Dentistry on the road…Taking care to underserved Floridians

Confident smiles are the most visible outcome of a six-year-old College of Dentistry outreach program that brings quality dental care to low-income adults and children statewide, from Miami to Tallahassee.

Pain relief is a more important issue to many of the patients who typically have seen a dentist only once or twice — or not at all — during their lifetime. They relish the chance to get professional help to regain the ability to live without constant toothaches.

Among the 87,359 patient visits recorded in the 18 community locations, where UF dental faculty, students and residents-in-training provided care during 2001-02, was a man who told the clinic staff he wanted his teeth repaired as soon as possible so he could smile for pictures at his upcoming wedding.

Another patient said she had not smiled in years because she didn’t want anyone to see her teeth, and another said he hadn’t been able to eat solid food or sleep through the night “for a very long time because of pain in my mouth.”

Nereyda P. Clark, D.M.D., the dental school’s associate dean for extramural programs, orchestrates the Statewide Network for Community Oral Health. She said the program aims to provide convenient access to quality dental care to impoverished Florida residents. More than 80 percent of the 87,000 adults and children reached last year have incomes at or below 200 percent of the poverty level.

“We’re lucky to have dedicated salaried staff and volunteers at every level who share the vision for helping people who are less fortunate,” said Clark. “Without the network, the majority of these patients would have had nowhere to go.

“By finding and treating dental problems early, we definitely reduce chronic diseases and help to prevent many emergency room visits,” Clark added. “We’re expanding every year — our success stemming from effective networking, sharing of university and community resources, and volunteer services provided by close to 140 community dentists and many more clinic staff.

Participants in the cooperative effort include the dental school, the Florida Department of Health, the Florida Dental Association, philanthropic clinics, community health centers, dental public health units and community colleges, the state- and federally funded Area Health Education Centers, hospitals, nursing homes, prisons and homeless shelters.

Clark ventured into her statewide leadership role 11 years ago when then Dean Don Legler, D.D.S., was developing a satellite dental clinic to serve a largely Hispanic population in Hialeah. Clark’s Cuban heritage suited her well for organizing the clinic. She helped hire new faculty and develop the dental program while also directing the dental school’s supplemental education programs for foreign-trained dentists.

In 1997, when Frank Catalanotto, D.M.D., came into the deanship with the idea of building a statewide network of community dental services, he didn’t have to look far to find a natural leader. Clark was primed for the assignment. She set out to make each connection a “win-win deal” to bring dental care to community residents and give the college many more real-world training sites for dental students and resident trainees.

Clark notes that the college’s campus-based dental clinics in Gainesville and its full-time satellite dental clinics in Jacksonville, St. Petersburg and Hialeah cater primarily to urban populations, whereas the 18 community outreach clinics are staffed on a rotating basis to deliver care to predominantly rural residents and migrant workers.

Services were extended for the first time in November to provide free dental examinations to about 1,000 school children in Gadsden County, one of Florida’s poorest incorporated areas. By joining forces with Colgate-Palmolive to use its dental van and with support from the Florida Dental Association, the dental school and the state, UF faculty and students provided the services over a three-day period.

More recently, the UF network team used the Southern Baptist Convention’s mobile dental van to provide primary dental care to 90 adults in Gadsden and Leon counties. The patients reached during this four-day visit lack the ability to pay for dental care and do not qualify for dental coverage under Medicaid. Much of the treatment provided these patients involved surgically removing abscessed teeth that were causing severe pain.

“There is definitely a disparity in oral health-care access in our state and our country,” said Kimberly Jones-Rudolph, D.M.D., a clinical assistant professor who is the driving force behind UF outreach services in Gadsden and Leon counties. “Unlike medical care, all you have to do is open a person’s mouth to see what economic resources have been invested in his oral health.”

Next targets for expansion of the dental services network are the Tampa Bay area, which is experiencing rapid and ethnically diverse growth in all age categories, and the critically underserved region of the Florida Keys.

Linda Kubitz, coordinator of the dental school’s distance education program, travels Florida highways often, videotaping scenes of patient care, research and education, which she later incorporates in orientation programs and videotapes for presentations to volunteers and partners in the outreach program.

“This program doesn’t work according to the principle you may have heard — if you build a clinic, the people will come,” Kubitz said. “The creation of our clinics starts with getting to know the people who will be helped — their lifestyles, economic challenges, health-care needs and interests. Then we organize a clinic to address their needs. What works well in one town wouldn’t necessarily be effective in another community.”

Patient-care providers and clinic staff find gratification in the special ways patients express their appreciation. One middle-aged woman who had undergone extensive dental reconstructive work at the ACORN Clinic in Brooker (northeast of Gainesville) walked out through the lobby smiling and exclaiming to everyone in sight, “Just look! I’ve been crowned.”