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The 2007 death of Deamonte
Driver, a 12-year old seventh grader from a Washington, D.C.
suburb, exposed yet another devastating contributor to the
wide gap in life outcomes between African Americans and
others. Deamonte
tragically died from complications from a tooth abscess
after his mother Alyce was unsuccessful in locating a
dentist who would accept Medicaid to treat his toothache.
Deamonte was treated at a
hospital emergency room for a headache, sinusitis, and an
abscess and sent home. He eventually died, however, when the
bacteria from the diseased tooth spread to his brain.
The youngster’s death exposed
the connection between oral diseases and other systemic
diseases and highlighted disparities in oral health and lack
of access to dental care for African Americans and other
minorities. Also historically overlooked is the fact that
tooth decay is the single most common chronic childhood
disease – five times more common than asthma, according to
medical sources.
Locally, the Dental Center of
Northwest Ohio is committed to addressing oral health
disparities and is an overlooked resource that is committed
to providing access to quality care for all, especially for
the underserved.
I spoke with Dental Center’s
executive director, Melinda (Lindy) Cree, and Lisa Lawson-LaPointe,
development officer, on this serious issue.
Perryman: Please tell The
Truth’s readers about the history of the Dental Center of
Northwest Ohio.
Lindy: We’ve been in business
going on 106 years. We were founded in 1910 by the Toledo
Dental Society and other community volunteers who felt that
there was a need for low cost dental care for folks that
were on lower end of the income bracket. And so we started
seeing mostly children. Then as we got more well known we
started seeing adults, and so right now children make up 50
percent of our practice and adults are the other 50 percent.
We see people that are living at or below 400 percent of the
federal poverty level, so we determined when the Affordable
Care Act passed that anybody who was eligible for a federal
subsidy should be able to come to the Dental Center and get
care that’s about 35 percent of what the average dentist
charges, so we’re very reasonable.
Perryman: If I’m correct,
dental coverage is an extra expense even with the Affordable
Care Act?
Lindy: Yes. So we felt that
folks who were below 400 percent probably were not going to
be able to afford buying dental coverage under the
Affordable Care Act. It’s still not affordable, and despite
what people say, dental coverage is not a real rich benefit
even when you have it. It’s usually capped somewhere between
$750 and $1500 a year, and if you have a family, you go to a
private dentist it could be $150 for each cleaning. You
could go through that $1500 in no time flat or if you have a
pair of dentures made, it’s more than gone. Most private
dentists are probably charging $1400 to $1500 just for an
upper denture, so we’re much more reasonable than that.
Lisa: I think it’s important
to note to that Lindy talked about 400 percent and below, we
also see a lot of patients who have Medicaid as their
insurance. We do accept self-pay, but I think the vast
majority of what we see are Medicaid-insured patients.
Perryman: So for those who
are self-pay or Medicare, which might as well be self-pay…
Lisa: Yeah, actually dental
isn’t covered with Social Security or Medicare.
Perryman: So you’re going to
be how much lower than dental care in a private practice?
Lindy: About 65-70 percent
less than a private office. For instance, on a cleaning for
an adult, it is $34. An x-ray is $5. An exam is $17, so an
adult can come here and for about $84, which is a lot of
money when you don’t have money, can get a cleaning and
exam, the necessary x-rays and a treatment plan and walk out
the door for that $84, whereas at a private office, they’re
probably paying upwards of $150.
Lisa: But keep in mind what
Lindy pointed out earlier was that we get the patients here
in crisis. They’re already in oral health crisis, and so
it’s not…we don’t see as much of the preventative as we do
the…
But someone can come in and
have an emergency exam and an x-ray and a tooth extracted,
for instance, for about $60. If you have a tooth extracted
alone at most private dental offices, it’s around $170. Plus
you can get a referral out to the oral surgeon.
Our dentists here are very
good at extractions and they will try just about anything
because there are six oral surgery private practices in the
area, but only two are really good at taking Medicaid, but
even they only do it like one day a month. It’ll be a year
before you get in there (private practice). And they cap the
patients that they’ll take. So access to private dental care
is very difficult and can be very expensive.
Perryman: Race and ethnicity
are significant determinants of oral health. There are wide
disparities, particularly in the health of black children
compared to others. Some research indicates that a major
contributor to the disparities is the underrepresentation of
minorities in the dental hygiene profession. The lack of
minority dental professionals contributes to a lack of
access by minorities, thus helping to fuel the disparities.
Let’s talk about your staff.
How many people do you have and how are they classified?
Lindy: We have about 85
employees, I’d say about 14 of them are dentists. Of those
dentists, only two are full time. The other 12, work private
practice and then work here anywhere from one to two days a
week. There are about six hygienists who make about a little
over three full time equivalent dental professionals.
The largest group of our
employees, which is about 21 or 22, are dental assistants,
and they go through a special training program post high
school. So it can be anywhere from 12 weeks to nine months
of training where they learn about the structure of the
tooth and tooth surfaces and dental materials and
instruments, and they assist the dentist. They can suction
the spit as somebody is having work done, pass instruments,
mix materials for the filling and take x-rays. They’re sort
of a paraprofessional group, I guess you would call them,
but each dentist is given two rooms and two assistants, so
they have an assistant for each room who stays with the
patient and who makes sure that things are going well, and
frequently a patient may be more likely to share the truth
with the assistant than with the doctor, so the assistant
can be a great resource for the doctor in truly
understanding the patient and the patient’s needs.
And then we have clerical
staff who, check patients in and check them out and make
appointments, call patients to schedule appointments or
confirm them. We do have a denture lab in here, so we make
all of our own dentures on site. That enables us to have a
quicker turnaround time for patients so that they’re getting
their dentures more quickly. And then the administrative
staff people, like me and Lisa and Jamie, and an HR person.
Perryman: You have a mobile
operation also?
Lindy: We do. We have a 40
foot motor coach, it has two exam rooms and treatment rooms
and that goes out to basically the 18 county service areas
that we have, mostly rural areas, but other things too, like
group homes or nursing homes, assisted living, head start
programs, all of that kind of thing.
Perryman: Please talk about
the diversity of the staff.
Lindy: It’s a very diverse
staff. I would say that most of the dental assistants, well
over a half are probably African American. We have a pretty
good representation of Hispanic, Latino individuals, and
some Asian, Middle Eastern, so we represent, I think, a very
fair representation of the communities that we serve,
particularly here in Toledo. Right now, we do not have any
African American dentists, although we have in the past. We
do have a number of Ohio State University senior dental
students, who rotate through the Dental Center, and so
they’re here for a two-week rotation, so that adds to the
diversity of the patient base, but I think we are very
reflective of the folks that we serve. And I think it’s a
wonderful career for the young people with a high school
education, but who really can’t afford six to eight years of
education, because you can be a hygienist with a two-year
degree from Owens Community College. You can be a dental
assistant with a certificate program that you can graduate
in a maximum probably of nine months, but from then on it’s
a good salary.
Perryman: What type of salary
could African-American dental assistants or hygienists
expect to make?
Lindy: Salaries are probably
anywhere from $11 to $24 an hour depending on the
credentials that the assistant has, and it’s not huge, but
it’s a respectable salary without a four-year college
degree, and there is always work.
(to be continued)
Contact Rev. Donald Perryman, D.Min, at
drdlperryman@centerofhopebaptist.org
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