Cavities in care

Dental coalition director says most emergencies preventable


The files of the Northwest Colorado Dental Coalition abound with horror stories of chronic, untreated tooth decay, from a 3-year-old girl with 18 cavities, to a boy who couldn't eat meat or kiss his mother because his mouth hurt so bad.

The coalition's executive director, Debi Garoutte, sees them as case studies in what she attributes to a lack of education about oral health and a shortage of dental care providers.

Garoutte is quick to point out that the dentists who work in Craig are "doing everything they possibly can." In fact most of them are booked four to six weeks in advance.

The reality is that people who can afford to visit the dentist, because they have dental insurance or cash, can get treatment for emergencies most likely within the week. And they can schedule cleanings well in advance to maintain adequate dental hygiene.

But those who can't afford the services and those insured by Medicaid have great difficulty getting emergency treatment, and almost no chance of receiving routine cleanings, Garoutte said.

No dentists in Craig accept Medicaid. And why should they? Garoutte asked. Their schedules are overflowing with customers who can pay market price for the services, much more than Medicaid reimbursements allow.

But admitting it doesn't make Garoutte's job any easier. She heads the Northwest Colorado Dental Coalition, formed in 1997, to address the lack of dental care for Medicaid and low-income clients in Moffat County. The coalition later expanded its services to the "tri-county area," which includes Routt and Rio Blanco counties as well.

When someone walks in her office for help finding a dentist, it's almost always an emergency. It's frustrating, Garoutte said, knowing from her research that dental decay in children is their most common chronic disease, yet it is 100% preventable.

The Caring for Colorado Foundation studied the problem in Colorado and in 2002 committed $5 million to address it. Garoutte said the Dental Coalition received $25,000 of that money as a grant to develop a plan for establishing an indigent dental clinic.

The model clinic she has studied is the Merillac Clinic in Grand Junction, which treats indigent clients on a sliding scale. The clinic grew from two chairs in a 480-square-foot office to a state-of-the-art 6,000-square-foot clinic with 13 chairs. But it only accepts Mesa County clients.

Garoutte said she spends much of her time trying to squeeze patients into clinics in neighboring counties where Medicaid patients are accepted.

"What would we do if neighboring counties didn't open their doors to our kids," Garoutte said.

Sometimes, the clinics aren't even in "neighboring" counties. Garoutte said she fits them in where she can, sometimes in Denver or even Colorado Springs. But then her problem becomes how to arrange transportation to the distant clinics.

It's not surprising that she's forced to look so far away. According to a study by the Caring for Colorado Foundation, nearly 85 percent of

all practicing dentists in Colorado

are located within 25

miles of Interstate 25.

Moffat County isn't the only county struggling. The study also found that in addition to Moffat County, 24 other counties in the state do not have a dental Medicaid provider. Nine counties have no dentists at all.

Unfortunately, it doesn't appear as though help is on the way. The majority of Colorado dentists are older than 40.

"In the next decade, the overwhelming majority of dentists in this state will have retired or reduced their practice activity. And the number of dentists needed to replace them is not in the pipeline," according to Caring for Colorado's study.

Even with her limited resources, Garoutte does have a collection of success stories. She's been able to squeeze emergency cases into local dentists, who, on occasion can shoulder the pro bono work. She works with a dentist in Rifle and Glenwood who can sometimes make room for the Medicaid clients. And the Miles for Smiles Dental Van, a traveling office, stops in Craig for eight weeks in the spring to treat indigent patients for only 10 percent of the cost of the procedure.

When the van is in town, Garoutte said it's booked solid. Even when it's elsewhere on the Western Slope, she sometimes sends a Moffat County patient there for treatment.

In the end, Garoutte said, education may be one of her most powerful allies. Even the concept of brushing one's teeth daily is a challenge for her to communicate to some people. She said she often sees the same clients return year after year with the same painful dental issues, only to find that they've ignored the advice to simply brush their teeth.

Parents are culpable, in many cases, using excuses like, "Johnny doesn't like to brush his teeth," or "We can't afford toothpaste."

The latter is especially frustrating because Garoutte tells indigent clients they can come by her office any time and get toothbrushes and toothpaste for free.

But unfortunately, "Many people don't think about oral health until they're in pain," Garoutte said.

Jeremy Browning can be reached at 824-7031 or

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