San Juan County expands school, mobile and community dental services as demand outpaces capacity

Kristen Rezebek, the county’s health and nutrition program coordinator, told the San Juan County Board of Health on April 16 that the health department has built a three-part oral health program to address low Medicaid dental utilization and gaps in local care.

The county is running school-based sealant clinics, community dental clinics on San Juan, Orcas and (starting April 24) Lopez, and a program called Mouth Matters that trains primary-care providers to deliver basic oral screenings and fluoride varnish. "Only 7.7 percent of our adults on Apple Health Medicaid were actually able to utilize their dental benefit," Rezebek said, citing 2023 Health Care Authority data. She said 38.7 percent of children on Apple Health used dental benefits in 2023.

Rezebek described three separate operational models the county now uses: (1) a partnership with a private eight-operatory practice on San Juan Island that opens periodically for clinics; (2) a fixed community dental clinic on Orcas created with Orcas Island Healthcare District and local funders after months of mobile-clinic logistics; and (3) a mobile dental van model to serve Lopez. Orcas also added teledentistry, with a dental assistant on-island taking x-rays and photos and a mainland dentist reviewing cases remotely so on-island visits are used mainly for treatment.

Nut graf: The program produced measurable services last year but faces capacity and funding shortfalls. In 2024 the county-sponsored community dental effort ran 44 clinics and 524 appointments and ‘‘provided over $274,000 worth of dental care,” Rezebek said. She said 44 percent of clinic patients were on Medicaid and the remainder were uninsured or unable to pay; the county’s wait list stands at 879 people and growing.

Program details and partners: County staff said school-based sealant clinics—now in their third year—served 90 children in partnership with Community Health Center of Snohomish in 2024 and produced 184 sealants. In 2024 San Juan Island Dental opened clinic sessions and saw 92 unique clients while maintaining a separate wait list of 341 people. Orcas moved from repeated mobile set-ups to a dedicated clinic space in October 2024; county staff said the equipment purchase for Orcas was about $170,000 and remains on Orcas, and that donated operatories and community fundraising helped create the fixed site.

Rezebek gave a snapshot of reimbursement and costs. The program billed roughly $79,000 in services to Medicaid and received about $23,000 in reimbursements, illustrating low Medicaid dental rates that make private practice participation financially difficult, she said. County staff time that supported the program in 2024—program coordination, scheduling and related work—was not all grant-funded; Rezebek said about $28,000 of county staff time was contributed in 2024 and estimated roughly $35,000 would be needed in 2025 to support oral health activities across the three islands.

Barriers and adaptations: Speakers described transportation and ferry-reservation challenges when bringing mobile teams or vans to Lopez and Orcas, and emphasized that low Medicaid reimbursement drives limited provider participation. The program added artificial intelligence tools for image review and charting efficiencies, and plans to use a scheduling platform called DentaFlow to better integrate appointment workflows with the electronic dental record that the county purchased to be shared across sites.

Quotes and local impact: "We provided over $274,000 worth of dental care to our community members," Rezebek said. She urged continued community and foundation support to sustain services for uninsured residents and those on Apple Health Medicaid. Board members noted the program’s downstream savings—avoiding lost work time, school absences and costlier dental emergencies—and encouraged the county to pursue stable funding sources.

Forward look: Lopez begins mobile van clinics April 24 (pending ferry reservations), Orcas is operating four days per month with one teledentistry day weekly in 2025, and San Juan Island Dental continues scheduled sessions in its private practice. County staff said they will pursue both local philanthropic funding and potential rural reimbursement models with partnered hospital districts to improve sustainability.

Ending: Board members praised the program as an innovative, replicable rural model and asked staff to return with updates on funding strategies and operational changes. Rezebek and partners credited PeaceHealth, Orcas Island Healthcare District, Orcas Island Community Foundation, Fish for Teeth, Washington Dental Service Foundation, Community Health Center of Snohomish, San Juan Island Dental, Mercy Flights and a network of volunteers for making the clinics possible.