Poor Struggle to Find Affordable Dental Care

People with low incomes often have extreme difficulty getting dental treatment. The lack of care can lead to gum disease, which scientists think may cause other serious illnesses, such as heart disease or premature birth.

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RENEE MONTAGNE, host:

Dental care is expensive. Prices are going up faster than inflation, and tens of millions of people, rich and poor alike, lack dental insurance. From North Carolina Public Radio, Emily Hanford reports on the problems facing people who don't have insurance or the money to pay.

EMILY HANFORD reporting:

Marie Jones has a toothache.

Ms. MARIE JONES: I had one to break off in the back about a year ago, and last week it got infected.

HANFORD: And the pain is awful.

Ms. JONES: It's like, as they would say back in the days, pins and needles sticking in your mouth, you know, and everywhere you turn it's there, everywhere you lay it's there, you know. It's...

HANFORD: Jones lives in Henderson, near the Virginia border. She's come to neighboring Warren County to a clinic called Healthco.

Ms. JONES: I cannot afford to pay the price that a lot of the dentists are asking for, and here I can pay.

HANFORD: Jones used to have dental insurance, but dropped it when she found out it covered only cleanings. Here at Healthco, she pays out of pocket based on her income, and even though she works two jobs, she's eligible for the lowest level on the fee scale: $25 per procedure. The majority of people who come to this clinic are like her. They have low incomes and no insurance.

Ms. NATASHA HICKS WILLIAMS(ph) (Receptionist): They come from Oxford, they come from Raleigh, they come from Richmond. They come from everywhere.

HANFORD: Natasha Hicks Williams is the receptionist at Healthco.

Ms. WILLIAMS: It seems like they would find somewhere closer, but I guess this is the cheapest place.

HANFORD: Healthco is a federally qualified health center that runs on government and private grants, plus the money patients pay. There are 18 of these health centers in North Carolina that provide dental care. Some county health departments have dental clinics, but a lot of them treat only children. There are at least a dozen free clinics. Most of them are open just a few hours a week, though, and almost all of these clinics provide just the basics: cleanings, pulling teeth, filling cavities.

(Soundbite of suction)

HANFORD: At Healthco, Marie Jones is having her tooth pulled.

Dr. KIRBY RANSOM (Dentist): Doing OK?

Ms. JONES: Mm-hmm.

HANFORD: The dentist today is Dr. Kirby Ransom.

Dr. RANSOM: Open a little bit wider for me. You'll feel a little pinch here on the inside.

HANFORD: Dr. Ransom pulls her tooth. When it's over, he gives Jones some advice.

Dr. RANSOM: What I'd recommend is that you come back and get an exam done and get a cleaning, because right now you're in the early to moderate stage of gum disease, and if we do something now, we could actually help you save the rest of your teeth.

HANFORD: Once Jones is gone, Dr. Ransom's assessment of her situation is not as optimistic.

Dr. RANSOM: Looking at her mouth, she's probably going to need gum surgery where they actually reflect her--do what's called a flap, hoping that that's going to basically stop the disease from progressing.

HANFORD: Ransom says this could cost her up to $1,500, and she can't have it done at Healthco.

Dr. RANSOM: She'll probably end up losing her teeth, but it's from the fact that she doesn't have the finances to pay for it.

HANFORD: This is what happens to a lot of poor people.

Dr. JANET SOUTHERLAND (UNC Hospitals): Hello, this is Dr. Southerland.

HANFORD: Dr. Janet Southerland is director of the dental clinic at UNC Hospitals in Chapel Hill. She says people without insurance come to the hospital all the time with toothaches. She presents the options: about $90 to pull a tooth or as much as 20 times that to save it.

Dr. SOUTHERLAND: I've had to give people antibiotic and pain medications so that they can go away and think about it.

HANFORD: And how many of them come back to you and have figured out a way to save it?

Dr. SOUTHERLAND: Very few. Many of them will not even come back until the tooth starts bothering them again.

(Soundbite of beep)

Unidentified Woman #1: We've added a patient for Dr. Jabril(ph) at 2:00.

HANFORD: Most of the people treated in this clinic are poor, but you have to be more than just poor to get treatment here. You also have to have major health problems.

Unidentified Woman #2: He has hep C, AIDS and his blood count is under 200.

Unidentified Man #1: OK.

HANFORD: The clinic dentists are meeting to go over the day's patients. All of these patients need good dental care to stay healthy. Some have conditions like diabetes that can cause problems with their teeth and gums. 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 is HIV positive.

Unidentified Woman #3: Say, `Ahh.' Stick your tongue out.

Mr. MARTY RHODES: Ahh.

Unidentified Woman #3: You're still smoking, ain't you? Like a fish.

Mr. RHODES: Can you tell?

Unidentified Woman #3: Yeah, I can tell. You got a brown tongue.

Mr. RHODES: I'm quitting.

Unidentified Woman #3: Hmm?

Mr. RHODES: I'm quitting.

Unidentified Woman #3: You'd better.

HANFORD: Rhodes drives two hours to get here because he says no local dentists will treat him. The clinic manager, Kim Marks, says the clinic gets 50 calls a day from people who need dental care but can't find it, or have no way to pay.

Ms. KIM MARKS (Clinic Manager): It's almost like our health care has taken care, looked at other parts of our body, but they disregarded the mouth totally.

HANFORD: And there is increasing evidence that going without dental care can actually make you sick. Dr. Steve Offenbacher is co-director of the Center for Oral and Systemic Diseases at UNC Chapel Hill.

Dr. STEVE OFFENBACHER (Center for Oral and Systemic Diseases): 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.

HANFORD: Offenbacher says there is scientific evidence that untreated gum disease may cause some pregnant women to deliver their babies early. Other research shows people who have untreated gum disease are at higher risk for heart attack and stroke. Scientists say the studies aren't conclusive yet and that more research is needed to find out whether treating gum disease can actually prevent these problems. But Offenbacher says if you want to avoid gum disease, simply brushing and flossing 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 pulled out.

(Soundbite of water)

HANFORD: Sheila Kingsbury-Burt is taking out her dentures.

Ms. SHEILA KINGSBURY-BURT: This top one has been broken and repaired so many times, that I can't--I pray it won't break.

HANFORD: Kingsbury-Burt got these dentures four years ago when she was 46. By then, she had only three teeth left in her mouth.

Ms. KINGSBURY-BURT: It's a dark spot in my life, going through losing my teeth.

HANFORD: She lost her teeth because she had untreated gum disease. She says she rarely went to the dentist for checkups or cleanings, never went when she was growing up. Kingsbury-Burt says paying the rent and a light bill were more important, and people in her family only went to the dentist when they had a toothache. She's hoping now for a new pair of dentures. She went to Healthco in Warren County recently and found out she'll need more than $1,000 to get them. For NPR News, I'm Emily Hanford.

MONTAGNE: This is NPR News.

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