Fortunate Fillings: Dental Care Bridges the Gaps, Even in Rural Regions

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When you see your dentist in the grocery store, do you ditch the candies and soda pop? When you pay your dentist in fish, do you get minnows in change?

These tongue-in-cheek questions might actually be appropriate for the only dentist in Lake Superior’s northernmost community of Nipigon, Ontario, who often sees patients in the local stores and has accepted pickerel for his services.

Dr. Derval Clarke set up his chair as Nipigon Dental in August 2015, shifting west after a year in Schreiber (pop. 1,126) to the bigger town of Nipigon (pop. 1,631).

But it wasn’t the added population that attracted him; it was community need.

“Dentistry is very accessible on the north shore,” Derval says of the Ontario shore. He lists dentists in Wawa, Marathon, Terrace Bay and Schreiber.

“Then I found out that Nipigon was one of the only small towns along the north shore that didn’t have a dentist. So I set up shop.”

He became the first dentist in the town for more than a decade.

Lake Superior’s rural neighborhoods fare pretty well when it comes to available dentists. Residents of most areas have at least one general practitioner within an hour’s drive – and usually much closer.

That’s good news because getting proper dental care on a regular basis, and seeking immediate care for dental problems, is important for good overall health. If you don’t think healthy teeth and gums are important, chew on these facts:

• In the United States, an estimated 164 million work hours and 51 million school hours are lost each year due to oral health problems, according to a government report on rural health. The same 2004 study estimated that 30 percent of U.S. adults older than 65 have lost all of their teeth.

• Oral infections have been linked to serious heart conditions, and periodontitis (a severe form of gum disease) may be a cause of chronic obstructive pulmonary disease in general and, for pregnant women, may be a risk factor for premature or low-weight births.

• The Association of Ontario Health Centres cites nearly 61,000 emergency room visits due to oral health problems, or essentially someone visiting the ER every 9 minutes due to dental problems.

 “What’s going on in your mouth does affect your body,” says Dr. Alyssa Hedstrom of Grand Marais Family Dentistry in Minnesota.

For many people in our area and elsewhere, payment can be an even bigger issue than proximity. Dental insurance generally is not provided through employment in the United States and it is not covered under the Canada Health Act, meaning the full cost of most dental work ends up with patients.

“Most people can get to a dentist,” says Derval, “but not everyone can afford it. Even people who have complete access don’t go because of a preconceived notion of what it might cost.”

Luckily there are options available and patients should consult with their dental offices about financing. For major work that will take place over a long period of time, such as a series of crowns or implants, some dentists might work out payment plans for regular patients.

Children are particularly susceptible to dental issues, with tooth decay among the top childhood illnesses, and some local programs work to get them good oral care.

Every February in Duluth, the dental hygiene clinic at Lake Superior College joins the statewide “Give Kids a Smile” program offering free care to local youth.

Farther north in Cook County, a coalition of partners address dental care access. The North Shore Health Care Foundation, Sawtooth Mountain Clinic and Cook County Health and Human Services have established the Oral Health Task Force to improve dental care for families.

The task force offers a sliding-scale insurance program for families, covering people from birth to age 26. In 2015, the sliding-fee program paid more than $16,000 toward dental care for children, covering 95 dental appointments for 35 member families.

The group also sponsors in-school screenings for kids and two “free days” each year for ages 18 months to 26 years to get an exam, cleaning, X-rays, and fluoride and sealant treatments at Grand Marais Family Dentistry. The task force even organizes a field trip to the dental office for area preschool-age children to offer preventive care.

Recently, the Oral Health Task Force received a $150,000 grant from the Delta Dental of Minnesota Foundation. Over a three-year period, this grant will help to establish a Cook County prevention program integrating community health services and a dental team. A dental hygienist serves as coordinator.

According to Alyssa, a task force member, “There are many different types of in-school programs, but my experience is that it’s hard to do the follow-up care. Getting kids into a dental office can be a barrier to care. That being said, if decay is present, it’s not going to go away. The Oral Health Task Force has helped remove that barrier. With parental consent, they will go and get kids and bring them to the dentist.”

Many colleges around the Lake offer dental hygienist or dental assistant programs –but there is not yet a school of dentistry at a regional campus.

The University of Minnesota School of Dentistry in Minneapolis does provides clinics in urban and rural areas, including at the Min-No-Aya-Win Health Center on the Fond Du Lac Reservation, where fourth-year dental students, third-year dental therapy students and fourth-year dental hygiene students treat patients under faculty supervision.

Although most towns surrounding Lake Superior can boast at least one general practice dentist, oral specialists are harder to come by, making it rare in rural areas to find periodontists (who specialize in gum diseases), orthodontists (who specialize in proper placement of teeth, fixing improper bites) and endodontists (who specialize in “dental pulp” and do root canal work).

While some general dentists like Alyssa do perform everything from root canals to extractions to orthodontics, rural patients might need to travel to the Lake’s larger urban areas for specialized care.

Simply ignoring problems, though, won’t fix them, says Dr. Mark Phillips, an endodontist with Great Lakes Endodontics in Hermantown, Minnesota. “If someone needs a root canal, and they’re putting it off, they can have a tooth infection and swelling and pain if left untreated.”

Sometimes untreated infections can be tolerated quite a long time, Mark adds, which is why some people don’t treat them. But delaying treatment might land you in a dental emergency and higher cost of care.

In his practice, Mark sees patients who might drive up to three hours for care. The distance makes consultations and followups challenging, so Mark often works with a patient’s general dentist to see X-rays in advance, allowing him to do consultation and treatment together at one visit. In some cases, the general dentist will coordinate with a specialist for postoperative care in the hometown.

While specialized dentists may need larger population centers, some general dentists find rural lifestyles suit them.

In Nipigon, Derval lives five minutes from his office. Jamaican born and raised, he attended college in Toronto and dental school in Washington, D.C., and practiced in Rochester, New York, before moving to the Lake Superior shore. He’s amazed at how quickly he can handle emergencies.

Not long after he started his practice, a child fell off his bike and cracked his teeth. “Within 10 minutes they had the kid at ER and 10 minutes after that, the kid was in my office,” Derval says. “Because I’m in such a small town, it is easy to come in on a weekend or an evening after work to see a patient. When I lived in D.C., it took 35 minutes for me to get to school … in Toronto it was an hour and a half. In Nipigon, there are no traffic lights at all.”

He also appreciates the cooperation within the local medical community. Because the local hospital is small, Derval says, it was easy for him to become credentialed and see patients in the hospital. That’s especially important for people on long-term care.

“Their mobility is limited; they can’t physically go to the dentist. So there have been times I’ve gone to the hospital and seen patients. Luckily there is a hygienist also there.”

He also covers people from the Biinjitiwaabik Zaaging Anishinaabek/Rocky Bay Reserve on Lake Nipigon. The remote First Nation provides medical rides to Nipigon twice a week.

Being the only dentist in a small town, he also gets the pleasure of seeing patients outside the office, Derval says. “I run into them at the post office, the grocery store, Tim Horton’s and Subway. It becomes easy because these are patients I know.”

Knowing his patients so well, he works with them to deliver the care they need … even accepting some unorthodox payments. “I have been paid in fish – trout, walleye, salmon.”

This coming year, though, he’ll be changing that, he jokes: “For 2017, my rule is that I will accept fish but not trout. I just don’t like trout.”

Think Twice

Cindy Upton, dental clinic coordinator at Lake Superior College, notes that one of the biggest threats to young people’s teeth is drinking soda all day long.

Both regular and diet sodas contain phosphorous (an acid) and carbonation that wear away your tooth enamel and can cause staining and rotting. Ditto for high sugar or acidic drinks like bottled ice tea, lemonade and energy drinks.

She cites the slogan: Sip all day, get decay.

Here, from the Delta Dental Insurance website, are a few foods to avoid to keep decay away:

Hard candies, suckers, jelly beans: Anything that sticks to your teeth or stays in your mouth can be hard for saliva to wash away. Cookies, cakes or desserts with lots of sugar also cause tooth decay. Eat them sparingly, limit the time you eat them and don’t snack on them throughout the day.

Chips, breads, pasta, crackers: Foods with starch and refined carbs can hurt teeth as much as candy can. White-flour starches are simple carbohydrates and linger in your mouth before breaking down into simple sugars. Bacteria eat these sugars and produce acid, a cause of tooth decay.

Fruit juice: Fruit is important to a healthy diet, but fruit juice can cause problems for teeth. While whole fruits have fiber and are a less concentrated source of sugar or acids, the juices have concentrated and sometimes even added sugar. If you regularly drink fruit juices – or even soda pops – use a straw to avoid too much contact with your teeth.

Lemons, citrus fruits and other acidic foods: Avoid keeping these foods in your mouth for long periods of time.

Free Kids’ Clinic

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Fortunate Fillings

Lake Superior College

Fortunate Fillings

On “Give Kids a Smile Day” in February, Minnesota dental professionals volunteer their services at clinics, like Lake Superior College’s.

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Fortunate Fillings

Lake Superior College

Fortunate Fillings

Kids get a free cleaning and dental students get valuable experience.

Every February, Lake Superior College in Duluth offers free dental care for children as part of the “Give Kids a Smile” program promoted by the Minnesota Dental Association.

The college’s dental clinic brings in eight to 10 dentists, along with assistants, hygienists and senior hygiene students to provide care for about 65 kids in a single day. They receive an exam, a teeth cleaning and can get more advanced care – such as sealants, fillings and extractions – if time allows.

“It’s a day for our students to work with the dental community and see how fun it is,” says Cindy Upton, LSC dental clinic coordinator. “We’ll have a kid in who is 10 years old and has never seen a dentist before. We’ll have a kid who doesn’t even have a toothbrush.”

About one in four children ages 2 to 11 have untreated cavities, according to the U.S. Centers for Disease Control and Prevention, and many children from low-income families receive little or no dental care during their youths.

Any kid 18 years old or younger, from any area, can attend the free LSC clinic.

“We’ve had kids here as young as a year old,” Cindy says. “The dentist looks in their mouths, sees the development and says they have a clean bill of health or they’re showing decay.”

The clinic begins scheduling in January. Call 218-733-5939 to schedule children for morning or afternoon sessions.

After their exam, says Cindy, “Kids get a spin brush to take home with them. They get their toothpaste. They go home with a smile.”

Mother of three young children, Duluth freelance writer Felicia Schneiderhan knows how hard it is to keep the candy from the kids.