Affordable Dental Health Services Bethany Hesselink, Zachary Holmes, Renee Ivers, Amy Lewis, Sara Towers, Sheri Van De Burg Ferris State University

Why is the dental clinic needed in Montcalm County? To meet the need for free or low cost dental clinics for low income, uninsured families. To detect poor nutrition and hygiene, growth and development problems and improper jaw alignment. To meet the need for education to the public about the harms of soda and sweet drinks. According to data retrieved from Community health assessment; Montcalm county health profile (2011) “access to dental care was perceived to be a health problem in more cases than was healthcare access by both providers and community respondents” stating further that “health insurance was available to twice as many community respondents as was dental insurance.” (p. 49) Furthermore, this assessment data highlighted the fact that 25.2% of respondents delayed seeking dental care due to cost. 16.7% of Montcalm County adults reported that they delayed seeking healthcare and 25.2% delayed seeking dental care primarily due to cost. Survey results also indicate that only 62% of adults had received an oral exam or dental cleaning in the past two years, this fell to 41% for adults that were uninsured. The authors point out further in the survey how the data points to the need for availability of low cost dental services. According to the Michigan Department of Community Health 70.9% of Michigan residents have dental insurance, 15.6% had no dental care access during the past 12 months due to cost. Data also shows that “despite programs reducing dental caries in the United States, individuals in families living below the poverty level experience more dental decay than those who are economically better off.” “For both those at low-income and low-education levels, tooth loss appears at much higher rates.” Compared to 91.7% of privately insured children who had a dental visit in the past year, only 66.6% of children without insurance and 80% of children on public insurance had visited the dentist in the past year. The data provided validates the need for increased access to care for the low income and uninsured population in Montcalm County. Providing care through Affordable Dental Services clinic will improve the oral health and of those taking advantage of this resource, through dental care and education.

Affordable Dental Services, a clinic providing services to low income and uninsured families, will look to fill the gap for this group of patients, providing the necessary dental services to this population. Providing high quality oral healthcare in a cost-sensitive manner, Affordable Dental Services will provide a full dental assessment including xrays, dental education, teeth cleaning, simple tooth extraction, and when needed, further resources.  Committed to excellence, the Affordable Dental Services Clinic team will promote optimal oral health through the care delivered. Mission Statement

Goals to remain fiscally solvent to refer clients to other specialties if they require more services than the clinic can provide to provide appropriate medication as needed to remain fiscally solvent to provide quality dental care to clients in need to assist patients to maintain the best dental health possible to educate patients in the proper brushing and flossing technique as well as the importance of doing so on a daily basis The first goal for the dental clinic is to provide quality dental care to clients in need. The Montcalm County Health Profile indicated that only 62% of residents in Montcalm County received an oral exam or dental cleaning in the past two years (Mid-Michigan Health Department, 2011). The clinic wants to be able to provide quality care to those who are unable to obtain dental services otherwise. The second goal for the dental clinic is to assist patients to maintain the best dental health possible. Through the delivery of quality care, the clinic can assist patients in maintaining their dental health by providing more affordable services. Thirdly, a goal for the dental clinic is to educate patients in the proper brushing and flossing technique as well as the importance of doing so on a daily basis. At the clinic we hope to educate patients in the correct way to brush and floss your teeth and thus assist patients in decreasing tooth decay and cavities and maintaining their overall dental health. The fourth goal for the dental clinic is to refer clients to other specialties if they require more services than the clinic can provide. If a patient requires a root canal or braces, the clinic would refer the patient to an endodontic dentist or orthodontist, and assist the patient in obtaining information needed. The fifth goal for the dental clinic is to provide appropriate medication as needed. If an infection is discovered after examination the clinic would provide the antibiotics needed or assist the patient in obtaining the antibiotics as needed. The sixth goal for the dental clinic is to remain fiscally solvent. The clinic would like to open for those who need it for as long as possible. The clinic charges limited amounts for services and needs to be able to pay for supplies and staff.

Objectives To treat as many patients as possible who the criteria of the dental clinic. To educate patients about proper brushing and flossing technique at every visit. To educate patients about the importance of brushing at least two times per day and flossing at least once per day at every visit. To educate patients with cavities about the prevention of tooth decay and avoiding things like soda and smoking at every visit and subsequent visits if needed. To remain fiscally solvent after one year. To provide patients with a free toothbrush, dental floss, and toothpaste at every visit. To assess level of pain before, during, and after each procedure and provide adequate pain control if needed at every visit. The objectives created will provide direction to the clinical staff so that the clinic will be able to make positive contributions to the delivery of oral health care services to the public.

Job Descriptions Dentist Receptionist Responsibilities Diagnose teeth/gums/mouth Education on oral care Treat teeth/gums/mouth Refer patients for follow up Two dentists have offered to volunteer their time each clinic day Responsibilities Organize and file charts Process referrals Greet and check in patients Answer calls Cashier 1 receptionist (position filled) 6 hours each clinic day Cost is $72.00/day No benefits will be provided

Hygienist 4 dental hygienists/ 6 hours each clinic day Cost is $720 per day No benefits will be provided Responsibilities Prepares treatment room for patient Prepares patient for dental hygiene treatment Provides information to patients and employees Maintains instrumentation for dental hygiene treatment Selects materials and equipment for dental hygiene visit Completes x-rays and dental prophylaxis Detects disease by completing oral cancer screening; feeling and visually examining gums; using probes to locate periodontal disease and to assess levels of recession; exposing and developing radiographic studies. applies fluorides and other cavity-preventing agents. Educates patients by giving oral hygiene and plaque control instructions and postoperative instructions; providing reminders of time of next dental hygiene visit.  Requirements Michigan Dental Hygiene License, Associates degree or equivalent from a 2 year or technical school, Use of Dental Technology, Dental Health Maintenance, Infection Control, Health Promotion and Maintenance, Bedside Manner, Creating a Safe, Effective Environment, Listening, Teamwork, Administering Medication, Thoroughness, Self-Development   Purpose · Promotes dental health by completing dental prophylaxis; providing oral cancer screening and radiographic studies; charting conditions of decay and disease; performing procedures in compliance with the dental practice act.

The Clinical Coordinator role will be filled by one of the hygienists, who will make out the schedule and assignments for staff on the days the clinic is open

Marketing Plan and Strategies The clinic will focus on promoting the clinic to the low income and uninsured population of Montcalm County who have unmet dental care needs. Flyers will be handed out through schools, health care clinics and welfare offices. Budget and Organizational Charts were created as a guide for planning.

Budget The proposed budget is subject to our clients being able to pay for the services provided. There is a projected net income of $198 each month, which will be used to provide services for those who are unable to pay. Money was saved by having clinic space donated by Lake Street Dentistry, Dr. Erich Rupprecht, DDS. This includes the use of x-ray machines, flash sterilizer, autoclave, exam supplies, use of filling resin material, fax machine, and general office supplies needed. Two dentists have offered to volunteer their time to save costs. One dentist will be doing only oral exams the entire six hours, with one exam scheduled every 15 minutes. He will see 24 patients during the clinic hours and this will generate $360 in fees. Two hygienists will be assigned with this dentist to complete the cleanings and education. X-rays will be done on all patients seen for an exam, generating $240 in fees. The second dentist will be doing only fillings and extractions the entire six hours, with one patient scheduled every 30 minutes. He will see 12 patients (as deemed necessary from the exams from Dentist #1) during the clinic hours, and this will generate approximately $540 total, which would be an average of three fillings and one extraction per client. Two hygienists will be assigned with this dentist to assist with procedures. These two hygienists will apply sealants, and an estimated four clients will be receiving sealants per Saturday, which will generate $80.00.

Budget Costs the clinic will be responsible for include: Four hygienists at the cost of $720 per Saturday (six hours each at $30/hour) Advertising for the hygienists proposed cost of $195 for The Grand Rapids Press/MLive and $380 for the Journal of Dental Hygiene. One Receptionist $72 (six hours at $12/hr) - position filled Oral Care Kit $2 each purchased from Dr. Rupprecht’s office at their cost to be sent home with each patient. Sealant material at a cost of $20 per client Lunch for dentists

Budget The charges for individual services are as follows: Cleanings and oral exam: $15.00 Fillings: $10.00/tooth X-rays: $10.00 Simple extractions: $15.00/tooth Sealants: $20.00 (only offered on clients less than 15 years of age) Education about oral care (to include brushing & flossing) Free with exam Simple supplies sent home with each client (toothpaste, toothbrush, floss) Free with exam

Budget Operating Revenue Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Exam Fees 360 X-Ray Fees 240 Filling/Extraction Fees 540 Sealants 80 Total Revenue 1220 Operating Expenses Hygienist Salaries 720 Receptionist Salary 72 Lunch 54 Oral Hygiene Kits 48 Sealant Supplies Advertising Total Expenses 1022 Net Income 198

References Mid-Michigan District Health Department. (2011). Community Health Assessment; Montcalm County Health Profile 2011. Retrieved November 2, 2014. Yoder-Wise, P.S. (2014). Leading and managing in nursing (5th ed.) St. Louis, MO: Elsevier Mosby.