North Carolina Voices: Understanding Poverty; The Trouble with Teeth: Dental Care and the Problems of Poverty

this is the trouble with teeth a special documentary as part of north carolina voices understanding poverty and kevin wolf for most of human history losing your teeth was considered inevitable part of life and so as the suffering that went along with it europeans in medieval times prayed to a saint they believed could take away their tooth pain and long before there was a dentistry there were two callers who wandered from village to village taking out terrible teeth by the nineteenth century people with the worst tv were the wealthy they could afford to eat lots of sugar tooth loss was still common in the united states fifty years ago half of americans had lost all of at the time he turned sixty five but today dental disease is almost entirely preventable it's really become a disease that's very heavily concentrated in a small segment of the population most people who lose their teeth are poor so these people are in their twenties early thirties

and they're losing teeth are a question usually comes down to cost how much does it cost to say the two forces take the tube and just finding a dentist take the truth out to be a challenge emily hanford reports in the trouble with teeth and dental care and the problems of poverty ms bee oh it's taking advantage of the head of a major gaffe filled with hot water and david a lot of this is war lessig hubble sheila got these dentures four years ago

and they're falling apart in the top one has been broken and repaired to lift that i came out for a ball boy she lost her first two when she was seventeen it had big cavity and dentists pulled it by the time she was forty six she had only three teeth left in her mouth that's when she gets dangerous it's a dark spot in my life going through losing my teeth you know cause is interesting i had i did have a perfect since he's at one point in my life so it seems like it was so long ago i hardly remember when it was but i did and i did not understand how important my teeth or until i was losing them sheila says she felt embarrassed an

inferior walking around with a snapple toothed grin and she couldn't your food very well my mouth would just hurt my guns of the roots down to the root of my teeth would just break and when it would end you know it would be all right for a while but it was two by two than it did then and they would start to her and then after a while it would be loose and now sometimes actors had to pull the truth was that loose that i could pull it you know why you want to get ahead of the disease and she wasn't getting any treatment sheila says she rarely went to the dentist for checkups or cleaning ska never went when she was growing up we even noted this because we didn't go to the dance my grandparents than go to the dance and my mother even after our she married a man and melissa they didn't go to the dance

dennis is monday as clyde barrow new dress a song you have no money to buy new jersey and you got a paper route then you gotta pay the light bill and your teeth only become a priority when you get today lots of people live life here a lot of people do avoid the dentist rich and poor alike government surveys show about one third of americans don't go on a regular basis but a closer look at the data shows people who suffer most from dental problems are poor young children living at or near the federal poverty line are five times more likely to have cavities than middle and upper income children poor adults are more than four times as likely to have destructive gum disease and people who work for are much less likely to get treatment and much more likely to lose their teeth

seventy percent of people over the age of sixty five who have less than fifteen thousand dollars of income here are missing most of their natural teeth it's almost exactly the opposite for older adults with more than fifty thousand dollars a year seventy three percent of them still have most of their teeth the state of oral health in america was much different fifty years ago i mean fifty years ago almost everyone had a lot of tooth decay they consider that normal they consider that part of life dr rebecca king is chief of the north carolina oral health section a lot of tv when people have problems had to be pulled that was really the only only avenue that they had to take care of it but by the nineteen fifties a revolution in dentistry was underway there are two things you wanted to fix the first is protection from the cape the second is who takes no other two faith offers better protection against decay and no other cases where this new formula

that you do you know by the nineteen fifties the invention of fluoride toothpastes made the discovery that florida did water could significantly improve oral health and increasing affluence all combined to put attention on the importance of pretty healthy teeth and that i really don't remember the formal if you can follow that help take care of your to the portland jack yantis was a year right the state of north carolina had a traveling puppet show that taught children the rules of good dental health the state's resources have always been devoted primarily to children and prevention in fact the legislature requires the state to focus on children dr rebecca king by the time adults ridge adult helland their dental problems are severe and very expensive sutton work on preventing you have to do it before the disease gets there which means children and the younger the better the state does not

have any programs for adults who need affordable dental care private dennis really provide reduced cost care or let people pay in installments and in parts of rural north carolina there were no dennis at all some county health departments have dental clinics but a lot of them treat only children there are community health centers were adults can find some dental services but you might have to travel a long way to get what you need our warren county north carolina is just off interstate eighty five year the virginia border there's a clinic here called health couple they come from richmond natasha hicks williams is the receptionist at health tell you things like a blue fans away closer that i guess is the cheapest place health care was officially known as vince warren comprehensive health plan it's been around since the nineteen seventies offering medical and dental care the clinic runs on government and

private grants plus the money patients pay based on their income marie jones is here with a toothpick i had one to break off in that about a year ago and last week it got infected memory used to have dental insurance but found out the hard way that only paid for cleaning sit back did not know what it covered until i went to the dentist about two months ago a nun the dentist told me to cost me six thousand dollars to get my mouth it's and nine shows with mark snow she dropped the insurance and now has none the majority of people who come to this clinic are like her they pay out of pocket and even memory works two jobs her income is low enough that she pays just twenty five dollars per procedure the lowest level on the fee scale maria's eager to have her aching tooth out today but she's helping eventually she can get a new one and implant just feel good when you could see ninety

percent you have such beautiful stephen is so even that song white and this is the actual existence that makes lives the show and now for the pie from in a dentist and held her with a doctor ran from holdout relief to when it's over he gives her some advice i think he also tells her she should stop smoking because it's making her gum disease worse once murray is gone dr ransom's assessment of her

situation is not as optimistic looking at her mouth she's probably meet them surgery with this reporter who was called a flap hoping that that's going to basically stop the disease from progressing ransom says this could cost her up to fifteen hundred dollars and she can't have it done at health co so if she could come up with the money she'd need to find a period on test and there aren't any near here to produce a victory for those opposed to the forties and to replace those lost teeth with implants like marie was hoping that would cost her twenty five hundred dollars or more per tooth ransom says he understands the problems of people like marie mr philip roth area one of the main things was don't care he says people who were missing teeth had a hard time getting jobs and that's why he works here one day a week to help out his as will stay until health poll finds a full time dentist the clinic's been looking for more than a year health co ceo charlesworth says it's hard to

recruit dennis to a poor rural county is to cove anyone has a special coming here and in a sense that we have offer we don't have a lot of other kids isn't made into someone's going with the family the school system may not be up to what they're used to really be coming from and the salary is low worth says he can pay up to one hundred and twenty five thousand dollars a year for an experienced dentist a dentist in private practice in the united states make an average of a hundred and seventy three thousand dr kirby ransom is an interest in the health code job full time he has his own practice where he sees mostly patients who have private insurance but he's thinking about taking some medicaid patients medicaid is the government sharon's program that covers many poor people ranson says he'd take just children though no adults this that more fully accusing the us of jewish versus the impulse ranson

says he sometimes sees adults of health co who come in with a mouthful of problems and then drive away in a fancy car and that bothers him ransom another dentist point out that it's not that expensive to take care of your teeth if you brush and floss eat healthy foods and you don't smoke you can prevent almost all dental disease there would be a lot less need for a place like health co if everyone just took better care of themselves doctor rob doherty is the director of a county run dental clinic near greenville in the eastern part of the state where he talks about the work he's doing with low income patients to his private practice colleagues he says they bring the personal responsibility a lot i hear them saying that they want to encourage maturity among our patients especially the low income patients in other words they need to suffer some consequences for making a bad choice of not taking care of their mouths and they need to not just suffer the pain but that also pay the high cost of making that bad choice doherty says some dentists use this as a way to justify why they don't participate in

programs that provide free or low cost treatment dentist like dorie say too many private dentists see themselves as businesspeople first not health care providers what if you don't see yourself as a business person you will be here to provide any health care in any body for very long oh so that's really unfortunate truth dr cindy bolton as a general dentist in retail she's also the spokesperson for the north carolina dental society and access to care issues the devil says it is a professional organization that represents dentists' bolton has been charged with encouraging her colleagues to take more medicaid patients but it's a hard sell i was gone last year paid less than fifty percent of what might these were to provide care for this patient population and my overhead to run my business is around eighty percent it was even worse a few years ago a class action lawsuit claimed children on medicaid could not find dentist to treat them because the reimbursement rates were so low the lawsuit was settled in two thousand and three when the

state agreed to raise some of the rates or dentist actively protests appeared in medicaid now but it's still only about one in four when you realize that the state only has so much money that you can't just always say we need to increase funding we need to increase by me had to do everything that she can do through other being used to try to provide care as well like volunteering at free clinics something bold and does once a month free clinics tend to target the working poor population people with little money and no insurance and there's a big demand this answering machine sits on a bureau in the extra bedroom of marian anderson's house near you sitting in a cluttered desk wearing shorts first and getting ready to take appointments for the open door dental clinic of alamance county the only way to get an appointment is to call it exactly ten am today you wanna come

it wasn't always done this way it used to be you would show up at the clinic to get your name on a list that didn't work people would end up fighting each other in the park not only got really ugly i don't want to say during when he'd have done treatment open door is free your income must be below two hundred percent of the poverty level or you have to be an adult and you can't have any insurance and medicaid the point is to provide service to people who have no other options mary says a lot of the patients are former factory workers these people that have worked for can fifteen twenty years of us and the jobs are gone their health insurance to go insurance everything is gone and they're trying to hang on to their house or their car dirk i'm receiving i've got married thanks but i marry says the phone rings day and night but once

tonight's lots or failed she turns off the reindeer and lets the answering machine takeover the clinic opens at five thirty pm they're eighteen people on the list one of the first people at the reception desk is a woman who is not on the list so thanks to be seen at the column and one hundred and five that they're making here myrick is the receptionist she's a volunteer and so if everyone else who works here including the dentist who started this clinic dr steven scott he sees a world full of people who desperately need dental care and he's trying to do something about it the tonight is extraction night that means pulling teeth

one of the patients is an inmate from the alamance county jail he's in an orange jumpsuit and shackles supported by a sheriff he has a tooth pulled the patient sitting next to him david fowler cant resist the common and i didn't have to be in as an army i want to finish with you know we had a sign no pro government about your home or do you but in fact it's the slots open door planet or not hear the jail they have nowhere to send inmates for dental care the local hospital refers patients here to sodas the homeless shelter for it's

b if it's thursday now restoration night and that mean feelings things move more slowly became a dental students do the work there are six of them here tonight and it's not easy for doctors like to sit back and let them were in jail now there's lots to use the future into students' he hopes they'll keep treating low income patients after they graduate it takes more town for me to deal with the no stints in the clinic in a student's patience of the clan but to me it's worth it if we can get them to go out to take on the causes thousands maybe tens of thousands of people over a career he's not just hoping they'll volunteer and free clinics like this one he's helping a work and one full time or start one or at least take medicaid patients in their private practice in his own private practice doctor slot season mostly patients on medicaid in fact he's the only dentist in the county who accept adults on medicaid at his office

i don't have a lot of excess money but that's not the point that the only is there that i can make a living that it a d sullivan educate mikey heads and the cigar live in our sales and doable dr slot makes his point by parking his bmw convertible at the clinic door right where the dental students can help but notice it we get attention for that you know at two o'clock people with dental problems who don't find a free clinic like open door or a place like health co often end up at the hospital the director of the dental clinic at unc hospitals in chapel hill is dr janet southerland amanda's in the emergency room with a swollen face and infected teeth emergency room physician calls dr southerland to find out what to do yet

it turns out the man wants to be put to sleep before his teeth pulled and i told about we got to get on stage of the tv is a severe enough over we do it station and the first thing that i say what he didn't have the money to pay for this case probably out of luck he's going to have to come up with some way to pay for the sedation and the extraction of his teeth or else he's not likely to get either a recent national study showed that when people show up at emergency rooms with dental problems they usually leave with pain medication and good advice get to a dentist but you're not likely to find a dentist after you leave if you couldn't find one before you came to marxism dental clinic manager she says the clinic gets about fifty calls a day from people who need dental care and have no way to pay but this clinic is not set up to help them we're here to treat sick persons persons who if they had a million dollars could be treated in an outside in

practice people treated in this clinic are already sick and usually has nothing to do with their teeth to start saying ok so this is really a sort of the clinic dentists are meeting to go over their patience for the day all of these patients need good dental care to stay healthy some of them have conditions like diabetes that can cause problems with their teeth and their bombs others like certain cancer patients need to have bad teeth taken out before they can have surgery or radiation still others have diseases or conditions that make it particularly hard for them to find a dentist like marty rhodes who was a chevy positive thing i think that he's just laugh like a fish his business marty lives in rockingham about two hours away

dr southerland says having a compromised immune system makes it that much more important for him to get good dental care because untreated infections in the mouth can spread to other parts of the body sutherland says for her patients in particular it's impossible to separate oral health from general health they'll have the medical problems then they'll have three or health problems and then you get into this vicious cycle of tears a dental problem this really exacerbating the medical condition clinic manager kim marks is almost like our health care has taken care looked at other ports our body but they disregarded the mouth totally and there's increasing evidence that rotten teeth untreated gum disease could have serious consequences for overall health dr steve often barker is co director of the center for oral and systemic diseases at unc chapel hill the concept that has emerged is that the oral cavity is a reservoir for these bacteria and these germs which can spread to other parts of the body and

therefore can have multiple effects in different organ systems often barker says there is strong scientific evidence that untreated gum disease can cause some women to deliver their babies early other research shows people who have untreated gum disease are higher risk for heart attack and stroke it's not clear yet if the gum disease is causing those problems but often barker is currently overseeing a large study to try to find out and he says if you want to avoid gum disease simply brushing and floss in your teeth is probably not enough you need a dentist to scrape the plaque off every once in a while and if you do end up with gum disease there's expensive treatment or there's the cheaper route having your teeth taken out for a lot of poor people this is still the only option so it's great it is now

forty is moving boxes papers and trash bags are piled high around her living room tomorrow the mortgage companies coming to take the house it's not she'll as house it belongs to her uncle buddy doesn't want it anymore and she can't afford to buy it and the mortgage is more than the house is worth she'll has been thinking about moving to florida to live with her son but her car just broke down and she knows several people money and i don't leave without pay and so you know when things like the car meaning the fix comes up about a fixed the car out and complications set me back even further so for now new dentures are on the back burner and now i make the best out of it because there was a time when i needed him and i didn't have them at all and i managed

to live with to like that she'll went to health co recently to find out what new dentures would cost more than a thousand dollars dentures are the only item not subject to the sliding fee scale she was sometimes feels that what is best for her is just out of reach the real improvement will live and my grandchildren that my sermons and their own spouses will make sure that their children have good dental care of his sons could take the same approach to act too which was we only do you would have if it becomes a problem and it's unfortunate that we don't know of what it means and until we've passed a boy who in addition to some balance the

trouble with teeth was produced by emily hanford and edited by deborah george production assistance from anthony case and sally council north carolina voices understanding poverty is a production of north carolina public radio wu and say executive producer of north carolina voices is emily hanford support for this series comes from the ag fletcher foundation of the center for documentary studies at duke university doug and teddy abrams julian price family foundation and martin taylor ph the michael and laura greater i'll write a foundation and the north carolina humanities council more information about north carolina voices is at wnyc dot org