Despite recent passage of House Bill 392 — a bill establishing guidelines for volunteer dentists, hygienists and dental assistants who want to help out Delaware patients in need — it’s a sad day for low-income residents of Sussex County ages 18-64 who need dental care. Sussex Smiles, the only clinic specifically targeted to that group, has decided to close its doors.
Coastal Point
After incorporating in January 2001, the group went about raising funds, establishing a location and attempting to hire a dentist and assistant, with the goal of being operational in the fall of 2001. Over the years, they did see patients and established relationships with area dentists, some of whom even donated money to the non-profit.
When they discovered that hiring a full-time dentist was more challenging than they had originally thought it would be, they set about trying to change Delaware law to allow retired dentists from other states come and volunteer some time each month at Sussex Smiles, without meeting full state licensure requirements, so Sussex Smiles could see all the patients on their growing waiting list.
The non-profit had the backing of some in the local dental community and had help in the state legislature from Rep. Gerald Hocker (R-38th), with support from Sen. George Howard Bunting (D-20th) — all with the hopes of changing the law and getting the non-profit firmly established.
But a snag in getting the law changed came from the Delaware Dental Society, which is the authenticating body for dental professionals in the state.
Hocker said prior legislation was lobbied against by Dental Society professionals. Their opposition was something Hocker said he struggled with, because, in all likelihood, the change in the law never would have affected the patient pool of Dental Society members anyway.
“I don’t understand why,” he said. “It wasn’t taking anything from them. And all the dentists I talked to had all the business they could handle anyway,” explained Hocker.
Sussex Smiles Executive Director Anne Greene, a hygienist by trade, had the same frustrations in trying to get the law changed.
“We are supposed to be improving the oral health of the public, not just the people with the big bucks,” she lamented.
In March of 2005, Greene and a dentist she had worked with in Milford, Dr. Bob Emery, went to Dental Society meetings, in the hopes of gaining support to change the existing law. At the time, Emery was the main volunteer dentist at Sussex Smiles, and he remained so until his retirement and subsequent move out of state.
In order for the clinic to operate within the existing law, they had to have a licensed dentist on site — something that proved to be a problem because the young applicants for the position, for one reason or another, decided not to work there, and retirees moving to the area who could volunteer their time would have had to take a Delaware dental licensing test to be eligible, something that few, if any, were willing to do.
Greene said Sussex Smiles still has hygienists calling to volunteer, but she has had to turn them down because they have no licensed dentist on staff.
Hocker said the way the proposed legislation had been worded in previous attempts to change the law made it virtually impossible for the clinic to legally use volunteer dentists who held licenses from outside the state, regardless of whether they were willing to volunteer their time.
“There’s a dentist that had a practice in Maryland, right outside the Delaware line, and who had a lot of Delaware patients, and he was not allowed to volunteer his time,” explained Hocker. “And there was a dentist I talked with from Pennsylvania that was willing to volunteer, but he had to take the written dental exam for Delaware and that was just an insult to him.”
Hocker had worked to broker a compromise that finally got HB 392 passed.
“I thought we were on the right road,” said Hocker. “I finally got an agreement with the Dental Society and thought it was really going to help.”
But the compromise bill was something that Sussex Smiles board members felt still had too many requirements.
“The way the new bill is worded, it requires a Delaware-licensed dentist to supervise or to grade the work of the charity dentist,” explained Anne Greene. “It’s hard enough to get the volunteers...”
“I am very sorry about Sussex Smiles,” Hocker said. “We finally made some headway with the Dental Society. Maybe it was too little too late. Sussex Smiles is the only dental clinic at all for Sussex County, and there is such a huge need for dental assistance here.”
Hocker added that he will not give up, because of the obvious need of Sussex County residents and the importance of good dental hygiene as a basis for good overall health.
The issue has been seeing increasing attention in recently, as states’ find low-income patients — including children — slip through the cracks in a system where few dentists see low-income patients and those who do are booked so much in demand that serious dental problems often do not get treated in a timely manner. A 12-year-old Maryland boy, Deamonte Driver, died from complications from a tooth abscess in February 2007 after his mother spent months trying to find someone willing to treat him. That case has sparked a push for reform not only in Maryland but nationwide.
Green said that she would like to see something like nationwide licensing for medical and dental professionals.
“I don’t have all of the answers,” she said, “but with a background in public health [it makes sense to me] that all licensing for medical and dental professions should be across the country. As mobile as our country is, the public would be better off.”
She said they have similar licensing requirements for nursing, such as a allowing nurses to get a regional compact license that makes them eligible to practice in a few neighboring states.
As for the future of Sussex Smiles and dental care for low-income residents in Sussex, for now it seems murky, but only time will tell.
“Who knows?” said Greene. “We just couldn’t seem to get off the ground,” she said. “We knew manpower would be an issue, and Hocker gave it his best shot. It was a wonderful attempt and, finally, something is on the books.”
Hocker said he thought that everyone had finally come to an agreement and that he is disappointed that Sussex Smiles will be closing its doors anyway, but he is adamant that this is not the end of affordable dental care for Sussex residents who need it.
“I’m still going to help,” he said. “We are so thankful for all the dentists involved. I’m very let down. It took five years to get this far. We are going to meet with the same dentist that helped me before to draft the legislation, to try to get another plan. My local dentist has agreed to meet to help us come up with another plan.
“We need something yesterday — not tomorrow,” he added. “We have such a need. It upsets me. I have a reputation of helping people, and it upsets me that we haven’t been able to, but I’m not going to quit. I’m not going to let it just die.”
At the present time, Sussex Smiles is referring would-be patients to Delmarva Rural Ministries in Dover, at (302) 678-3652, which provides dental care to low-income residents.