Dr. Divina “Camelia” Chang began work at the Molar Roller May 30, becoming the program’s first permanent, full-time dentist in more than a year. The Molar Roller’s first dentist quit to join a convent in 2005, throwing the program into a year-long period of contracting out to fill the county’s needs. Although the contracting process still provided services to the public, its tenuous nature left staff members questioning the program’s future.
“I think it’s lifted staff morale knowing they have a full-time dentist,” said Ken Ring, health director of the Macon County Public Health Center.
The hiring makes it easier to schedule visits several months out. Currently the Molar Roller is parked at the Macon County Public Health Center, but with the start of the school year will again begin making its trips to local schools. The Molar Roller is only able to visit five out of the 10 Macon County schools, plus the Head Start program, each year. When the school year starts, the Molar Roller will pick up where it left off.
As an added bonus to the hiring of a full-time dentist, the last dentist the Molar Roller contracted with to provide services is contemplating joining the program to treat Medicaid and underinsured adults. Currently the Molar Roller only treats adults on an emergency basis. Adding on a second dentist would expand services to a segment of the population that current is underserved, Ring said.
“Since most of our clients are Medicaid, few if any private dentists accept Medicaid or low-income clients,” Ring said.
Consequently, the board of health is looking for ways to fund the creation of a new office. The second dentist most likely would operate out of leased office space, rather than on the Molar Roller, which only has room for one dentist and one hygienist. As it is now, the Molar Roller may be able to fund a second office.
“It’s slightly more than a break even type operation,” Ring said.
At the end of the 2004-05 fiscal year, the Molar Roller has grossed approximately $30,000. Such funds could be used to grow the program, albeit slowly. Also, grants are available through the Kate B. Reynolds trust and possibly the Duke Endowment fund. In expanding dental services, the board of health would aim to continue to provide services that offer savings to patients, but carry the financial weight of operation.
“We’re definitely looking at programs that are self-sufficient,” said Roberta Swank, a member of the Macon County Board of Health.
Currently, payment for Molar Roller services is based on a sliding scale. Children must be age 18 or under and meet the federal guidelines for poverty to qualify for services. There are similar qualifications for adults.
The Molar Roller has serviced more than 2,200 patients a year since its inception. Creation of the Molar Roller first was identified as a health department goal in 1998, as the board of health, county officials and the Healthy Carolinians organization teamed together to provide a clinic just for children. Having researched options for establishing a clinic, board of health members found that a mobile unit was more efficient that office-based clinics.
“The no show rate was much lower,” Ring said.
The system is designed so that if a student were absent on the day his or her appointment was scheduled, staff members could simply move on down the list and reschedule the missing student for another day, as the Molar Roller generally remains at a school for a period of several weeks.
The program is one of few of its kind in the region. Jackson County has a mobile and fixed dental clinic. Haywood and Buncombe counties both have only fixed clinics. And Clay and Cherokee counties share a fixed clinic.
However, getting the Molar Roller going proved harder than anticipated.
“It’s very difficult to recruit dentists, especially to rural areas,” Ring said.
The program’s first grant application to the Kate B. Reynolds charitable trust was turned down because a dentist had not yet been hired to work on the Molar Roller. North Carolina does not graduate enough dentists to serve all the state’s needs, Ring said, and at the time the state did not allow for licensure by credentials, which would allow dentists with five years of experience in another state to practice in North Carolina. The system only recently changed, with the state legislature passing licensure by credential in 2004, and reciprocity — an acknowledgment of another state’s license being equivalent to that of our own — passed this year, Ring said.
However, those changes weren’t made in time to help the Molar Roller. It took the Molar Roller until September 2003 to hire its first dentist. The program celebrated its ribbon cutting almost a year later in July of 2004. This week marks the program’s two-year anniversary.
The process for using the Molar Roller begins with a visit to the health department to fill out an application. If the patient does not participate in NC Medicaid or NC Health Choice insurance, then proof of income will be required at the time of application. For more information, call the Macon County Public Health Center at 828.349.2513. Information also is available in Spanish on the health center Web site at www.maconnc.org/healthdept. Click on Mobile Dental Unit.