Community health dentistry: Saying yes in a world of noes

This morning I sat in a room full of 600 people. Most of them I didn’t know. We were all different shapes and sizes and colors, really only connected by a single logo printed on all of our name badges.

Dr. Vaughn

Dr. Vaughn

In front of the room stood several important people, including the CEO. One by one, they told their stories and confessed why they did what they did. Speech by speech, the room filled with their compassion for the work they do and the reasons why they do it with the people they do it with.

It was inspiring. This atmosphere. I can’t say that I had ever been a part of anything like it before.

What I’m talking about is what we call Community Health, and it’s where I work now. The room I was in this morning was filled with the employees of one of Seattle’s largest community health institutions, Neighborcare Health.

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It wasn’t easy finding a job in Seattle. The market is oversaturated and the job prerequisites are laughable. “Minimum 3-5 years of private practice experience required!” the classifieds shouted.

“Want an associate general dentist that is proficient in placing implants, molar endo, and third molar extractions.”

“Looking for an associate to work nights and weekends at our booming office!”

What has happened to dentistry? What type of market are we creating where general dentists are required to be as proficient as multiple specialists in order to get a decent job? But that’s a topic for another post.

I have been with the Neighborcare family for three months now. And although we primarily treat a patient population similar to the one I treated last year in residency, I have already learned a few new lessons that I’d like to share below:

People just want a dentist to be on their side. I can’t tell you how often a patient walks in the door that hasn’t been to a dentist in 10 years or more. It’s because of fear. It’s because they have no money and no insurance. It’s because they were burned by their last dentist.

And they finally end up on our doorstep because they know they’ve gone too long without a dental home, and so they bravely step back into a realm that is traditionally unfriendly and unforgiving to their kind.

These patients just want to be heard. They want a doctor and a treatment plan that fits them and their situation. They want a dentist that will look them in the eye. A dentist that will give options other than the ideal treatment plan.

Because there ARE other options. “My last dentist told me I needed nine crowns.” “What about my silver fillings? My last dentist told me I needed them all replaced.” I hear it all the time. And I’m so relieved that I can be a part of a world that isn’t driven by production and speed and talking patients into treatment plans that they can’t afford.

I always tell my patients the ideal. I always give my recommendations and what I would do if I were them. But the fact is that I’m not them. And I don’t understand their situation and what they’re going through and the expenses they may have.

So in my work, we often times do the less-than-ideal. I do composites on teeth that need crowns. I place Glass Ionomers in cavities that are very difficult to access. I plan scaling and root planing on teeth that would have been planned for extraction at any Periodontist’s office in the state.

What I’ve found is that patients appreciate the willingness to work with them. To let them know what they should do in the ideal situation, the risks with not doing that treatment, and then giving them a treatment plan that they can comfortably accept.

We have a choice to be the step forward or the step backward in a patient’s oral health. In residency and even now in community health, I often get patients who have been moved around from doctor to doctor trying to find someone to treat them. Whether it’s because of a complicated medical history or because it requires a little more patience to treat them.

But when a patient comes in with a toothache who hasn’t been to the dentist in years, we have a choice. “Root canal or extract?” we tell them. But then the patient tells us they want to save the tooth. That they don’t know if they can handle missing another tooth.

But they have no money.

They can barely afford to make it through the month. And so you’re sitting there and they’re looking at you and asking what they should do. At my work, we offer to save these teeth. We tell the patient we can get them out of pain with an “open and broach,” buy them some time, and invite them back for a root canal once they can afford it. And then we talk to the patient about the importance of getting a comprehensive exam to make sure something like this doesn’t happen again.

And what’s happening is that these patients are coming back. They are getting those root canals. They are coming back for exams and becoming committed patients of record.

We all go through slumps. We all have times of economic hardship. The mountain of student debt that I have on my credit profile reminds me of this every single day. Patients need a break every now and again. And if we work with them, oftentimes they will follow through.

Lastly, working in community health has made me understand the great value of training and continuing education. Just yesterday, my office got a call from a desperate patient. She was a 22 year old pregnant woman with an awful toothache. She had called several clinics begging to be taken in to have the tooth extracted. She was turned away because the dentists at the other offices didn’t feel comfortable extracting a tooth on a pregnant woman. She begged my front desk to take her in and that she would provide written approval from her primary physician to extract the tooth. So we are working her into our schedule to take out the tooth.

I see this as a problem.

Every dentist needs education. Every dentist needs to stay caught up on guidelines and what’s safe and what’s not. If you don’t feel comfortable doing something, that’s fine. But as healthcare providers, we have a duty to make sure patients find help. Never leave a hurting patient to fend for themselves.

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Community health is tough sometimes. It’s not always fun. And I believe the patient base is one of the most difficult to handle in dentistry.

But many times, we are the last line of defense. We are the ones that say ‘yes’ when everyone else said ‘no.’ We are the ones that will work with the patient to make sure that they can get the best possible care they can with the situation that they find themselves in.

And I can tell you there’s no other feeling than when a patient says “Thank you, I’m trying to turn my life around, and you are helping me do that.”

Dr. Joe Vaughn is a New Dentist Now guest blogger and a member of the American Dental Association. He grew up in Alabama and recently graduated from The University of Alabama at Birmingham School of Dentistry in 2015. He now lives in Seattle, Washington, and works at Neighborcare Health, a community health center in Seattle. Two cups of coffee, writing and indie music are everyday occurrences for Joe. Go Seahawks and Roll Tide!

2 comments

  • I learned of your excellent article from a dentist friend who has spent most of his career working for a community clinic. I have received most of my medical and dental care from this clinic, which has been here since about 1975. But we don’t think of it as a “community clinic” because it takes all types of patients, and through the years, has opened other offices in 6 towns even tinier than ours (pop 550). My husband has spent his medical career in this clinic. We have taken this good quality of care, great dentists and doctors, for granted. When my daughter lived in another state and was looking for a doctor, one option was the community clinic. She said, I’m not sure I want to go to a clinic for poor people. We said, hey, what do you think your father worked for his whole life? Later I was in CA and my tooth fell apart. I had no dental insurance at that point, so I was concerned. But the initial check up and xrays were very inexpensive. However, besides doing a crown, they gave me The Plan for $5000 of more dental care. You gotta be kidding. I emailed my dentist back home for advice and he said just sit on it. But I did get good care from the private dentists. This is no place for details, but to say that the Urgent Care is $65 upfront, but they had no lab, xray, doctors, etc. and that city of 50000 had no hospital. A diagnosis was guessed at without the patient removing clothing and the shotgun approach to treat was used.

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