Few Mainers have dental insurance, and those that do usually must pay a high premium for it. Mainecare covers dental care for children of low-income families, but for adults it pays only to alleviate immediate pain. Many go without dental care because they simply can’t afford it.
Yet lack of dental care can lead to more dramatic consequences than just a crooked smile. Untreated dental disease can cause chronic pain and lead to complications with diabetes and heart disease. Studies have even linked it to spontaneous miscarriages.
As co-director of the Ellsworth Free Clinic, Nell Beer has long been frustrated with the lack of affordable dental care in Maine.
“It’s almost like the mouth isn’t part of the body,” Beer said. “There’s this mindset that dental care is like a frill.”
In the 1990s, her Free Clinic was constantly inundated with patients seeking help for painful dental conditions. People often couldn’t find a dentist in the area who would accept Mainecare. Many previously had resorted to the emergency room.
Since the clinic wasn’t equipped to deal with dental problems, Beer and co-director Dr. Robert Scovin set up eleven dental clinics with volunteer staff in borrowed offices.
“We didn’t understand the scope of the problem,” Beer said. “What we found, it was just a drop in the bucket.”
The waiting list had grown to over 200 by the last clinic, but future clinics seemed doubtful. The roving clinics proved more expensive than expected, and volunteer dentists quickly burned out.
After years of organizing and fundraising by the directors of the Free Clinic and Downeast Health, the Maine Coast Community Dental Clinic (MCCDC) opened in Ellsworth in 2003. Now at MCCDC, patients can have existing dental problems treated and get dental cleanings to prevent future problems. The clinic accepts Mainecare and offers a sliding scale fee for those without insurance. It also has flexible hours, open from 7:30 to 5:00, Tuesday through Saturday.
Dr. David Drohan, the clinic’s new director, had practiced dentistry in New York City, but even he was shocked by the enormity of dental problems in the Downeast.
“I’ve seen 17-year old patients with abscesses the size of my thumb,” he said. “The need I see here dwarfs anything I’ve ever seen in inner-city New York.”
Judy Feinstein, director of the Maine’s oral health program, says Maine’s dental problems stem partly from a lack of affordable dental care, but also from a lack of dentists. Currently, there are roughly six hundred dentists registered and practicing in Maine, including orthodontists and oral surgeons. The concentration of dentists is greater in affluent, urban environments.
“There are places where the nearest dentist is an hour away,” Feinstein said.
Dentists often come out of dental school with debts in six figures. They usually choose not to establish practices in less-affluent rural communities. Feinstein said it took one retiring dentist in Greenville a year to find a replacement.
To fill the gap, there are less than 25 low-cost dental clinics throughout Maine. But often, low-income parents can’t regularly travel to take their children to clinics in other towns because it would mean too much time off work.
“Instead of 18 months without a dental cleaning, [some children] were 18 years without a dental visit,” she said.
Until recently, Alice French, a gardener and musician, found it impossible to get her children’s teeth cleaned in Ellsworth. Two of her four children have autism and are covered by Mainecare, but area dentists either wouldn’t accept it or wouldn’t treat her children.
“My children are kind of difficult in places like that,” she said.
She had to travel to a Bangor dental clinic, where they wouldn’t treat the autistic children without sedation.
As soon as MCCDC opened, French made an appointment. She’s been very impressed.
“They’ve been really good,” she said. “They’ve been really patient with the kids.”
The clinic’s existence has not been without bumpiness, however. There has been high staff turnover, including several directors. New director Drohan says he understands how easy it is to burn out at a low-cost dental clinic, but he hopes to recruit and keep a committed staff.
“You’ve got to have a sense of mission to do this stuff,” he said.
The biggest obstacle to the dental clinic’s continued existence might not be staffing issues, but economics. MCCDC’s low-income patient base is continually growing, but Mainecare only covers some 60 percent of real costs for each Mainecare patient treated. The rest must be subsidized through sliding scale fees or grants. Meanwhile, the dental clinic’s rent has risen dramatically, a move that drove out the neighboring free clinic. At one point, it took a bailout from the Ellsworth hospital for the clinic to remain open.
Still, Drohan remains confident. He feels that through his new money management policies, MCCDC can stay open.
“The economics before I got here were not run like a dental practice,” Drohan said.
He even hopes to expand MCCDC’s reach by working more at dental disease prevention. He wants to bring in another hygienist and to do outreach work in area schools.
“We’re working on trying to access more of the children,” he said.
But in the meantime, his primary focus is to help patients feel better.
“You have to solve these problems one case at a time,” he said.