Archive for September 30th, 2011

A Personal Story: Oral Health System is Broken – Marisa, Fairlee

Friday, September 30th, 2011

Marisa lives in Fairlee, Vermont. This is her story:

I am a “big sister” to a girl whose family lives in the Upper Valley. I’ve worked with her for six years now, and have become close with her family. About three years ago, her mom had all of her top teeth, and some of her bottom extracted because they’d become infected and rotten. Unfortunately, she’s been without any top teeth or partial bottom this entire time because she cannot afford the cost of dentures. She has no dental insurance. I know that it affects her self-esteem and her diet every single day. But even an affordable denture plan is out of their price range, or requires good credit for a repayment option.

Also, when my brother turned 18 three years ago and was no longer eligible to stay on my parents’ insurance plan, he lost dental coverage. We filled out paperwork to take him to a free clinic for a cleaning about two years ago, and we were told he’d be put on a list. We never heard anything. Fortunately, he now has a job that provides dental insurance. But our “system,” it goes without saying, is beyond broken.

A Personal Story: A Dentist You Can Trust – Joyce, Woodstock

Friday, September 30th, 2011

Joyce and her husband live in Woodstock, Vermont, and have never had dental insurance. About six or seven years ago they both had quite a bit of work done on their old fillings. Three at a time, the old fillings were drilled out and replaced by a ceramic pearl. Unfortunately the dentist drilled up too far into the root which resulted in buckle decay in their back molars. This dentist later closed her practice and went out of business, before she could repair the problem. Now Joyce and her husband were both faced with tens of thousands of dollars of work they needed done, with no way to pay for it, and nowhere to go.

Fortunately, they knew they were moving to a town with a reputable dental practice. This practice referred them to a grant program for residents of their town. Joyce and her husband applied as soon as they moved. They got the grant for the dental work, and their new dentist came up with a comprehensive and systematic plan for all the dental work they needed to have done. “She gave us a very complete plan of action and prioritized it for us, and told us how much (money) they could take off… She actually did the work and took out those things that we had in our mouths, and fixed the buckles.”

Joyce and her husband are now on a maintenance plan of cleanings and checkups which they can afford to pay out of pocket. “We think that she’s great and we are ever grateful for this program because, guess what, we would not have been able to do it. I don’t know what was going to happen to us… We were devastated when we realized what really had happened and what was happening in our mouths, and what we had to do to try to rectify it, until we heard about that program. And without that, I really don’t know…”

Joyce still has some work she needs done. A root canal by the first dentist has left her with a pain in the tooth, and a small bump. Her current dentist recommends some oral surgery and repacking and redressing the tooth. Her dentist thinks the problem may be affecting Joyce’s immune system. When it flares up, Joyce does everything she can to bolster her immune system from a dietary angle, but isn’t able to afford to have the dental work done.

Illustration by Dennis Pacheco.

A Personal Story: Won’t Take Teeth for Granted – Sarah, Topsham

Friday, September 30th, 2011

Sarah feels really lucky about her family’s dental care. Living in Vermont, her children have been covered by Dr. Dynasaur since they were young, “I feel like we got in with a really good dentist… and then I started hearing about this shortage.” Sarah used to see the same dentist as her children, but she had a lapse where she didn’t go for three years. When she tried to go back and re-establish regular care, they weren’t accepting new patients, so she had to find another dentist. The lapse in care occurred because Sarah herself was uninsured and paying out of pocket for her care: “Fortunately, one of my wisdom teeth was impacted so I got medical insurance coverage for that.”

Sarah had a few complications from her wisdom teeth removal: some of her soft tissue healed in such a way that it formed a pocket next to her molar, making it very difficult to clean. She got a crown on her molar because of the decay. Sarah was able to pay out of pocket for her crown, and sees this kind of dental work as an inevitable part of growing older. “I have older friends who said, oh – my partner didn’t take care of his dental situation when he was in middle age and now it’s really giving him problems… I’ve had friends telling me, get your teeth taken care of now, because it just gets worse if you leave it.”

Sarah and her family used to qualify for VHAP and Dr. Dynasaur, but now they don’t and now they pay for all dental care out of pocket, which Sarah doesn’t mind: “I really feel like my teeth are worth investing in. I feel really lucky that I inherited these genetically strong teeth and it would be really foolish not to just continue to take care of them. I can’t take them for granted.”

A Personal Story: Glad She Has Insurance – Michelle, Strafford

Friday, September 30th, 2011

Michelle lives in Strafford, Vermont, and works full time as a surgical nurse. She pays $120 a month for the dental insurance that covers her, her husband, and son. Her son has braces and the insurance pays $2,000 a year towards those. Nonetheless, Michelle must still pay an additional $150 a month for her son’s braces. “It definitely makes it so that we can’t afford other things, like vacations and things like that… But, if something happened, we’re glad that we have dental insurance.” Four years ago Michelle’s son knocked out a permanent tooth that had to be re-implanted. He was on Dr. Dynasaur at the time, so, fortunately, the dental work that would have cost them thousands and thousands of dollars was completely covered.

“I would definitely say that having dental insurance for sure makes me use it…. for preventative care. If I didn’t have dental insurance I would probably always have (my son’s) teeth cleaned but I don’t know if I would do it for myself… Most people have some kind of fear about the dentist. So once you wait too long, if it’s been ten years since you’ve been for a cleaning, you’re less apt to go. As a nurse, I will say that good dentition is really kind of a fundamental part of a person’s well being, because if you can’t eat then you can’t get nutrients from food. People with poor dentition tend to not live as long.”

Michelle is surprised by the number of people she sees in her line of work who have full sets of dentures, some of them as young as 50. She feels fortunate that she was raised with the practice of going to the dentist for cleanings and check ups every six months. She also feels fortunate that when she did have VHAP, when she was living in Burlington, she found a dentist who would take her insurance. She remembers many dentists were not accepting new VHAP patients because they would not get reimbursed fully for their services, and in many cases were losing money.

A Personal Story: No Clemency for Uninsured – Naomi, Thetford

Friday, September 30th, 2011

Naomi lives in Thetford, Vermont. This is her story:

For almost 25 years our family had health insurance that included dental benefits. I had to have a tooth pulled a decade or so ago, after a botched root canal procedure; there is a visible gap, but fixing it was and is not an option: insurance didn’t cover such things and it was – and is – just too expensive.

Our children had good dental care while growing up, then, in college, our elder son put off visits to a dentist; he knew that, at the time, we were unemployed and uninsured and there was no money for what he thought was unnecessary care. After a few years, his teeth started to hurt (he never told Mom and Dad what was going on) and eventually he made an appointment. He had seven cavities; we had to find $2,000 to take care of what was at that point urgent. The dentist who had taken over the practice of our former (trusted, competent, kind) long-term dentist was and is completely inflexible and seemingly heartless about payment. No clemency of any kind for uninsured patients: pay up front is the rule. We now have health insurance, but there is no dental component. I’ve been told that I need fillings; my jaw hurts; but I’m just going to live with it.

Illustration by Dennis Pacheco.

A Personal Story: Can’t Afford It – Fred, Strafford

Friday, September 30th, 2011

Fred, who lives in Strafford, Vermont, had this to say:

My wife and I are on a very limited fixed income. We are both 81. Our parents and then ourselves have always taken good care of our teeth. We have always had 6 month checkups and necessary work done. However, for the past four years we have only had annual cleaning and checkups as the cost has gotten to be more than we can afford. At my last cleaning it was noticed that I had one filling that was cracked and the remedy would have been $195. I chose not to have it done. The cost for oral health care is just too high – we can’t afford it.

A Personal Story: Dental Issues in the ER – Tina, Corinth

Friday, September 30th, 2011

Tina lives in Corinth, Vermont, and is an emergency room nurse at a critical care hospital in the Upper Valley. “I would say in an eight hour shift I tend to see two to three people with dental pain issues…sometimes it’s just pain from a cracked tooth but more often than not somebody has an infection in their mouth. The majority of the people I see don’t have dental insurance and a lot of them use the local free clinic which can take up to six months to get an appointment. It’s just really hard, so they end up in the emergency room to get antibiotics for their infection…if they have an appointment at the free clinic to get a tooth taken out they won’t take it out if there’s an infection, but they don’t prescribe antibiotics, so people come back to us then, to get antibiotics so they can get the tooth pulled. We see people after they’ve had their teeth pulled who have infections… We’ve had serious infections (where) people are on IV antibiotics because they have a really large abscess in their mouth and it can be really dangerous if it doesn’t get taken care of… It’s really common in the emergency room for us to see people with dental issues… It’s a regular occurrence. I’m never surprised when someone comes with dental pain, and half their face will be swollen. We’ve had to incise people’s mouths to drain out pus from having really bad infections.”

Tina says a lot of the ER patients who come in with dental pain can’t get appointments or don’t have insurance, and it’s very expensive to get dental care. Tina sees a lot of people who aren’t taking good care of their teeth and aren’t as educated about dental hygiene. But she also says it’s common to see middle class people who don’t get benefits through their job, and can’t afford to spend $1,000 at the dentist. When they have a dental problem, they put off care, and the problem gets worse.

Tina herself falls into this latter category: “When I didn’t have insurance for three years, I didn’t go to the dentist. Lo and behold I go to the dentist, and now I’ve got multiple cavities. I did have to get a crown when I was uninsured and it was $2,000. I had to put it on a credit card I’m still paying off.” Tina now has insurance that only pays for half of her dental work, and she still has work she hasn’t had done because she is saving the money to pay for it.

Tina thinks that the Dr. Dynasaur dental program is great and that we’re lucky to have it in Vermont. But she also notes that a lot of people don’t start to get cavities until their twenties, so lack of insurance for adults is still a problem. Tina, herself, pays $700 a month for health and dental insurance for her family of five, and she works 40 hours a week to get those benefits. “It’s really pretty ridiculous…. I’m not that happy about it. Because it seems like a lot of money that I’m spending for services that I don’t render… I do a lot of preventative things at home so I don’t actually use it. It’s good to have it, but it seems like a lot of money to pay for something I don’t use very often.”

A Personal Story: One at a Time – Dottie, Strafford

Friday, September 30th, 2011

Dottie and her husband Stan live in Strafford, Vermont, and have no dental insurance. Dottie is currently scheduled to have three cleanings a year, because she is on the edge of periodontal disease. She can afford to pay for her cleanings, but in the last ten years she has also had five crowns and two root canals which were more difficult to find the money for. One year she had two crowns and a root canal, Stan had a crown, and the couple’s total dental bill that year was $8,500. Fortunately their dentist offered them a loan at 0% interest if it could be paid within the year, which they did, but it wiped out their savings. They thought, “Well we’ve paid off our dentist but we have no money. It’s crazy…Luckily nothing else happened that we needed to access some quick cash.”

Currently Dottie has a mouth full of old fillings, all of which will eventually need to be crowned. She thinks she should probably get her teeth done one at a time, one a year, but she knows she’ll have a hard time paying for a second crown if one of her other teeth happens to break.

Dottie has considered a local free dental clinic but isn’t sure if she’d qualify because her family’s income wavers between qualifying for VHAP and not. She has also heard that you can go to Boston and let Tufts medical students practice putting crowns in, which seems like a good option for her when she considers the number of crowns she still needs. Dottie has a friend who opted to have a tooth extracted rather than pay $2,500 for a crown and root canal that was recommended by her dentist. “Now she has this hole back there and I’m like, yeah, but aren’t all of your teeth going to shift?… That’s like, whoa, you start pulling out your teeth because you can’t afford to fix them? I mean, I suppose that’s what we all do in the end, and we end up with false teeth.”