Posts Tagged ‘Pregnancy’

Dartmouth Students Simple Design for Big Impact – Improving Oral Health during Pregnancy

Friday, June 1st, 2012

This year a group of Dartmouth College undergraduates including Lucas Yamamura, Karl Schutz, Melissa Saphier, Winnie Yoe, Hannah Kim worked with Tom Roberts and Good Beginnings to improve oral health for pregnant mothers.  They are part of the group Design for America (, a national organization from Chicago that has established studios at colleges in the US to use design thinking as a way to solve local social issues.  Lucas and his colleagues learned that gum disease is a common problem for pregnant women, and poor dental health is usually correlated to negative birth outcomes.  Brushing teeth twice a day is the recommendation of most dentists – a simple strategy for healthy teeth and gum.  In order to tackle this issue, the group asked the following question: How to encourage pregnant moms to promote their own oral health?  The group’s answer is a tooth brush holder in the form of a simple, low cost cup and lid that holds the brush.  The cup is decorated in honor of the coming baby and and can include a copy of the baby’s ultrasound or any other picture or drawing the mom and family apply. That way, they intend to elicit a personal connection between the parents and the upcoming child, reminding future mothers that brushing teeth is part of the  Not yet in production, but the group will be suggesting this idea to a group of pregnant moms for their input.  Great work and let’s hope it works.

A Personal Story: Can’t Find Affordable Local Dentist – Amy, Chelsea

Thursday, March 22nd, 2012

Amy and her family moved to Vermont eight years ago, and had three children at the time. “We had private insurance, and it did not include dental. We did not qualify for state dental insurance. We were private-paying for all of our dental work.” Then Amy’s husband lost his job and they could no longer afford $1,500 a month for private health insurance. After this happened they qualified for Dr. Dynasaur for their children. Amy started looking for dentists and found one who took her children on as patients. They saw him for a year and then got a letter saying he no longer accepted Medicaid. Amy found it very difficult to find a new dentist who would take her children, but did eventually find one in the Upper Valley, and most recently she has made use of the mobile dental van that visits local schools. “I do feel like even though it’s difficult to find dental care for my children it’s doable: difficult but doable.”

“As an adult, on the other hand, it’s practically impossible.” Amy couldn’t afford to pay out-of-pocket for her own dental care, so when she qualified for Dr. Dynasaur during her last two pregnancies, she figured she’d use the coverage to address her own dental needs. “I needed two extractions over a four year period. For my initial visit, I had to travel to Plainfield [nearly an hour's drive] … and my first visit took four months to get in.” When Amy had some chronic pain that she needed addressed immediately, she called her former dentist who made an exception and saw her. “I basically begged and pleaded. He did take my Dr. Dynasaur and he was really nice, but it was really clear that it was the only time.”

“The other piece that’s hard for us right now is we have a fourteen year old who needs braces…. I took her to an orthodontist and he said, compared to what she needs, the Medicaid was not going to pay for a lot of it, because it’s partially a cosmetic thing…. I have this fourteen-year old, and she’s going into high school, and I can’t afford braces for her and she needs them.”

“The cost of private dental care is high–prohibitive for me–I am now a single mother. My children and myself, we are covered by state Medicaid. There’s nothing that’s covered for me for dental right now. I need a cleaning, I need dental work done, and I don’t know when I’m going to be able to have that taken care of.” Amy sees dental care accessibility as a nationwide problem that is particularly acute in Vermont. “At one point, when I was the most frustrated, I did call the VT Department of Dentists, and I did explain the situation, that I couldn’t find a provider for my children or for me that was within fifty miles. There was really no help on the other end, other than, ‘Oh well, bring more dentists to Vermont.’

Amy believes compensation for dentists from Medicaid is a big problem. “Obviously, they’re not getting it. And obviously they can’t afford [to treat patients on Medicaid]…. I would guess that more than fifty percent of their customers would come from Medicaid, and if they’re getting paid fifty percent of their costs, I don’t blame them. They can’t volunteer all their efforts. But at the same time, there’s lots of people that are going without.”

A Personal Story: A Year and a Half of Pain – Paula, South Royalton

Thursday, March 15th, 2012

When Paula moved to South Royalton, Vermont, because she had no job she was on Medicaid. She had a cap on her left rear molar which had cracked, but Medicaid did not cover any dental for her, even what seemed to her to be an emergency. She had to wait until she got a job, and then she had to wait nine months before the insurance kicked in to go get her tooth looked at. The first appointment was just an assessment, and she was referred to a different dentist where she had to wait again to get an appointment. “We were probably about a year and a half out where I was going with nothing on that tooth, dealing with the pain and the hot/cold sensitivity. When I finally got it taken care of by the dentist he said the gum was really worn down and damaged because it didn’t have the tooth protecting it and the surface there. So he actually had a difficult time and it was not the ideal crown that he put on…. It wasn’t a perfect fit.”

With the dental insurance from her new job, Paula could now afford dental care, but still found it difficult to get the care she needed because there were so few dentists, she still could not get on a regular six month schedule. It seemed like she could never schedule an appointment when she wasn’t working.

After she had her baby and wasn’t working, Paula called around to quite a few dentists because she was having pain in her lower left molar again. She found a dentist who was able to see her in the weeks before her insurance from her job ran out. Unfortunately, he ended up canceling the appointment, so although she got her teeth cleaned, Paula was not able to get her other concerns addressed. So now it’s been over a year since Paula has been to the dentist, she has no dental insurance and can’t afford to pay out of pocket.

A Personal Story: Dentist Won’t Take Me Back – Naomi, White River Junction

Thursday, March 15th, 2012

Naomi is 23 and pregnant. She lives in White River Junction, Vermont, and has dental work she needs done. The last time she saw a dentist was about six months ago, when she got three cavities filled and two teeth pulled. “They told me they weren’t going to see me again because I don’t take care of my teeth…. I take care of my teeth, but my teeth are the way they are because … no one taught me proper hygiene.” Naomi is missing a front tooth and the rest of her teeth have shifted as a result. She needs more fillings and has a tooth that is cracked in half. She is in some pain but feels that she can deal with it.

Naomi got the number for the local free clinic yesterday, but hasn’t tried yet to make an appointment.

Illustration by Dennis Pacheco.

A Personal Story: Living with Delayed Care – Brianna, White River Junction

Thursday, March 15th, 2012

Brianna is 22 and is pregnant with her third child. She lives in White River Junction, Vermont, and goes to a local free dental clinic, where she gets cleanings and has had two teeth pulled. She finds it difficult to get in for an appointment, though. Brianna has one tooth that needs a filling; she will have to wait six months before the work can be done. She’s never tried to find a dentist who might be able to see her sooner, because she doesn’t know of any others who will take Medicaid. Brianna wishes she didn’t have to wait so long to get her cavity filled, but overall she’s satisfied with her care, “They’re really nice there.” Her kids go to the same clinic she goes to, and are able to get cleanings and care there as well.

A Personal Story: No Help for Young Mom – Elane, Lebanon

Thursday, March 15th, 2012

Elane lives in Lebanon, New Hampshire, and has worked for 36 years as a nurse at an Upper Valley hospital. She often sees patients with dental health needs who cannot find or afford care. One case has stayed with her for a long time: that of a 34-year old pregnant woman with recurring infections in her mouth. This woman went to the emergency room multiple times but could not get lasting treatment. Finally, someone got grant money so the woman could get dental work done, and all of her teeth were pulled. Elane remembers, “…and then what happened was even worse, because after she had all of her teeth pulled, they mandated her to go to work, or she would lose her grant…. She was so humiliated with no teeth that she couldn’t go apply for jobs that way. She ended up losing her grant, and … ended up on the street trying to find a place for her and her baby.”

Elane will remember this story for a long time, “We turned over every leaf we could to get this mom help–it just wasn’t coming.”

Elane sees real gaps in the system in the area of dental health–she feels it should all be regarded as medical help, since it all comes down to that sooner or later. She also feels accessible and affordable care would be more possible here if Vermont and New Hampshire had a dental school. “If you have a dental school, you have dentists that need training under the supervision of dentists that are trained … that’s our only hope…. Wherever I’ve seen a program that works where they can get help … [it] is because it’s in affiliation with dental schools.”

Illustration by Dennis Pacheco.

A Personal Story: Delay Causes Cavities – Tessa, White River Junction

Sunday, September 25th, 2011

Tessa, who lives in White River Junction, Vermont, hadn’t been to the dentist in five years because her previous dentist had closed their practice and she didn’t know where else to go. Tessa’s mom helped her find a new dentist about six months ago. Although Tessa had never had a single cavity up until her last visit, “I had eight cavities and two root canals, because we went five or six years without going to the dentist. I had a lot of work to be done. And I had just been pregnant.” Fortunately the work was all paid for by Medicaid. “It was a new thing for me and it sucked, especially the root canals.” Tessa does not have an appointment to go back since her dentist’s office got washed out by the flooding [or Tropical Storm Irene], although she just found out he has a second office up in Barre.

A Personal Story: Safe If I’m Pregnant? – Elizabeth, White River Junction

Sunday, September 25th, 2011

The last time Elizabeth went to the dentist was probably two or three years ago. She doesn’t go now because she can’t make appointments that often and doesn’t have the money. Her last appointment was for an extraction, which she said didn’t hurt too much because they give you medication for it. “I don’t mind the dentist too much.”

Though she is currently living in White River Junction, Vermont, Elizabeth has moved around a lot and hasn’t yet found a dentist in the Upper Valley. She has a sharp pain in her mouth now, particularly when she eats sweet food. Elizabeth thinks she needs a couple more teeth pulled but doesn’t think she can have the procedure done while she is pregnant. “They stick a needle in your jaw with a certain kind of medication that numbs it, so I don’t know if it’s safe. And also they’ll probably end up doing surgery because of my wisdom teeth, I don’t have enough room in my mouth, so they’ll probably have to cut open my gums and take them out. I don’t know if that’s safe either.” Fortunately, Elizabeth is due in about a month, and thinks she will probably find a dentist for herself after her baby is born.

Illustration by Dennis Pacheco.

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

Tuesday, September 13th, 2011

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.