Help me get back to the dentist

NINA MOINI: Time now for the latest in our series Professional Help. We all need a little help to get through life sometimes from everyday questions to more complex problems. We're asking the experts to lend us a hand. Here's Minnesota Now producer Alanna Elder.

ALANNA ELDER: Here's a confession. I was supposed to have my six month tooth cleaning on Monday, but had to cancel. It's now Thursday, and even though it's been a nagging thought at the back of my mind, I still haven't pinned down a new appointment. I'd just gotten back on track with the recommended twice yearly cleaning schedule after, let's just say, a spotty record with the dentist in my adult life.

I bring this up because I know I'm not alone. The COVID-19 pandemic, for one thing, caused big interruptions in routine and preventative appointments. Research shows that was especially true for dental care. It's also the type of health care that people most frequently skip because they can't afford it, according to a study by the Federal Reserve.

For many people, the dentist's office is on the other side of a mountain of barriers not only cost, but widespread dentist shortages and powerful emotions, like fear, shame, or anxiety. It's a lot to navigate. So I got some professional help from someone who's had a positive outlook on the dentist since she was just a kid.

SHIVAN NELSON: Pretty much always wanted to be a dentist since about third grade.

ALANNA ELDER: Dr. Shivan Nelson is dental director for the nonprofit community dental care, which has clinics around the Twin Cities and in Buffalo and Rochester.

SHIVAN NELSON: Your dental health impacts so much more than just how your mouth feels. It's are you comfortable smiling and you know how the world perceives you if you're not comfortable smiling? Can you eat? Can you speak well?

Dental issues are the number one cause of missed school for children, medical reason. So there's just so much more that goes into your overall health with mouth. And I had a lot of family members who didn't have the best dental health growing up. And so that always implanted in me that this really matters and this is important. So I think that's really why I wanted to get involved, is you literally giving people their smiles back.

ALANNA ELDER: About half her patients are kids, so she feels a lot of responsibility to start off on the right tooth or something.

SHIVAN NELSON: A lot of the patients that I see older on in life that have a lot of untreated dental disease, it's because they've had a bad experience as a kid and they just were too scared to go back. If you have kids that are nervous, sometimes they feed off your own nervousness. So if you yourself have had bad experiences or are scared of the dentist, do whatever you can to not let that show for kids and be mindful about how you talk about the dentist with kids.

We never want to view dentistry as punishment. Oh, if you don't brush your teeth, you're going to get this and the dentist is going to have to do X, Y, Z. We want that, oh, the dentist is here to help.

ALANNA ELDER: It can also help if kids know the drill ahead of time.

SHIVAN NELSON: Clinics like ours also have meet the dentist or videos where we have a video online that walks the child, here's what it looks like in our waiting room. Here's what it looks like in the operatory. Here's the tools the dentist might use. So things like that to make all the things we're going to do a little less scary.

ALANNA ELDER: And what do you recommend for adults who are still holding on to some of those bad experiences and the fear that is still around today?

SHIVAN NELSON: Yeah, absolutely. So I see this with some of my patients all the time, where it's been years since they've come in and they're ashamed of the way their teeth look, and maybe embarrassed that they didn't address it sooner. And what I always tell those patients is, listen, we can't go backwards. You're here now, and that's what matters.

And I reassure them that matter how bad their mouth is, I guarantee I've seen worse. And there are options to get them back to a point where they're comfortable and smiling.

ALANNA ELDER: For people who are nervous about what they're going to hear when they do go back, and what issues they may then have to pay for, whether it's fillings or root canals, how do you recommend that they approach that?

SHIVAN NELSON: Well, first thing I'll say is, just because your teeth don't hurt doesn't mean something's not wrong. And generally, the more we put off dental care, the worse it gets. So by the time a tooth hurts, we're probably not talking about a filling anymore. We're probably talking about a root canal or removal of the tooth, or something more major and more expensive.

So first thing, try not to put it off any more than maybe they already have. And for those that have put things off, it can be overwhelming. You get this big long treatment plan, you think, well, how am I going to afford this? Where do I start?

Dentists are really good at helping patients navigate that. It's a little bit different than the medical world, where if you say you go to emergency room or something, you don't know what it's going to cost you. Often the doctor doesn't know what it's going to cost you, and you get this bill three months later. It's really not the same with dentistry.

Dentists work really hard to try and estimate within reason what's this going to cost and then what order things should be done. Sometimes the dentist can say, hey, here's the things that you should get done within the next month or two to avoid pain and infection or them getting worse. But here's a few things that while important, maybe can wait a few months or even till their insurance benefits if they have insurance reset next year. So being able to walk patients through the priority of things.

They don't have to tackle everything all at once, break it up into bit-sized pieces, so to speak. If you do get one of those big treatment plans and it can be overwhelming, it's OK to get a second opinion. I often have patients come in that just want that gut check before they spend this much money, is this the best option for them? It's not necessarily not trusting the other dentist, but just hey, is this the best option for me?

And also finding a dentist that you feel listens to you and you can trust. Again, you're going to spend a lot of time in that dental chair if you have a full treatment plan, make sure that, that person is going to be taking care of you, you really feel comfortable with because then you're more likely to come back and get the work done if you feel heard and well taken care of.

ALANNA ELDER: And then for people who don't have dental insurance, what resources are available to them to help pay for care?

SHIVAN NELSON: Yeah, absolutely. So there's a little bit of a misconception that you need dental insurance to see a dentist. And while dental insurance can be really valuable in helping reduce costs, it's not an equal comparison with medical insurance. So even if you don't have dental insurance, there are cost effective ways to go to the dentist.

First, I would say for individuals living in poverty, check to see if maybe you do qualify for some assistance, either through medical assistance or through the MNsure exchange where they can purchase some affordable dental insurance. But even for individuals who don't have access to those, there's a little bit of a misconception that you need dental insurance to see a dentist.

And while dental insurance can be really valuable in helping reduce costs, it's not an equal comparison with medical insurance. So even if you don't have dental insurance, there are cost effective ways to go to the dentist.

ALANNA ELDER: The Minnesota Dental Association, for example, has a list on its website of low cost clinics that offer sliding scale fees or grants to help meet urgent needs. And if wait times are your issue and you're in pain and need to see a dentist soon, there may be ways to skip the line.

SHIVAN NELSON: All dental clinics, I think, nationwide are facing a pretty large workforce shortage issue, so it often can take three to six months to get a new patient exam. But again, a lot of, especially community clinics that serve the underserved who already have a lot of barriers to care, work to overcome those in different ways.

And one of the ways we do that is through offering walk in emergencies, where you can either call ahead or just walk through our front door and we see you as we can. And just like an urgent care, sometimes we can get you right in, sometimes you wait for three or four hours, but to at least be able to get in and get that acute need addressed that day and help get you out of pain or help get an infection under control.

ALANNA ELDER: Still, Dr. Nelson says nothing beats preventative care. For Professional Help, I'm Alanna Elder.

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NINA MOINI: Check out all our Professional Help stories by heading to the Minnesota Now page at mprnews.org.