Addressing Children's Dental Needs – FirstHealth Dental Care Center

Sharon Harrell, D.D.S., recalls dozens of children with swollen faces, dental pain and lots of tears after the first FirstHealth Dental Care Center opened in Southern Pines five years ago last month.

The first couple of weeks, all we had were emergency patients, she says.

The center’s staff suffered along with their young patients – Medicaid, Health Choice or medically indigent children, babies to 18-year-olds. Many of the children had never had any kind of dental care, and most of the staff had come from private dental practices where emergency situations were the exception rather than the rule.

They were thrown by the fact that every child who came in was crying, Dr. Harrell says. We were just overwhelmed with that type of patient at first. All I could say is ‘Hang in there. It can’t stay this way long.’

Sure enough, things did settle down after a few weeks, but only in the demand for emergency care. Today, new-patient slots at three Dental Care Centers are booked solid through March of next year. The patient caseload has been unusually heavy from the very beginning.

It’s a unique problem, because it usually takes a while to build up a practice, says Dr. Harrell.

During two weeks of the time that its doors opened on Oct. 19, 1998, the Southern Pines office recorded 97 patient visits. Forty-three percent of those patients had never seen a dentist at all or hadn’t seen one in more than a year.

While the number of new patients in the program has since remained relatively constant, the number of patient visits has almost tripled – from an average of 380 per month in October 1998 to 1,000 this year.

Part of that number can be attributed to the fact that are now three Centers. A Troy office opened in January 1999, followed in October 1999 by an office in Raeford. But it is also true that the need is great; some would say overwhelming.

There are about 12,000 Medicaid-eligible children in Moore, Montgomery and Hoke counties and, according to an assessment by the North Carolina Oral Health Section, 20 percent of the children in those areas account for 80 percent of the tooth decay.

Despite the numbers, the Dental Care Centers are beginning to reap the benefits of five years of good works. They have reached 88 percent of their target population and, by identifying children who are eligible for Health Choice or Medicare coverage, have contributed to significant growth in the insured rate – from 72 percent in 1998 to 94 percent in 2003.

The number of clinic sessions has increased, too – from 4.5 in 1998 to 11 this year – as has the non-duplicated patient count.

The Southern Pines Center, the only full-time office in the operation, sees patients six days a week, while the Troy office is open three days and the Raeford office two days each week.

We’re also getting more and more patients who don’t have new cavities, Dr. Harrell says, and that’s what we are aiming for.

Instead of attending only to the near-constant flow of cavities and abscesses of five years ago, the program’s dentists, hygienists and support personnel are now able to concentrate more on the preventive work – fluoride treatments and sealants – that is so important to dental health.

It was just the opposite in the beginning. Holding her hand away from her face, Dr. Harrell recalls in particular a boy of about 9 who came to a center with his face swollen to here.

He came in with tears, she says. He was so nervous and frightened and in pain.

The dental staff entered its tell-show-do mode – first by telling the patient what was about to happen to him, a problem compounded by the fact that the boy was non-English-speaking; then showing him what was going to happen; and finally by doing it.

A round of antibiotics and two extractions later, the boy was ready for less-emergent restorative work and eventually for the preventive care that he so desperately needed. Still a patient, he has become an advocate for the Dental Care Centers among the local Hispanic community.

We all know him when he comes in the door, Dr. Harrell says. He accompanies his relatives and tells them not to be afraid.

While many referrals to the Dental Care Centers come from school health nurses or public health hygienists, most are word of mouth – from the relatives, friends and co-workers of children who have been treated at the centers.

They find out that there’s a place that sees children and that we’re kind to them, Dr. Harrell says.

The Dental Care Center program was initially funded by grants from the Kate B. Reynolds Charitable Trust, The Duke Endowment and FirstHealth’s Community Benefit Program and was endorsed by the Sandhills Dental Study Club, the local dental society.

It is unique that a health care system like FirstHealth would be the agency that took on the responsibility to address the dental care access problem, says Lisa Hartsock, Administrative Director of FirstHealth Community Health Services.

Hartsock organized the community partners and secured the grants to build the centers and develop the dental program. But then again, it was the agency that was able to pull together all the resources necessary to create a comprehensive program, she says.

Three other local dentists – Ganiat Lawal, D.D.S., Kamron Monroe, D.D.S., and Jennifer Massey, D.D.S. – help out as they are needed and when they are available. Both Drs. Monroe and Massey have their own private practices and regularly assist with clinic sessions on their days off. I have always enjoyed working with the FirstHealth Dental Care Centers, which serve a great need to the children of this area, Dr. Monroe says. The combination of Dr. Harrell – an inspiring leader – a motivated and caring staff and exceptional facilities that all cater to children enable us to provide the best possible dental care.

The support staff, the majority of which rotates among the three offices, includes one full-time and several part-time hygienists, six full-time and several part-time dental assistants, and four full-time and several part-time receptionists. Program Manager Leigh Smith oversees the program’s administrative and financial operations.

FirstHealth takes a lot of pride in being able to offer dental services to the pediatric population in such a professional, caring and efficient manner, says Michael Lachina, FirstHealth’s Senior Vice President for Medical Affairs.

Our Dental Care Centers have made a tremendous impact over the past five years of their existence in improving the dental health of children in our service areas. We are very fortunate to have Dr. Harrell, under whose leadership the centers are predicted to have a positive operating margin this fiscal year.

Author Notes:

James Wilkinson contributes and publishes news editorial to http://www.teeth-whitening-smiles.com.  Everything you need to know to get a whiter, brighter smile!