Billy Mason catches some sleep about 6 a.m. Friday, Sept. 30, 2011, while he waits in line to receive free dental services at the Douglas County Dental Clinic, 316 Maine. The clinic offers a Free Dental Day once a year for low-income, uninsured residents, and the services are provided on a first-come, first-served basis. The clinic typically is able to help about 70 patients. Each year, the line begins to form earlier with last year's starting about midnight. by Richard Gwin

Douglas County Dental Clinic has hired a third full-time dentist who will start in June and it will move to a larger building in November to help meet the growing need for its services.

The clinic, now at 316 Maine, serves low-income and uninsured residents.

Last year, the clinic had 6,816 appointments, up 343 percent from its first full year of operation in 2002, when it had 1,537 appointments.

The wait for a nonemergency appointment is now about nine weeks.

"That's crazy," said Julie Branstrom, the clinic's executive director. "There are times that people will call with a toothache and we can't get them in for a day or two."

She said they would leave more emergency appointments open each day, but they can't afford to not have the chairs filled.

"It's a constant balancing act," she said.

The clinic is the only safety net dental clinic in the county and it isn't coming close to meeting the need for affordable care.

According to a 38-page Community Health Assessment released this month by the Lawrence-Douglas County Health Department, one in five residents had not seen a dentist in the past year, and Lawrence Memorial Hospital reported that more than 470 cases of preventable emergency department visits in 2011 were caused by dental problems.

'Poorest of the poor'

Branstrom said the clinic has seen an increase in the number of uninsured adults who qualify for services at its lowest fee level, which is 100 percent of the federal poverty level. That's an annual income of $10,890 for an individual or $22,350 for a family four.

"These are the poorest of the poor. They don't have money to come in and have a filling done," she said. "They are worried about basic necessities like putting food on the table and paying rent and putting shoes on their kids' feet. Our fees are out of reach for these people."

Branstrom would like to charge just a $10 fee for all dental care for anyone who is uninsured and meets the lowest income guidelines, but she can't do that and keep the doors open.

"It's crazy expensive to deliver dental care," she said.

That's because of the cost of supplies and the time each appointment takes. Here are some examples of the clinic's lowest fees:

• $24 — to diagnose the cause of a toothache. That covers an exam, X-ray and diagnosis, which takes about 30 minutes.

• $50 — for a filling on only one surface of the tooth. She said most patients need to have fillings on more than one surface.

• $44 — for a preventive appointment which includes an exam and cleaning.

• $200 — to clean the teeth of someone who has periodontal disease, which the vast majority of the clinic's patients have. It takes about one hour to clean one quadrant of the mouth, so it requires four appointments to do the entire mouth.

Branstrom said a majority of the clinic's patients operate in crisis mode.

"They come in here when something hurts, so they're not doing anything preventively. Oftentimes, it has been more than 10 years since they've seen a dentist," she said.

Sara Castaneda, 31, of rural Baldwin City, said she went to the dentist as a kid and had braces because her parents had dental insurance. She continued to see a dentist as an adult until she lost her corporate job and dental insurance about six years ago. She sought affordable care elsewhere for years but had no luck until someone referred her to Douglas County Dental Clinic.

"I was just so happy to find them," she said and added that she needed some work by that time.

She and her husband both use the clinic because they are uninsured despite working full-time jobs. Her husband found out he needed a root canal about a year ago and they've been saving to get the procedure done at a Kansas City safety net clinic where they were referred. The estimated cost is $620. That's a hefty price for the couple who have two young children.

"We just scrimp and save and make room for it," she said, of dental care. "That's one of our top priorities."

Dr. Cheryl Biesterfeld, left, and dental assistant Kristin Parrish work on 11-year-old Ethan Bryan, Lawrence, at the Douglas County Dental Clinic on Thursday, Dec. 12, 2010. The clinic helps fill a need in the region by accepting Medicaid patients because so few dentists do. by Kevin Anderson

Funding struggles

Branstrom said the clinic loses money when it cares for people who have no insurance. Last year, the clinic had 3,676 patients, and 1,466 were uninsured. However, it makes a slight profit from taking care of children who qualify for Medicaid, and so the clinic continues to expand its mobile outreach program. Currently, one dentist travels to area schools in Douglas County and its surrounding counties to provide preventive services.

"It's a struggle for us because we have to use Medicaid as a cost-shifting measure so we can continue to see uninsured adults," she said.

Branstrom said the clinic has received no increase in state funding for several years, and it lost $8,000 in United Way of Douglas County funding this year.

The clinic's 2011 budget was $905,000, with 66 percent coming from Medicaid reimbursements and uninsured patient fees. Thirty-one percent came from grants, and 3 percent was from private donations and fundraising.

This year, the clinic is hosting a new dinner-and-dance fundraiser in October and it is seeking more state grant money.

In November, the clinic will move to a dental practice at 2210 Yale Road that was formerly occupied by Peterson, Krische and Van Horn. The building, which is just west of Montana Mike's Steakhouse at 1015 Iowa, is about double the size of the current location, and the clinic will expand from six dental operatories to nine. Branstrom said the rent will be lower, but the clinic will pay between $5,000 and $7,000 more annually due to taxes, utilities and other maintenance costs.

"We just felt like we had to bring on a third dentist to help meet the needs of the community, and we are committed to finding the resources to do it," Branstrom said.

The Douglas County Dental Clinic will be moving in November to a building at 2210 Yale Road that was formerly occupied by the dental practice of Peterson, Krische and Van Horn. The building, which is just west of Montana Mike’s Steakhouse at 1015 Iowa St., is about double the size of its current location. The safety net clinic will go from six dental operatories to nine, and will be able to serve more low-income and uninsured patients. by Karrey Britt

Douglas County Dental Clinic, which services low-income and uninsured residents, will be moving to this building at 2210 Yale Road in November. The building previously was occupied by the dental practice of Peterson, Krische and Van Horn. by Karrey Britt