For many of us, the impetus for scheduling a visit to the dentist runs along a sliding scale of discomfort, ranging from a slight sensitivity to ice cream to the relentless throb of pounding toothache. But regardless of our individual thresholds for pain or apprehensions about hearing the dentist’s drill, many of us are fortunate enough to get dental work done on our own terms, which usually means as quickly as we need it.
Not so for most of Missoula’s low- and moderate-income residents, whose limited access to dental care has reached such critical proportions that they may be forced to wait several months before ever seeing dentist, by which time their problems can become more critical and the pain unbearable.
Consider, for example, the case of Dean Yates, a patient at the Partnership Health Center’s dental program in Missoula, a non-profit community health clinic for people with low incomes or insufficient health insurance.
“I came here initially on an emergency. I had an abscess and it was really severe,” says Yates. “I had a 102 temperature and an unbelievable amount of pain. They got me in about four days later and they extracted the tooth. They saved me, I’ll tell you what. I didn’t have the money for a dentist.”
You might say Yates is a typical patient for Partnership Health Center. He was, as he put it, “a starving student” who had never been to a dentist before his 35th birthday. This summer, when his emergency arose, he was unemployed and had no health insurance to cover his dental costs.
But this week, Yates was back at the Center getting a few fillings, thanks to a $100,000 grant from the Chutney Foundation, a charitable foundation established by former Ovando ranchers Thomas and Cora Barbour to serve the needs of the Blackfoot Valley and the institutions serving those communities.
“This was an incredible gift to us from the Chutney Foundation,” says Karyn Collins, director of Partnership Health Center. “To have the need for access to dental care acknowledged by a local foundation for us was really important. This was really heart-warming.”
As Collins describes it, that need is considerable. About 82 percent of their patients are at or below 150 percent of the poverty level. Most of them do not have health insurance, and only a very small percentage are served by Medicaid or Medicare.
Nevertheless, relief does not always come as swiftly as the patients or the providers would like. As clinic coordinator Joan Beebe points out, with more than 800 people on a waiting list to see a dentist, the clinic sees only about six new patients a week, not including emergency and return visits. As a result, patients are ranked in order of priority. Children are given a higher priority, as are diabetics, whose conditions can become life-threatening if left untreated.
Ironically, publicity for the dental program can be a mixed blessing. When Partnership Health Center opened its new building last April, it received plenty of media attention—and many more patients for its dental waiting list. And although the clinic is a division of the Missoula Health Department, it receives no direct public health dollars and must rely exclusively on other funding sources, as well as a pool of all-volunteer dentists, hygienists and assistants from the Missoula area.
“We need to continue to fundraise for this program,” says Collins, who emphasizes that the Chutney Foundation grant, though generous, will be spread over a five-year period and will only go so far in filling the gap left when a two-year federal grant expires this year.
“The need for dental care in Missoula is almost like a bottomless pit for low-income and uninsured folks,” says Collins.
The same—or worse—can be said for dental care throughout Montana. A report issued in November by the Montana Dental Association (MDA) found that Montana has only 466 practicing dentists, or one dentist for every 1,888 people, a ratio well below the national average. Such shortages are further compounded by a decline in the annual number of dental school graduates and a decrease in both the size and number of dental programs nationwide.
The MDA study also found that many Montana communities, especially those in rural areas, are losing dentists to retirement and other economic pressures, such as higher salaries paid in larger metropolitan areas and Medicaid reimbursement rates that have not kept pace with rising expenses.
Thankfully, Missoula has fared better than some areas of the state.
“I think [Partnership Health Center] is a great service. A lot of people here don’t get dental work because the cost is way too overwhelming,” says Ryan Huckeby, a volunteer dentist at Partnership Health Center who moved from Portland to Missoula six months ago and only recently learned how bad the problem was. “I mean, I knew it was bad, but I didn’t realize it was that bad. So I feel really fortunate that I can help out.”
For Huckeby, who volunteers about one day a month, his time may not seem like much to him. But for John Cash, a sheet metal journeyman who was laid off last year, has no health insurance and had an appointment this week to have three teeth extracted, “The important thing is I won’t be in pain.”
Were it not for Partnership Health Center and the Chutney Foundation grant, Cash puts it succinctly: “I’d be buying a lot of Advil.”