Dientes! Community Dental Clinic: Dental Care for Low-Income Residents of Santa Cruz County

By Jay Balzer, DMD, MPH, and
Catherine Webb, DDS

Dientes! is a private nonprofit community dental clinic that was established in 1994 to provide dental care for low-income residents of Santa Cruz County. Its founders were successful in securing support from a diverse group of community agencies, including city and county governments, philanthropic foundations, the dental community, and corporate and individual donors. Dientes! provides approximately 250 visits per month in a three-chair clinic in Santa Cruz; a school-based program in Watsonville was scheduled to begin in March 1998. The major challenge facing Dientes! is to establish a reliable financial base that will allow the program to better meet the needs of low-income county residents over the long term.

Article copyright 1998 Journal of the California Dental Association.
Photographs copyright of the authors.

Dientes! Community Dental Health Clinic came into being for a very simple reason: It just didn't seem right that low-income residents of Santa Cruz County had to travel to neighboring counties to obtain dental care they could afford.

In many other counties, dental care for the poor is provided by county health departments and/or community health centers. In Santa Cruz County, these organizations limit their clinical services to medical care; dental care is not provided.

So in early 1990, several community-minded dentists and concerned citizens got together to solve this problem. The answer they came up with was to create a private nonprofit organization to provide dental care for the poor.

But the story is far more complex than that. It took more than four years of planning, fund raising, and community organizing to bring the project to fruition in October 1994. The Dientes! organization had to be developed from the ground up since it is a "stand alone" dental clinic, without ties to a parent health care organization.

The effort was akin to starting a private dental practice, but without that key ingredient -- the dentist/owner -- who has all the incentive in the world to make things work because his or her livelihood depends on it. Dientes! was developed by a group of volunteers, unpaid individuals with jobs and lives of their own, who were developing the clinic in their spare time.

What the founders did represents a textbook example of how private citizens can bring together the diverse resources of a community -- both public and private -- to meet a pressing community need. They persuaded the County Health Department to use a portion of its state tobacco tax funds to purchase equipment for the clinic. They obtained substantial start-up grants from the Monterey Bay Dental Society, Dominican Hospital/Catholic Healthcare West, and Community Foundation of Santa Cruz County. Smaller sums were obtained from local corporations and individuals. Private dentists volunteered in the clinic, and dental supply companies donated materials. The words "partnership" and "collaboration" tend to be overused these days, but these terms accurately describe the process that made Dientes! a reality.

The People We Serve

Our name, "Dientes!" is the Spanish word for "teeth;" and it signifies our commitment to those Latino members of our community who lack access to dental care. However, these are not the only people we serve. People with low incomes who lack dental insurance reside throughout the county. A recent survey1 conducted by United Way found that less than half the population (47 percent) has dental insurance coverage, compared with 68 percent who have medical insurance.

Even people with Denti-Cal insurance have difficulty getting care. Among the approximately 200 active dentists in the county, only 12 general dentists and three pediatric dentists accept Denti-Cal.2 Consequently, we are a major source of care for Denti-Cal patients; they account for approximately 60 percent of our visits.

Patients who do not qualify for Denti-Cal and who have incomes at or below 200 percent of the poverty level -- a group often termed the working poor -- constitute our other major class of patients. An individual with a monthly income of less than $1,315 and a family of four with a monthly income of less than $2,675 qualify for our services. These patients pay on a sliding fee scale, which for most patients is approximately half as much as a private practice fee.

We also serve people who have difficulty obtaining care elsewhere, for whatever reason, such as people who are homeless; have HIV disease; or have developmental, mental, or physical disabilities.

Our Clinic

Dientes! is governed by an eight-member Board of Directors and employs a part-time executive director. We operate a 1,000-square-foot, three-chair clinic in a one-story Santa Cruz office building. Our clinic is small, modern and well-maintained; it gives the appearance of a modest private dental office, rather than a low-income clinic.

Thanks to a grant from the California Endowment, we recently expanded our weekly schedule from three to 4 1/2 days per week. Each day we employ a dentist, two dental assistants, a receptionist, and an office manager. Five volunteer dentists help us serve additional patients. Dental hygiene students from Cabrillo College work in our clinic as part of their community rotation.

More than 85 percent of the services we perform are preventive procedures, fillings, and emergency visits for the relief of pain and infection. We also provide a relatively small number of full and partial dentures, root canal treatments, crowns, and periodontal treatments. We provide approximately 250 visits per month. Our annual budget is approximately $400,000.

Where We're Headed

At a strategic planning session in May 1997, the Board of Directors endorsed an expanded role for Dientes! Specifically, we want to improve access to dental services for families in Watsonville, which is 30 miles away from Santa Cruz in the southern end of the county. Our first step in that direction is to start a school-based dental program in partnership with the Pajaro Valley Unified School District's Healthy Start program.

We are also exploring ways to serve low-income families in Watsonville through partnerships with both the government and private sectors. One partnership we are exploring is with the County Health Department, whereby we would establish a Dientes! clinic in a county-owned building adjacent to the medical clinics that serve low-income people. Another potential partnership is with the local community health center, Salud Para la Gente, whereby we would establish a Dientes! clinic within their facility. Still another option we are exploring, with the help of a Packard Foundation grant, is the feasibility of creating a partnership with several private dentists, whereby we would contract with them to serve our low-income patients in their own offices. If this type of collaboration could be developed as a reliable source of care, then we might be able to avoid the high cost of developing a new facility in Watsonville.

Our Major Challenge: Financial Sustainability

We are working hard to strengthen the financial health of our organization so that we can continue to serve the community over the long term. That is not an easy task, given the nature of our business: a dental practice that pays its expenses (rent, staff, materials, etc.) at market rates but collects its Denti-Cal and sliding-fee revenue at a fraction of private practice fees.
Our challenge is to increase revenue and reduce costs by various means:

• Increasing the productivity of our clinical staff;
  
  
• Increasing the contribution of dentist and dental hygienist volunteers;
  
  
• Increasing donations from community businesses and individuals;
  
  
• Developing fundraising events; and
  
  
• Increasing grant and contract income.

Summary

The creation of a private nonprofit community dental clinic requires a tremendous amount of work by many dedicated individuals. Successful planning must take into consideration not only the oral health care needs of the community, but also the financial requirements of a stand-alone dental practice that provides care at reduced rates. The key to success is the ability to identify partners -- in the local community and beyond -- that share an interest in the organization's mission and are willing to share in the cost of providing services.

Authors

Jay Balzer, DMD, MPH, is the executive director of Dientes! Community Dental Clinic.
Catherine Webb, DDS, is a co-founder of the clinic.

References

1. United Way of Santa Cruz County, Life in Santa Cruz County; Comprehensive Report of the Community Assessment Project, 1996, p 84.
2. Ibid; p 109.

To request printed copies of this article, please contact/Jay Balzer, DMD, MPH, c/o Dientes! Community Dental Clinic, 930 Mission St., Suite 2, Santa Cruz, CA 95060