Wisconsin System Takes Dental Care to the Needy

By Guy Boulton

Nov. 28--A parade of pint-sized patients made their way to a dental clinic set up on the stage in the cafeteria of St. Anthony School 5th St. campus last week.

The makeshift dental clinic -- staffed by two hygienists and two assistants employed by Ascension Columbia St. Mary's -- is providing basic preventive dental care to about 250 first- and second-graders at the school over a three-week period.

The students are among the roughly 10,000 children who will receive preventive care this year through Ascension Columbia St. Mary's Smart Smiles program.

The health system provided preventive care to the same number last year -- and 700 of those children needed urgent dental care because of infections, swelling or bleeding. An additional 4,000 children had untreated cavities.

Ascension Columbia St. Mary's, which has steadily expanded its Smart Smiles program over the years, now is taking a step beyond preventive care to help children with the most immediate dental problems get the treatment they need: The health system is raising money for a mobile dental clinic that will be able to provide urgent dental care and treat cavities at schools in the Milwaukee area.

So far, Ascension Columbia St. Mary's has raised $550,000, including a $100,000 grant from Delta Dental of Wisconsin, and hopes to raise $1 million.

Delta Dental, based in Stevens Point, is a nonprofit company that sells and administers dental insurance plans.

Ascension Columbia St. Mary's estimates the mobile clinic will be able to treat 1,600 children in the next academic year. It will be staffed by a dentist, two dental assistants and two support workers.

"For some kids, this is going to be their first dental experience," said Bill Solberg, director of community services for Ascension Columbia St. Mary's.

The mobile clinic itself will cost an estimated $500,000. Ascension Columbia St. Mary's hopes to raise $1 million to offset some of the initial operating costs.

The mobile clinic will be made by Burlington-based LDV Inc., which builds specialty vehicles, including trucks for mobile command centers and for dealers of Snap-on tools.

Dental Dilemma

Ascension Columbia St. Mary's Seton Dental Clinic, 1730 S. 13th St. in Milwaukee, provided care to about 250 of the 700 children who needed urgent dental care last year.

Whether the remaining 450 children, as well as the 4,000 children with cavities, were able to get dental care elsewhere is uncertain.

Most of the children were covered by BadgerCare Plus, the state's largest Medicaid program, and the lack of access to dental care for children and adults in the program is a longstanding and well-documented problem.

Fewer than one in three -- 28.3% -- children who get health care through Medicaid in Wisconsin received any dental services in the federal fiscal year that ended Sept. 30, 2012, according to a 2014 report by researchers at George Washington University.

That compares with 48.1% of children nationally covered by Medicaid.

In yet another measure, emergency departments at Wisconsin hospitals saw 27,741 patients who were in pain because of dental problems, such as abscesses, in 2013, according to the Wisconsin Hospital Association.

It worked out to an average of 533 a week.

Wisconsin's Medicaid program has one of the lowest reimbursement rates for dentists in the country. As a result, few private dentists see children and adults covered by the health program, though some dentists set aside time each week to see children.

Ascension Columbia St. Mary's planned mobile clinic will improve access, said Matt Crespin, associate director of the Children's Health Alliance of Wisconsin.

"It will be a great way to take care directly to the community," he said.

But Crespin said that even two or three mobile clinics would not significantly improve access to dental care.

More private dentists need to accept Medicaid patients, he said. And until the state increases what it pays dentists, that is not going to happen.

Advocates and the Wisconsin Dental Association have pushed for increases in reimbursement rates for more than a decade with little or no success -- though the state has begun a pilot program that increases payment rates in four counties to see if it improves access to dental care.

Progressive Community Health Centers and Milwaukee Health Services, as well as Children's Hospital of Wisconsin, have expanded their dental services in recent years.

But that, too, only lessens the problem.

One bright spot has been the state's Seal-A-Smile program.

The statewide program, partly supported by a $350,000 grant from Delta Dental for the 2016-'17 school year, provides oral exams, cleanings and, when needed, fluoride varnish and sealants to children in schools with a high percentage of children from low-income households.

Dental sealants can prevent 80% of cavities in the back teeth, where nine in 10 cavities occur, according to the U.S. Centers for Disease Control and Prevention.

The Seal-a-Smile program, administered by the state Department of Health Services and Children's Health Alliance, estimates that it will provide basic preventive care to 54,000 children statewide, including about 23,000 in the Milwaukee area, this school year, Crespin said.

Sealants will be applied to about 28,000 of those students statewide, up from 5,000 in 2006.

In addition to Ascension Columbia St. Mary's, Preferred Dentistry Associates of Wisconsin, Marquette University School of Dentistry and Progressive Community Health Centers also contract with the Seal-A-Smile program in Milwaukee County.

More Smart Smiles

Ascension Columbia St. Mary's, which will visit 58 schools as part of its Smart Smiles program this school year, has five teams of hygienists and dental assistants. It plans to add a sixth team next year.

Its Smart Smiles program has a $1.1 million budget, with about $604,000 projected to come from billing the managed care organizations that contract with the state to manage the care of people in BadgerCare Plus, Solberg said.

Ascension Columbia St. Mary's is paid a total of $44 for an exam, cleaning and fluoride treatment. It also receives $17 for each sealant, with children getting an average of four.

A hygienist and assistant can see about 12 children a day.

All of this involves some logistics. An oral health advocate works with principals, teachers, school nurses and parents to get the needed consent forms.

Brandy Hart, principal of St. Anthony School 5th St. campus, recalls when the school would have to work to get dental appointments for children who needed urgent care -- she still remembers a boy who wasn't eating because of the pain from his infected and rotted teeth.

Ascension Columbia St. Mary's now offers to provide urgent care at its Seton Dental Clinic for students like that child.

The planned mobile clinic will make that easier -- and also will mean that a parent doesn't have to miss work to take a child to a dentist.

"We will have no problem filling the coach," said Lisa Froemming, president and chief executive of Columbia St. Mary's Foundation, which is raising the money.

The result will be only a small improvement in the overall access to dental care -- but it will mean a big improvement in the lives of the children who get care.

"The numbers are one thing," Froemming said, "but I always think about the impact on each one kid."

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