Interesting work out of the University of Michigan discusses the concept of getting dental care for free by performing community service. A master’s thesis by Lorene R. Kline titled “No Cost Dental Care in Exchange for Community Service Hours: Participating Patients’ and Dentists’ Responses” (2016) discusses this concept. The article is located over at https://deepblue.lib.umich.edu/bitstream/handle/2027.42/123017/Kline_MSDH_Thesis_%20Final_2016.pdf?sequence=1&isAllowed=y
The work discusses a program to help low income Michigan residents where adult participants were offered $25 in dental services for every hour of volunteer work. The program was titled Pay it Forward and was a partnership between Care Free Medical and Dental and the Central District Dental Society of Michigan. Pay It Forward was geared toward low-income adults who fell between 133% and 250% of the poverty level and did not qualify for Medicaid. The cost was based on Medicaid schedule fees. The thesis work focused on forming an assessment of the perceptions of the volunteer dentists and patients who participated in the program because it is beneficial to gain an understanding from the patients’ and the dentists’ viewpoint.
Roughly 80% of the 27 patients who responded to the survey (38 participated) said they liked the program and would recommend it. About 12% of respondents said volunteering was tough to find time for with their other work and family commitments. Patients eligible for the program took a one-hour oral health education class and performed four hours of community service. This covered an initial exam, x-rays, and a dental cleaning. After this, dentists outline their treatment plans and patients were told how many more hours they needed to volunteer in order to continue with treatment. It was found that patients volunteered an average of 33 hours. The program mostly covered extractions and restorations and not more major work like crowns and bridges; however, the following was also performed: 6 core build-ups, 32 quadrants of scaling and root planing, 4 endodontic treatments, 1 teeth whitening treatment, 1 bonded denture, 1 instance of nitrous oxide delivery, 1 Peridex treatment, 2 crowns, 1 four-unit bridge, 1 maxillary partial, 1 mandibular partial, 1 instance of IV sedation, 1 treatment for dry socket, and 1 occlusal guard.
Roughly 70% of patients who responded to the survey were in pain when they entered the program. A total of 33% of respondents said their teeth and gums limited the food they ate; 38% said it caused discomfort and concern; and 40% said it made them uncomfortable when eating in front of others. Seven dentists who responded rated the program favorably on all aspects. Two dentists voiced issues with the volunteer activities and said the quality of care was not as comprehensive as it should have been. When asked about program improvement, dentists recommended to find a lab to participate so more extensive treatment can be offered, offer Continuing Education (CE) credits to participating dentists, clarify when relationships with patients ends, and have patients provide community service in the providing dentists’ community instead of some other community. Of course one drawback of this study is the small amount of patients (38) and dentists (10) who participated in the program.
Overall, both patients and dentists liked the program. Patients perceived their dental treatment to be valuable and important, and found the volunteering experience to be rewarding. Dentists perceived the program to be innovative, rewarding and valuable, and they liked giving back to the community by volunteering. There are millions of patients in the U.S. without dental insurance. Many of these patients then later end up in hospital emergency rooms for preventable dental conditions and many of the bills go unpaid.
The author of this work says
“…a program of this type can lead to the question of whether the concept of volunteering in exchange for dental care is a form of exploitation of the working poor in this country.”
The U.S. should do a better job of providing dental care to it’s citizens without relying on charity and having people perform community service in order to get needed care.