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Stanton Center patient Veronica Forrester of Annapolis talks with Dr. Sullivan during her check-up.

Devoted dentists help the uninsured
By Karen McLaughlin
Photos by Kimi Raspa

Certainly, many of us dodge the dentist's chair. For some, it's an anxiety second only to public speaking. And let's face it-that soothing music in the dentist's office is also accentuated by the whirring of a drill. But for thousands of people across Maryland, sitting in the dentist's chair would be a blessing. They don't fear the drill, they fear the bill-a bill that, without insurance, can be nearly impossible to pay.

When Dr. Neil Sullivan, chief of oral surgery at Anne Arundel Medical Center (AAMC), saw the need for services for the uninsured, he organized a way to make a difference. Last March, after 3 years of planning, a free dental clinic opened up in the Stanton Center on West Washington Street in Annapolis.

"This would not have happened without the support of the AAMC Foundation," Dr. Sullivan says. "They came to me. That's where this all started."

Filling the Gap-and the Cavities

The Stanton Center's free dental clinic serves Anne Arundel County residents age 21 and over who meet income guidelines and are without insurance. The facility boasts new donated equipment, including two chairs and an x-ray area. On the third floor of the former Stanton School, the clinic looks almost like any other private practice. Simple and without frills, the waiting area is clean and open. Patients are met by a friendly staff member at a front desk window. Inside, the clinic is bright with fluorescent and natural lighting. Dr. Bonny Mitchell, a dentist who volunteers at the clinic, is pleased with the new facility.

"It's state of the art," she says. "It's sterile, clean. I would go and have treatment done there."

At present, the clinic is open on Wednesday afternoons and Friday mornings. Sullivan hopes that the hours will expand, but right now he is trying to keep up with the need. Fortunately, he says, more dentists are volunteering every day. Currently sixty dentists have offered their time and expertise.

"The need is exceeding our expectations," says Sullivan, "but the volunteerism is exceeding our expectations too."

Nothing to Grin About

Why are there so many patients without insurance or the means to pay for dental care? Many low paying or part-time jobs do not provide dental insurance, and for many working people with limited income, energy bills and other expenses take priority. Dentistry, especially without insurance, can be considered a luxury instead of a health issue. An Anne Arundel County Department of Health survey found that, out of the 23 percent of respondents who hadn't seen a dentist in the past year, 53 percent said it was because they didn't have insurance. The Stanton Center Clinic targets that population and is the only free clinic in the area.

"(We're) the only clinic for the working poor, people who live paycheck to paycheck," Sullivan says.

Mitchell, the first dentist to volunteer at the dental clinic, says that most underserved patients have dental problems that started small but later became aggravated by the lack of professional care.

"They are like anyone else. Most of them take care of their teeth the best they can at home," she says. But when patients get a cavity or need dental work, "it doesn't get taken care of and little problems can lead to big ones," such as advanced tooth decay, toothaches, and infections, Mitchell explains.

That, in turn, can spell more health problems. For example, the inability to chew properly could lead to poor nutrition. According to a study done by the University of Maryland, Baltimore County, for the Robert Wood Johnson Foundation,* poor dental health may exacerbate underlying medical conditions, such as heart disease, hypertension, and diabetes. The study also indicates that three out of five uninsured adults who have a chronic condition also lack annual dental care.

The Stanton Center in Annapolis

Location, Location

Most patients who go to Anne Arundel Medical Center's free dental clinic at the Stanton Center live close by. Many of the dental patients first go to AAMC's Annapolis Outreach Center to receive medical care and are referred to the free dental clinic on the next floor.

Dr. Scott Finlay, a dentist with a private practice in Arnold and a volunteer with the American Academy of Cosmetic Dentistry's national Give Back a Smile program for victims of domestic violence., was also one of the clinic's first volunteers.

"Neil's (Sullivan) done a fine job. Annapolis is such a growing community that we call home . . . our responsibility is to provide good care to our patients and to reach out to those who don't have access to dental care."

Finlay agrees that the clinic's location makes it unique and serviceable to those who need it. He notes that many programs, including reduced-rate ones supplemented by local government agencies, require the patient to reach a participating dentist's office. That isn't always feasible, he says, due to transportation problems or even privacy issues. The Stanton Center's clinic, he says, put the care in the neighborhood where it is attainable to the people who need it.

That location is a great service to the dentists too, according to Mitchell, who has a practice in Davidsonville. She has done dental work in missions abroad, but now she can do the same type of work just a few miles away. That's an advantage, she says, now that she has a 2-year-old.

"It's the same feeling that you get, same satisfaction, but close to home," Mitchell says. "So many (dentists) have wanted to volunteer, but there wasn't a place for it."

Mitchell is scheduled to visit the clinic again in the fall, and she's offered to volunteer a total of 4 days this year.

Specialty Dentists Open up Their Offices

Not all donated work is done at the clinic. More complicated procedures are referred to participating dentists who are happy to donate their services.

"For the last 15 years or so I have participated with a group of dentists who have volunteered to go to Nicaragua, Costa Rica, and Panama to do free dentistry and surgery on people who don't have access to care," says Dr. Clifford Walzer. "It became apparent that we have the same problem right in our own backyard, and when the Stanton Center opened, it was just a given that I extend my participation to those in need locally. Since they are not as well set up at the center for surgery and since my office is literally just down the street, I treat those patients referred for surgery in my office."

Child Smiles: Ages 21 and Under

Annapolis dentist Dr. Kathy Farley is one of many dentists scheduled to donate some of her time to the adult patients of the Stanton Center clinic. But she also provides dental services for underserved children. Every year for the past 10 years, Farley has provided a Children's Dental Day for Anne Arundel County children who don't have insurance. On that day, approximately 40-60 children come to her office, by appointment only, for exams, cleanings, fluoride treatments, extractions, and fillings, as needed. Although Dr. Kathy J. Farley and Associates is an adult-based practice, Farley says that they do it to give back to the community.

"A lot of kids have never been to a dentist," she says. "Their parents aren't aware (of resources available to them)."

The office strives to make the day fun and comfortable for the visiting children, because many of them are not sure what to expect. On Children's Dental Day, Farley's office is filled with clowns, face painters, and an interpreter who speaks Spanish.

Shirley Wells works as a receptionist at the Stanton Center Dental Clinic

"It's a very crazy day," Farley laughs.

But it's also very rewarding. One year, an 8-year-old with a severe jaw infection came in. His infection was a result of a gunshot wound that happened when he was 4 years old. After treatment at Farley's clinic, he was referred to an oral surgeon, who treated the child's jaw.

"It's amazing what we see," Farley says.

Last year, on the 10th annual Children's Dental Day, a special visitor stopped by to recognize the program. Maryland's first lady, Kendel Ehrlich, visited with the children and presented the program with a proclamation from the governor.

"It was nice to get recognition for doing it for 10 years," Farley says. But she and her associates, Dr. Heather Ruland and Dr. Holly Bidwell, who also donate their time, equally appreciate the little rewards that come with offering such a program.

"It's incredible. They are the best-behaved kids. It's so rewarding. They appreciate what we do so much. We all love this day. You get lots of hugs," says Farley.

Slide into the Chair: Reduced-Rate Services

Farley refers some patients who might be able to afford care at a reduced rate to an Anne Arundel County program. This program offers services for county residents under age 21 on a sliding fee scale as well as under some Medical Assistance plans. It also provides services, such as fillings, to children under age 6. The county also offers oral health education, cleanings, and screenings to pregnant women under age 21 at the department's clinics. They can also learn about the prevention of bottle tooth decay and other pediatric health concerns through the program.

The county's Gray Area Dental Access program works with local dentists to provide services to eligible patients age 21 and over at reduced fees. The program interviews patients for eligibility and refers them to a participating dentist. For older residents, the county also offers biannual oral cancer screenings at local senior centers.

For people with disabilities, Donated Dental Services (DDS ) matches dentists with those who need assistance through the National Foundation of Dentistry for the Handicapped. Says participating dentist Jay McCarl of the McCarl Dental Group, "While we can't help everybody, the people we do help can really change their lives by being able to eat properly and smile from their hearts. It's very gratifying."

Baltimore offers its share of services for the uninsured, too, through the University of Maryland, Baltimore. The university's dental school offers a student-run clinic for patients ages 21 and younger. The first appointment costs $45, a screening fee. Then the clinic assigns the patient to a dental student, who puts together a treatment plan. The university also offers an emergency walk-in clinic, open Monday-Friday at 7 a.m. The emergency walk-in clinic costs $40 to be seen; an extraction runs about $45 or more, depending on how complicated the procedure is.

Beyond the Basic

What happens when a patient needs braces or dentures? Often, for those whose dental care has lapsed because of limited means, other needs might be impractical and possibly out of reach. Many patients need basic care first; straightening or whitening are not priorities for them, except in some extreme cases. Although the Stanton Center's dental clinic is not able to provide dentures, it is in the process of securing help from dental volunteers, including those at the University of Maryland, to make dentures for qualified patients. According to Farley, underserved patients' needs go one step at a time.

"If they can't afford cleanings or sealants, if you put braces on them you're asking for problems," says Farley.

Clinics such as the one at the Stanton Center seek to provide basic care so that the underserved can be free of pain and infections. The clinic's ability to attract volunteer dentists who want to help provide that care is no mystery to Mitchell.

"Everything Dr. Sullivan does is first class," she says. "They know if Neil (Sullivan) is presenting something, it will be worthwhile."

* The Robert Wood Johnson Foundation commissioned researchers of the Department of Public Policy of the University of Maryland, Baltimore County, and the Health Policy Center at the Urban Institute in Washington, D.C. Details of the report can be found at www.CoverTheUnInsured.org.

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Dental Clinics

For information about Annapolis Outreach Center's dental clinic at the Stanton Center, call (443) 481-3599.

University of Maryland, Baltimore, College of Dental Surgery:
(410) 706-7101, patient care coordinators: (410) 706-8127

Anne Arundel County Department of Health Dental Health Services
J.Howard Beard Health Services Building
3 Harry Truman Parkway
Annapolis MD 21401
Monday-Friday, 8 a.m.-5 p.m.
(410) 222-7138

North County Health Services Center
791 Aquahart Road, Second Floor
Glen Burnie MD 21061
Tuesday, Friday, 8:30 a.m.-4 p.m.
(410) 222-6861

Dr. Kathy J. Farley & Associates
600 Ridgely Avenue Suite 217
Children's Dental Day
by appointment only: March 9, 2007, from 8:30 a.m.-3:30 p.m.

Donated Dental Services Program
6410 Dobbin Road
Columbia, MD 21401
(410) 964-1944
contact person: Nancy Messick-Evans