Back in 2005, Missouri de-funded dental care for all Medicaid recipients except, children, pregnant women and the disabled. And it’s left a lot of people with only bad options.
Many of them find themselves in the ER with tooth infections, where cost for treatment per patient can run on average around $9,000. Some try to find affordable care at Federally Qualified Health Centers where services are discounted for low-income patients, but aren't free.
But for Missouri’s very poor, their only option is charity dental care. And there are very few people who do this kind of work. Dr. William Kane is a dentist who runs a charity dental clinic called “Smiles of Hope” in Dexter, Mo. Every month Dr. Kane and two other dentists treat 60 to 70 patients over the course of one day amid what he describes as “controlled chaos.” There are so many people in need of emergency dental care, that he compares the clinic to a M.A.S.H unit.
Smiles of Hope is run out of the Lighthouse Christian Center, a church in Dexter. Volunteers converted an old attic space into what is now the exam room. At first glance you could be fooled into thinking you’ve walked into a professional dental office. Only after looking closely do you realize everything is mismatched. Some of it’s been bought for a discount, but mostly the clinic runs on donations. They do, however, have to pay for their equipment when it breaks. That money comes from the $20 fee the patients pay to get treated. The clinic could certainly use more money, but Kane says $20 is really all these people can afford.
“We see patients, working poor, people who are on Medicaid, that the only time they get dentistry is when they go to the ER for antibiotics and pain medicine,” Kane says. “So we're seeing desperate people.”
The day officially starts at 6 am with a quick medical exam – blood pressure, heart rate, medical history. Then people are moved upstairs in small groups for triage. The dentist will take a look at your mouth, ask you what hurts, determine what tooth needs to be pulled that day. A lot of the patients come with more issues than the clinic can handle in one sitting.
“Unfortunately we are an emergency room,” says Kane. “We will get some patients in that need cleanings or restore a simple filling. We have to refer them elsewhere,” he says. “The need for the removal of teeth is just unbelievable.”
This year the Missouri legislature agreed to re-fund adult dental care under Medicaid for the first time in a decade, which will likely reduce the number of people in need of free dental services. But as we in Missouri know, 300,000 low income adults who could qualify for Medicaid under the ACA don’t, because the state has so far decided not to expand the program. Which means Smiles of Hope isn’t going anywhere.