Clinic closures leave thousands without dental care

Cuts in government funding have forced the closure of teaching clinics in Jacksonville, FL, and Alexandria, LA, leaving the working poor and those in need of emergency care with little access to affordable dental services and dental students without the opportunity to hone their skills in a clinical setting.

The University of Florida (UF) College of Dentistry's Jacksonville clinic, where supervised dental residents provided emergency dental procedures and a full range of advanced treatments for 23 years, was forced to close its doors June 30, citing cutbacks in state funding.

"Unfortunately, at this point the building is in disrepair and very badly needs comprehensive repairs that we just don't have the funding to do right now," Micaela Gibbs, D.D.S., director of community-based programs for the UF dentistry program, told DrBicuspid.com. "The dental clinic requires a basic standard of care that has to be maintained, especially when you represent an institution like the University of Florida."

The clinic is making a profit, but she said cuts in government funding made it impossible to continue operating it. "One-third of our budget is state revenue, which has been drastically reduced," Dr. Gibbs said.

The closure will have the worst impact on people who struggle to afford dental care.

"All these patients are screwed," observed Cliff Starr, D.M.D., director of the clinic and UF's Advanced Education in General Dentistry residency program, one of the few programs in the U.S. that provides specialized training in advanced procedures. "It was known as one of the top dental training schools because of its excellence in patient care and implant dentistry, but now it's gone."

The clinic provided emergency services and full-service procedures, including implants, oral surgery, and endodontics, but only charged about 70% of the usual fees. Patients paid $135 for an examination and extraction; implants cost $950.

Michelle Sarasola, D.M.D., who just completed her residency program at the clinic, said the building wasn't in such bad shape. "We were kind of caught off guard [by the closure] because they just spent several thousands of dollars to fix the roof and buy a lot of high-end equipment. I just don't understand why they thought the building was an issue."

Popular clinic

The popular clinic drew up to 20 patients a day, including children, elderly patients, and those with medically compromised conditions, Dr. Sarasola said. Over the past 23 years, the clinic performed more than 2,000 implants, and she proudly noted that her class (which included eight student residents) placed 287 implants in the past year.

"Most patients were at the poverty level and needed a tooth pulled or had infections and couldn't afford to go to the dentist," Dr. Sarasola said.

The situation is complicated by the fact that the building is owned by the Shands Jacksonville Medical Center, which has leased it to the university but makes the school responsible for the building's maintenance. The school has already spent $250,000 to fix the roof and air conditioning, but the building still needs further extensive repairs, according to Gibbs.

The school tried to find another location and approached city officials, the University of North Florida, and Jacksonville University, but to no avail, she said. Retrofitting commercial office space into dental operatories would be prohibitively expensive, she added.

"Community service is a huge mission of our college, and of course it saddens us because we've had a presence in the community for 23 years," Dr. Gibbs said. "We're open to new ideas to continue and expand our service there."

Louisiana clinic

The Louisiana State University (LSU) School of Dentistry's clinic in Alexandria was also forced to close its doors last week due to funding cutbacks.

"Our budgets are being pared, and we're having to look at economies of operation," said Elaine King, spokesperson for LSU's Health Sciences Center in Shreveport, LA.

The clinic, located in a rural area, has served approximately 5,000 indigent and working poor a year since it opened in 1998 at the Huey P. Long Medical Center's campus at England Airpark. LSU dental students provided the care.

About one-third of the patients seen at the LSU clinic had significant dental problems, said David Holcombe, M.D., a public health medical director for the Louisiana Department of Health and Hospitals and the medical director for Community HealthWorx, a nonprofit dedicated to providing free medical services for working people who are uninsured or underinsured.

"I mean horrible dental problems: abscesses, rotten teeth, horribly advanced pyorrhea," Dr. Holcombe told DrBicuspid.com.

The clinic was open seven days a week, but it still took a year to get an appointment, he noted. "It was a Band-Aid on a hemorrhage," said Dr. Holcombe, calling local access for dental care "dreadful."

Some 25% of the local people were on Medicaid, but most of the area dentists don't take it, he noted.

Among the proposals to improve access to dental care that have come up at meetings of various groups trying to solve the problem is tying dentists' licensure to seeing a certain percentage of uninsured or underinsured patients, Dr. Holcombe said.

But Larry Nissen, D.D.S., president of the Florida Dental Association, said singling out dentists and not all medical professionals for this sort of requirement would be unfair. Dental associations nationwide are working with legislators to develop programs to encourage dentists to work in areas of the greatest need, he pointed out.

Among the incentives are scholarships, forgiveness of student loans, and low-interest loans to build and equip dental offices, Dr. Nissen said. It costs a minimum of $150,000 to adequately set up a dental operatory, he estimated.

"Access is a major issue across the U.S.," Dr. Gibbs said of the growing number of clinic closures that are making it harder for the poor and uninsured to get dental treatment. "And nobody is filling that niche in the near future."

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