After receiving upper dentures from the Madison Dental Initiative, Morgan Ernest got her health and confidence back.
For months, Morgan Ernest lived in fear of the next infection.
Only 35, her teeth were rotting. She recalls waking up a year ago with pain from abscesses "10 times worse than a toothache."
At the time, Ernest had a part-time job as a janitor but minimal dental insurance. She couldn't afford co-pays for major procedures. With neglect, her problems got worse.
"There were things I wanted to eat that I couldn't," she says. "I was losing weight. It was affecting my health."
Looking for better jobs felt hopeless, too. At interviews, she sensed the eyes of potential employers fixate on her mouth.
"You can just tell by the look on their face," she says. "They assume there's something wrong with you. Do you use drugs? Do you have bad hygiene?"
But last year, Ernest, who is currently homeless, found help at Madison Dental Initiative, a three-chair clinic inside the Salvation Army's family shelter at 630 E. Washington Ave.
Over the next six months, MDI's volunteer dentists extracted what remained of her upper teeth and fitted her for dentures, free of charge. The pain was gone, and her smile returned.
"People treat me different," she says. "They treat me as an active part of society, even though I have been for years.... It's unfair, but it's how it is."
Ernest's smile is a rare success story. Dental care is hard to come by for the uninsured or low-income patients covered by BadgerCare Plus, the state's largest Medicaid program.
Some fear it's about to become even harder to find with the closing this summer of the Max W. Pohle Dental Clinic, in Meriter Hospital, 202 S. Park St., which has served low-income residents for almost 40 years.
Medicaid reimbursements to Wisconsin dentists are among the nation's lowest and don't begin to cover dentists' costs, so most dentists turn away patients covered by the program or strictly limit how many they take.
MDI, which relies on volunteer dentists and a combination of grants and fundraising, was founded in 2009 as an antidote to a growing problem. By 2010, concerns over gaps in dental care prompted city and county health officials to team up with dental experts to issue a 2012 report about Dane County's "oral health crisis."
It contained a raft of scary data.
Between 2005 and 2010, annual visits to local emergency rooms for dental pain surged 65%, to nearly 2,600, at a cost of more than $1.6 million, even though ERs only provide pain relief and don't fix the root problems.
In one year, roughly 3,300 absences at Dane County middle and high schools were due to dental pain.
Inadequate care was more common for people of color. For example, 39% of Hmong students and 26% of black students had not seen a dentist in more than a year, compared to 6% of white students.
The report concluded: "This problem is larger than one organization, entity or group can address."
Recently, there have been signs of improvement. Between 2010 and 2013, ER visits for oral care at local hospitals dropped 22%, says Debi DeNure, dental health coordinator for Public Health of Madison-Dane County. That tops statewide declines of 6% over a similar period, according to the Milwaukee Journal Sentinel.
DeNure couldn't pinpoint an explanation for the decline but guesses the expansions of MDI and Access Community Health Centers, which operates two dental clinics for uninsured or Medicaid patients in Madison and two more in Sun Prairie and Dodgeville, have helped a lot.
"We're very lucky to have as many good dental providers as we have here," she says.
Last August, however, an announcement by Meriter-UnityPoint Health again shook up the dental community. The Max W. Pohle Dental Clinic, a mainstay in providing oral care to low-income folks since 1977, would close in June.
Named for a former Madison dentist who died in 1951, Max Pohle serves about 1,800 patients a year. But it was bleeding money, losing about $530,000 in 2014, says Meriter spokeswoman Leah Huibregtse.
Most of that loss was due to a small -- and rare -- program that serves about 100 patients a year who require full sedation before dental work because of severe developmental disabilities or other conditions.
"That was one area where we thought it's just not sustainable to keep any longer," Huibregtse says.
Statewide, only Children's Hospital of Wisconsin in Milwaukee offers a similar program, but it's limited to people 21 and under.
"I have been struggling to find colleagues who can help out and take over for these folks," Dr. Stanley Brysh, Max Pohle's dental director, told Wisconsin Health News last month. "When we go, I don't know what is going to happen to these folks." (Brysh declined to comment for this story.)
Max Pohle's closing will also end the state's only hospital-based residency program that trained young dentists to conduct operating room procedures. Again, no replacement has been identified.
Losing both programs "delivers two major blows" to area dental care, said Dr. Thomas Reid, former president of the Greater Dane Dental Society, in a letter last December that urged Meriter to reconsider its decision.
But a separate concern -- that Max Pohle's June 25 closing would flood nonprofits like Access and MDI with uninsured or BadgerCare patients -- might not be as dire.
In advance of the closing, Meriter transferred the clinic's $1 million endowment to Access, which has already hired three new dentists and is in the process of transferring more than 1,600 Max Pohle patients to its clinics, Huigbregtse says.
In 2010, Access had 8,300 dental patients. Now it serves more than 14,000, and that could climb to 19,000 within 18 months, says Access spokesman Paul Harrison. That doesn't include the thousands of low-income or uninsured kids given free dental screenings at 24 grade schools through the growing "Celebrate Smiles" program, which Access also manages.
As a "federally qualified health center," Access receives about $2 million annually in federal support to treat uninsured patients, and reimbursements for Medicaid are higher than for private practices.
But the nonprofit has its limits. Access hasn't taken new walk-in patients in Madison since last June, partly due to the looming transfer of Max Pohle clients, but also because it is linking more of its current medical patients with its dental programs, Harrison says.
MDI, which doesn't receive federal funding, is comparatively small. Last year, 29 dentists offered about $333,000 in free care to 700 patients. But demand has grown about 30% annually, and executive director Aaron Warren worries the trend -- and Max Pohle's closing -- could overwhelm the small clinic. "2015 could be a hard road," he says.
David Gundersen, a Fitchburg dentist and president of the Oral Health Coalition of Dane County, says he's confident Access "is doing everything it can" but will need help tackling "the hidden epidemic" of inadequate oral care.
Gunderson is optimistic, though. While Max Pohle's closing is a "moment of chaos," he says, "that may offer opportunities."
Case in point: MDI is launching a new phone service that could become like a 211 service for people seeking affordable dental care, DeNure says. The coalition has pledged $30,000 this year and could chip in another $45,000 through 2017 to fund the community care dental coordinator position.
Efforts like that could help all providers -- both private practices and nonprofits -- "pull together" and address the crisis, she says.
Max Pohle's closing "is scary because it's unknown," DeNure says, "but everyone is trying to figure out how to fill in the gaps. I'm hopeful."