Oral Health: The First Line of Defense

“I love to get people out of pain,” said Jeremy Bullock, DMD. The Community Health dentist says his goals as a dentist are in synch with the Rutland-based health network’s complete approach to primary care, bringing health and wellness to the whole body and mind. Community Health provides dental and behavioral health care as part of their overall primary care services.

As a Federally Qualified Health Center (FQHC), Community Health works with the entire community, offering affordable care across the board with sliding scale payments and accepting a range of insurances in addition to Medicare and Medicaid. Since Vermont is one of 19 states that provides dental care as part of Medicaid, providers in the network understand that patients can take advantage of the dental health care services in addition to all of the other primary care offered by Community Health.

Community Health’s dental offices are portals for primary care, checking blood pressure and other vitals while screening patients. “Sometimes we are the first line of defense,” Bullock said.

“We had a Shorewell patient who was supposed to see one of our mental health professionals,” Bullock said. When the social worker told Bullock her client was “dying in pain tooth-wise,” he took care of the dental issues on site. Community Health has two dental practices, one in Rutland and the other in Shoreham. (Behavioral health providers are available at all Community Health practices.) At Community Dental Shorewell, Bullock said, “it’s literally walking 20 steps over to the other check in area and we can get them seen and taken care of.”

The first line of defense

“There are a lot of Federally Qualified Health Centers that pull teeth, or they see emergencies, and that’s it,” said Community Health Dental Director Rachel Rivard, DMD. “Community Health views itself as a primary care facility and takes pride in ownership of that. They operate in best practices, with the best technology, with the best equipment, keeping up with it all,“ she said.

One of the benefits of being part of the Community Health network is continuity of care. “Every new patient, every recall patient, sometimes we are seeing them at three months, four months or six months and we are updating their medical history as well. There is a huge list of what we doublecheck,” Bullock said.  Changes in medical history can be updated at any point. “With new patients we go through if they are COPD, or if they have asthma. Those are the things we are looking for or if  they are on a blood thinner.  And we are just making sure that they are up to date and are staying on top of things as well.”

The condition of a person’s gums and teeth has been shown to have a major impact on health, medical costs and quality of life. Serious gum disease is associated with diabetes, heart disease and other medical conditions. “Cavities haven’t changed too much, Bullock said. “Gingivitis, periodontitis and gum issues are the things we are looking for as signs of heart problems.”

Research by the American Dental Association has found that treating gum disease can help diabetics control blood glucose and lower overall medical costs for patients with the chronic condition. About 30% of low-income adults report that the condition of their mouth and teeth affects their ability to interview for a job, and 42% report difficulties biting and chewing, according to research by the American Dental Association’s Health Policy Institute. Dental pain is a common reason patients end up in the emergency room, accounting for 2.1 million such visits in 2010, according to the ADA.

Caring for the Whole Person Is a Team Effort

Even just to smile makes a big difference. Community Health Behavioral Health Practice Manager Christopher Chadwick says dental work can restore self-confidence as well as reduce anxiety. The connection between oral hygiene and overall health, physical and behavioral, is something that Community Health providers practice.

Bullock said his goals are simple for his patients: good oral hygiene, eliminating decay and saving teeth. “We are just talking about getting things cleaned up, maybe we get some stain off their teeth. It really does make a big difference in people’s lives. That’s why I say we are the first line of defense. If we can get people to take care of their mouths, then they tell me ‘Things don’t hurt when I am eating, when I am chewing, when I am talking.’ That makes a big difference.”

Community Health’s approach to primary care includes dental and behavioral health, offering their network dental practices as part of the services available to every patient. Over 13,700 patients in the Community Health network take advantage of Community Dental, with the largest demographic in the 21 to 41 year-old age group.

Affordable Dentistry

“Maintenance is much more affordable than taking care of fires especially in dentistry,” said Rivard. “Keeping up with exams and cleanings and doing small fillings is always going to be more cost effective than putting something bigger on the tooth,” she said. And according to Rivard, data really backs up the fact that if you can keep a child cavity free until they are three years old, they are much more likely to have a lifetime of being cavity free.

Community Health’s sliding scale payments and Medicare coverage have made dentistry more affordable and accessible with the two dental practices in Rutland and Shoreham. “Access to all health care is something we spend time troubleshooting in Vermont,” said Rivard. “You can do some of it as telemedicine, but ultimately for dentistry you need somebody to be in the office.

You can assess it over video, but to do treatment they need to come to see you.”

The American Dental Association says cost is the top reason senior citizens of all income levels don’t visit the dentist more regularly. And among low-income seniors, not being able to find a dentist is one of the top reasons for not going.

A lot of what Community Health dentists do is see people who have never been to a dentist, but most often have not been for about 10 years. Over that amount of time there is a lot of deterioration. “Then there is an overwhelming process to get back on track,” Rivard said. “Whereas people who we see regularly, one filling here or there it’s not going to overwhelm you. If you have 19 fillings and a root canal, it’s going to feel much more burdensome financially and emotionally.”

“At Community Health I am very fortunate to be part of an organization that is in the business of saving teeth and their goal is to make it accessible for people to keep their teeth if they want to. We really try to adjust our prices to where people are financially,” she added.

“Community Health is unique in how they value dental care,” Rivard said. “They are committed to the sliding fee scale and they apply it very heavily to dental.” About 1,600 of their patients had no dental insurance at all. The majority of patients subscribed to some type of primary care insurance.

Patients ask if discount materials and processes are used to keep prices low. “We use the same high-quality materials,” Rivard said. “We treat patients like patients. Community Health doesn’t treat them by socioeconomic status. It’s a refreshing view of patient treatment.”

As oral health is being recognized as a part of primary care, the industry is investigating how to make dentistry more affordable and accessible to underserved communities. Rivard said that legislators and health advocates in Vermont are considering a mid-level provider role where a dental therapist would help with routine preventative care. The dental therapist would also be trained to provide a few restorative procedures, like filling cavities and extracting baby teeth, procedures that dentists usually perform.

“I enjoy being part of a team and organization that makes dental health a priority within our community,” Rivard said.

Community Dental Practice Manager Ellen Seaver says the dental group is preparing for when the governor’s “Stay Home, Stay Safe” order is lifted. At that time, regular dental appointments will be scheduled. Community Dental will only treat dental emergencies as long as the “Stay Home” order is in place.

For more information about Community Dental,  Community Dental Shorewell , Community Dental Rutland, and all of Community Health’s primary care services, check our website.

Dr. Rachel Rivard is a graduate of the University of Colorado School of Dental Medicine. She joined Community Dental in the summer of 2017.  Along with her professional interest in pediatric dentistry, Dr. Rivard has been honored with dental and public health awards including the Dr. Solomon Averback Humanitarian Award, the American Association of Public Health Dentistry Community Dentistry and Dental Public Health Award, and the American Academy of Implant Dentistry Award. Dr. Rivard is currently a member of the Northeast Delta Dental Board of Trustees.

Dr. Jeremy Bullock is a 2005 graduate of Case Western Reserve School of Dental Medicine in Cleveland, Ohio. Bullock operated dental practices in Utah, Colorado and Texas before joining Community Dental in 2019.Dr. Julie M. Pratt, a graduate of Tufts University School of Dental Medicine, joined Community Dental in 2013.