Mobile dental vans have never worked, regardless of gas prices, hard economic times, shortages of dentists or low MaineCare reimbursement rates. Vans simply aren’t cost effective especially in northern climates. I was the director of the Bangor Children’s Dental Clinic for 32 years as well as the state dental consultant in the 1980s. It was my job to study the successes and failures of dental van delivery systems in New England. After many years of research, I concluded (along with the state, the city of Bangor and the Maine Dental Association) that dental vans have never been successful in the northern U.S. or Canada. In 2003, I was invited along with the Health Department director, the late Maryanne Chalilla, to visit the Penobscot Community Health Center dental clinic. We also got a tour of their new dental van, partially funded by Anthem-Blue Cross as well as by federal tax dollars. Despite what looked like changing times, we upheld the belief that public funds are better spent using older, donated equipment instead of using new stuff like expensive mobile dental vans. I liked the idea of going on the road in rural areas, but preferred a lower cost approach. Ms. Chalilla proposed using new, but low cost, portable dental units, a utility van for transportation, and a system that would set up clinics in schools, hospitals, community centers or hotels to get the work done inexpensively. It’s been five years since the PCHC van first saw patients. Now it’s for sale and the dental equipment’s been stripped from it. There’s no perfect system for the delivery of dental care to the indigent. I recently accepted a job as the dental director of a rural health clinic in Oregon. There’s not one practicing dentist in our county. Money’s tight. It always is for projects like this, so we’re proceeding on the cheap. Our model is the Bangor Children’s Dental Clinic, where, for over 30 years, we treated thousands of children for a very low cost. Maine dentists helped by providing political and financial support. Oregon dentists will do the same. For those who think that dentists in Maine don’t care about poor people, please think again. Many dentists contributed thousands of dollars to the Children’s Dental Clinic Trust Fund so Bangor kids on MaineCare could be treated by a specialist in pediatric dentistry (namely myself). Even before the Children’s Dental Clinic closed (when I semiretired two years ago), various dentists in Maine treated poor kids in their private offices without submitting claim forms because the state makes the reimbursement process so demeaning. Maine dentists do more free work than most people will ever know. What breaks my heart is that so many of the patients I left behind are no longer being treated anywhere. A public health dental clinic for needy children should be able to treat at least 1,000 patients a year. This is no longer happening in Bangor. I wish PCHC all the luck. These days, they’re the only game in town. I hope, now that the dental van’s been put aside, they can hire a pediatric dentist who will work locally (if not regionally) to restore what’s been lost.

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Dr. John C. Frachella is the former director of the Bangor Children’s Dental Clinic.