By Joan Tupponce and John Wallace

Nataja Bailey couldn’t take it anymore. Her molar had a deep cavity, and the pain was radiating through her jaw and causing headaches. She contacted several dentists, but they didn’t accept her insurance. Finally, she came across Virginia Commonwealth University School of Dentistry’s Urgent Care Clinic online and was thankful when she called and was told that she could be seen immediately.

“The pain started in 2022, but I don’t like going to the dentist so I had been putting it off. The cavity was so bad, I thought the tooth was cracked and needed to be pulled,” said Bailey. “After the exam, they said they could save it and scheduled me for a root canal later in the afternoon.”

The school’s Urgent Care Clinic opened in 2017 under the leadership of former VCU School of Dentistry Dean David Sarrett, D.M.D. It serves a critical need in the region for urgent oral health care, and now the school’s administration is putting a renewed focus on improving its operations to serve as many people as they can. 

“Every day, for years, there would be a line outside of the school before the doors opened. The clinic operated on a first-come, first-served basis, and the word was out that if you were not here early, you might not be seen,” said Chad Lockhart, M.H.A., F.A.C.H.E., president of VCU Dental Care, who assumed the role 10 months ago.

During his first few months on the job, Lockhart wanted to gain the perspective of the patients waiting in the early morning lines. He began going outside, asking questions and listening to their issues.

“We made a goal to see every patient on the same day. Our team started focusing on the patients’ journeys through our services and honing in on the way we register the patients and refer them to the various specialty clinics at the school,” Lockhart said.

 David Sarrett, D.M.D., mentors a third-year dental student as they work to affix a patient’s loose crown. (VCU School of Dentistry)

“Now, the vast majority of patients are seen on the same day. If there is a complication or another reason they can’t be scheduled, they will be given priority for the next day.”

Lockhart says the contributions from Conway Upsher, D.D.S., director of the Urgent Care Clinic and Angela Carter, manager of the clinic, have been critical to improving urgent patient care and enhancing the experience of those patients.

The clinic’s walk-in volume has increased 43% in the last year. The growing numbers are enhanced by a similar focus on the operations of the school’s specialty clinics.

“We changed the check-in process so we could do pre-triage of the patients,” said Donnie Parris, director of patient business services at VCU Dental Care. “Staff members will refer them to the clinic or to oral surgery. That increased capacity at the same time.”

For example, the school’s Oral and Facial Surgery Clinic has more than doubled its number of cases through the improved triage process.

“Last July alone, there was a 166% increase in surgery cases,” Lockhart said.

Connecting education to improving access to care

Accessing timely and regular dental care can be challenging for some Virginians who are underinsured, low-income or simply have insurance coverage some dentists don’t accept.

“The last time I went to the dentist was to have my wisdom teeth removed in 2016,” said Bailey. “I was offered a screening appointment in the student clinic, so I want to start coming regularly.”

VCU School of Dentistry is the largest provider of oral health care for patients insured by Medicaid. Since Virginia expanded Medicaid dental benefits for adults in July 2021, demand for the school’s services has increased substantially. For many patients, the Urgent Care Clinic is their first interaction with the school.

“Treating patients in the Urgent Care Clinic is a different experience than what we get in the predoctoral clinic,” said Sana Habib, a fourth-year dental student. “Here, we see patients back-to-back at a fast pace as opposed to the longer, scheduled appointments in predoc.”

Sarrett, now an adjunct faculty member, spends his Wednesdays supervising the fourth-year dental students who staff the clinic during their required two-week rotations. He sees the fast-paced clinic as an excellent learning opportunity for the students.

Sometimes, when the clinic is busy, he will go to the school’s predoctoral clinic and pull third-year students to assist.

(From left to right: Clayton Jackson; Lyda Sypawka; Conway Upshur, director of the Urgent Care Clinic; Angela Carter, manager of the Urgent Care Clinic; Hoordad Sharif; Aufia Zhowandai) (VCU School of Dentistry)

“The Urgent Care Clinic reinforces the importance of following a systematic protocol and developing an evidence-based treatment plan,” Sarrett said. “Patients often show up in pain and we want to help them as quickly as possible. However, it’s important that the students base their treatment plan on a thorough evaluation and don’t jump to conclusions that result in unnecessary care.”

Sarrett also emphasizes the importance of being compassionate and understanding when it comes to the challenges some patients have in accessing oral health care.

“Many of the patients insured by Medicaid aren’t fully aware of their benefits,” Habib said. “There are also other factors, such as work or family responsibilities, that prevent people from receiving care.”

Lyndon Cooper, D.D.S., Ph.d, dean of the School of Dentistry, says the school’s services are considered an important “safety net” for patients who struggle to access dental care.

“Treatment of emergency patients is an important learning opportunity and one needed to gain the experiences needed to become a well-rounded professional,” Cooper said. “At VCU, we are focused on how we can operate as efficiently as possible to serve the overwhelming demand from our community.”

Cooper says that the supervised training and experiences providing care in the school’s clinics and external rotation sites are key to VCU’s reputation for graduating highly skilled providers.

“Ninety-seven percent of our students passed the board exams on their first try. The main difference between seeing a student dentist and a faculty dentist is not in the quality of care, but the time it takes,” he said. “We believe we are training some of the best new dentists in the country.”

Making it easier to get appointments for dental emergencies

In many instances, people will show up in an emergency department with a dental issue instead of a dentist’s office. Those patients will often be prescribed medication for infection or pain and referred to an oral surgeon or other specialist.

To help make those connections, the clinic is piloting a novel scheduling system that gives priority care to patients who need immediate attention.  

Working with their electronic health record provider, Axium, the school’s information technology team has developed a QR code and mobile app for priority scheduling in the clinic. If successful in this setting, it may be rolled out to other clinics in the school.

“This new technology will allow patients to make an appointment at the convenience of their schedule. Confirmations can be sent and accepted via text and email, and all of their medical records will automatically be available to their provider if they are existing patients,” Lockhart said. “It will change the way we do patient care throughout the building.”

The self-registration will flag the person as an emergency care patient and put them in the queue immediately. As Lockhart says, patients won’t have to stand outside in line anymore since they can sign-up for an appointment at home.

It takes the effort of a whole team, everyone in the building, to ensure patients can receive care when they need it the most. The work done to make the process easier reflects the needs of the patients, making the Urgent Care Clinic a “truly community facing facility,” Lockhart says.