Archive for March, 2012

A Personal Story: No Need to Pull Teeth – Nathan, Woodstock

Friday, March 30th, 2012

Nathan lives in Woodstock, Vermont. This is his story:

Twenty-five years ago I went to a local dentist. He stated I needed to have all my teeth pulled and replace with dentures. I was only in my 50′s; this was not an acceptable treatment plan, regardless of my financial situation. I obtained a second opinion. The second dentist told me that most of my teeth would be lost within five years. The most cost-effective treatment would be to pull all the teeth and be fitted for dentures. I was outraged.

Instead, I went to Boston for treatment. It was successful. I have only had to have one tooth pulled in these last twenty-five years.

Why would a dentist’s first course of action be to pull all the teeth? Was income a factor?

Illustration by Dennis Pacheco (click here for Dennis Pacheco’s website).

A Personal Story: No Phone, No Gas, No Dentist – Leslie, Lebanon

Thursday, March 29th, 2012

Leslie has spent 2 years out of work due to health issues and has been living on $500 a month for the past year. Nutritional deficiencies over the last few years have weakened her teeth so that now many of them have nerve damage and are falling out. She has no insurance for herself and so has been unable to address any of these issues. She has no income to cover the phone minutes to call dentists or the gas to drive to visit them in person.

A year and a half ago, Leslie’s daughter had an accident in school where she was hit in the face by a basketball and chipped her new adult tooth. Her daughter is covered by a dental insurance plan through her father, who lives further south in New Hampshire, as well as by Medicaid, but many of the prescriptions she needed for this accident weren’t covered and the root canal she needed meant that they still owed $450. “Even with insurance you can’t get in anywhere to get dental care…There are a couple of different children’s dentists around the Upper Valley but they aren’t taking new patients…” Or they don’t take Medicaid. Now her daughter needs orthodontia work, but she doesn’t have the money to start looking into addressing it.

Illustration by Dennis Pacheco.

A Personal Story: NH School Nurse Sees Problems in Kid’s Teeth – Norwich

Thursday, March 29th, 2012

Sylvia is in her 60s, lives in Norwich, Vermont, and works as a school nurse in New Hampshire. “We see a lot of kids coming in with just completely rotted out teeth.” She explains that it’s sometimes difficult to persuade parents in low-income families to participate in free dental care programs. “It’s really hard to convince that group that not only are they eligible, but that it isn’t a hand-out . . . Sometimes they’re afraid to get linked into the system, because a lot of these [dental care] groups say, well, we’ll give it to you for free but then there’s always some cost, even if the cost is, we need to see you four times a year so you need to get here. That’s a huge cost to a lot of people who are figuring out every day any place they can get to where they could possibly work for a day.”

Sylvia believes providing dental care through the schools is the best way to ensure access. There used to be a dental van that provided care to students at her school, but it has stopped. She remembers it being very successful. “The whole thing came here and the kids were already at school, so there wasn’t any cost [to the parents] . . . I don’t know what un-did that program . . . I don’t know whether they were asked by the state to stop, or whether something happened and there was some kind of a lawsuit.”

The van will be back, but as Sylvia understands it, only to provide cleanings and education. While she thinks that’s valuable, she also thinks it’s not enough: “If we’re seeing a fair number of kids coming with already serious problems, we’ve got to have treatment.”


A Personal Story: Pain Comes and Goes – Thomas, White River Junction

Wednesday, March 28th, 2012

Thomas is 29 and lives in White River Junction, Vermont. The last time he went to a dentist was about five years ago–he hasn’t been back because he can’t afford it. Thomas feels lucky that his teeth are in pretty good shape overall, and he’s taken good care of them over the years. However he does have one tooth that abscessed about eight months ago. “It got so infected that I couldn’t sleep, I couldn’t think, I couldn’t work. I went to the hospital. They told me they really couldn’t do anything about it. They told me to see a dentist, they tried to make me a dentist appointment. I didn’t have any insurance. They wanted to charge me a bunch of money I didn’t have. I’d just had a baby, too, at this point, so I just kind of took Tylenol and ibuprofen and kind of just waited it out. Every now and again it really really starts to hurt–it comes and goes.”

Thomas just found out about the free dental clinic in White River Junction, so he plans on making an appointment with them as soon as he can. He is frustrated by how expensive dental care is: “It should be free. One of the most important things in life is your teeth. I mean, the health of your teeth determines the health of the rest of your body, really.”


A Personal Story: No Dentist in 10 Years – Sam, White River Junction

Wednesday, March 28th, 2012

Sam is 44 and lives in White River Junction, Vermont. It has been over ten years since he has seen a dentist. He just moved to the area in January, and he does not know where to start looking. He gets $700 a month from disability and does not know whether dental care is covered for him. He has teeth he knows need attention, because he can see that they’re decaying. In the past when this has happened, they have been painful and needed to be pulled. He’s also got one that is crooked and one that is chipped. Since Sam has lost nine or ten teeth already, he suspects he will need dentures at some point. He’s planning on asking his doctor later this week when he goes to the hospital for heart surgery if they know of any dentists he could see.

A Personal Story: Fixed Income – Ellen, Lebanon

Wednesday, March 28th, 2012

Ellen is 81 and lives in Lebanon, New Hampshire. She has a dentist that she sees regularly but has no dental insurance. She takes good care of her teeth and gets them cleaned once a year, although her dentist would like to see her every six months. Ellen’s income is fixed at just over $1,000 a month, which means she needs to watch her expenses. In the winter, Ellen finds it more difficult to get out, and the cost of heat makes her living expenses higher, so that’s why she doesn’t go more often. “I’m on oxygen all the time and I can’t walk very far.” Ellen recently had a tooth removed that had a cap on it but had decayed underneath. “I probably could have caps put on or a bridge put across where it was but it’s $1,400, so right now that’s out of the question.”

A Personal Story: Family Access – Robin, Lebanon

Wednesday, March 28th, 2012

Robin is a 33 year old single mom who lives in Lebanon, New Hampshire. Robin and her children have New Hampshire state Medicaid insurance, which is limited in the dental care it covers for kids and does not meet Robin’s family’s needs. Robin’s eldest daughter just had three cavities filled, only two of which were covered by her insurance. It’s especially frustrating for Robin that her dentist claims her daughter is not taking care of her teeth, when, in reality, her daughter’s decay is due to medication she is taking. Robin has Crohn’s disease, and her daughter has irritable bowel syndrome, which will likely turn into Crohn’s. She explains: “I’m already facing probably getting dentures because I’ve been on my medication for Crohn’s for the last ten years … My kids do not do soda, they do not do candy, she’s gluten-free. It’s just the medication makes your teeth bad, so they’re soft, so she’s had to get a couple fillings. And they pretty much tell me it’s preventive care that I’m not doing correctly, and that’s not it at all. So they cover two cleanings a year and two fillings and that’s pretty much where it stops and they do not help with braces at all whatsoever. So she’s not getting braces because I can’t afford them.”

To make matters worse, Robin’s regular dentist has just informed her that he is no longer accepting Medicaid payments as of January of 2012. Robin’s family can still go, and her bill will be a sliding scale fee based on her income, but she doesn’t have the additional money in her budget right now, so she’ll be looking for a different provider.

Robin works with families who primarily have Medicaid as their insurance, so she knows how hard it is to find a dentist in her area who will accept Medicaid patients. A dentist in Vermont she regularly refers families to just told her he’s full and has met his quota for Medicaid patients. Some of the families she works with go to Concord, New Hampshire, for their dental care. “For some of these families that’s a big hardship because a couple of my families don’t have a vehicle … so it’s them trying to find a ride and then of course it’s during the day and then the kids lose out on a day of school.” Some of Robin’s families have had to make repeated trips to Concord, because a tooth wasn’t filled correctly the first time, and it was bothering the child, and they had to go back to get it fixed. “The parents that do have vehicles … it’s just extra gas money that they don’t have.”

Lack of access to affordable dental care is a problem for the adults as well as the kids. “It’s hard for the parents. Because a lot of them get disability or Medicaid and they don’t have the dental services … a lot of my parents are just literally pulling their teeth out and they’re just going without. One of my parents just did that because she can’t afford the dentures. Her teeth were really bad, and she just now is toothless and she just lives that way. It’s hard. It’s very hard.”


A Personal Story: Physical Health Keeping Her from Dentist – Margaret, Lebanon

Tuesday, March 27th, 2012

Margaret is 96 and lives in Lebanon, New Hampshire. Margaret has had false teeth for the past six years, and she had a new upper plate made a few months ago for which she paid $1,000. The problem is that they don’t fit properly and they hurt her after being in for an hour. She wants to go back to the dentist, but she can’t get there, because she has a heart condition, hasn’t been out of the house all winter, and has to be very careful not to catch cold. She normally winters in Florida, and her body is not used to the New Hampshire cold. With no upper teeth, she has to watch what she eats. She has been able to bring her weight up from 101lbs to 113, but would like to gain a bit more so that she’s at 120. Margaret is hoping to get back to the dentist to get her upper plate fixed or remade when the weather is better.

A Personal Story: Routine Maintenance Too Expensive – Doris, Lebanon

Tuesday, March 27th, 2012

Doris is in her 80s, lives in Lebanon, New Hampshire, and has had a lot of dental work done over the past year. She’s been able to afford it by pulling the money from other areas. However, the routine maintenance is more difficult to afford: “I don’t go to the cleanings often enough. They’re expensive.” Doris knows about a dental clinic she could go to but you need a car and need to be able to go at night. Her daughter has a car, but can’t drive at night, so Doris has no way to get there.


Doris doesn’t understand why dental work is more expensive than doctor’s visits. “The doctors adjust their fees, but the dentists won’t … because it’s nonessential. They think the doctor’s more essential. But if you don’t have good dental work, you’re going to need a doctor very soon. That poison from an abscessed tooth goes all through your body. You’d probably die from it. I don’t think that teeth are not important. A lot of people don’t take care of them.”


A Personal Story: Stay Active or Keep Teeth? – Jeanette, Lebanon

Tuesday, March 27th, 2012

Jeanette is 86 and lives in Lebanon, New Hampshire. She has no dental insurance, but she has supplements to her social security that make her able to afford to pay out-of-pocket. Jeanette has had a crown recently and gets cleanings every six months. She feels very fortunate that she still has most of her natural teeth and takes great pride in taking care of them.


Jeanette has osteoporosis, and one of the medications her doctor prescribed for her, Flomax, affected her teeth. Jeanette explains: “It softens your gums and your teeth fall out…. Three teeth fell [out] and [my dentist] had to dig the roots, and that wasn’t easy.” Jeanette’s dentist talked to her doctor, who didn’t want to take her off Flomax. The dentist explained that she was going to lose all her teeth if she stayed on the medication. Jeanette’s doctor said, “She’s got a choice between her teeth and being able to be active.” Her doctor finally relented and Jeanette now takes vitamin supplements to strengthen her bones.