Smiles for Life
- Need: Oral healthcare for low-income adults and children unable to obtain dental care in the Mid-Ohio Valley of West Virginia.
- Intervention: Public health dental hygienists act as gatekeepers, screening low-income clients and placing them with area dental providers who volunteer from their private practices to provide needed dental treatment.
- Results: Reduces the number of emergency department visits for dental pain and infections and provides a safety net for those unable to afford dental treatment.
Following a 2009 two-day Mission of Mercy mass dental clinic that served 1,300 patients in Parkersburg, West Virginia, dental providers suggested an alternative for providing oral care for people with low incomes. In lieu of the mass clinic once a year, they suggested donating their own services throughout the year by utilizing their own dental offices, staff, and equipment, thus providing more efficient services.
In 2011, the Smiles for Life Screening and Referral Program began operating as a public/private partnership between the Mid-Ohio Valley Public Health Department (MOVHD) and participating area dental providers. Serving a six-county area (Wood, rural Calhoun, rural Pleasants, rural Ritchie, rural Roane, and Wirt) in West Virginia, Smiles for Life is open to all low-income adults and children without dental insurance and not currently receiving dental care.
Public health dental hygienists screen and then place patients with area dental providers best able to meet their needs. Since needs are so great, patients are triaged, with people in pain or with infections being seen first. Three-quarters of the treatments involve extractions.
When possible, the program also utilizes West Virginia University dental and dental hygiene students on rural rotations at area dental offices. Scheduling with a student helps the Smiles for Life patients receive treatment in a timely manner. Student participation also eases the burden on private practitioners and provides valuable experience for the student.
The patient pays the public health department a $40 clinic fee in order to schedule a screening. Patients are charged for necessary treatments based on a sliding scale according to Federal Poverty Level guidelines (proof of income required). Fees generated through the program then help sustain Smiles for Life. Volunteer dentists receive a $40 stipend per client visit to help cover staff costs and overhead.
All fees are due in advance of scheduling and are nonrefundable. If a person misses an appointment without calling first, that patient will lose their payment.
- Public health dental hygienists perform a thorough screening (including for oral cancer), provide oral health education and home care supplies, take X-rays, and schedule appointments for most-needed treatments with participating dental providers.
- Patient records are transmitted electronically from the public health department to the dental provider.
- Basic dental services (extractions, restorations, and prophylaxis) are provided by the dental providers.
- Smiles for Life creates a "dental home" for patients, so they don't have to see different providers at mass dental clinics.
- Onsite dental hygiene services were added in July 2017.
MOVHD also sponsors a preventive dental services program in Wood County schools and recently launched an emergency health services mobile unit, which will travel to schools to provide care and be available for emergency response.
Recent expansion will allow volunteer dental hygienists to treat patients at MOVHD. Smiles for Life is also working on an additional expansion plan to have at least one onsite part-time dentist in addition to its present volunteer model.
The program is cost-efficient and provides a resolution to patients' oral health problems in an infection-controlled environment. Smiles for Life works with 15 area dental providers and 20 dental hygienists in addition to the public health hygienists. When dental emergency department visits occur, ED staff now make referrals to Smiles for Life.
Numbers as of January 2020:
- 2,518 adults screened
- 4,086 dental visits
- 2,835 volunteer hours contributed
- $1,390,300 in donated treatment provided
- 14% reduction in emergency department visits for dental pain and infection
Patient demographics as of January 2020:
- 95% of clients in the program at the federal poverty level
Sustainability is a challenge with the Smiles for Life program. It has been totally grant-funded, but there is a focus now on billable services in addition to the minimal fees for service. Currently, Medicaid covers only extractions for adults in West Virginia.
- Replacement teeth are not available.
- Provider capacity limits program size.
- Over time, it can be difficult to retain volunteers.
- Medicaid reimbursement challenges exist.
- Medicaid and client fees alone cannot sustain the program.
Smiles for Life has expanded to provide preventive services, which will aid in better patient health outcomes and improve sustainability. The program is working to obtain Ohio Medicaid provider status, which covers expanded dental services such as preventive and restorative, which will be an additional billing source.
Involve dental providers early to get their input. Smiles for Life would not have happened if the dental providers hadn't requested it after the Mission for Mercy mobile clinic. This unique model of partnering MOVHD with area dental providers could be easily replicable in other parts of the country.
Here are other factors to consider:
- Minimal fees for service help sustain the program.
- The program needs to be in an area with a reasonable number of providers so that each dental provider is not overwhelmed.
- Continued communication and engagement of volunteers are very important for ongoing involvement and program success.
Contact InformationRebecca J. Eaton, APRN, Director of Clinical Services
Mid-Ohio Valley Health Department
304.485.7374 Ext. 132
Community engagement and volunteerism
Uninsured and underinsured
November 25, 2014
Date updated or reviewed
November 4, 2020
Suggested citation: Rural Health Information Hub, 2020. Smiles for Life [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/779 [Accessed 6 May 2021]
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.