As dentists across Alabama abandoned low-income patients in the last two decades, a few communities took dental matters into their own hands through determination and local, federal and private funding.
The dental clinics that their efforts produced are few and far between; only about 20 can be found around the state. But patients and health care workers agree that the clinics are making a big difference in areas where dental needs had been all but forgotten.
Almost everyone involved in building this patchwork-quilt of dental services says that other Alabama counties and cities can take the same initiative, for the good of the larger community.
“There are grants out there. It’s just a matter of getting everything together and applying for them,” said Sherry Goode, acting director of the dental program for the state Department of Public Health.
“The need is so great. It really is,” said John D. Finlay, a trustee with the Brewton-based D.W. McMillan Trust. That trust, established in the 1930s by a Pensacola physician, this year teamed up with the W.T. Neal Trust of Mobile and the Escambia County Commission to build a $950,000 health department building in Brewton, replete with a full dental clinic. The county paid about 35 percent of construction and dental equipment costs, said Tony Sanks, the county administrator.
The dental part of the clinic is slated to begin operating in February, serving people from Escambia and surrounding counties, which have more than 5,900 Medicaid-eligible children, but only two dentists who’ll accept Medicaid patients.
Clinic organizers now are waiting on a promised $300,000 federal grant that will pay a dentist’s salary and fund operations for a year.
They’re also looking for a dentist, which isn’t easy for rural communities such as Brewton.
“There’s a major push from Washington now to get more dental services to the underserved, but recruiting a dentist is still very hard to do,” said Jim Holland, executive director of the Mostellar Medical Clinic in Bayou La Batre, in southern Mobile County. Mostellar is one of three federally funded health clinics in Mobile County, along with the Franklin Primary Health Clinic and the Mobile County Health Department. All three offer dental services. Around the state, some county health departments have dental clinics, some don’t. A few are planning to add the services.
Holland was able to recruit Dr. Malea Griffith of Jasper, Ala., for Mostellar’s dental clinic a year and a half ago by tapping into the National Health Service Corps, a U.S. Department of Health and Human Services program that forgives dentists’ student loans if they spend a number of years in an underserved area.
The Monroe County Hospital found a dentist by teaming up with the University of Alabama at Birmingham’s dental school to send a dentist-in-training to its new clinic in Frisco City. A $144,000 grant from the Health and Human Services agency pays his modest salary and provided the clinic with expensive dental equipment and supplies.
Next year, the grant will drop to $65,000, then to $45,000 the following year as the clinic gets established and Medicaid income rises, said Pattie Crawford, development director for the Monroe Health Foundation.
Getting established won’t take long. On the Frisco City clinic’s first day in mid-November, Dr. Todd Chambliss saw 23 children and teen-agers who needed dental work. The next day, he saw 20, about the standard for many dentists’ offices.
The push for the clinic began more than a year ago, after school nurses and health department workers noticed that many kids never saw a dentist, even though they had tooth problems that seemed to worsen every year. The nearest dentist who would see Medicaid patients was in Thomasville or Brewton, both more than 30 miles away.
“We identified early on a serious lack of access,” said Jeanne Sewell, director of nursing for the health department that includes Monroe County. “I mean these were kids whose teeth were rotten to the gum; they had painful mouths so they weren’t eating right; they weren’t concentrating in school. It was bad.”
Sewell approached hospital officials, who worked with the Monroe Health Foundation and with UAB to apply for the grant. Chambliss, in his third year of pediatric dentistry residency at UAB, now comes to the clinic two days a week. To save time and money, the 33-year-old dentist usually spends two nights in a spare room at the Monroe County Hospital in Monroeville.
On a recent Tuesday, Chambliss saw one child after another, most of whom said they had not been to a dentist in years, despite pain in their mouths and holes in their teeth.
One of those children was 9-year-old Tevin McClain. His mouth had at least six cavities. A front tooth, broken in a fall, was in danger of becoming abscessed. Chambliss said that the boy would have to come back for extensive work.
“If I weren’t here, he’d probably get an abscess here and here and here,” Chambliss said, pointing to three distinct, yellow-brown holes in Tevin’s molars. “It’s just a matter of time.”
Until Chambliss arrived, Tevin’s mother, Jacqueline McClain of Frisco City, had to take her son all the way to Camden, a 50-mile drive, to see a dentist, she said.
Other communities have taken slightly different routes to bring dental services to underserved citizens. In east Alabama, the Opelika school system, with the help of local tax money, private donations and United Way funding, has established a dental clinic for elementary-age children. In southeast Alabama, Enterprise, through local and state funding, has set up office space and dental equipment, and hopes the higher Medicaid reimbursement will attract dentists to work on a rotating basis.
The governor’s office also has recognized the need for dental services in rural areas. In the spring, dentists who serve as Alabama National Guard members will be asked to devote some of their service time to treating patients in at least three counties: Marengo, Dallas and Perry, said Carrie Kurlander, spokeswoman for Gov. Don Siegelman.
As much as these locally based efforts are helping, they can’t reach everyone who needs it, local health officials say. The Frisco City clinic, for example, has to limit its practice to patients under age 21, per the rules of the federal grant, simply because the demand is too great otherwise.
The low-income adults of Monroe County must continue to travel many miles for dental care, or simply do without. Older residents on fixed incomes are especially vulnerable.
“What do the elderly do? Nothing. They don’t do anything,” the foundation’s Crawford said. “They lose their teeth.”