WELLS RIVER – With more than $1.3 million in federal funding and most of the required permits in hand, Little Rivers Health Care plans to begin construction on a new dental clinic in the fall and begin treating children there. patients early next year.
The clinic aims to fill a long-standing and growing gap in dental care in a rural part of the Upper Valley. Difficulty in finding oral health care has increased due to labor shortages during the COVID-19 pandemic. These challenges are particularly acute for people covered by Medicaid, which reimburses dentists at a lower rate than commercial insurers, and Medicare, which has no general dental benefit. Little Rivers, based in Bradford, Vermont, is a federally licensed health center and as such cannot turn people away based on their ability to pay.
“We see it on the primary care side in dire ways,” said Andy Barter, Little Rivers chief operating officer, of the current oral health care shortage in the Bradford, Vermont area, where operates Little Rivers. Barter noted that patients come for treatment of “other physical ailments that stem from oral health issues.”
These are “very difficult times,” he said.
Access to dental care in northern neighboring Grafton County has also become more difficult of late. The Ammonoosuc Community Health Services dental clinic in Littleton, NH, is closed “due to staffing shortages,” according to the federally licensed health center’s website. Additionally, Dr. Ralph Faluotico, a Bath, NH-based dentist in private practice, recently retired, Barter said.
It became harder for patients in the Randolph area, across Orange County from Wells River, to access oral health care when a Medicaid-accepting dentist retired early This year.
At the start of the COVID-19 pandemic, dental practices closed. Afterwards, some of the workers never returned, said Stephanie Pagliuca, senior director of workforce development and recruitment at the Bi-State Primary Care Association.
This labor shortage “has hit Vermont and New Hampshire hard,” she said.
But the problem goes beyond the twin states. There’s “not a single place in the United States that doesn’t have a problem,” Pagliuca said. In addition, “rural areas (are) more in demand”.
Faced with workforce challenges, Little Rivers is moving forward with its new clinic, which will be located on Route 5, also known as Main Street, at the junction with Route 302 leading to Woodsville . Little Rivers also aims to create a training center for oral health workers at its nearby clinic in Newbury, Vermont.
Last month, the Newbury Development Review Board granted site plan approval to Little Rivers to convert a former gas station on Main Street next to its Wells River primary care clinic into a dental practice. The approval, dated May 19, also includes adding 855 square feet to the existing 2,500 square foot building and rearranging parking and access points on the 0.4 acre site. Still pending at the time of the DRB’s decision was Transport Agency approval for access and traffic patterns. Exterior lighting and signage will be subject to city regulations.
The facility is expected to have five dental operating rooms and one consultation/examination room, according to plans filed with the DRB. The clinic is expected to employ 11 people. Barter estimates that the clinic will receive 5,720 visits in the first year and will eventually see up to 7,800 per year. Ultimately, the facility is expected to house two dentists and serve 3,500 patients.
In support of the project, Little Rivers raised $1.33 million in congressional directed spending this year through Sen. Bernie Sanders, I-Vt.
Little Rivers planned to move forward with the new clinic even if the federal money had not been forthcoming, but with the debt service that would have been required if the health center had to borrow money. , he “couldn’t have done the same,” Barter said.
Little Rivers bought the property in February 2021 from South Burlington, Vermont-based Champlain Oil Co. for $135,000, including a $20,000 donation from the oil company. Due to the contamination of the service station and a former mechanical workshop, the property has been classified as industrial wasteland. It took three different phases of testing and research, Barter said. An under-slab depressurization system will prevent gases from the ground from entering the building and becoming trapped there, he said. He said he was grateful to Stone Environmental, based in Montpelier, and the state Department of Environmental Conservation for helping with the environmental work.
“These entities made this possible because otherwise we would never have been able to go,” Barter said.
Additionally, Faluotico, the retired Bath dentist, donated his equipment to Little Rivers, which the health center plans to install at its Newbury, Vermont location. There, Little Rivers plans to offer dental services and train new oral health staff, Barter said.
It was “extremely kind of him to donate all of his equipment and office setup to us,” Barter said.
Little Rivers aims to establish the training center in coordination with the Vermont Department of Health, Vermont Technical College, River Bend Career and Technical Center and the University of New England Dental School, Barter said. .
The plan is to provide a place for dental students and recent graduates to complete internships and residencies, as well as provide training for the new dental therapist program planned by VTC and for dental assistants at River Bend in proximity. The hope is that such a program would create “more opportunities for people, young adults; even adults, to pursue those careers,” Barter said. In the meantime, the interns would “help us deliver the services.”
Little Rivers and its partners are seeking federal funds for the training center project, which Barter says hopes can become a model for other health centers.
“Over time, we have a plan that should benefit us and do a lot more than us,” he said.
Meanwhile, patients across the region are challenged to find the oral health care they need. Ed Shanshala, CEO of Ammonoosuc Community Health Services, said the Littleton dental clinic has been closed for about six months. He hopes to reopen it eventually through a partnership with a dental school such as Tufts or New York University, but those conversations are ongoing.
Currently, ACHS is offering patients vouchers to use at area dentists who will accept them. This works out to about $750 per patient per year.
Shanshala is among the patients who lost their dentist when the Littleton clinic closed. He recently found emergency care at Mid-State Health Center, which has locations in Plymouth and Bristol, NH But he will have to wait until September for a cleaning. He manages with brushing and flossing, and uses mouthwash in the meantime. He may eventually need an implant, which would cost around $5,000.
At the moment, he said, he’s “tinkering around with a bit of dental tape.”
Nora Doyle-Burr can be reached at [email protected] or 603-727-3213.