For Those in Need, Service With a Smile

Catania said he became attuned to dental problems by walking parade routes in the city. Along some avenues, the smiles were bright and full. Along others, many smiles were gap-toothed.

He had his staff comb through the Health Department's budget to look for money that could fund dental care initiatives and began an effort to raise Medicaid reimbursement for dentists so that more private providers would accept Medicaid patients.

Medicaid, which is funded by District and federal money, and the locally funded D.C. Healthcare Alliance provided dental benefits before the Primary Care Association grant program. But critics said those benefits were too limited and too few dentists provided care.

Beginning in October, however, the District will fund a comprehensive dental benefit for adults and children on Medicaid, putting the total amount allocated for dental health at roughly $12 million for fiscal 2007. The funding will include the first rate increase for dentists since 1985, Catania said.

He hopes the higher rates will draw dentists to a program they have largely shunned. Of 600 dentists belonging to the D.C. Dental Society, fewer than 40 provide services to Medicaid patients, according to Catania. Those who do, he added, lose money. The council also approved a $225,000 grant to Howard University's College of Dentistry and SOME to develop a program to serve homeless people who may not qualify for Medicaid or the Alliance programs. Aspects of that program will include Howard dental students who will work at the SOME clinic.

"This is a historic moment for dental services in the District," Catania said.

The importance of adequate oral health care goes beyond having a pretty smile. "If you have no teeth, it is very difficult to summon the courage to go ask for a job, to get a job," Catania said.

Stangel has been working on the teeth of the homeless at the clinic for 2 1/2 years. "We have gone from a facility that has been in place for 15, 20 years with donated equipment to a state-of-the-art clinic," Stangel said. "We have a lot of enhanced efficiencies built in the same place."

The renovations added a fourth treatment room to the dental clinic. The SOME facility also offers behavioral services and medical care.

Stangel said the old clinic had no privacy between the dental chairs, which made it difficult to keep details about patients' health confidential, as required by law.

In addition, much of the equipment was old or hand-me-down and on its last legs. In one area, Stangel and his staff kept a bucket to collect water that leaked from a machine that couldn't be repaired.

Post-renovation, "we have an extremely delightful space for patients to come into," Stangel said. Jazz pipes softly from computer speakers, serving as a backdrop for dental appointments.