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50 MN clinics offer free dental care this week. Someday, they’d like to offer COVID vaccines, too.

1February 2021

With the goal of saving teeth and gums, second-generation dentist Jennifer Marker Johnson is pulling her personal hero, John Marker, out of semi-retirement for some father-daughter dentistry this week on St. Paul’s East Side.

The two Dr. Markers will offer free care to low-income children during “Give Kids a Smile Day,” an annual charitable event she’s participated in since purchasing East Dental, a private clinic on Payne Avenue, four years ago.

Give Kids A Smile Day is scheduled for Friday and Saturday at clinics across Minnesota. The event ropes in private dental clinics and publicly backed community health centers across the state to offer free cleanings and minor procedures such as tooth extractions to kids in need, regardless of their ability to pay.

FEAR OF COVID-19

What doesn’t come around annually is a pandemic. While the charitable event will include some 1,000 volunteers at 50 clinics across the state, many dental clinics that typically sign up have opted out this year. So have some patients.

“I would say approximately half the number of clinics are participating this year compared to last,” said Christine Lekatz, a spokeswoman for the Minnesota Dental Association initiative. “It’s hard to say about the appointments — some clinics are near capacity and others have quite a bit of capacity.”

Dentists remain concerned that nervous parents who have delayed their children’s dental procedures out of fear of contracting COVID-19 are putting kids at risk of more serious medical situations or leaving them in painful straits.

More than half of Minnesota children enrolled in Medicaid have not received dental services in the past year, according to the Minnesota Dental Association.

“I have some families who are very reluctant to re-enter because of their fear of COVID. They’ve delayed things to the point where we’re dealing with an abscessed tooth, or we’ve got a child that needs to be hospitalized with a serious infection,” said Jim Nickman, a pediatric dentist and president of the association. “We’re actually seeing a higher cavity rate, especially in kids, because routines are blown. They’re not in school, they’re grazing throughout the day, oral care practices have dropped. Some families are under such stress, teeth aren’t necessarily the priority. Some families are showing up with kids who have a handful of cavities, who have never had that before.”

ACCESS IS HARDER, STATE REIMBURSEMENTS ARE LOW

Still, even for families diligent about making dental appointments, access has gotten harder.

“We’ve seen probably a 70 percent decrease from a non-pandemic setting, partially because of wait times — we have to clean an area between each patient,” Nickman said. “It may be harder for them to get in.”

Meanwhile, legislative questions also are looming.

Officials with the Minnesota Dental Association say the state is well toward the bottom of the nation in terms of Medicaid reimbursement to dentists. That makes it difficult for private clinics to accept as many low-income patients as some would like, which takes added significance at a time of deferred care.

In September, a state legislative blue-ribbon commission on Health and Human Services issued a 271-page report on needed changes to the state’s health care safety net. Updating the rate structure for dental reimbursement was one of several recommended strategies.

For every dollar of business she charges, Marker Johnson said keeping the lights on and other fundamental overhead costs eat up about 70 cents, “and that’s pretty high,” she said. “The state will reimburse me about 29 cents. That means, for every dollar I’m doing, I’m donating 40 cents. If you’re running a business, unless you have grant money, every time I see a Medicaid patient it’s a donation. Somebody who is on a state-funded plan, it becomes a donation.”

She said she gets about five to eight calls each day from people on state plans who need a provider.

“You can’t see everybody, even if you want to,” she added. “It doesn’t help everybody if I lose my business. But I’m pretty lucky — I don’t have any student loans, and I’m on Payne Avenue. My mortgage is not what it would be, say, if I were closer to Summit Avenue.”

COVID SHOTS AT THE DENTIST’S OFFICE?

COVID-19 vaccination is still not widely available, but once the vaccine comes to Minnesota in greater quantities, some dentists believe their clinics would be ideal places to administer shots to patients, which they are already allowed to do for the flu vaccine.

They say COVID-19 transmission rates within dental settings have remained low over the course of the pandemic for a good reason — they know what they’re doing — and offering the vaccine could be an incentive for patients who have delayed care to come in and get a check-up and a cleaning.

“We want to meet people where they’re at,” said Marker Johnson. “Across the nation, the transmission rate between staff and patients and patients and staff have been really negligible. I think most practices have done a fantastic job of figuring it out. Every patient should feel comfortable asking their doctor what they’ve done. It’s your personal health. You have the right to know, but you want to do that not out of fear. You want to do that with good science.”

“You ‘ve got to weigh the risk factors,” she added. “The risk of a tooth infection or untreated gum disease is potentially far greater than the theoretic risk that you might encounter COVID. You should contact your doctor and determine if you’re someone who is better to wait, or if you should come in.”

To find a participating clinic for Give Kids a Smile Day, dial United Way 211 — 211 on a smartphone, or (800) 543-7709 — or visit mndental.org. Appointments can then be scheduled directly with the dental office. No eligibility questions are asked.

Patients must be 18 years old or younger and accompanied by a parent or legal guardian, and specific services will vary by location. Many clinics have enlisted volunteers who speak multiple languages.

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