our patients in Honduras must decide between paying for dental care or putting food on their tables. They always choose food, but because of Heartland Dental, Mission Lazarus, and our supply partners Henry Schein, they do not have to make that choice," Dr Foster explains, adding that the benefits to the Heartland team are significant, too. "I am always blown away by the quality of character our Heartland Dental doctors have on these trips. While serving others, we are developing life-long relationships and sharing dental knowledge. We are growing together as an organization while making the world a better place."

In 2024, Heartland Dental and the Foundation have additional mission trips planned, both to Mission Lazarus and to serve underserved areas in Appalachia.

Heartland Dental supported offices also participate in Free Dentistry Day, an initiative that has provided over $14 million in free dental care to patients over the years. This year, supported doctors have provided care for 5233 patients, resulting in $2,122,122 in donated dentistry, which is even more than they had the year previous. Many Heartland Dental supported doctors also participate in community outreach and local events, giving back to the communities they serve.

At Pacific Dental Services, they recognize the vital role they play as leaders in the health care industry within the communities they serve, says Carli Casey, Senior Manager of Corporate Social Responsibility and Service.

"Providing donated restorative dental care to those in need is one of the primary ways we choose to serve," Casey says.

Pacific Dental Services established several key initiatives and partnerships to address the critical needs of underserved populations, which include:

• Smile Generation Serve Day: Since 2011, they have actively participated in Smile Generation Serve Day, a nationwide campaign of giving that focuses on providing donated dentistry to underserved patients.
• Local Collaborations: Collaborating with local nonprofits and community health centers ensures their services reach individuals who may face challenges accessing dental care.
• Community Education: Their clinicians regularly participate in community events and health fairs, offering free consultations and educating individuals on the importance of maintaining oral health.
• International Outreach: Their international service program takes their clinicians and team members to countries like Guatemala, where residents have limited access to dental care. There, team members generously volunteer their time and skills, providing donated dental care, education, and community service.

"Since our first international service trip in 2010, PDS team members have traveled to countries like Guatemala, Ethiopia, and Fiji, providing over $11 million in dental care and positively impacting the lives of thousands of patients," Casey explains.

"In addition, our participation in Smile Generation Serve Day over the past 13 years has allowed us to make a significant impact on underserved communities here in the U.S. We've provided over $57 million in donated dental care, encompassing essential procedures like cleanings, fillings, extractions, and more complex treatments, such as root canals and dental implants, on that annual day of service alone," Casey says.

Pacific Dental Services' most recent Serve Day was a remarkable success, Casey says, resulting in over $10.6 million in care for those who need it most, serving over 3500 patients nationwide.

“And through meaningful partnerships we’ve made with dental laboratories and other organizations, patients receive 100% pro-bono care, further amplifying our impact."

These projects have impacts on the organization as well. Casey says serving those in need brings substantial benefits, not only to the patients they serve but also to their team members providing the service. Research shows that the act of giving boosts the production of 3 brain chemicals–dopamine, serotonin, and oxytocin, often referred to as the "happiness trifecta."⁷ This increase in brain chemicals improves the overall mood and well-being of those serving others, Casey explains.

"Engaging in acts of giving through their core competencies enriches our team members' lives, providing them with a profound sense of purpose and fulfillment," Casey says. "This transformation in their daily routines enhances their dedication to their work throughout the year, creating a win-win situation for everyone involved."

References

1. Oral Systemic Health. American Dental Association. Published 2023. Accessed October 25, 2023. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-systemic-health
2. Hinton, E. and Paradise, J. Access to Dental Care in Medicaid: Spotlight on Nonelderly Adults. KFF. Published 2016. Accessed October 25, 2023. https://www.kff.org/medicaid/issue-brief/access-to-dental-care-in-medicaid-spotlight-on-nonelderly-adults/
3. About Give Kids a Smile. About Give Kids a Smile | ADA Foundation. Accessed November 2, 2023. https://www.adafoundation.org/give-kids-a-smile/about-give-kids-a-smile
4. Medi-Cal Dental Program. 2023. Dhcs.ca.Gov. Accessed October 31, 2023. https://www.dhcs.ca.gov/services/Pages/MediCalDental.aspx
5. "Developmental Disabilities & Oral Health” National Institute of Dental and Craniofacial Research. U.S. Department of Health and Human Services. Published 2023. Accessed October 31, 2023. https://www.nidcr.nih.gov/health-info/developmental-disabilities
6. Unger Baillie, K. "A growing focus on equitable oral care for people with disabilities." Penn Today | The University of Pennsylvania. Published 2022. Accessed October 31, 2023. https://penntoday.upenn.edu/news/penn-dental-medicine-growing-focus-equitable-oral-care-people-disabilities
7. The power of a smile: what helping others does for you. Benefits of Helping Others|Why Should I Help Others|Grin! Magazine. Accessed November 3, 2023. https://www.grinmag.com/archive/en/ddpa/2020/spring/wellness/what-helping-others-does-for-you/