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Unique collaboration created Fergus Falls’ new Center for Dental Health

A partnership between DHS and the nonprofit Apple Tree Dental, the center’s clinics focus on serving children, families and seniors who cannot afford dental care and people with disabilities who need specialized facilities and expertise.

Lori Hanson lives with a developmental disability, and for years her family has struggled to find a dentist qualified to provide the specialized care she needs.
Lori Hanson lives with a developmental disability, and for years her family has struggled to find a dentist qualified to provide the specialized care she needs.
Minnesota Department of Human Services

A couple weeks before Christmas, Lori Hanson needed to get a filling in one of her teeth. So one morning, she and her mother got into their car and drove about an hour from their home in Detroit Lakes to visit the Minnesota Department of Human Services Special Care Dental Clinic in Fergus Falls.

Later that day, with her cavity filled, Hanson was in a happy mood.

“They’ve been so good to me,” she said of clinic staff. “I didn’t pay anything. All I had to do today was sign a paper for the filling and stuff.”

Hanson’s history with dentistry hasn’t always been this positive. She lives with a developmental disability, and for years her family has struggled to find a dentist qualified to provide the specialized care she needs. This conundrum, combined with Hanson’s reluctance to focus on her oral health, has added up to a mouthful of teeth that needed serious attention.

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“If I would’ve listened to my parents,” she said, with a rueful laugh. “They said, ‘You have to brush your teeth,’ and I didn’t.”

Because it offers dental care for individuals with developmental and intellectual disabilities, severe and persistent mental illnesses and traumatic brain injuries, the DHS Special Care Dental Clinic turned out to be a perfect match for Hanson’s needs. Her clinic visits are covered under her Medical Assistance plan, and dental staff understand how to meet her unique care requirements.

“That’s the good part about it,” Hanson, 60, said. “That’s why we said we’ll take advantage of it so I don’t have to pay.”

This fall, people in need of specialized dental care and individuals without dental insurance seeking standard dental care now have a new, expanded care option: The $5.1 million Center for Dental Health, a partnership between DHS and the nonprofit Apple Tree Dental.

The newly constructed center, home to the two separate dental clinics, focuses on serving children, families and seniors who cannot afford dental care and people with disabilities who need specialized facilities and expertise.

Both Apple Tree and DHS already had dental clinics in Fergus Falls that needed updating. The unique partnership allows the two clinics to share equipment costs and special care facilities.

Minnesota DHS Commissioner Jodi Harpstead said that her agency had been investigating ways to expand its existing clinic when representatives from Apple Tree approached them about a possible partnership. “We were looking at what was next for us in Fergus Falls,” she said. “It felt like a great idea to join forces.”

Apple Tree Dental co-founder Michael J. Helgeson added that teaming with DHS meant that both organizations would be able to help more people have access to dental care.

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“We concluded, ‘Wouldn’t it be smarter to work together and join forces?’” he said. “We could bring in state resources and experience and bring in Apple Tree’s experiences as a nonprofit.”

Hanson said she didn’t know anything about the partnership that resulted in the new dental clinic, but she’s happy with the result.

“It’s really a nice place,” she said. “It’s a lot bigger than the old clinic, and everything seems really new.”

Partnership expands care options

The partnership between DHS and Apple Tree represents a renewed commitment to providing dental care to the region’s underserved communities. In Greater Minnesota, even people with dental insurance can have a hard time making an appointment with a dentist, Helgeson said; for people on state-run medical plans or people with disabilities, finding a qualified — or willing — dental professional can be even tougher.

Michael J. Helgeson
Minnesota Department of Human Services
Michael J. Helgeson
“More than half of the counties in Minnesota are designated as dental-health-professional shortage areas. Only about one out of three children enrolled in Minnesota public dental programs get one dental visit a year. It is a major problem throughout the state, and it impacts rural communities in a big way.”

A shortage of qualified dentists means that once they are able to make an appointment with a dentist, many rural patients must travel great distances, Harpstead said: “There are a lot of places in Minnesota where people are more than an hour away from the nearest dentist.”

Apple Tree Dental’s Fergus Falls clinic was located in a shopping mall that had been sold to a new owner. Clinic directors were informed that they needed to find a new location.

While the lease on the DHS Special Care Dental Clinic wasn’t up, clinic managers felt that their facilities also needed an update. Beyond basic infrastructure weaknesses, size was also an issue: Both clinics were small and had limited capacity to serve the many people in need of the kind of dental care they provided.

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“We lacked any capacity to grow at Apple Tree in Fergus Falls,” Helgeson said. “We had 1,200 families on our waiting list. The DHS facility was likewise really out of date and inadequate.”

The new, expanded Center for Dental Health will help Apple Tree welcome more patients to the practice and reduce the size of the waiting list, Helgeson said.

“What we’ve been able to do is double our capacity with this huge new building and all this infrastructure. We’ve been able to hire two or three more dentists at Apple Tree. Our capacity is going to grow quite a bit.”

Modern dental care requires more than a reclining chair and a drill. For a small clinic serving a patient population dependent on public insurance, the cost of providing the latest up-to-date technology can be prohibitive. Joining forces, Helgeson explained, helps bring costs down because they are shared.

Commissioner Jodi Harpstead
Commissioner Jodi Harpstead
“We use really expensive compressed gases, vacuum systems, water supplies and medical gases,” he said. “We have really expensive digital imaging equipment and sterilization facilities. We thought that if we could share all the technology it would a real cost savings to both of us.”

Because the DHS dental clinic specializes in serving patients with challenging behavioral health issues, brain injuries and severe developmental disabilities who sometimes require sedation before treatment, the new clinic has been equipped with a special sedation suite to help make dental exams and procedures possible.

The sedation suite, Helgeson said, is “like a mini operating room in a hospital. It will be staffed by anesthesiologists. Sometimes a person with a brain injury cannot sit in a dental chair, open their mouth and cooperate even for a checkup and a cleaning. With IV sedation, that person can relax. It is less expensive than doing general anesthesia.”

Financing for the project was provided in part by local community leaders.

“We have members of the business community in Fergus Falls that stepped up to the plate and provided resources and made connections,” Helgeson said. “The local business community was really supportive of the effort. The city issued tax-exempt bonds. Bremer Bank worked with the city on the financing.”

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The project now complete, Helgeson said that he and his partners at DHS are pleased with their new facilities and excited about the prospect of serving more patients.

“This is a great collaboration between a nonprofit and a government program,” he said. “We were kindred spirits from the very beginning and this project has great potential for success.”

Dental care key to overall health

Many people think of a trip to the dentist as nonessential extra, but the reality is that dental care is key to overall health.

“Believe it or not, there are 500 to 600 different bacteria that live in the mouth on a normal basis,” Helgeson said. “If these bacteria get out of balance you can have all sorts of problems in the mouth and these problems can spread to the rest of the body. There are documented links between heart disease and periodontal disease,”

Harpstead agreed. “Putting off regular dental care can create serious physical health problems,” she added.

Helgeson’s grandfather was a dentist. He said that the advances of modern dentistry had helped to raise life expectancy worldwide.

“Hundreds of years ago, dental diseases were the leading causes of death all over the world. Even when my grandfather was a dentist — he was born in 1899 and started practicing in 1922 — at that time most patients were losing most or all of their teeth by the time they were 30.”

Apple Tree was founded in 1985 with a focus on providing dental care for frail elders in senior-living settings. In the years since, it has expanded to provide care to people of all ages. About 80 percent of patients are enrolled in Minnesota public health programs. The rest pay for care on a sliding scale. In 2019 the nonprofit provided almost 100,000 dental visits statewide, Helgeson said.

In the early days of the pandemic, many dentists’ offices were closed. Apple Tree Dental kept its offices open, providing services for patients in need of urgent dental care.

“Between March and June 2020, we provided over 4,500 emergency dental visits statewide,” Helgeson said. “These were people with abscesses and pain. They were swollen and couldn’t sleep. More than a third of our patients were referred to us from the ED and other dentists that were closed. We stepped up to the plate and lived out that frontline role.”

Even in more normal times, lack of insurance coverage or a general fear of discomfort means that many people put off dental care until they have no other choice. Often that means they end up in an emergency room.

“Until you have a really serious toothache you think your teeth are fine,” Harpstead said. “It doesn’t occur to people that keeping up with regular dental care is important to their overall health. Dental health is the No. 1 reason for children missing school.”

Hanson said she’s hoping that with the help of staff at the DHS Special Care Dental Clinic she’s starting a new chapter in her life of better dental health.

“I just have upper dentures for right now,” she said. “I’m going to try to take care of the rest of my teeth so they won’t have to be pulled. I hope so. Time will tell I suppose.”