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Rural Health Information Hub

Something to Smile About: Preventive Dental Care for Garrett County

  • Need: In rural Garrett County, Maryland, a 1998 community survey found that 41% of kindergarten students had untreated dental decay, and many dentists in the area were not willing to see patients with medical assistance or state health insurance plans.
  • Intervention: In 1999, the Garrett County Health Department started the Something to Smile About program to improve access to dental care and help dentists negotiate higher reimbursement rates from managed care organizations.
  • Results: The program established a community dental clinic, provided care to thousands of individuals, and negotiated 30% higher rates for dental service reimbursement.


Garrett County, Maryland, is rural and sparsely populated. Before the Something to Smile About program was created, many of the county's residents did not receive dental care. A 1998 survey of kindergarten students in Garrett County revealed that 41% of students had untreated dental decay.

The Garrett County Health Department (GCHD) received a Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant in 1999 to start Something to Smile About (STSA). Now replaced by a statewide effort, STSA was a program that addressed the great need for expanded access to dental care, especially for children and pregnant women.

Services offered

STSA supported a variety of initiatives to improve access to dental care, including:

  • Providing preventive dental care for children and pregnant women participating in the Maryland Children's Health Program (MCHP) but not receiving dental care at the GCHD dental clinic
  • Establishing a network of community dentists who provide dental care in either their own offices or in the GCHD dental clinic
  • Helping dentists negotiate higher reimbursement rates from managed care organizations (MCOs)
  • Helping dentists with claim submission and paperwork
  • Guaranteeing payment for valid claims
  • Establishing a dental surgery center in the local hospital
  • Providing dental education in public schools
  • Advocating for community water supply fluoridation
  • Recruiting needed health providers to the area
  • Continuing medical education for health professionals


During the first three years of the program, STSA provided:

  • Dental care to 2,365 patients
  • Community education to 11,996 individuals
  • Continuing medical education for 30 health professions
  • Assistance in negotiating a 30% higher rate for reimbursement, which resulted in the number of dentists seeing medical assistance and MCHP patients growing from 3 to 6

STSA reached 49% of the target population in the first three years and successfully recruited a dentist to work full-time in the GCHD dental clinic. By establishing a dental surgery center in the hospital, the program eliminated the 6-month wait and long travel times to receive dental care under general anesthesia.

The program exceeded its goal of providing dental care to 1,500 individuals. It also developed a sliding-fee scale and became self-sustaining. The program also was influential in three municipalities voting to fluoridate their water supplies, which is one of the most cost-effective ways to prevent tooth decay.

Despite the fact that Garrett County is still an underserved area for dental care, Medicaid reported in 2013 that Garrett County had the highest percentage in Maryland of children who had been to the dentist in the past year (Garrett County = 72%, Maryland = 63.3%).

In 2009, the Maryland legislature raised the Medical Assistance fees across the state for children's dental care, which lowered the fees that the Garrett County Health Department had negotiated with the MCOs by 5%. In 2014, this statewide effort replaced the STSA program.


Challenges with starting up STSA:

  • Negotiating rates with MCOs
  • Developing partnerships with local dental practices
  • Recruiting dentists to rural Maryland

Challenges today:

  • Low rate of reimbursement for dental care
  • Recruitment of dentists to a rural Appalachian community


This program was successfully received by area dentists because leadership worked closely with them and established trusting relationships. Some dentists initially felt threatened by the program, but once program leaders met with each dentist individually, everyone was on board and STSA could move forward. By leading the MCO reimbursement negotiations and guaranteeing that dentists would be reimbursed for valid claims, the program helped underserved residents by connecting them with private dental practices in the community that would serve them.

Contact Information

Robert Stephens, MS, Health Officer
Garrett County Health Department

Children and youth
Health insurance
Oral health
Uninsured and underinsured
Wellness, health promotion, and disease prevention

States served

Date added
July 11, 2005

Date updated or reviewed
July 12, 2021

Suggested citation: Rural Health Information Hub, 2021. Something to Smile About: Preventive Dental Care for Garrett County [online]. Rural Health Information Hub. Available at: [Accessed 4 June 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.