DENTAL CARE DILEMMA
By Kelly Retan

For Sandy Buck, 62, of Champaign-Urbana, getting dentures was not an easy task.

In February of 2003 she realized she desperately needed new upper dentures, and at first she was not sure how she would pay for them. Then she discovered Donated Dental Services. She filled out an application, sent it in, and waited. She knew it was going to be a while because they told her it would. By the time she had new dentures in her mouth, nine months had passed.

A few months into waiting for her upper dentures, her bottom dentures broke. She called around town in a panic, trying to find dentures she could afford. Eventually she found Affordable Dentures in Decatur. They make them for as low as $190 as long as patients pay up front.

Buck brings in only $930 a month from her part-time job at Stevick Senior Center and through Social Security-she is a retired nurse. She has few options for receiving dental care. "I have enough to get by," she said in an interview. "But I still can't afford insurance." Even looking ahead three years to Medicare, her options will not increase. Medicare does not pay for dentures or most other dental care.

Dental care is sorely lacking for seniors in America. For every adult without medical insurance, there are three without dental insurance according to the U.S. Department of Health and Human Services. And only 22 percent of seniors are covered by private dental insurance according to a study by the Centers for Disease Control and Prevention. They often lose those benefits when they retire. Seventy-nine percent of dental costs by seniors are paid for out-of-pocket in the United States, but seniors often have a difficult time paying for that care. Many are on fixed incomes through Medicare.

Unless people are under the age of 18 or have dental insurance in Champaign-Urbana, payment for dental care usually must come up front and out of pocket.

It is not as if seniors do not need dental care. They often have gum disease and cavities that lead to tooth loss, according to the National Center for Chronic Disease Prevention and Health Promotion. About 23 percent of 65- to 74-year-old seniors have severe gum disease. About 30 percent of adults 65 years and older no longer have natural teeth.

And the number of seniors in the United States is increasing rapidly. Nearly 35 million Americans are currently 65 years or older, and by 2050 the number is expected to increase to 48 million according to the Bureau of the Census in 2000. More and more seniors will need dental care in the coming years.

Buck is an example of a person about to reach her senior years who will need dental care as she gets older. Specifically, she will need new dentures every 10 years or so. Last year she looked to Donated Dental Services for help. It is a national program designed to get free dental care to the disabled and elderly populations in the United States.

Just as Buck did, people interested in participating call to get an application. Because the program receives a large volume of calls, they cannot approve every application. While there is no magic formula to qualify, said the program coordinator Jennifer McKeag, 31, in a phone interview, they look for people who are not earning enough money to pay for dental services and who are in need of a lot of dental care.

"We look for patients with more extreme needs," McKeag explained.

Approved applicants like Buck are put on a waiting list. In Illinois participants typically wait about six months, said McKeag. In March 2004 there were 12 people on the waiting list in the Champaign-Urbana area. Once people leave the waiting list they are matched with a dentist and receive comprehensive care-with one big catch. The program is designed for one time use. Participants get all the dental care they need at that time over a series of appointments. Then they are sent on their way. Donated Dental Services coordinate services but do not provide ongoing case management for participants.

A careful screening process is used because they simply cannot help everyone. "We don't have a ton of participating dentists," McKeag explained. Dentists who participate in the program donate all of the care they give to the participants. Laboratories donate all supplies, as they did for Buck's dentures.

The length of time on waiting lists varies from community to community depending on how many dentists participate. In Champaign-Urbana, five dentists and four oral surgeons are currently involved in the program. Typically the more affluent the community, the more dentists choose to participate in it, McKeag mentioned.

A lot of dental resources exist in Illinois, McKeag said. They are all taxed a great deal. The situation is not ideal. There are waiting lists. All patients cannot get all the care they need.

The majority of participants in Donated Dental Services are not seniors. While she knows of participants in their 80s and 90s, McKeag said the majority of participants fall between the ages of 21 and 60, and many suffer from chronic mental illness.

Donated Dental Services is also not designed for emergency service, McKeag mentioned. She does get calls from people who are in severe pain. All she can do is refer them to the emergency room at a hospital. She realizes this is hard on emergency rooms. They are meant for true emergencies. While it is unusual for dental problems to be life threatening, there is nowhere else to send people with acute dental problems.

For a lot of seniors mouth problems become so pronounced that it makes more sense to simply have the teeth extracted and to get dentures.

"They find out how much it is going to cost to restore the teeth they've got, and it's too cost-prohibitive," said Dr. Scot Brewer, 46, of Champaign-Urbana Denture Services in an interview. "You could spend five to ten thousand dollars on your mouth without batting an eye, with crowns and root canals, and all that fancy stuff."

Brewer does not do any of that fancy stuff, at least not anymore. When he was vacationing in the south a little over 10 years ago he noticed denture clinics peppering the communities. "The more I looked into it the more I realized that in this area a denture clinic would go over big…and it has," he said.

Brewer saw a niche and filled it. His fees are drastically lower than everyone else's since dentures are all he does.

"It's just like Midas muffler," said Brewer. "They can sell mufflers for cheaper than Chevrolet can. They specialize. They do one thing and they keep their costs down. We have our own in house lab. We make the dentures here. Most other offices send out to have lab work done. We just keep it simple, make it all on site, keep the prices way down."

Brewer mentioned that because many seniors do not have dental insurance, they cannot afford most dentists' prices. The average cost of a denture at a regular dentist is $1,200 a plate, and $2,400 for the set. Brewer makes them for $300 a plate and $600 a set.

His prices are so low that usually people find a way to come up with the money, Brewer said. Sometimes people do only one denture at a time. Brewer discourages it, but sometimes people get the upper denture and then wait three months to get the lower denture. Some people drop off $50 or so a month with every paycheck and build up an account. When they hit $300 they make the appointment and get the denture.

Buck is not entirely happy with the bottom dentures she got from Affordable Dentures in Decatur for $190. "To tell you the truth," Buck said in an interview, "they're not that good of dentures. I went back five or six times because I had sores, really bad sores." She bought the "economy dentures." Some clients invest in "premium dentures" that cost as much as $435 a plate. She could never have afforded those. The upper dentures she received through Donated Denture Services would have cost $1,100 if they were not donated. She has not had any problem with them thus far. She just wishes she could have gotten them sooner and that Donated Dental Services was more than just a one-time service.

Not all seniors need dentures. Brewer once had a 103-year-old client who came in only for partial dentures. The rest of her teeth were intact. Some seniors need good, old-fashioned dentistry work: fillings, cleanings and root canals. But not a lot of resources are available in the community for dentistry for low-income people, Brewer said. With Donated Dental Services a person may not qualify, and if they do they must wait many months.

Another route for dental care for low-income people in Champaign-Urbana is the Champaign County Health Care Consumers Dental Referral Program. The program consists of a hotline that helps low-income people get set up with a dentist at discounted prices. There are three eligibility levels. With the first level people pay 40 percent of what usual clients pay at the dentist's office, with the second 60 percent, and with the third eligibility level they pay 80 percent.

"The majority of people actually fall into the first category," said Janna McGregor, 26, the hotline coordinator for the program. "That requires you to be at the federal poverty level, which for a single person is $8,860 a year."

When people call and qualify for the program, McGregor refers them to one of the three participating dentists. They get an appointment with that dentist and then consult with him or her. The client and the dentist figure out what absolutely needs to be done versus what the client can afford, even with the discount.

"People generally can't afford to have everything taken care of," McGregor noted.

The Health Care Consumers hotline is not only for dental calls, but they end up being about half of the calls they get on the line. McGregor thinks this is phenomenal. "Most other types of calls we'll get at the most five per month, but with dental calls we get in the 30s up to 40s every month. That's at least a call a day."

The program is not as comprehensive as McGregor would like it to be. While they have three participating dentists, no oral surgeons in the area have agreed to get involved, and in her experience, oral surgery is what a lot of people need.

"People will ignore dental problems because they don't seem problematic until they're acute, and by the time they're acute, people have problems that can't be solved," McGregor said. "They just need to have the tooth extracted."

While most people who call qualify for the program, some do not. "People do call us and think we can solve all of their problems but unfortunately we can't," McGregor said. If people do not qualify McGregor must refer them to a dentist and send them on their way.

If seniors call and do not qualify for the program McGregor mentions that Medicare will cover a visit to the doctor to treat an infection. Many of the clients that call the hotline do not know Medicare will cover that kind of visit.

"That's something that can be done very quickly to help ease the pain a little bit before they can get to someone," McGregor said. "The doctor will prescribe an antibiotic." But this is basically a band-aid. The person still needs to see a dentist.

A possible route to dental care for some low-income and disabled seniors is the Medicaid program. Over 150,000 seniors aged 65 or older were eligible for Medicaid in Illinois in 2001 according to the Centers for Medicare and Medicaid Services Web site. The program covers acute dental needs like fillings and dentures, but there is a big catch. Most dentists do not take Medicaid. Only two dental practices in the Champaign-Urbana area currently take it: Drs. Phillip and William Jones in Villa Grove and Dr. John Karich in Mahomet.

Illini Dental in Champaign sometimes takes Medicaid but they go on and off the program, Brewer said. "They get too swamped and they back off for a few months to a year, and then they go back on it."

Dr. Phillip Jones, 29, of Villa Grove has a private dental practice with his father Dr. William Jones. They have been taking Medicaid for many years. Phillip Jones said in an interview that they sometimes get into a cycle where Medicaid patients take up almost the entire schedule. Some of them need a lot of work and it takes four or five visits to get everything fixed.

But the main reason dentists do not take Medicaid is that it just does not pay well. Phillip Jones said they only end up getting about half of their normal fee with Medicaid patients. If the Medicaid program paid dentists the same as their other patients, more dentists might take Medicaid. "If they paid 100 percent, I'd love them all to come, cause then it's 100 percent guaranteed money because the state would come up with it," said Jones.

Medicaid currently does not pay even close to the same amount dentists get from other patients. The Illinois Medicaid dental program also reduced the reimbursement rates by 6 percent in 2003, and more cuts are possible during imminent legislative sessions, according to Oral Health America.

Phillip Jones knows dentists who signed up for Medicaid but changed their minds when the budget cuts went through. "They're already only getting half the money, and then you cut 6 percent off of that; it's a break-even deal at best," Jones said.

Jones thought he and his father might stop taking Medicaid if there are more cuts. "Right now the number of Medicaid patients we see are 20 percent of our patients, which we could fill with regular patients right off the bat," Jones said. If they started losing more money they would definitely have to cut it. When the government cut 6 percent last year they saw only one Medicaid patient a day for a while. It was a short-term protest and now they are back to seeing all the Medicaid patients right away.

Medicaid changes happen quite a bit. "Things fluctuate a lot, and right now we're in a bad state as far as the economy goes," McGregor said. "When the economy is bad, social services agencies suffer and they rearrange Medicaid. We'll see things like Illini Dental no longer taking Medicaid patients."

Lisa Bell is the coordinator of the Champaign County Health Department Dental Access Program for children in Champaign-Urbana. Her program reimburses dentists at a higher percentage than the state does for Medicaid. They also reimburse in about two weeks ("It takes forever to get paid from Springfield," Brewer said.) and dentists have only one local number to call if they have questions or problems.

"A lot of providers have jumped on board," Bell said. The fact that dentists are willing to get involved in the Dental Access Program shows that many do want to help people in the community with dental care, she said.

The Dental Access Program is only for people under the age of 18. Bell often has a hard time explaining to families that she can get free care for the children but there are almost no resources available for the parents and grandparents. "It's difficult to talk to a family about nutrition habits when mom and dad struggle with abscesses and infection," Bell noted.

Another important dental service is available to adults in Champaign-Urbana-the Parkland College Dental Hygiene Clinic. As students learn to become dental hygienists at Parkland College they work on real patients from the community. The services only cost a flat fee of $10. Senior citizens are welcome. Since the appointments can take as long as four hours, seniors are often the people who take advantage of the service because they sometimes have more time during the day than working people.

Seniors are also good patients for other reasons. "We want to create a situation that's realistic for the students," Mary Emmons, the co-director of the program said in an interview. "The elderly present that for us. They also dental-wise present the characteristics of a mouth that has been living 80 years with the tissue being very thin and delicate."

Students are required to see a certain amount of patients over 65. They are required to see a variety of patients so they get a feel for the real world of dentistry.

The services at Parkland College can be very helpful for seniors with low-incomes. People can get a dental assessment, get their teeth cleaned and get X-rays for only $10.

The enormous catch, of course, is that cleaning is all these students do. "We do what we can to help the person, but we make it to the point where we say 'I'm sorry, we can't do it for you. It's too extensive,'" said Emmons. "We ask them to go find a dentist that can help them. And, of course they probably don't. Most of the time they can't afford it."

Emmons lamented the lack of dental resources for adults in Champaign-Urbana. She mentioned the tendency of people to visit the emergency room to treat toothaches. "There is nowhere else to send them," Emmons noted. "The emergency room doctors will tell you about patients they see that are in pain, but they can only give them antibiotics and pain medication."

The dental hygiene clinic at Parkland College cannot solve all the dental problems in the community. They are not set up for operative dentistry. "We're here to teach students how to be dental hygienists," Emmons said. "That's a problem to use an educational facility to provide public health care."

Emmons has been on committees and task forces to address the problem of adult dental care. She has given numerous interviews about the topic. She is frustrated that nothing ever seems to come of her efforts.

She can think of possibilities for getting care to adults. "If the Public Health District that treats children could open in the evening and treat adults we would be in good shape," she said. "That's the purpose of the Public Health District and that's what our taxes pay for."

The dental resources for adults in town - the Champaign County Health Care Consumers hotline, Medicaid, Donated Dental Services, Brewer's low-cost dentures, and Parkland College Dental Hygiene Clinic - all provide worthwhile services. But they also almost always come with a big catch that means they cannot help everyone. People like Sandy Buck will wait seven months and have to solve minor emergencies themselves, scrounging up the money to pay for "economy dentures" that may give them sores. Others will simply do without.

"It's embarrassing and it shouldn't happen in this day and age that we can't get basic restorative care for anyone over 18," Emmons said.

Buck does not know where the money for her next dentures will come from. She does not want to buy "economy dentures" again from Affordable Dentures in Decatur and she cannot use Donated Dental Services because they only provide a one-time service.

"It's such a crisis," McGregor said. "Every day I think about how many people don't have access to dental care, and how critical it is not just for your physical health but for your mental health. I really feel as if we all need to kick in and work on this. It's not right for so many people in the community to have this problem.