A Personal Story: What Value 4 Teeth? – Nurse Nancy’s Clients, West Topsham


Nancy is a nurse who has been working with pregnant women, babies, and children in the Upper Valley for the past eighteen years. She, herself, lives in West Topsham, Vermont. Many of her clients do not have access to the dental care they need. She remembers one client of hers, a twenty two year old mother of three, who had advanced decay and had to have all of her teeth pulled. This was paid for by Medicaid, but the dentures she needed were not, “which is a rather sad commentary on looking at a twenty two year old woman who we’re now going to ask to go out and get a job, and she had no teeth.” Fortunately, Nancy was able to find a private donor so the woman could get dentures made.

Another woman Nancy works with had an abscessed tooth. She went to a dentist who extracted the tooth and in the process did a large amount of nerve damage. In trying to help this woman get follow-up care, Nancy found that that care was non-existent. “It has now been eight months. She’s still in horrible pain. She has altered movement in her jaw.” Trying to find care for this woman has been like, “calling in circles.” The woman has Vermont Medicaid but one clinic wouldn’t see her because they only accepted Medicaid from Chittenden county. Another clinic in New Hampshire wouldn’t see her because she had Vermont Medicaid. The one doctor that did see her referred her to a nerve specialist in Boston. When she did finally see him it was too late for him to do anything about the nerve damage. Nancy describes Medicaid and dental services for adults as “pathetic…basically, they will pull your teeth out.”

Another of Nancy’s clients, a young woman who just had her second baby, went to the dentist during her pregnancy. She found out that she had cavities and needed work on nearly all of her teeth. She was told if she didn’t get the work done right away she could wind up losing her teeth. She’d used up her year’s cap (on her insurance) and so she had to decide whether to have teeth pulled out, which would be covered by Medicaid, or to wait until January, hoping that at that time she could have more work done, and that her teeth would last that long.

“It’s really really frustrating and I always end up feeling like we don’t value people’s teeth, which are such a huge part of who they are. The impact of dental infection and gum disease on health is huge – I don’t even think we have a clue about the impact.” According to Nancy it not only affects cardiac health but also prenatal health. “But nobody acknowledges or is willing to take that on.”

Illustration by Dennis Pacheco.

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