TEETH CARE ON THE GO: MOBILE DENTISTS, HYGIENISTS TRAVEL TO YOUR DOOR( CONT.)
Boothby, who visits 50 to 70 patients a week from Yuba City to Jackson, sees an endless variety of cases. She’ s treated patients in their 20s with multiple sclerosis and young children with autism. She’ s had patients with dementia, Alzheimer’ s and Lou Gehrig’ s disease. She’ s had women in their 80s who want their teeth whitened for a grandchild’ s wedding. And in three cases this year, Boothby said, she found evidence of oral cancers, which were referred to a dentist for treatment.
“ The worst thing to see is an elderly person with $ 5,000 worth of crowns and bridges, but their gums are bleeding and infected. They end up losing all that expensive dental work because nobody is brushing or flossing their teeth,” said Boothby.
Recently, an assisted living facility called about a new resident who wasn’ t eating, she said. An exam revealed part of his denture had broken off and was imbedded in the roof of his mouth. In such cases, where care goes beyond routine oral hygeine, RDHAPs like Boothby refer to traveling dentists like Kanas for further treatment.
Kanas, now semi-retired and without the overhead and staffing of a conventional office, said he enjoys his mobile practice, Mobile 1 Dental, primarily because of the patient camaraderie and flexible scheduling.
“ I don’ t make as much as I did, but the happiness factor is what I’ m interested in. I’ m much more relaxed than I was with a full practice and the pressure of trying to keep up the patient volume,” he said.
Technology has made mobile equipment lighter and quieter, helping the profession’ s growth and acceptance.
“ It’ s definitely enabled by technology. Mobile dentistry just wouldn’ t be possible without the technology we have today,” said Dr. Masood Cajee, owner of SmilesAhead Dental Care, based in Manteca.“ We can take X-rays with a handheld X-ray gun that didn’ t exist 20 years ago.”
Cajee, whose mobile visits represent about 5 to 10 percent of his overall practice, said,“ It takes dentistry beyond the four walls of the practice and serves populations that were really difficult to serve before.”
Boothby keeps a rolling cart filled with sterilized packets, ultrasonic cleaner and a suction vacuum for cleanings. Kanas found his 15-pound X-ray machine in Washington state, part of surplus military equipment used by dentists who parachuted into remote areas to treat soldiers. His equipment is batterypowered, so he’ s never hunting for cords or plugs.
Despite technical improvements, mobile dentistry clearly isn’ t for everyone.
“ In a nursing home environment, it’ s very difficult. You don’ t know if they’ re available or agreeable to be seen because their day-to-day health or mental status may change daily,” said Cajee, who worked several years for a dental practice that provided care to Sacramento skilled nursing facilities.
Other issues are the ergonomics of leaning over bedridden patients and those in wheelchairs. Incontinence, aggressive Alzheimer’ s patients and other issues that residents struggle with on a daily basis also can be off-putting.
In some cases, after an initial visit to assess a patient’ s needs and mental state, Kanas will prescribe a Valium to relax a patient before an upcoming visit.
Despite these challenges, Kanas said he often walks out from appointments“ with a smile on my face,” buoyed by the personalities and stories from his clients. Boothby recalls a husband who hired her for several years to regularly clean the teeth of his invalid, homebound wife. In thanking Boothby, she said he told her:“ I always know when you’ ve been there. She always has her lipstick on, her breath smells better... and I can kiss her.”
It’ s a bit of giving back.“ We’ ve all had parents, grandparents or even young people who are unable to help themselves,” said Cajee.“ Sometimes it’ s the small things you’ re doing that can provide some comfort. It fulfills the best of this calling we call dentistry.”
MOBILE DENTISTRY: AT A GLANCE
What it is: House calls made by dentists and dental hygienists, who travel to a patient’ s home, a skilled nursing facility or residential care home. Carrying their own portable equipment, they do routine cleanings, X-rays, extractions, fillings and denture fittings.
What they charge: Varies by individual practitioner, but fees are typically comparable to conventional office charges. Mobile hygienists generally charge $ 135 to $ 200 for a deep cleaning. Mobile dentists may charge $ 90 to $ 150 for an initial consultation, then $ 80 to $ 175 for a regular exam, $ 25 to $ 29 for single X-rays or $ 1,400 for a single, custom-fitted denture. For a mobile dentist’ s exam, X-rays and cleaning in a private home, it’ s about $ 300; slightly less in a residential care facility. Fees include cost of travel.
How it’ s paid: Some patients pay directly; others have mobile practitioners bill their insurance or Denti-Cal.
Who uses it: Generally elderly patients who can’ t, or prefer not to, travel, or younger patients with physical or mental disabilities that prevent them from easily going to a dentist’ s office. Mobile dentists and hygienists treat those in hospice care, as well as patients with agoraphobia, autism, Alzheimer’ s, dementia and physical disabilities.
How to find it: For mobile hygienists, search for a Registered Dental Hygienist in Alternative Practice( RDHAP), listed by name and geographic region at the California Dental Hygienists’ Association website, cdha. org �
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