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‘The Need Is Huge’

Mercy McAuley Clinic Adds Dental Service

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Posted: Wednesday, April 2, 2014 6:32 pm

Liam Sansom is just 19 months old, an age many parents might think is too young to see a dentist. Luckily, his mom, Dawn Sansom, Union, knew better.

She took Liam to a dentist for his first checkup when he was just 6 months old, after his first teeth began to erupt. Now he has a mouthful of teeth, and they are healthy.

Other kids his age aren’t so fortunate, said Dr. Ben Connor, a dentist now seeing patients at the Mercy McAuley Clinic in Washington.

“A lot of people ask, ‘When do I need to start taking my child to the dentist — 3, 4, 5?’ If you talk to a pediatric dentist, it’s when the first tooth erupts at 6 or 7 months,” said Dr. Connor.

“If you wait until a child is 3, they might come in with baby bottle decay. I’ve had a child come in with decay at 9 months old.”

Young children with mouths full of decay are faced with having to be treated in the operating room, Dr. Connor noted.

It’s easy for young children to end up with decay if their parents aren’t aware of how dental caries (rot) form.

“Most people don’t know that,” said Dr. Connor. “They know to brush twice a day and floss, but they don’t know one of the most important things is frequency — the more often you have sugar intake, whether it be juice or foods, and not necessarily sugary foods, but every time you eat or drink something, the bacteria in your mouth eat the sugars, and they produce the acids in your mouth that cause tooth decay.

“So one kid could drink a gallon of juice for breakfast every day, and that’s the kid who doesn’t get any cavaties,” said Dr. Connor. “But the kid who has one glass of juice in a sippy cup and sips on it all day long, every sip can lead to cavities.”

Sending infants to bed with a bottle or letting toddlers feed on demand can cause the same problems, he noted.

People also tend to think that cavities run in their family, but that’s not true, Dr. Connor said.

“For the most part, people’s teeth are all made to the same hardness, unless you do have some kind of developmental abnormality,” he said.

“However, certain bacteria are better at causing tooth decay, and where do you get your bacteria from when you’re little? Your parents, because they’re the ones you share food with, you kiss, all kinds of things.

“So some people who tend to get a lot of cavities may have to work harder at taking care of their teeth because the bacteria runs in their family,” said Dr. Connor.

These are some of the messages Dr. Connor is sharing with parents as he sees children in the Mercy McAuley Clinic.

The clinic added dental services last fall, with Dr. Connor seeing his first patients Nov. 20.

The Mercy McAuley Clinic started in 1992 to provide prenatal and pediatric care to uninsured, underinsured and Medicaid-eligible women and children in more than five counties. Today the clinic includes comprehensive family medicine and mental health services.

Adding dental care was the logical next step, said Mark Covington, vice president of mission and ethics at Mercy Hospital Washington.

“The need is huge,” he remarked.

Three Years in the Making

It was several years ago during the process of creating a community master plan that dental care came up as a need, said Covington.

He and Jim Delvaux, practice manager at the McAuley Clinic, had conversations with staff at Mercy Hospital St. Louis, where a private dentist does some charity work.

“We said, ‘We think this fits here (in Washington),’ ” said Covington.

“Then we did some research and found out that dental caries was the No. 3 reason why people were using the emergency room.”

That wasn’t an anomaly.

“The ministry office identified dental services as a big need in the community, and the Franklin County Area United Way identified dental as the No. 1 health access need in the county,” Covington said.

“For those reasons, we got very serious about this.”

Three years ago Covington and Delvaux began the process of taking the idea of adding dental services at the McAuley Clinic from a need to a concept to a plan and then a strategy and then implementation. It took so long because it has never been done before within Mercy, and it was an entirely new service.

“This is the first hospital-based rural health dental program in Mercy,” Covington stressed.

“Hospitals are not used to having dental services. It’s just not part of their scope. They don’t know how to think about it. So that was part of the selling act that we had to do.

“But eventually we got strong support,” said Covington with a smile.

Getting it up and running was still a major challenge.

“There wasn’t a single barrier you can think of that we didn’t have to go over,” Covington remarked.

“If doing this was easy, everyone would do it,” added Dr. Connor. “This is very difficult.”

That’s one reason others in the Mercy system are following news of the dental clinic closely. There is serious interest in replicating the service at other locations.

“I’m aware of at least four other hospitals that are considering it,” said Covington.

“We are the beta site or pilot program for Mercy,” he said. “This isn’t being done anywhere else.

“We just happened to have this wonderful, comprehensive, integrated primary care patient-centered home with very complex integrated services, and it made sense to try to fit dental into that matrix.”

Funding for the addition of the dental services at the McAuley Clinic was provided through a grant from Mercy Caritas, established by Mercy in 1987 to provide funds to health and human services programs that meet unique community needs.

Additional funding comes from the Mercy Health Foundation Washington to ensure that the dental clinic is running and serving patients, but even more philanthropic donations will be needed, Covington said.

For Established McAuley Clinic Patients

Currently the dental clinic is reserved for established McAuley Clinic patients, with an emphasis on children and secondarily on adults.

“We need to make this program sustainable,” said Delvaux. “We want this long term. We don’t want this to be a three-year or five-year wonder.

“To do that, there has to be a certain amount of payable, which is pediatric and women’s health, along with the charity, the adult clinic,” he explained. “We have to have a balance.”

“Right now we have a good balance of 60/40 or 60 percent paying, 40 percent charity,” said Delvaux, noting an ideal split is 70 percent payable and 30 percent charity.

For those patients without insurance, the cost is a $50 co-pay, which serves two purposes, said Delvaux. It contributes a little to the clinic, and it “puts some skin into the game for the patient, which a lot of times, they need, as opposed to everything being free.”

They need to show a commitment, that the dental care is important to them, Delvaux said.

Already Dr. Connor has seen over 450 patients and extracted over 300 teeth in the few months that the dental clinic has been open.

“That’s a credit to Dr. Connor and his team,” said Delvaux. “That’s 450 patients that a year ago, didn’t have dental care.

“Those are people who are not having to be seen in the ED (emergency department), who aren’t being treated with pain medication, who are not on antibiotics, because they treated the cause of the discomfort, not just the symptoms,” said Delvaux.

Those 450 patients are a combination of children and young mothers, and the mothers are so young, that for some of them this is the first dental care they’ve ever received.

In March, the dental clinic added an OR for young children (under 5) who come in with a full mouth of decay and need to be placed under general anesthesia for treatment.

Most of these patients would have had to drive some distance, St. Louis or even beyond, to receive the care they needed, Dr. Connor noted.

Oral Health Linked to Overall Health

Many people may not realize it, but most studies do link oral health to overall health, said Dr. Connor.

“For instance diabetic patients are more prone to infections, more prone to periodontal abscesses in their mouth,” he said.

“Oftentimes the lack of oral health care really hinders the treatment of diabetes. By ignoring the mouth, the physician really can’t get control of the diabetes for that patient.

“You clean up their mouth, it makes helping them out with their diabetes easier, getting it under control, and quality of life improves,” said Dr. Connor. “It’s the same things with heart disease and OB patients, as well.”

People who end up in the emergency room because of a dental infection do not get their problems solved, only treated for the time being.

“If you go to the ED (emergency department), they’re not going to pull your tooth,” said Dr. Connor. “They don’t have a dentist there . . . they’re going to give you medications, you’ll feel better for a month or two, maybe three months, then you will be back.

“By the time you go to the emergency department for a toothache, it’s not a savable tooth. It’s a $1,500 to $2,000 problem for one tooth.”

Dental caries are the most common chronic disease of childhood, however, unlike most diseases, they are 100 percent preventable, which is part of what the dental clinic hopes to accomplish.

“What we do here is we have this OB clinic as well, so a lot of these pregnant moms come in . . . They get treated, they have their child, their child becomes a patient in the pediatric department, and we can get that converted over into dental care very young,” said Dr. Connor.

“That’s the interesting thing about what we have set up here,” he said. “It is kind of a patient-centered medical home. The OB patients have dental coverage while they’re here and six weeks post (delivery). Then you grab the children and get them a good start, because that’s the only way you’re going to be able to make a change in the future as far as ED (emergency department) over utilization with adults.”

First Pediatric Visit

Dental visits for infants and young toddlers are usually simple, 10- to 15-minute appointments, said Dr. Connor.

“It’s a knee-to-knee lap exam,” he said. “They look in the mouth, and you can pretty quickly tell if there’s anything that looks off or needs further investigation.

“The most important thing about that first visit is instructing the parents on good oral hygiene,” Dr. Connor stressed. “Prevention is the key, that’s where you minimize the cost.”

For infants and young toddlers dentists recommend wiping down their teeth with a washcloth after they are finished eating/drinking.

One Front Door

Mercy McAuley Clinic sees over 4,000 children a year in its pediatric clinic, and that number is growing, said Delvaux.

What began as a pediatric clinic for the underserved, has grown to include an adult clinic, behavioral health clinic and an adolescent behavioral health clinic, diabetes clinic, and now the dental clinic.

“So we’re kind of a one front door for everything that involves mental health, behavior health, medical health and now dental health,” Delvaux remarked.

“All this is in furtherance of our mission to serve the poor,” Covington added.

“That’s the fundamental mission of Mercy, to take care of those who are underserved, underprivileged, left behind, vulnerable . . . ,” he said. “This is a manifestation of our commitment to that Mercy maxim, which is to take care of those who are poor.”

Dr. Connor is the son of Jeff and Bev Connor, Washington. He graduated from St. Francis Borgia Regional High School in 2001. His wife, Emily (Mundwiller) Connor, also is an SFBRHS graduate.

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