Dental center prevents ED visits, provides hospital referrals

St. Bernard Hospital Dental Center addresses social determinants of health by offering preventive services, regardless of a patient’s ability to pay, which the community may not receive otherwise.

“One advantage of a dental department in a hospital system is that it can bring in more patients for the whole system,” says Mary Joyce Gomez, DDS, medical director of the Dental Center at St. Bernard Hospital in Chicago’s Englewood neighborhood on the South Side. In this interview, Gomez explains how her department serves a community in serious need of dental care, which keeps some patients out of the emergency department (ED) and provides referrals to other hospital services.

How did the St. Bernard Hospital Dental Center get started?

Gomez: The program started in 2007. We had a pediatric mobile unit that would go to into the community to give the important vaccinations to the kids. They found that many children had broken teeth, dental pain and many other dental problems. Some of them didn’t even have toothbrushes. So, the hospital held some fundraisers and started the program. At that time, it was just for pediatric dental, but since then we’ve added adult services because the need there is great, too.

What services do you provide?

Gomez: We provide everything from basic prophylactic services to emergency dental care. One area we have become known for is treating patients with special needs, many of whom require general anesthesia. Since I joined the staff in 2017, our general anesthesia patients have soared from 72 cases a year to 400 cases a year. Special needs children and adults cannot be seen by regular dentists for a number of reasons.

For example, children or adults with cerebral palsy have myotonic contractions of their muscles, and they are not able to sit in a chair and open their mouths for a lengthy procedure in an ambulatory setting. Others have emotional or psychological limitations and cannot cope emotionally with sitting in a dental chair.

How is your program funded?

Gomez: Experience shows 99% of our patients are Medicaid patients, which covers only 40% of the expenses of running the department. We make up the difference through support from the hospital and the funders and donors of the program.

How important is dental care for a child?

Gomez: Lack of pediatric dental care trickles down from oral health to the health of the whole body, and more importantly the mind and emotions of the person. Baby teeth act as the predecessors to the permanent teeth. They guide the growth of permanent teeth and the jaw. If baby teeth have to be extracted because of infection or decay, the permanent teeth do not have that guide. This leads to orthodontic problems in the future, such as mouth occlusion. And how will mouth occlusion affect a teenager? It will affect their self-confidence, and they may get periodontal disease from crowding of the teeth. Periodontal disease, in turn, is related to diabetes and heart disease.

How does the dental clinic affect the financial health of St. Bernard Hospital?

Gomez: Before the clinic opened, people in the community would go to the ED when they had massive swelling or severe pain in their mouths. Our ED couldn’t do much more than control the airway and then transfer them to a bigger hospital for drainage of major abscesses. Now, instead, patients come here to the dental clinic. We can address the pain and even save their teeth, because our approach is comprehensive. We address urgent needs first, but we always encourage patients to come back for comprehensive care, explaining that their oral health is related to their physical health.

We also take a medical history of our patients, because it affects their dental treatment. If we ask, “When was the last time you saw your physician?” and they say, “Oh, I don’t know, I really don’t remember,” we encourage them to see a physician at our immediate care center, because we need to understand their health status before we can remove a tooth. At the clinic, dental patients get their blood work and a physical. With this strategy, we’re treating the whole person and not just the teeth.

Overall, the clinic creates revenue for the physicians and the different departments of the hospital, plus we are improving patients’ quality of life. I think that’s the best thing. And, of course, it is keeping them from the ED, which is costly to the hospital. And we’re growing our patient base overall at St. Bernard.

Interviewed for this article:

Mary Joyce Gomez, DDS, is medical director, Dental Center at St. Bernard Hospital, Chicago.