Low income people in northwestern Minnesota often have to travel long distances -- sometimes hundreds of miles -- to get dental care.
The region is one of the areas hardest hit by a shortage of dentists. In Beltrami County, for example, a state report from a few years ago shows there were only 14 dentists serving a population of more than 40,000 people.
That's why so many people are anxious for the new Northern Dental Access Center in Bemidji to open.
Construction workers are still putting on the finishing touches. The facility is a huge collaborative of local public health agencies, foundations and private donors.
Center director Jeanne Edevold Larson says when the clinic opens next month, she expects it will be overwhelmed by patients.
"We know there are 6,000 children on Medical Assistance in northwest Minnesota, and we know that roughly, on a state average, 30 to 40 percent of children on Medical Assistance don't have dental care," said Edevold Larson. "We do expect to be very busy."
The center will serve only people enrolled in publicly subsidized care programs. The goal is to combine basic dentistry services like check-ups, cleanings, extractions and fillings.
The clinic will also offer other public health services, like immunizations and health screenings. Staff will make referrals to other social service agencies. They'll try to remove obstacles for low income patients, helping out with things like transportation and even day care.
State health officials say there are fewer than a dozen similar dental access clinics in the state, including facilities in Park Rapids, Hibbing, Deerwood, Pillager and Brainerd.
Oral health is often a low priority for poor people struggling with many other challenges. Dental problems often go unchecked until it's too late.
Edevold Larson says many end up not in the dentist office, but in hospital emergency rooms.
"We've certainly heard stories of families who have never been to a dentist," said Edevold Larson, "or of hygenists who have had to work an hour or more on a single teeth cleaning because the person is an adolescent -- 12, 15, 17 -- and has simply never been to a dentist."
Edevold Larson has been searching for more than a year for a dentist to oversee the operation. She says it illustrates the problem communities have with attracting dentists to rural areas.
In the meantime, she's putting together a schedule of local dentists who are willing to commit to working at the clinic on an occasional basis.
Bemidji dentist John Lueth figures he'll put in one day a month at the center.
Lueth's own private practice takes as many public assistance patients as it can, but he's had to turn many away. He says it's financially a losing proposition.
"The reimbursement by Medical Assistance by the state is about 50 percent," Lueth said. "Now, to put that into context, the average dental office runs at about 70 percent overhead. So it's a loss of money to accept those kinds of patients. That's kind of a disincentive for a lot of offices.
The reimbursement issue has been a problem in the state for decades. Michael Scandrett heads an advocacy group called the Minnesota Safety Net Coalition. Scandrett says he's not optimistic the problem will get fixed.
"There's just no hope that that's going to change any time in the foreseeable future, especially with the major state budget crisis that's looming ahead of us," said Scandrett. "So we're simply not going to be able to get more money to pay for people, so we've got to look for more alternative ways to provide the services less expensively."
Scandrett says clinics like the one in Bemidji are a start. There are other efforts, too.
A few years ago the state gave dental hygenists the ability to work more independently and do more dental procedures. There's also a plan in the works -- approved this year by the Legislature -- to create a brand new, mid-level dental worker. Graduates of the program could do some dentistry without going to school as long as a dentist does. The first round of graduates of the program are expected to enter the workforce in 2011.
But there's a long way to go, says Mark Schoenbaum, who's with the Office of Rural Health and Primary Care at the Minnesota Department of Health.
Schoenbaum figures there are close to 350,000 low income Minnesotans statewide who don't see a dentist as often as they should, if at all. That lack of dental care can lead to more serious health issues. Schoenbaum said there are also broader social implications.
"That has effects on kids missing school days, workers missing work, and poor dental appearance can even be a barrier to people being competitive who are seeking jobs," said Schoenbaum.
Many believe the shortage of dentists will get worse before it gets better. An estimated 60 percent of dentists may retire in the next 15 to 20 years.
That problem will be magnified in rural Minnesota, where there's a higher percentage of dentists over the age of 59.