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Duluth dental clinic gives uninsured a reason to smile

When Dr. Chris Delp starts his day at St. Luke's emergency room, he knows some of the common problems he'll see aren't just a string of bone fractures and dislocations. What he'll often see are severe tooth ailments.

When Dr. Chris Delp starts his day at St. Luke's emergency room, he knows some of the common problems he'll see aren't just a string of bone fractures and dislocations. What he'll often see are severe tooth ailments.

"There's never a shift where I don't see at least one to two patients who have dental pain," he said. "It's a huge problem."

Why? Because many of those patients are uninsured or on medical- assistance programs and rarely get preventative dental care.

Dental clinics often won't treat those patients because the clinics lose too much money. If patients can't afford care, statistics show that they'll put it off entirely -- until emergency care is needed.

"If they were able to get access to preventative dental care, we

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wouldn't see so many problems," Delp said. "But because they can't

afford to, they just let their teeth go."

Last month the Lake Superior Community Health Center opened a dental clinic in Duluth that many hope will be a step toward solving the problem.

The clinic will be the first in the city and only the second in the Northland to provide dental care on a sliding-fee basis, meaning no patient will be turned away because of a lack of money.

WAITING LISTS

The other area dental clinic to provide the same payment option was opened by the health center at its Superior site in December 2005, and since that time has averaged almost 500 patient visits a month, its maximum, Executive Director Wende Nelson said. About 92 percent of those patients are uninsured or on a state or federal insurance program.

At the Duluth clinic, Nelson said she expects the same number of patients with the about the same level of insurance coverage.

Nelson said the health center has long had dreams of opening a dental clinic in Duluth, but never had the finances to do it. The Superior clinic was opened after the state government earmarked more than $600,000 for renovations and equipment.

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"We knew it was such a huge venture that it was beyond our capacity to consider [for Duluth]," Nelson said. "I used to say it would be the black hole that would swallow our whole clinic."

A $630,000 grant from Duluth-based Generations Health Care changed that. Karen Geegan, the health center's chief operations officer, said the clinic used the money to renovate the Duluth clinic and buy equipment, while an additional $17,000 grant from the Ordean Foundation will be used to help pay for ongoing operations.

But it will take more than $17,000 to keep the clinic going. Geegan said that while the clinic will still charge on a sliding-fee scale based on income and number of people in a household, the clinic will target patients on medical assistance programs.

Dentists are usually reimbursed for 33 percent to 40 percent of their costs if they see someone on medical assistance, according to the Minnesota Dental Association. But the law works differently for the health clinic, which is reimbursed for 100 percent of its costs to treat medical assistance patients.

The clinic will offer the gamut of dental services from cleanings to extractions to root canals. Dr. Frank Gerber, one of the clinic's new dentists, has worked at a health clinic and private practice, and said he often sees a difference in low-income patients than other patients.

"There's a lot more gross pathology, gross decay, people in pain and discomfort," he said.

'DIFFICULT TO PAY THE BILLS'

While the clinic will help with access to dental care, critics say that the low reimbursement of traditional providers led to the problem in the first place and needs to be changed.

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"When I started 34 years ago, this was a problem," said Tim Langguth, a dentist who works in the Medical Arts building and is a past president of the Minnesota Dental Association.

Dick Diercks, executive director of the Dental Association, said federal and state health insurance programs typically offer low reimbursement for types of health-care services, including hospitals. But hospitals have other ways to make up the income that smaller dental clinics don't.

Langguth said he's reimbursed only 35 percent of his costs for seeing a medical aid patient, while he needs to recover 60 percent to 65 percent of costs just to pay for overhead of his clinic. Langguth said he still tries to see some low-income patients, "but as you get to a certain number, you end up in a cash-flow problem where it makes it difficult to pay the bills."

Statistics show that many low-income people are often forced to put off dental care. Nationally, more than twice as many low-income adults and children had untreated decay compared to adults and children with higher incomes, according to the CDC. Locally, according to the 2005 Bridge to Health Survey, almost 20 percent of Duluth residents said they postponed dental work in the past year. Of those, 69 percent said it was because they had no insurance and 61 percent said the care would cost too much.

That was the reality for 60-year-old Beverly Downs of Duluth, who is unemployed and on medical assistance, but couldn't find any providers willing to take the state insurance. The last time she saw a dentist was five years ago.

"You know what needs to be done, but it goes on the back burner," Downs said.

Downs found that she needed only minor repair work, but for many the damage from waiting too long to see a dentist is far worse.

At St. Luke's, Delp said it's common to see severe tooth decay and abscesses -- painful bacterial infections that accumulate as pus in the jaw bone. Left untreated, abscesses can sometimes infect the blood stream and lead to substantial problems, from breathing problems to heart disease to paralysis in rare cases, Delp said.

Last February, for example, a 12-year-old homeless boy living near Washington, D.C., died after an infection in his molar spread to his brain.

Delp said emergency room doctors can drain the abscess and provide temporary pain relief, but actual dental care is needed to correct a problem.

"We only put a finger in the dam," he said.

Diercks said many dentists provide volunteer time to treat low-income patients, and there are a few legislative proposals being pushed by the MDA to increase reimbursement. However, he said those proposals still wouldn't see dentists recovering their cost for care.

"By itself, that's not a solution," he said.

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