Public dental system works to expand equitable access to care

Preventive dentistry could save hospitals $1.7 billion.
In MCDC’s Kentwood office alone, there are 17 different languages spoken by patients in a given day. Courtesy MCDC

My Community Dental Centers is sounding the alarm on disparities in dental health among West Michigan residents.

Dr. Eric Cao, a dentist serving out of MCDC’s Kentwood office, has been in the public dental practice for more than eight years. He has served numerous communities throughout Michigan, including Greenville, Big Rapids, Hart and Muskegon. Cao said much of the same racial and class disparities in medical care carry over into dental care as well.

“In West Michigan we’re blessed to have a lot of resources and organizations that are able to help — Bethany Christian Services, the Catholic Diocese, God’s Kitchen, Mel Trotter — all of those are really great entities that help funnel patients into our offices for care,” Cao said. “But we still have a lot of disparities with language barriers. A lot of refugees are coming over.”

In MCDC’s Kentwood office alone, there are 17 different languages spoken by patients in a given day, Cao said. Transportation reliability, especially during the winter, also is a barrier to accessing quality dental care.

“We don’t fault the patients when they call saying, ‘Hey, the buses are running late.’ I get it,” Cao said. “We don’t want to have that as an obstacle for patients to come in.”

In many cases, patients don’t even know they have certain coverage, Cao said. Part of MCDC’s mission is to educate patients about their existing coverage options.

“We get a lot of referrals from Spectrum and Metro Health hospitals for dental-related emergencies,” Cao said. “A lot of that could have been easily mitigated if the patient knew they had coverage … instead of thinking, ‘Oh no, I can’t afford this,’ in reality they had coverage all along.”

Access to dental care doesn’t just impact the health of one’s teeth. Good oral health is critical to one’s overall health and wellness, and dental professionals for the past few decades been pushing for preventive care, rather than just reactive care, Cao said.

“A toothache can ruin your day,” Cao said. “We see it all the time where patients are like, ‘Oh, I had a toothache three months ago, and I kind of put it off.’ And it just got to a point where it’s affecting their daily life. They can’t think straight. They’re missing work. It affects more than the one tooth. It affects the entire body.”

MCDC’s Kentwood office sees a number of minority groups seeking emergency care, Cao said, and the office has refocused its efforts into educating the community to come in before greater problems happen.

Providing the best possible care for underserved communities also promises financial returns for health care overall. According to a 2010 study from the American Dental Association (ADA), 20% of emergency visits to hospitals were dental in nature, accounting for $2.1 billion in health care funds. The ADA estimated if those dental emergencies could have been prevented, it would have saved about $1.7 billion.

“We could have done quite a bit to increase benefits and made it a little bit more sustainable to see patients with Medicaid, non-cover payers and stuff like that, so we could do a lot with $1.7 billion,” Cao said. “And that’s just one thing we can do to keep patients out of the ER.”

Environment and lifestyle also factor in to one’s overall dental health. Cao said people who use city water, which contains fluoride, have a lower chance of developing cavities than those who use well water.

Additionally, people who already are missing teeth tend to go for more chewable foods that are higher in sugar and carbohydrates, thus exacerbating their poor dental health.

“It’s kind of a vicious cycle that’s detrimental to your teeth,” Cao said. “Because the bacteria that live in your mouth love that type of environment, and that’s where the cavities come from.”

Lack of access to proper nutrition, particularly fresh fruits and vegetables, is a problem in urban cores, Cao said. It’s harder for residents of these communities to reach an actual grocery store, as opposed to buying cheap, high-carbohydrate food from a convenience store.

MCDC also works to address these multiple barriers to equitable dental health on the state level. The company’s chief of governmental and community affairs, Kim Singh, has been working to expand access through increasing budgets for Medicaid and the Healthy Michigan plan, as well as cross-collaborating with state and local partners to create awareness and education.

“Each community we serve is different,” said MCDC Marketing Manager Ashley Bodien. “We know that it takes not only the state level but also local — local level being education, breaking down some of the barriers of education, creating pathways to connect with local organizers, whether it’s Mel Trotter, Bethany Christian Services, local schools — where we can create an access point about the importance of preventive care.”

Cao said while it can be improved upon, West Michigan does benefit from a better transportation system, compared to communities like Big Rapids or Hart, which have no bus systems at all.

“Even if it’s negative three degrees out, we have patients that walk to our offices, because there’s no other way to get to us,” Cao said. “We’re blessed, and we’re also kind of cursed for that, because it’s one of those things where patients know they can get to us, but it’s trying to make it more of a priority … going back to that education of being preventive, rather than reactive.”

In West Michigan alone, patients have almost a dozen dental offices, not just MCDC, to choose from if they have Medicaid or no coverage at all, Cao said. But because of that choice, the urgency on the patient’s part isn’t there until it’s too late.

“One of the things I’ve noticed — traveling and being around different areas — in Greenville, for instance, patients know if they’re coming in for emergency care at 8 o’clock, they’re lining up at 7:30,” Cao said. “Within Kentwood and Grand Rapids, patients get there anywhere between 8 and 2. They’re not lining up unless there’s a true emergency, and at that point, those patients are calling and banging down your door trying to get in sooner than later.”

Access to care also requires having the clinical staff to support the need for care, Bodien added, particularly as the state continues to suffer the ripple effect of COVID-19 and unemployment issues.

“Often it’s breaking down the myths and misconceptions of public, mission-driven care,” Bodien said. “Just because we are a mission-driven organization doesn’t mean we don’t provide quality care, doesn’t mean we don’t provide great technology, doesn’t mean we don’t provide these great benefits and opportunities for our staff and our patients.”

“A lot of dental students do rotate through offices within community and public health, and they get to see the disparities firsthand,” Cao said. “But to get those individuals to also serve in those communities, because of the outrageous and unbearable amount of student loans kids are coming out with nowadays … unfortunately you can’t focus on the amount of money you’re making at the end of the day. Being able to provide good, quality care for patients … everything else will fall into place.”

My Community Dental Centers is a full-service public dental system offering regular checkups, cleanings, ongoing treatments and more. Care is available for patients from all walks of life, including those who have Medicare or no coverage at all.

The organization operates 34 locations throughout the state of Michigan.

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