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County's dental clinic fills a big gap in care

Dentists worry their limited work won't be enough for many


by: TRIBUNE PHOTO: CHRISTOPHER ONSTOTT - Dennis Cooper, a first-day patient at the Billi Odegaard Dental Clinic, gets a cancer screening from dentist Beverlee Katz Cutler. The Old Town clinic is run by Multnomah County. 
At the Oregon Dental Association’s annual two-day dental clinic in 2011 — the last in Portland — volunteers provided more than $1.2 million in free dental care to more than 2,000 people.

Thousands more showed up to the Oregon Convention Center event, but had to be turned away. Some had slept in line outside overnight, unwilling to take a chance at not getting their painful teeth pulled or cavities filled.

A survey of patients at the event revealed that 78 percent had no regular dental care, and about the same number had no dental insurance.

As far as Bill Zepp, executive director of the association, is concerned, those people will likely show up at the next Mission of Mercy event with more teeth to be pulled and worse problems because they won’t be getting regular dental care.

On Wednesday, Multnomah County opened the only permanent safety net dental clinic on Portland’s West Side. The Billi Odegaard Dental Clinic, in the Old Town Recovery Center run by nonprofit Central City Concern at Northwest Broadway and West Burnside Street, has five exam rooms and cost nearly $1 million to build. With its electronic dental records system and sinks that can be turned on with the push of a hip, the new facility is something county dentist Beverlee Katz Cutler has lobbied for during the past decade.

Katz Cutler, who has maintained her private dental practice while working as a public health dentist with Multnomah County since 1988, has confronted on a daily basis the same conundrum Zepp has witnessed annually.

“There’s no place for routine care for those who can’t pay,” she says.

The new county clinic should serve about 1,500 patients a year, almost all of whom will be referred through one of the nonprofit agencies which serve the downtown-area homeless. That means a heavy percentage will be in addiction treatment and mental health programs.

Katz Cutler guesses that most will need urgent care, such as extractions, but she’s hoping that with some she can break the cycle of urgent dental care without routine care that ends up costing patients their health and taxpayers money.

Katz Cutler is thankful for the gleaming new facility, but also frustrated at continually providing urgent care.

“You tell them, ‘What I’m doing will get you out of pain, and then within six to 12 months you need to have this root canal finished by somebody else,’ “ she says. “A lot of people think they can. Very often they come back a year and a half later, they never did get it finished, and I have to take the tooth out. And that’s frustrating.”

Routine care missing

With little dental care available for those without insurance coverage, the few available providers such as the county’s new clinic are forced to try to treat as many as they can. That often means limiting care to the basics: taking out teeth, filling cavities and educating patients on what they can do to maintain dental health.

Routine dental care?

“Frankly, I refer people to the dental schools to get their teeth cleaned and checkups for free,” Katz Cutler says.

Zepp says dental care is often the first thing cut from contracts when union negotiations get tough because it is seen as less necessary than most medical care. Few Oregon Health Plan enrollees get coverage for regular dental care. Medicare does not cover routine dental exams for most of the people it insures.

Yet the cost of having so many without dental insurance is enormous, say Katz Cutler and others in the field. Providence Health Systems studied its emergency departments and found that dental pain is consistently among the top maladies leading to emergency department visits among the uninsured and those on the Oregon Health Plan, according to Priscilla Lewis, director for community services and development. Annually, Lewis says, more than 7,000 emergency department visits in the Portland area by people suffering dental pain.

Almost all those visits and more would have been unnecessary, Lewis says, if people were able to see dentists regularly for preventive care. Oral disease and resultant inflammation contribute to chronic heart conditions and pregnancy complications, she adds. Dental pain is the No. 1 cause of children missing school.

Smart policies

Providence completed a community health assessment last year and discovered that oral disease was one of the top four unmet health needs in the Portland metro area.

Sam Chase, executive director of the Coalition of Community Health Care Clinics, says that adults unable to see dentists often end up missing work. And, Chase says, getting teeth extracted at a free or low-cost clinic can result in a gap-toothed look if patients don’t have the money for expensive replacements, which can make it hard to find or keep a job.

Oregon children are faring even worse. According to data supplied by Chase, one in three Oregon children from low-income families have what is called “rampant decay,” which means seven or more teeth have suffered decay. Oregon children have among the highest cavity rates in the United States.

Mel Rader, co-director of advocacy organization Upstream Public Health, says Portland’s lack of fluoridated water has exacerbated the problem.

“All dental disease is preventable with the right policies, unlike a lot of conditions,” Rader says. “We’ll never get heart disease or cancer down to zero, but there’s no reason we couldn’t get the dental disease rate very low with some smart policies.”

The Billi Odegaard clinic won’t be seeing children, other than the homeless teens referred by downtown nonprofit Outside In. Cutler Katz hopes eventually she will be able to provide more preventive care and less urgent care there, but she knows such a day is well in the future.

Providence’s Lewis says Portland will need many more dentists for that to happen, an unlikely scenario until there are more people here with insurance to cover all their dental needs. Lewis is hoping that health reform and the new Coordinated Care Organizations, which are supposed to manage Oregon Health Plan enrollees as efficiently as possible, get the message on the importance of regular, preventive dental care. That, she says, could start reversing the cycle now frustrating public health dentists such as Cutler Katz.

“I think over the next 10 years we’ll see a dramatic impact,” Lewis says. “But it will probably take a decade.”