“We’re going to do it right or we’re just not going to do it at all!”
Access Dental Care
Sadly, many North Carolinians living with complicated intellectual and physical disabilities have little or no access to dental care. Known as “special care populations,” they may be homebound or living in nursing homes or group homes. The 2010 Special Care Oral Health Services Advisory Group estimated that there are 450,000 special needs individuals in North Carolina who belong to all age groups and have a variety of disabilities including profound intellectual disability, autism, cerebral palsy, dementia, cerebral vascular disorders (stroke), head injuries, multiple sclerosis, and muscular dystrophy.
While the challenge is a big one, there is a strategy that works, as Bill Milner, president of Access Dental Care, has demonstrated for 16 years. Headquartered in Asheboro, Access Dental Care provides on-site, high quality dental care for frail elderly and individuals with disabilities in nursing and group homes, retirement communities, PACE programs, a seven-county HIV/AIDS program and to special care patients in the community at large. Access Dental Care’s service area now extends from Shelby to Raleigh, as a result of acquiring a similar service in the Charlotte area in 2015.
How the Program Works
Access Dental Care is a mobile on-site dentistry program. Five days each week, a dentist, hygienist and one or two dental assistants travel in a 16-foot truck to a special care facility in the North Carolina Piedmont. They transport everything found in a regular dental office: dental chairs, state-of-the art operating units, lights, digital x-ray and supplies—enough equipment to support two operatories. Milner and his staff have the process down to a science and are able to wheel the equipment into a designated room and set up in about 20 minutes. This space, usually an activity room, requires electrical outlets, a sink, and some privacy. Milner says that the team can see 15 or more patients per visit. Before any patient can be seen, the facility’s social worker must obtain signed permission fromthe patient’s family. This is required before the dentist can conduct the first exam or perform any treatment. Most patients are brought to the dental room, although a few must be treated at their bedside.
The staff keeps meticulous files on each patient and updates these throughout the day. X-rays are taken with a hand-held device and can be viewed on a laptop computer. Treatments include cleanings, extractions, fillings, dentures and bridges, oral cancer exams and treatments for gum disease. While this may sound like a fairly normal day in the life of a dentist, it is anything but that. Patients often arrive with dire dental situations—severe pain and equally severe infection. They may not have eaten normal food in weeks. They may not be able to open their mouths. Many cannot explain what their problem is. Many are on medications, including anticoagulants, which means they are at risk of serious bleeding. Some have lost their swallowing reflex. They cannot clean their own mouths and have no one else to do it. And yet, there is normalcy in the room. The dental team takes it all in stride, making gentle jokes among themselves and with patients. There is happiness; patients smile, even laugh. Before a treatment begins, Dr. Milner and his staff stop and talk with each patient, often placing a reassuring hand on an arm or shoulder. “You have to get it in your DNA,” says Milner. “You have to crawl into the minds of the people you’re serving.”
Access Dental Care provides comprehensive dental care to 3,400 residents in 13 Piedmont counties each year. Since its inception, the organization has treated over 15,000 patients during 100,000 dental appointments.
Funding comes from three sources: Medicaid (75% of patients), which pays slightly more than 40 cents for every dollar of care; private pay including insurance; and a facility retainer fee. The retainer fee insures that the Access Dental Care can break even. Access Dental Care also has received $1.6 million in capital funding from North Carolina foundations.
Looking to the Future
Milner, ordinarily a cheerful man, is increasingly concerned about finding the right people to do the job and public funding issues. “If you do this right, it takes trained staff, state-of-the art equipment, communication with facilities, patients and their responsible parties, and constant attention to the needs of the community. There are not many programs operating in the U.S. that provide consistent, comprehensive continuity of care,” said Milner. He is busy these days working on financing strategies for the future as well as considering the possibility of expanding into other areas of the state.
Personal Reflections from the Innovators
Mary Elizabeth Andreyev, a dental assistant who is part of the Access Dental team, said that she enjoys working with this population. “Plus,
I like that I am in a different place every day. I’m not in a cubicle,” she said with a smile. “I could never do that!” As for Milner, he has done this work for 41 years and still finds it to be fun. “I have a story to bring to the dinner table every night. One woman told me, with tears streaming down her face, that she had been to many dentists, but this was the first time she had been able to get help for her mother. That’s as warm and fuzzy as it gets.”
Bill Milner, D.D.S. or Betsy White, R.D.H.
Access Dental Care
125 South Park Street
Asheboro, NC 27203
Spotlight on the Innovator
Bill Milner, DDS, MPH
Access Dental Care
Dr. Bill Milner is widely respected for the quality of service provided by Access Dental Care and for its ethnical approach to treating patients who often cannot speak for themselves. “We’re going to do it right,” he said, “or we’re just not going to do it!” Dr. Milner received his dental surgery degree from the Baylor College of Dentistry and a master’s degree in Public Health Administration from UNC-Chapel Hill. He is the chair of the North Carolina Dental Society Special Care Committee and has served as consultant to the American Dental Association, state dental societies and local health departments. He is the recipient of many awards, including the North Carolina Dental Society’s Special Recognition Award for achievement in leadership, academics, research and health care delivery.