Access to dental care for low-income Mainers could be on the verge of a big step forward thanks to the ambitious goals of Community Dental, a Portland-based nonprofit where narrow hallways and elbow-to-elbow examination rooms may soon be replaced by spacious new digs in a location closer to downtown.

The extra space at a to-be-determined location will permit Community Dental, which operates five clinics around the state, to enhance its mission of providing care to thousands of the state’s neediest, specifically children on MaineCare and adults with no insurance at all.

The agency, now located on Brighton Avenue in the city’s Rosemont neighborhood, has begun raising money for what would be a $1.6 million investment in new rental space, equipment and furnishings.

Dental health experts say there’s a lack of access for children on MaineCare, and even more so for uninsured patients who can’t pay the full cost of a dental visit.

Currently, Community Dental has maxed out its Portland clinic with about 5,000 patients. The new space will allow Community Dental to add another 2,000 patients. And if a proposal to expand a partnership with Maine Medical Center and Tufts University becomes a reality, thousands of additional low-income patients could gain increased access to dental care.

Community Dental is also working with Portland Community Health Center and the Preble Street social services agency to provide dental cleanings and other services, with a long-term goal of expanding capacity at those locations as well.

“We have a mission. We have a vision to provide all Maine people with access to good-quality dental care,” said Lisa Kavanaugh, CEO of Community Dental.

Since 2008, Community Dental has added locations in Rumford, Biddeford and Farmington to its existing clinics in Portland and Lewiston, as it seeks to serve key population centers. The five clinics now care for about 20,000 patients.

The expansion has mostly been accomplished without being part of a state government program – except for a $570,000 state contract to serve southern Maine’s homeless population as well as mentally ill patients who must be sedated before having dental work performed.

Community Dental took over those services after a state-run clinic in Portland closed in June 2013.

BALANCING THE TYPES OF PATIENTS

Community Dental initially couldn’t restart the sedation service because of a lack of space and equipment. But Kavanaugh said a partnership with Maine Med restored sedation dental services to Portland in the interim, meaning patients avoided a two-hour trip to Bangor to receive treatment at Dorothea Dix Psychiatric Hospital. Community Dental resumed the sedation service late last year.

So how is it possible for Community Dental to expand low-income services when many private dentists either don’t accept MaineCare patients or severely restrict their number for financial reasons? MaineCare – the state’s Medicaid program – covers children but does not have an adult benefit. Moreover, MaineCare reimbursements to dentists are typically lower than payments made on behalf of patients with private insurance.

One reason Community Dental can target the neediest patients is that Kavanaugh keeps a close eye on the patient mix. Although the focus is on low-income patients, Community Dental also accepts private insurance.

When its new Portland location opens – probably in 2016 – it will be necessary for Community Dental to serve a higher percentage of patients with private insurance, perhaps 25 percent instead of 10 percent, Kavanaugh said. But because the total number of patients would increase, Community Dental would still be treating more low-income patients.

Uninsured patients pay on a sliding fee scale based on income, but often it’s much less than what insurance pays, perhaps $30 for a visit compared with $200 for private insurance reimbursement.

“It is a financially sustainable business model,” Kavanaugh said.

However, she said the agency would not be able to expand services without its Maine Med/Tufts partnership. A federal grant that began in July allows the agency to bring in three dentists per year who have completed their degrees but are doing one-year post-graduate residencies.

Dr. Robert Bingyou, vice president of medical education at Maine Med, said the program with Community Dental is going so well that more residencies are being sought. A successful application would boost the number of dentists in the program from three to five or six within the next two years.

“It’s a great program and it adds a nice dimension to our educational mission,” Bingyou said.

PARTNERSHIP WITH UNE PROGRAM

Bingyou said the program could also benefit Maine by bringing younger dentists into the market, helping to offset the state’s aging population.

The partnership also gives Community Dental access to oral surgeons at Maine Med who occasionally provide specialty services, such as gum treatments, dental implants and wisdom tooth extraction.

Kavanaugh said long-term, Community Dental is looking to form a partnership with the University of New England that would provide fourth-year dental students to help at the clinics.

Overall, Maine’s rankings for dental care are a mixed bag when compared with other states. For instance, the percentage of people who have seen a dentist within the past year was 65 percent, according to America’s Health Rankings. That’s about the national average but lowest among the New England states.

However, Maine received an “A” grade from the Pew Center on the States for children’s oral health, largely because of its children’s sealant program and the fact that most residents drink fluoridated water.

For Kelly Cousins of Buxton, whose 14-year-old son Alexzander Sprague was getting a cavity filled Tuesday, Community Dental is well worth a 30-40 minute drive. Cousins, a mother of four, said she couldn’t find a dentist near Buxton who would accept MaineCare patients, but she’s happy to have dental care for her children.

“Just finding a place that took MaineCare patients was very difficult,” she said.