Filling a need for dental care

Dental care is a privilege that millions of poor Americans cannot afford. The result is the prevalence of tooth decay in low-income communities. A small dental clinic, funded largely by donations, serves thousands of patients in Washington, D.C, many of whom are homeless, unemployed or simply lack health insurance.

If you want to know how tough someone’s life has been, look inside his mouth.

Teeth are made of the hardest substance in the human body. They can withstand floods, fires, death itself.

But poverty, neglect and disease can crack them, break them, ruin them. Homelessness can pound them down into stumps.

The patients at the SOME dental clinic on O Street NW have been through a lot. Their teeth tell the story.

“A lot of the things that go with homelessness also go with poor oral health,” says Jacqueline You, 34, a dentist here.

SOME, which stands for So Others Might Eat, was founded more than 40 years ago by a group of Washington priests and ministers who started feeding the hungry from the basement of a North Capitol Street church.The organization still offers meals, but has expanded over the years to provide for many other basic needs as well, from clothing and showers to housing, counseling and medical services.

SOME’s dental office, which opened in the late 1970s, was born out of the recognition that for many poor and homeless people, dental care can be the most difficult kind of help to find.

Now the small, friendly clinic, which handled 4,139 patient visits and 7,338 procedures last year, never sees a quiet moment. The clinic has a budget of about $700,000 a year, and funding comes from donations, Medicaid reimbursements and a public health service grant. Many of the patients have lacked care for years, if not for their entire lives.

“The first appointment I came in, I was scared. I’d never been to the dentist before,” says patient Kerry Jackson, 47. On an early visit, a half-dozen of his badly decayed teeth were extracted. Now You is filling and repairing the rest.

“Turn your right side a little bit towards me,” says You gently as she works. “Good job!”

Through SOME, Jackson has found a place to live and rebuild. And he has gotten over his dread of dental care.

“We are blessed to have these dentists in our lives,” Jackson says.

Bad teeth are emblematic of poverty. While middle and upper-class children and adults, covered by private health insurance and with money to pay for out-of-pocket costs, get regular preventive care, millions of poor and working poor Americans lack access to dental services.

Tooth decay, caused by bacteria and often passed on from mother to child, remains rampant in many poor families and communities. Dental pain distracts poor children in school and poor workers on the job. Ruined teeth hold people back from career and social advancement and prevent them from eating well. Oral infections and disease have been linked to illnesses throughout the body.

Medicaid, the national health insurance program for the poor, entitles children to dental care. But a shortage of dentists in poor communities remains a significant problem. In 2007, 12-year-old Deamonte Driver, a homeless boy living a few miles from Washington, D.C., in Prince George’s County, Md., died after bacteria from an untreated dental abscess spread to his brain. When Deamonte got sick, his mother was struggling to find a Medicaid dentist to treat his younger brother.

Poor adults are not entitled to dental care under Medicaid, and in many states, benefits are scant. For homeless people, chronic illness, addiction, disabilities and transience can complicate the search for and provision of care.

A 2010 study published in the American Journal of Public Health found that clinically significant dental problems were identified in two-thirds of the homeless individuals studied in a nationwide sampling. Together with eye care, dental care topped the list of unmet medical needs.

While the District, unlike most states, offers good adult Medicaid dental benefits, here, too, there is a shortage of places to go for help. The SOME clinic is so stretched by demand it is currently not accepting new patients.

When You arrived at the clinic in 2007, fresh out of dental school and burdened with $260,000 in student loans, she was happy to learn she qualified for help paying off her educational debts through a city program designed to attract doctors and dentists to clinics serving the poor.

She was also stunned by the need she found among her new patients. Their gratitude has kept her job satisfying, she says. And there is always a new challenge.

“Relax and close,” she tells James Bracey, 51. “Keep biting, keep biting.”

Bracey is trying on a model of the new dentures he has been hoping for. You takes out the teeth and studies them in the articulator, a mechanical jaw.

Bracey says he used to print money at the U.S. Bureau of Engraving and Printing. Then he was disabled by an accident.

“A strap broke,” he says. “The metal went in my eyes.”

Getting hurt took a terrible toll upon his life. To make matters worse, dental disease runs in his family, he says. He watched his father, a shoemaker, lose his teeth to severe gum disease.

“I took after him,” says Bracey. Since he lost his own teeth, he has been boiling his food so he can manage to swallow it. Thanks to SOME, he hopes to have his new dentures by summer.

“We need to take your bite again,” You tells him. “It’s a little off.”
She works with the model of the lower denture to see how the bite needs to be adjusted. “Close and squeeze,” she says. “OK, perfect.”
Larry Wiggins says that his arrival at the SOME dental clinic marks an important moment in his efforts to recover from homelessness and substance abuse and reclaim his life.

Felled by a stroke last Thanksgiving, the former car detailer and furniture mover has been undergoing physical and occupational therapy.

“My mobility is coming back,” he says.

He has been staying at Christ House, a residential medical facility for homeless men and women, attending 12-step meetings and spending time in deep reflection.

The realization that he neglected his teeth has come to him as just more proof that somewhere along the way, he stopped valuing himself.

“I’ve been putting this off and putting this off. It’s time to get back to reality,” he says quietly, sitting in the dental chair.

Now he is ready to return to his life, and take care of himself again.
He remembers growing up, how he and his five sisters and his brother always got compliments on their high cheekbones and handsome smiles. Now, his siblings are all reminding him of those days.

“They are all saying ‘You gotta get that Wiggins look, that Larry Wiggins look back,’” he says.

At first, he was not sure where to turn for help with his teeth.
“I have a friend who has a beautiful smile,” says Wiggins. “I asked him, and he said he went to SOME.”

So here he is, waiting to see a dentist. You examines him and tells him many of his teeth are beyond repair. The bad ones will need to be extracted, but he will be able to get dentures. Wiggins, 56, thanks her. He makes another dental appointment and says, “Let me live the second half of my life the correct way.”