The investment was worth it.
“Demand for our medical service has remained pretty constant (since the spring), but our demand for dental care has gone through the roof,” Executive Director Anita Ruff said earlier this month.
The expansion – a suite of modern dental exam rooms – allowed Oasis to increase its number of dental clinics from two to 13 per month at the Baribeau Drive offices.
“In (the last nine) months, we’ve tripled what we did in one year (prior to the expansion),” staff dental hygienist Tammy Tyree said.
Over that period, the value of the clinic’s free dental services has totaled over $188,000 – up from $63,100 for services it provided during all of 2015, according to Ruff.
Still, dental coverage is part of a much larger pie.
Between January 2015 and June 2016 – when Oasis last issued an annual report – the clinic’s network of more than 80 volunteer practitioners saw nearly 250 patients last year, and provided more than $266,000 of free care, including dental.
Ruff said Oasis made the deliberate move to invest in dental coverage because of a comparatively high unmet need. Notably, dental is not covered under MaineCare, resulting in a wider pool of uninsured patients.
When someone lacks insurance, they are more likely to visit the emergency department to attend to their problem, Ruff said.
“(But) emergency room doctors aren’t licensed to do dental work,” Ruff noted, adding, “That’s not a great use of the Mid Coast (Hospital) ER, either.”
Volunteer dentist Dr. Kathleen Winn said to her knowledge, Oasis is the only free clinic providing dental care north of Portland.
Eligible patients must live in Freeport, Durham, Brunswick, Harpswell and Sagadahoc County, be at or below 175 percent of the federal poverty line, and without health insurance.
Volunteers are supplemented by a lean core of paid staff, whose salaries and supplies are supported by grants and fundraising.
Winn has a practice in Brunswick, but at least one dentist makes a monthly trip from Bangor to provide free care – care that goes beyond just alleviating pain, Tyree said.
Damaged or missing teeth “affect (patients) socially,” as well as physically, Tyree explained; patients have confided in her how their teeth have led to social isolation and difficulties in finding jobs.
“We’re not just restoring teeth here,” she said. “We’re restoring people’s lives.”
It was a Friday earlier this month, and she and Winn had just finished with a patient whose roots were so damaged from lack of proper care they kept breaking as they worked.
Earlier in morning, Winn said, a patient told her they “just wanted to smile again.”
Likely because of the surge in dental patients, Oasis has seen a 10 percent increase in the overall number of patients – a surge Ruff attributes, on a hunch, to expanded dental services.
“Most people can’t ignore an infected tooth,” Ruff said, whereas they may let their high blood pressure go unattended; an initial dental appointment can be what gets patients through the door to treat other existing problems.
Without basic proactive care, practitioners have seen problems accumulate to a point where Tyree “can’t even see the teeth to see where the cavities are.” As of March 13, she was booking cleanings into July.
For many of the same socio-economic reasons that resulted in a lack of health care, Ruff said patients often have “long back stories,” and arrive with needs in addition to the one for which they scheduled an appointment.
It isn’t uncommon for the clinic volunteers, after attending to a set of cracked teeth, to refer clients to resources related to the triggering incident of domestic abuse; some of those services exist within the same office complex.
“Sometimes our patients wait until they can’t wait anymore,” Ruff said.
For those living in poverty, access to health care is either cost-prohibitive or difficult to make time for if patients work several jobs or lack easy transportation; a “chicken and egg” cycle of interrelated, compounded issues can delay medical attention.
Acknowledging the pattern, Andree Appel, Oasis’s clinical director, called the state of health care in Maine “incredibly short-sighted.”
Because of the state’s decision not to expand federally subsidized Medicaid following the passage of the Affordable Care Act, Appel criticized the system for failing to provide the preventative care that ultimately leads uninsured Mainers to emergency departments.
“Emergency room care is some of the most expensive care around,” she said. “It’s just incredibly short-sighted and ultimately more expensive to not provide access to (preventative) care.”
For example, she said, she spoke to a girl earlier this month who had a chronic disease, but was automatically dropped from MaineCare coverage when she recently turned 18.
Not equipped to handle a condition that serious, Appel said, “We’re clearly not the place for her,” and helped connect the patient and her parents with a caseworker to help reacquire MaineCare.
“It’s just so amazing that there is no calculus on the part of MaineCare that she’s going to end up in the emergency room with something preventable,” she said.
But as the fate of the country’s health care system continues to hang in the balance, both Ruff and Appel said politics aren’t their focus.
For one, changes in the health care system don’t affect the model of their practice, which serves the uninsured and relies on volunteer hours, not federal or state reimbursements.
“I think like everybody, we don’t know what’s going to happen,” Ruff said.
As frontline health-care workers, Ruff said charting the political scene is not their priority; her days, she alluded, are busy enough.
But if large swaths of the population lose their health insurance, she expects the clinic might see demand for their services rise.
And if that happens, Oasis will be ready: Ruff said they have the facility, they just need more volunteers.
Winn, whose dental patients are already entirely made up of those who can’t find coverage through the state, agreed.
“We have plenty of patients,” she said. “It’s the volunteers we need.”
Executive Director Anita Ruff sits at the intake desk at Brunswick’s Oasis Free Clinics, the state’s largest provider of free dental health care north of Portland. The clinic also provides basic medical coverage to low-income, uninsured area residents.
Andree Appel, clinical director at Oasis Free Clinics in Brunswick, said she has witnessed a surge in dental patients since the clinic expanded its facilities and hours last spring.