As a general dentist who recently began practicing in Illinois, I care for Medicaid patients and perform third molar extractions. Some of the most meaningful moments in this work happen before the procedure begins, when patients explain what it took to find care before I started working here.
Some patients have told me they previously had to travel three hours to have their wisdom teeth removed because they could not find a closer provider who accepted Medicaid for the treatment they needed. Even after locating a provider, they were offered an appointment a month later.
A month of waiting. A three-hour drive each way.
For a patient arranging transportation, taking time away from work, finding childcare, or coordinating someone to accompany them, that journey can become an overwhelming obstacle. And after treatment, they still have to get home.
Real physician voices, twice a week
Free, and one click to unsubscribe.
An extraction is a familiar part of my clinical work. For someone who previously faced a long wait and an exhausting journey, receiving appropriate care closer to home can mean much more.
The struggle before the appointment
A referral can seem straightforward from the clinician’s perspective. We identify a problem, explain the treatment, and direct the patient to an appropriate provider.
But what happens when the patient cannot find someone who accepts their insurance? The next step becomes a series of calls and questions. Does the office accept Medicaid? Does it perform impacted third molar surgery? Is it accepting new patients? How far away is it? When is the next available appointment? Each unanswered question adds another task to a person’s life.
For someone with flexible work hours and reliable transportation, these tasks may be inconvenient. For someone with little room for an unexpected expense or a missed workday, they can determine whether treatment happens at all.
Insurance coverage matters. But coverage becomes meaningful only when a patient can reach a provider who can deliver the needed care.
When the need cannot wait a month
An appointment a month away may be manageable when a patient’s condition can safely wait. But what happens when someone needs urgent evaluation or an extraction sooner?
The same barriers remain. Nearby offices may not accept their insurance. The available provider is still three hours away. Work, transportation, and family responsibilities do not disappear because the need has become urgent.
Imagine making those arrangements while experiencing significant dental pain. Eating, sleeping, and concentrating at work may already be difficult. Now the patient must also decide whom to call, where to go, and how to get there.
An urgent problem requires timely assessment to determine the appropriate treatment and setting. An appointment weeks away cannot be the only available path.
For an office, a waiting period is an entry on a schedule. For a patient in pain, it can shape every part of the day.
A referral must lead somewhere
There are sound clinical reasons to refer impacted third molar cases. Surgical difficulty, medical conditions, anesthesia needs, and the dentist’s experience all matter. Patient safety must guide those decisions. Yet an appropriate referral can leave a patient stranded if the destination is inaccessible.
We need to ask both questions: Where should this patient receive treatment, and can this patient realistically get there? When a referral is not completed, we should ask what stood in the patient’s way.
Bringing care closer
Individual dentists cannot solve this problem alone, but there are practical places to begin.
- Build usable referral networks: Dental offices, community clinics, and specialists could share regularly updated information about Medicaid participation, available procedures, and appointment availability. When possible, referring teams could help secure an appointment and confirm that the patient connected with the receiving office.
- Create pathways for urgent cases: Referral partners could establish direct clinician-to-clinician communication for patients who need prompt assessment. Participating offices could consider reserving capacity for urgent evaluations, with treatment decisions guided by clinical need.
- Support appropriately trained general dentists: Surgical education, mentorship, and specialist consultation could help dentists provide selected extractions within their competence. This requires careful patient selection, appropriate equipment, safety protocols, and reliable referral options for complex cases.
- Make Medicaid participation practical: Policymakers and Medicaid programs should examine reimbursement, payment delays, and administrative requirements that may discourage participation. Providers need sustainable resources to deliver safe care.
- Expand community-based services: Partnerships among oral surgeons, dental schools, and community clinics could explore scheduled surgical sessions closer to underserved patients, with plans for follow-up and postoperative concerns.
- Address transportation early: Care coordinators could help patients explore available transportation benefits and understand escort requirements. Asking about the journey before scheduling may uncover a barrier before it becomes a missed appointment.
Listening beyond the tooth
My patients’ stories are clinical observations, not a formal study. They cannot establish how widespread these barriers are. They do show what deserves closer attention.
Research should examine travel distances, waiting times, unsuccessful attempts to locate providers, and access to urgent assessment. It should also evaluate whether local programs make treatment more reachable. Until then, I will keep listening.
When patients describe waiting a month and traveling three hours for an extraction, I think about everything that had to happen before they reached the dental chair: the calls, the arrangements, the time, and the uncertainty. I also think about those whose needs become urgent while they are still searching for help. As someone who recently began practicing in this community, I am learning that the value of treatment extends beyond the procedure itself.
Sometimes, it begins with being able to tell a patient: We can help you here.
Keerthi Prasanna Chennuri is a dentist.
