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By Anne Blythe
As Bill Milner pulled disposable green medical gloves onto his hands, the man in the dental chair beside him offered a preview of what the dentist was about to see inside his mouth.
A front tooth was gone, and it just might have been lost to an altercation, the patient said.
“Did you have an altercation?” Milner, 69, asked, already knowing the answer even before taking a look for himself. “No more altercations. That’s just going to have to be the rule from now.”
“It was the rule before,” his patient responded with a tinge of humor.
Milner, a dentist in North Carolina for the past 45 years, was set up with two portable dental chairs and two hygienists and all their equipment in a conference room at a Cone Health clinic in Greensboro.
They see 600 patients as part of a partnership with the infectious disease center, which draws from a community of people with compromised immune systems.
Some are infected with HIV or have progressed to developing AIDS. Others have “undetectable viral loads.”
Milner explains that some of the people on the patient list have been shunned by dentists in private practice. Others are too worried about potential stigmatization or an outing of their diagnosis that they, themselves, choose to steer clear of such offices.
Many live on the margins, too. A lack of transportation plagues some, making it difficult to get to appointments or keep them.
Some might be homeless and forced to spend the better part of each day looking for a place to sleep, occasionally landing in a cheap motel or make-shift shelter where there is great potential for altercations.
‘Wanted to be a barefoot dentist’
As Milner treated the man in his chair, the conversation shifted away from the altercation to the other teeth lost since the last visit to the Cone clinic.
Milner, who grew up in Fort Worth, Texas, and got his bachelor’s and dental degrees from Baylor University in Waco, Texas, came to North Carolina more than four decades ago because of the state’s reputation at the time for caring about public health.
“In dental school, I wanted to be a ‘barefoot dentist’ patterned after the ‘barefoot doctor’ in China,” Milner said, referring to Mao-inspired healers in China trained to bring health care to rural regions where people didn’t have easy access to the urban centers for health care.
Since then, he has built a 45-year career, developing plans and business models to ensure that special-needs populations in North Carolina have access to oral health care.
It hasn’t always been easy.
But Milner and others with whom he works at Access Dental Care, a non-profit mobile provider, are working to clean and tend to the teeth and gums of the people who, for a variety of reasons, need dentists and hygienists to come to them.
He started out with the state public health program in 1975 and walked into a nursing home the next year. That gave him a sharper focus on where his barefoot dentistry philosophy would take him.
The state provided some oral health screenings in public schools, but when problems were detected those children typically were sent to providers already in the community.
In the nursing home, Milner encountered a special-needs population that had been overlooked. He set out to do something about that and continues to be a big advocate for PACE, or Program of All-Inclusive Care for the Elderly that serves people who otherwise would be confined to institutions.
“I always thought public health was more than kids,” the dentist said.
‘Food is good’
That’s evident as he treats patients and talks with others at the Cone Health infectious disease program in Greensboro.
Meekah Malloy, who got out of the chair after having a tooth extracted and her gum sewn together with stitches that would dissolve in four days, flashed a big smile.
Milner cautioned her about the pain ahead. He encouraged her to use ice on her jaw that afternoon in addition to ibuprofen and extra-strength Tylenol that he had prescribed.
Even with the temporary pain, the dentist assured his patient that the tooth extraction would help alleviate the thudding pain from an unchecked infection.
“You’ll be able to eat food without bothering that tooth any more,” Milner told his patient.
“Food is good,” Malloy responded.
When asked what the Cone Health program meant to her, she quickly answered: “This means a whole lot.”
Milner chimed in, too, as did hygienists and assistants Linda Ellis and Mary Elizabeth Andreyev, the crew at the clinic that day.
“We’re just actually doing something very simple,” Milner said. “Just taking care of folks.”
Andreyev likes it because she finds herself in a different place every day, not in a cubicle or one office.
“I always wanted to work with a special needs care team,” Andreyev said.
With a handshake and a smile
Milner was contacted by people in the Cone Health infectious disease program six years ago about helping them tend to the oral health needs of many of their patients.
When people have compromised immune systems, tooth decay, ulcers and gum disease can cause grave illness if it spreads throughout the body.
Also, the oral cavity can provide a telling glimpse of immune collapse symptoms and related problems that can be dire.
When Milner got the call from Cone Health, he told them he would be happy to bring his mobile care to Greensboro from Asheboro, but they would need to come up with a financial model that could work.
In 2000, after 25 years as director of the Randolph County Public Health Dental Program, Milner created Access Dental Care, a non-profit that serves residents in nursing homes, assisted living facilities, group homes, home health and hospice programs. The North Carolina Dental Society was its first sponsor and contributor, he said.
“I thought that was important,” Milner said.
Since then, the non-profit has added more special needs populations to their care model. They take their van with equipment and provider team to people with autism, cerebral palsy, dementia and profound intellectual disabilities.
Five days each week, a dentist, hygienist and one or two dental assistants travel in a 16-foot box truck to a remote site and unload dental chairs and other equipment typically found in state-of-the-art operating units.
A mobile room can be set up in 20 minutes and broken down nearly as quickly, too.
The team can see 15 or more patients on some visits.
Occasionally, they find themselves at someone’s bedside instead of in the conference or recreation rooms where they often treat patients.
Over the years, the non-profit has expanded its reach.
Each year, it provides comprehensive dental care to 3,400 residents in 13 Piedmont counties. In nearly two decades, the organization has treated more than 15,000 patients during 100,000 dental appointments.
“We meet them with a handshake and a smile,” Milner said.
The funding model for Access Dental Care is built on three major sources — Medicaid, which 75 percent of the patients receive, private pay, which also includes insurance, and a facility retainer fee.
Foundations in North Carolina also have provided $1.6 million in capital funding, according to the Access Dental Care site.
Knowing that Medicaid pays only slightly more than 40 cents for every dollar of care, Milner was able to make the clinic at the infectious disease clinic work with a grant from the Cone Health Foundation (Note: The Cone Health Foundation has been a sponsor of North Carolina Health News.)
Tammy King, resident nurse clinical manager for regional center for infectious disease at the Cone Health facility, said that if it weren’t for Milner and his crew, their patients’ oral health needs might go untreated.
“It’s an underserved population,” King said. “It’s a highly stigmatized population. A lot of patients are uninsured. It can be a lot of trouble to get them in other places.”
Michelle Evans, a social worker at the infectious disease clinic, said the oral health wait list has grown as word spreads about the care provided on site. More than 200 people are on the list if the program were to expand.
Milner, a jovial dentist, is quick with the one-liners as he finishes up an extraction or helps a patient plant his feet back on the ground after an exam.
“I love to heal. I love to heal,” he sings out while preparing paperwork for his patient to sign.
The clinic provides him with a complete medical history and a social worker’s narrative on each patient that allows Milner and his crew to be a part of what he describes as rewarding wrap-around care.
“After 45 years, dentistry is still fun,” Milner said. “But it’s tough work.”