One of those clinics is scheduled to open in Sylva this coming summer and will serve the entire WNC region. The location was selected based on a 2005 study and statistics that identified Jackson County, as well as the surrounding region, as lacking in dental care.
According to health officials, there are only about a dozen dentists total in Jackson County. That equates to about three dentists per 10,000 residents — a number consistent with many other rural counties in North Carolina. That ratio is about half the national average.
And placing those numbers into sharper focus is the fact that some of those rural dentists work part-time, or, in the case of those counted in Jackson County, maintain offices near the Qualla Boundary and only serve Eastern Band of Cherokee tribal members.
Furthermore, for low-income residents seeking dental care, some practitioners don’t provide cost assistance or accept Medicaid patients because of the low reimbursements.
“We do have a shortage in dental care,” said Paula Carden, health director with the Jackson County Department of Public Health. “And it’s very difficult for people without means and with Medicaid to find clinics — many dentists don’t accept those patients.”
The future ECU clinic will be staffed with dental hygienists, one part-time and one full-time dentist, in addition to a rotation of upper-level students in their final year of education or seeking a fifth year in advanced dentistry. And the clinic will provide dental care for patients with Medicaid and help low wage earners with a sliding fee scale.
“They’ll be operating very much like a public health clinic in terms of accepting everyone,” Carden said. “It’s good for the working poor and people with some resources but no dental insurance.”
The clinic will be built on land donated by the county, and once completed, the county’s own dental program will partner with ECU and move into the building to provide services. Currently, the county’s dental program operates out of a doublewide trailer retrofitted with three chairs and other dental equipment. The new clinic will have 16 chairs.
The new facility couldn’t come at a better time, said Carden. She recently got word that, because of funding shortages, the N.C. Mission of Mercy dental clinic — a mobile care unit that serves needy patients for free — will most likely not be able to make its regular stop in the county in the near future. Historically, it has come to the Sylva or Cullowhee at least once per year, seeing up to 300 patients at a time.
Carden hopes the new clinic will fill that void in services.
A revolutionary model
If all goes as planned, the new ECU clinics will not only fill a temporary break in services but change the landscape of dentistry around the state. By introducing students to rural areas for their final year of schooling, the hope is they may stick around after graduation to add to the rural dental workforce.
The newly formed dental school at ECU took on its first class of students only two years ago; each class at ECU’s dental school consists of 52 students. When those students reach their final year, they will pass through one of the 10 planned learning centers.
So far, one of the clinics has been completed in Ahoskie, and the next is slated for open in Elizabeth City in early 2013. Sylva’s clinic is scheduled to open in August. The centers are being built with funding from the legislature but are designed to be self-sustaining with the money paid for dental services.
Mike Scholtz, director of community dental practices for ECU, calls the university’s satellite clinic approach revolutionary. Typically, a dental school may have a clinic near its campus, but that may only directly help the urban population where it is located.
“This model has never been done before,” he said. “All the dental community is watching us.”
But getting those dental students into the workforce is a race against the clock.
When compared with other states, North Carolina ranks fifth highest in population growth but 47th in relative number of dentists. Not only is there a shortage, there’s also a poor distribution of dentists, with many concentrated around cities.
As an example of that distribution: four rural counties in the state have no dentists at all and many more have two or less. To compound the problem, the average age of a dentist in North Carolina is 55 years old.
“There’s a real graying of the dental force,” Scholtz said. “And most of those dentist are in urban areas.”
Sen. Jim Davis (R-Franklin), who is an orthodontist himself, applauded the idea of using advanced students to provide dental care in the region. But he wasn’t entirely convinced that there is a shortage of dentists in Western Carolina.
“I have a hard time believing that to be perfectly honest,” Davis said. “For ECU to set up a clinic is a good thing, but we have plenty of dentists in the western part of the state who aren’t as productive as they’d like to be.”
Davis works one to two days per week as an orthodontist now that he is a legislator but isn’t sure there would be anymore work for him if he wanted to go fulltime.
However, he acknowledged comparing his specialty practice to general dentistry may be like comparing apples to oranges.
He said a solution to the perceived dental services shortage might lie in convincing dentists to open up their practices to more people, such as those using Medicaid. He said many dentists avoid the program not because of the payment amount but because of the bureaucratic hoops one needs to go through to serve someone in the program.
But Jackson County isn’t the only health department that sees the need to expand its services.
The construction of the new clinic in Sylva also coincides of the expansion of the Macon County dental services. At a November County Commission meeting, commissioners approved a proposal to lease a new building, to hire an architect to design the renovation of that building and to purchase dental equipment including a state-of-the art X-ray machine.
Macon County’s dental clinic serves Medicaid patients as well as low-income residents at reduced rates. The new facility is planned for a spring opening.
Jim Villiard, personal health section administrator with the Macon County Health Department, said the county had outgrown its current facility.
“We can’t see more people because of limitations of the size of facility we have,” Villiard said. “We’ve just basically outgrown our current facilities.”