DENT's 3rd Year of Success

The Dental Emergencies Needing Treatment (DENT) Program has almost completed their 3rd year of connecting Apple Health patients to a dentist for emergent dental needs while preventing unnecessary and costly ER visits, and wow has this program grown. In 2016 we we scheduled 2786 appointments for clients with dental issues.

At our start in July 2014, there were 51 monthly dental appointments being offered through DENT, and this year we consistently offered over 200 appointments each month. This is in large part due to the work our DENT Program Manager Karen Davis has put into recruiting more dentists to participate in the Dental Provider Network by making appointments available to Apple Health patients – that number has grown from 22 participating dentist at the start of the program to 71 today.

Even more exciting from this year was a drop in our no-show rate. Nationally, the the now show rate for dental appointments is between 15-35%. Each patient who is referred to DENT receives personal coaching from a Community Health Worker on what to expect and how to prepare for their appointment. In on recent example, our DENT CHW Rita, worked with a young single mother of two who had severe dental decay in her front teeth. She had extreme anxiety which had kept her away from the dentist for 10 years, but the pain in her teeth had driven her to the ER multiple times. She told Rita that she was so afraid of the dentist that she would prefer to just go under, have all of her teeth taken out, and be given dentures. Rita worked hard to build a relationship that would make this patient feel safe and supported, answering all of her questions, dispelling myths, and encouraging her to take charge of her health. Leading up to the appointment, this young woman sent Rita multiple texts and calls about how nervous she was and how she didn’t think she could do it, but Rita’s support and encouragement helped to get her through the door, and to successfully treating the pain in her mouth. This individual attention and coaching has kept the no show rate of DENT patients at 7% in 2016, which means better access to care for patients, and dollars saved for providers.

DENT’s successes even achieved national attention in 2016, when Karen Davis was asked to present at NASHP’s 29th Annual State Health Policy Conference’s Oral Health Preconference. We couldn’t be more proud of the achievements of the DENT team.

Question: Does basic Medicare cover regular dental visits?


Does basic Medicare cover regular dental visits?
A)    Yes
B)    No
C)    I’m not sure…

If you answered A or C, you aren’t alone, as a recent Washington Dental Service Foundation survey showed 51% of respondents in Spokane believe Medicare covers dental. However, you would be wrong.

Correct answer: B) No, basic Medicare does not cover dental, and a lot of folks entering retirement are learning that the hard way. A recent article in The Spokesman Review talks about what steps folks approaching retirement should take for their oral health.

Good oral health relates to a lot more than just our teeth; our ability to chew effects the nutrition we receive, our ability to smile effects our confidence, and chronic conditions like Type 2 Diabetes can exacerbate dental decay.

Organizations like Smile Spokane, WDSF’s The Mighty Mouth, and our own DENT program are helping connect folks to the dental care they need, but for lasting change, we need a health care system that includes our mouths as part of our overall health. That's why the BHT ACH has set full integration of Oral, Physical, and Behavioral health systems as one of our region's main priorities. 

Read the Spokesman article to learn more:


DENT Story: "...for the first time in months, I was able to eat solid food."

Christina, a student at WSU and a Apple Health patient, had a filling fall out in late November. She made the calls and found an Apple Health accepting dentist, but had to wait two months for the appointment.

When the day finally came, her dentist noticed two other teeth that needed work done, in addition to the lost filling. Even though those two teeth had not been bothering her, the dentist chose to work on them instead of addressing the missing filling. Over the course of the appointment, the doctor ended up injuring a bone around Christina's eye socket with his pneumatic drill, causing damage to her optic nerve and resulting in her vision being severely affected in her left eye. Christina spent several days in hospital following this procedure, and after recovering she understandably was too scared to go back to his clinic.

Now in even more pain, Christina began to make the calls again looking for another Apple Health accepting dentist. The earliest available appointment was May 30th, nearly four months away! Unable to chew solid foods and in tremendous pain, Christina was desperate for relief. One clinic told her she could try an emergency appointment to have a dentist extract the teeth, but this seemed extreme when at first she just needed the filling replaced.

A provider at WSU’s Health and Wellness Services referred Christina to DENT. She called Rita, and was able to get an appointment that same day! Her new Dentist replaced the missing filling that had been plaguing her for months, and together they made a treatment plan to repair the two additional teeth injured by the previous dentist. Here is what Christina has to say about her experience:

I honestly cannot tell you how incredibly grateful I am to you for your help. I was nearly crying with happiness after my appointment because last night, for the first time in months, I was able to eat solid food. I cannot begin to say how grateful I am. [My dentist] is completely wonderful and I honestly cannot even begin to tell you how thankful I am to have been put in touch with him and especially, to have been scheduled in for a same-day appointment. So thank you so much and please pass on my gratitude to the amazing woman responsible for scheduling me! If I could give you all a big hug, I certainly would! I owe you my health and my sanity....Better Health Together gave me a lifeline and I could not be any more grateful for it.  

Christina, we are so happy we could help!

DENT Story: From Dental Emergency to Family Oral Health

DENT Story: From Dental Emergency to Family Oral Health

A 42-year-old Marshallese gentleman was referred from the ER. He was suffering from a very painful tooth on his lower jaw. He and his family recently moved to Spokane to include children, ages 18, 17, 11 and 9. The entire family is Apple Health eligible and this man needed emergent dental care for himself and to establish his children and wife with a local dental provider. 

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DENT Story: A Pregnant Woman Receives Vital Dental Care

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The initial visit to the ER doesn’t always mean the dental patient will accept the resources offered the first time. In the case of a 31-year-old woman with right and left lower teeth pain who was referred from the ER to the DENT Program, she received antibiotics and her abscess appeared to have cleared. However, pain and abscesses almost always return with a vengeance.

Unfortunately, the woman did not return DENT calls with offers of dental appointments the next day.  DENT staff continued to call and text and even mailed a letter, reminding her that she was Apple Health eligible and that the insurance would pay for her dental care. Still no response.

A little over a month later, she called in pain with a very swollen face. She was newly pregnant and very ill and needed emergency dental care. She was very concerned about the pain and swelling but even more worried about the possible effect on her unborn child. In crisis, she became motivated to call. Luckily, she kept the DENT phone number. 

Both the Unify and CHAS Clinics (FQHCs) offer immediate dental appointments to pregnant women because they are committed to assisting in any way to ensure healthy births. DENT staff was able to schedule the woman the following day with the Unify Clinic for emergency dental care.

The woman stated, “I am so thankful you did not give up on me after not calling back last month. I was in a bad situation and just couldn’t think about my teeth. I started to feel better and I thought the tooth problem was over. I was so wrong.”

DENT (Dental Emergencies Needing Treatment)


The DENT program connects patients to dental care and expands the network of dental providers accepting Apple Health. It was designed to reduce unnecessary Emergency Room utilization for dental emergencies and to coordinate a network of oral health care providers to improve access, health, and reduce costs for this population.

Our Community Health Worker team receives referrals from the Emergency Room and connects patients with Medicaid accepting dentists, provides behavioral coaching and ensuring that patients have the support to follow their dental care plan. We are also working to to recruit new dentists to accept Apple Health patients.

Go to the Regional Impact Map to see funders and partners for this and other BHT programs.

Spotlight: Dr. Brian Macall, Unify Community Health

Dr. Brian Macall    Lead Dentist    |     Unify Community Health

Dr. Brian Macall 
Lead Dentist
 |  Unify Community Health

By working at a community clinic, Dr. Macall is able to treat many individuals from underserved populations. The clinic takes patients that are unable to seek dental care elsewhere, including DENT patients.

Dr. Macall believes the biggest health challenge facing the region is access. If community clinics and providers were not present, a large percentage of the region’s population would not be able to get treatment at all. But even then, it’s not enough. Many private dentists that took Medicaid have stopped because of low reimbursements and challenging paperwork.

Eastern Washington has a huge population of individuals who have dental insurance but are unable to get treatment. Because of this, many people go weeks and months with severely decayed teeth, pain, and sometimes infections. For a lot of patients, Macall is the last resource. The best feeling, for him, is being able to say, “I can help you,” and seeing the excitement and joy on his patients’ faces.

Spotlight: Tina Shute, DENT Client

Tina Shute      DENT Client

Tina Shute 
DENT Client

When Tina Shute found herself with a broken tooth, she headed to the ER. Life circumstances had caused Shute to go without dental insurance and regular dental care. Even though her tooth caused excruciating pain, Shute put off seeking treatment for several weeks.

When she finally did visit the ER, the only option was to pull the entire tooth. As she was leaving the ER, Shute was given the number of a dental advocate at the DENT program, who got her into a dental appointment right away. Shute even had car issues, so her dental advocate drove her to the appointment.

Since then, Shute has noticed a huge improvement in her oral health and in her overall health. She is no longer in pain, and DENT is helping her take care of other dental issues until she can afford to have a regular dentist.