Lincoln County dentists: We’ve built a better clinic for kids on Medicaid

Dr. Cordell Scott of Lincoln Dental Services talks with Letisha Young, mother of patient Angalecia Morrison, 9, about a dental procedure. At center is dental assistant Renee Lee.
Dr. Cordell Scott of Lincoln Dental Services talks with Letisha Young, mother of patient Angalecia Morrison, 9, about a dental procedure. At center is dental assistant Renee Lee. mhames@charlotteobserver.com

For the last 15 years, Lincoln Dental Services has taken pride in offering low-income children skilled dentistry, even if the setting was shabby.

Now the nonprofit pediatric clinic has a new home, and the founders hope it will highlight what’s going on inside. In a small town 35 miles northwest of Charlotte, they say they’ve built a model for Medicaid dental care that feels like a private practice.

Where many counties provide the service through their health departments, the founders say, a close-knit community of dentists raised the money to create and support their own clinic. They say they focus on building family relationships and providing preventive care such as sealants and fluoride treatments, rather than reacting to toothaches and other emergencies.

“Instead of doing a little for a lot of people, we do a lot for everyone,” said Dr. Richard Pence, a dentist who’s a founding board member.

Dr. Cordell Scott, who used to practice in nearby Cherryville, thought he’d just help get the clinic started in 2000 but has stuck around as the clinic’s sole practicing dentist. He says the key to providing better care was getting credentialed for hospital work, which allows him to work on young children under anesthesia, rather than using physical restraints that are unpopular with many dentists and families. It also brings in higher Medicaid reimbursements, allowing him to see fewer patients per day and give them each more attention, he and other founders say.

Dr. Alec Parker, executive director of the N.C. Dental Society, said recently he wasn’t familiar with the Lincolnton clinic, but it sounds like a promising model.

The merits and risks of anesthesia and restraints are a topic of ongoing discussion among dentists; one dental blog dubbed the dilemma “To juice or papoose?” Papoose boards are a form of restraint that can be used to keep children and mentally disabled adults from squirming during dental work. Parker describes them as “a straitjacket with a back.”

Opponents of restraints say children who are conscious and strapped in often grow up to be adults who avoid dentists. But general anesthesia has significant risks.

The key, Parker says, is making sure the decision is made by someone with the knowledge, skills and support to put children under appropriately and safely.

Born from need

Lincoln Dental Services was inspired by the Gaston Family Health Services dental clinic, which opened in 1996 with a combination of private and Health Department support.

At the time, founders say, no Lincoln County dentists took Medicaid. That meant kids from low-income families were often referred out of county, where they might have to wait months to get in. Follow-through was patchy, and tooth decay was rampant, Pence says.

Local dentists Lincoln County Health Director Maggie Dollar and the late Betty Gamble united to raise money for a children’s clinic. The Kate B. Reynolds Charitable Trust and the Lincoln/Gaston Partnership for Children (part of the state’s Smart Start initiative) each kicked in $100,000 or more, while 10 local dentists gave $1,000 each.

In 2000, Scott was hired to work in a house in downtown Lincolnton that had been built in the 1920s and served as home to several dental practices. It was always a bit cramped, and more so as the practice grew. Patients, parents and staff shared the single bathroom.

The board began setting aside money for a new home, spending about $800,000 to buy and equip the new 5,000-square-foot office in Doctors Park, about five times the size of the old space.

It has room to expand – the board would like to hire a second dentist – and offers a roomy waiting area. A restroom for patients and families is decorated with a poster outlining the sugar and acid content of popular sodas and juice drinks, part of the constant campaign to teach better dental health.

The clinic moved this spring. Monique Cespedes and her 13-year-old son, Gabriele Epifanio, said they like the new space.

“It’s modern, it’s cleaner, it’s up-to-date,” said Cespedes, a janitor at East Lincoln High, whose three children use Lincoln Dental Services. Scott and dental assistant Renee Lee bantered with Gabriele and urged him to do better at brushing and flossing. As soon as he finished his cleaning, Gabriele pulled out his phone, bared his teeth and shot a selfie to send his friends.

Seeing the rewards

Down the hall from Gabriele, 5-year-old Caroline Smith had just gotten her first X-rays. Her arms and legs wiggled as she got her cleaning, and Scott talked to her mom about scheduling a hospital appointment to have some baby teeth with cavities capped.

Her mother, Carolyn Smith, admitted some reluctance – “I don’t like the idea of having her under anesthesia” – but said she thinks it’s the best move for her daughter.

Scott and board members say that kind of preventive care, along with the personal connections the clinic has built with families, has made painful, decayed teeth far less common. Instead of having to send local children elsewhere, Lincoln Dental Services now gets referrals from nearby counties.

The founders are proud that a private nonprofit has been able to fill a need for children. They cite two keys for anyone else trying a similar effort.

One, they say, is hiring a great dentist, ideally one who will stay. “Hire Cordell’s twin,” quipped Dollar, the health director.

The other is one of the rare areas where a small town may have the edge in health care. They say having a dental community that united and kept its focus for 15 years and counting is crucial.

“Here it was like everybody was involved and everybody cared,” said Dr. Todd Hamilton, an orthodontist, who was the founding board president. “We all knew each other.”

Helms: 704-358-5033;

Twitter: @anndosshelms. This article is done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Visit Lincoln Dental

Lincoln Dental Services will hold an open house from 5 to 7 p.m. June 8 at 111 Doctors Park, Lincolnton. Details: 704-735-2324.