Ali Price went to the St. Joseph hospital emergency room twice last summer with pain from an infected tooth that she described as "all-consuming."
Price, who works providing in-home care for elderly people, doesn't have dental or medical insurance. But she needed to get antibiotics for the infection while she searched for a dentist to save her tooth. The 31-year-old Bellingham resident had already lost two molars and was trying to avoid a third.
"I didn't want to lose any more teeth," she said.
Dental providers and advocates say Price isn't alone, noting that many poor adults in Whatcom County and the state have struggled to get dental care since 2011, when the state's Medicaid program stopped paying for non-emergency dental care for most adults to help balance the state budget.
That means, in effect, that someone on Medicaid who has tooth pain can have it pulled - and that's about it, according to Bracken Killpack, director of government affairs for the Washington State Dental Association.
The state's decision affected 450,000 adults on Medicaid, leaving just 38,000 adults, including pregnant women and some disabled people, with access to comprehensive dental care, such as cleanings and restorations, Killpack said.
Now, a group called the Coalition to Fund Dental Access is urging state legislators to restore those cuts, saying routine preventive care would help the uninsured and curb the expense of having them turn to emergency rooms where doctors can treat the pain but not fix patients' teeth.
Coalition members include the Washington State Dental Association and the Washington Dental Service Foundation.
Advocates said the cuts are straining emergency rooms and community health centers.
Caregivers in Whatcom County said they haven't seen more adults at their walk-in clinics or emergency rooms as a result of the cuts, in part because oral health problems can take years to develop. When they do see clients, though, they're worse off.
"They're delaying coming in," said Sidney Williams, lead dentist at Sea Mar Community Health Centers in Bellingham. "People are coming in when they're hurting. It's unfortunate."
Added Leah Gehri, director of critical care and emergency services for St. Joseph hospital in Bellingham: "We can expect to see an increase in dental emergencies as people delay preventive care due to lack of insurance. The bottom line, preventive care always saves money in the long run."
Price was nearly resigned to having her tooth pulled, but she got help through a program administered by Whatcom Alliance for Health Advancement, which connects low-income clients to dentists who are willing to volunteer their services. Price got a root canal on the infected tooth, and a cavity filled on another tooth.
Price said she was grateful for the help she received through the program, Whatcom Project Access Dental, which has been around for about 18 months.
In its first year, a total of 21 dental providers donated more than $70,000 in care to 116 clients.
"There's way more need than there are resources," said Elya Moore, development coordinator for Whatcom Alliance for Health Advancement.
The state's cuts made a bad situation worse, according to Moore and Aaron Lemperes, who volunteers to provide dental services and is president of Mt. Baker District Dental Society.
"More often than not they're going to need more major procedures like extractions, partials or full dentures," Lemperes said. "We're looking at people who are losing teeth that, if there was an ability to get care earlier, would have been something simple, like a filling, to fix a problem."
Moore also referred to the access issue.
"Even prior to the Medicaid cuts, there was an access issue for dental care - 60,000 Whatcom County adults and seniors, or 37 percent of Whatcom County residents, did not have dental insurance in 2008," she said.
Moore pointed to Interfaith Community Health Center patients as an example of the impact when the Medicaid cuts went into place.
"For just Interfaith patients, this cut meant denying dental care to an additional 5,500 Medicaid patients who received dental care for non-emergency dental services in the previous year," she said.
Even before 2011, poor adults in Whatcom County and elsewhere have repeatedly said what they needed most was access to affordable dental care. It's also the service they're least likely to get, according to survey results like the 2006 and 2011 Whatcom Prosperity Project.
"There's never been great access for people," said Greg Winter, a research director who has conducted Whatcom Prosperity Project surveys.
That's shown in a survey of 53 hospitals in Washington state that found that among uninsured people, those with dental problems were the most frequent visitors to the ER. That 2011 study by the Washington State Hospital Association covered 18 months in 2008-09.
"If dental visits were the No. 1 reason uninsured folks visited the ER prior to the cut, now with more people without dental insurance, we have to assume it's gotten worse," said Diane Lowry-Oakes, spokeswoman for the Washington Dental Service Foundation.
So coalition members hope legislators will restore the cuts, which is expected to cost a little over $14 million a year in the next biennium.
GOOD TEETH, GOOD HEALTH
Beyond curbing costly emergency room visits for dental problems, they said dental care is important to overall health. Recent studies link oral infections to such chronic diseases as diabetes, heart disease and stroke, according to the federal Centers for Disease Control and Prevention.
Research indicates that treating gum disease in people with diabetes reduces their medical costs an average of $3,200 a year, advocates said, citing an oral health study of 1.7 million patients conducted last year by insurers United Concordia Dental and Highmark Inc.
Restoring dental care to adults on Medicaid could not only pay for itself by reducing costs for medical care, they argue, now also is a good time to do so as part of the federal government's expansion of Medicaid, which will have a 100 percent federal match for the first three years, then a slightly lower match.
"This is by far the best outlook we've had for getting it restored," said the Washington State Dental Association's Killpack.
A spokeswoman for Gov. Jay Inslee said that while the governor supports the Medicaid expansion and people having access to preventive care, including dental, he's waiting on the state's revenue forecast later this month. The priority is the mandate for education funding as required by the state Supreme Court's McCleary ruling, explained Jaime Smith, spokeswoman for Inslee.
"Obviously we want to take a look at it and see what our options are," Smith said.
For Pamela Blakesley, a 63-year-old Sumas resident, those dental services are needed.
"It's bloody impossible. There's nothing out there available," said Blakesley, who eventually found help getting new, badly needed, dentures through Whatcom Alliance for Health Advancement at an out-of-pocket cost of $500.
"They are absolutely terrific," she said of the dentures. "It is so nice being able to eat without suffering at the same time."