Poor, Sick And Cut Off From Dental Care

By Dianne Finch
Guest Contributor

Mike Bush eats only one meal a day to avoid chewing (Photos: Dianne Finch)

Mike Bush is 45, unemployed and struggling with paranoid schizophrenia. But he has an even more pressing problem at the moment: lunch.

Bush’s teeth are so bad that he eats only one meal a day to avoid chewing.

“I shy away from meats and things. I told my dad that I’m running out of teeth to chew with. No big deal,” he said. “I’m probably going to end up with dentures.”

Bush, who lives in Bedford, Mass. started seeing a dentist three years ago for the first time in decades.

But his timing wasn’t ideal. In 2010, just after getting his initial dental exams and cleanings, MassHealth, the state’s program for low-income residents, cut its budget dramatically. Critical dental benefits were eliminated from the plan: fillings, crowns, root canals, and dentures were no longer covered. Extractions, for better or worse, were spared.

The problem isn’t isolated to Massachusetts. In states across the country, adult dental services provide an easy target for cash-strapped lawmakers looking for cuts, according to a 2011 report by the Institutes of Medicine, “Access to Oral Healthcare for Vulnerable and Underserved Populations.”

One reason, the report points out, is that Medicaid requires dental coverage for children, but not for adults. It referred to a February 2011 letter to states from the U.S. Department of Health and Human Services reminding them that Medicaid savings can be achieved via adult dental cuts.

“While some benefits, such as hospital and physician services, are required to be provided by State Medicaid programs, many services, such as prescription drugs, dental services, and speech therapy, are optional,” the HHS letter said.

So, many states are scaling back on the adult programs. Others are already moving to restore certain dental services after struggling with some unintended consequences due to earlier cuts.

Heading To The ER Instead Of The Dentist

For example, some states that track dental-related emergency room visits are seeing much higher costs. And physicians unable to treat dental problems are generally handing out opiate painkillers and antibiotics, according to Centers for Disease Control data cited in The New York Times.

Dental problems are sometimes perceived as less important, or somehow distinct, from overall wellness and good health, studies show.

But the 2011 IOM report advised governments and universities to integrate oral health into overall health programs in order to improve access to services and remove disparities.

“The enduring separation of oral health care from overall health care has marginalized issues related to oral health,” the report said.

An elderly woman on MassHealth exhibits the results of poor, erratic dental care over the years.

An aside: I know this from personal experience. A close relative who is mentally ill and on MassHealth has black front teeth due to multiple, untreated cavities and old fillings that are falling out. After waiting two years for a dental appointment, she recently had the two most painful teeth pulled, though they could have been saved with fillings. (She also has 40-year old fillings that need replacing, but has no disposable income to pay for treatment.)

Another close relative, an elderly woman, also on MassHealth, has been trying to get dentures for several years because she only has five teeth left. She can’t afford care, though, and today I’m taking her to my own dentist for an emergency appointment, paying out of pocket, because her teeth became so jagged they were stabbing her in the tongue.

As for Mike Bush, even though he is now going to the dentist, he can’t afford the treatment. He’s done his best to keep from breaking his decaying teeth. And after the last dental visit he learned he needs six fillings, and something has to be done about his 10 missing teeth – mostly molars.

His gums hurt when he chews, he says, but he’ll live with it until he can find a way to pay for the dental work.

“If I hit the lottery, I’d get implants,” he said.

Requesting The “Soft Menu Option”

Carrie Endicott, the director at Elm Brook Place, a rehabilitation facility for the mentally ill in Bedford, said that all of the dental cuts have had profound impact on the members’ nutritional health – and on their ability to get jobs.

“People come here for vocational reasons to get back into the job market and you know it’s hard to go on an interview when you are missing half of your teeth,” she said. “They are self conscious about smiling.”

Endicott added that salads and raw vegetables are often left untouched. “It’s tough. Members have asked for a “soft menu option” for people who can’t chew…You can’t push raw vegetables on people who are missing half their teeth,” she said.

The Mentally Ill More Likely To Suffer

About 20% of Masshealth subscribers are physically or mentally disabled adults – not including those living in nursing homes.

People suffering from mental illnesses are 3.5 times more likely than the general population to go without teeth, and also have significantly higher rates of tooth decay, according to a 2011 meta-analysis published in the British Journal of Psychiatry.

Mark Etheridge has learned to conceal the fact that he has no “uppers.”

Mark Etheridge, 47, suffers from Bipolar disorder.

At Elm Brook, he’s discovered a passion for cooking. Another thing he’s learned: how to conceal the fact that he has no “uppers.”

“I stick my tongue out to kind of hide it a little bit when I smile,” he said.

A Fix In The Works
After intense lobbying by consumer advocacy groups like Health Care for All, and complaints from dentists and patients, Massachusetts lawmakers devised a plan to partially address the problem.

Last month, the state Senate passed an amendment to reinstate some of the dental services that were cut from MassHealth in 2010. If the Senate amendment survives, an infusion of $7.2 million would be added back to cover anterior fillings.

State Representative John W. Scibak of South Hadley said that by addressing front teeth as a first step, it would at least help people who are interviewing for jobs.

This won’t get Etheridge his uppers, and Bush will have to wait for his molars.

Coverage for cleanings and extractions will continue, but anything beyond those services would require out-of-pocket payments.

Pulling Teeth Instead of Filling Cavities
Scibak supports full reinstatement of services, and views the amendment as a first step toward that goal. He says the current system of emergency-room dental care is not only expensive but it’s also bad medicine, with the wrong specialists working on the wrong problem.

“Clearly if you go to the emergency room for a dental problem, A: It’s going to cost far more than if you saw a dentist. And B: In many situations the person in the emergency room may not be able to address your problem other than perhaps giving you pain medications or treating what may be a localized infection,” said Scibak

He says he’s heard from dentists and constituents that some of the 700,000 adults on MassHealth are having teeth pulled that could be saved with fillings, while others use hospital emergency rooms for tooth pain and infections. While the overall number of poor patients seeking out such services because they can’t pay for more appropriate dental care is unknown, a spokesperson for Health Care for All says in the last two months alone, the nonprofit has received 71 calls specifically about problems related to dental care.

Elm Brook’s Endicott said her clients’ bad teeth continue to haunt her. She told the story of one man she has known for 17 years:

“While we were having lunch together one of his teeth just snapped and fell out of his mouth,” she said. “Then another one chipped…his mouth was disintegrating while we were having lunch. And to look at his teeth now they, I mean they are just kind of like stalagtites; they’re just a fraction of normal teeth.”

Dianne Finch is a freelance journalist and multimedia producer in Rockport, Mass. She’d like to thank Leslie Johnson for helping with reporting at Elm Brook.

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  • rb

    I just want everyone to know what happened to me at the Tufts Dental Faculty Practice. I want everyone to know this because I wrote to the Tufts Dental Clinical Practice Assistant Dean about the issue and he has not responded. I have written to the board of licensure and neither have they. Here’s my story.

    About a month and a half ago I went to the Tufts Dental Faculty practice. I was in excruciating pain in several of my molars as well as my entire mouth, gums were hurting. I have a failed root canal that developed an abscess over the years. In the last two months it seems to have become exceptionally active.

    I made the trip from the north side to Tufts because none of the local docs had been able to help me. In fact, the practice I went to connected up with Mass General Hospital cleaned my teeth / scaled, but did not flush while cleaning, so about a week later my entire mouth, practically every teeth began to hurt and felt infected.

    The dentist at Tufts was highly belligerant and had major communications problems. I carried my X rays with me. But she didn’t bother to look at them. Instead, after a super mini exam, that did not address the cause of my pain, mainly the infection in my molar and the pain and deep cavity in two other molars, she mandated that I go down to the post doctorate maxillofacial department and get evaluated for TMJ! She also refused to treat me until I FIRST demonstrated to her that I had been not only evaluated but also fully treated and wearing devices before she would treat me. She paid no attention to alleviating my pain or placing me on opiates or other pain killers for the short run. She did not mention an endodontist, an oral surgeon nor make an appointment to take care of my cavities. She completely ignored my red and pale swollen gums, my blue gum around the root cannalled tooth. She gave me no emergency treatment but demanded the TMJ appointment.

    I left bewildered and short $125.00 for an appointment that did not include the taking of X rays, nor a comprehensive exam. The less than 10 min exam was just so that she could write “something” to justify my visit. I drove myself all the way from the northside, spending money on gas and in pain to get treated and all I came back with was nothing and wondering why had I even bothered to got the prestigious Tufts dental school! On my way home I nearly fainted and had trouble breathing for the pain and the infection.

    Total lack of standard of care and forcing a patient in acute pain to seek a non-emergency treatment for TMJ (btw I’ve never had any pain in my TMJ nor any trouble with it at all, and I’m nearly 60 years old).

    She took my money but refused to treat me! But forced me to got to the post doctoral maxillofacial floor for a treatment that was totally irrelevant, considering the level of pain and nature of the pain I was in .

    On returning home, I made an appointment with a periodontist who immediately started me on antibiotics for nearly 20 days and I am on Doxycycline now. This the dentist at Tufts could have done, but she did not, My periodontist was amazed that she refused to treat me!

    Adding insult to injury, I asked them to mail my X rays back. I paid for the faxed release, the printing, the gas to to go to the library to make copies and fax it etc. which to this day they have not bothered to return to me. I asked them to expedite the X rays about 20 of them, and they didn’t.

    Terrible treatment of a patient needing urgent dental care.

    Complete waste

  • alina

    Mass Health is now willing to fill anterior teeth because this allows people to go in for job interviews! wow! Thanks Mass health. It doesn’t matter if I am in pain, and havent’ eaten for days because of decaying molars and failed root canals that I’ve already paid dentists thousands of dollars for.

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  • doggone it

    Sadism. They will pay for extractions but not a filling in time that could have prevented the need for an extraction. How stupid and counter productive. Then they have the experienced dentists who wont’ accept Mass health. So you gotta go to a mediocre rookie who is further going to wreck your teeth. You try to get dental insurance but the idiotic limit is only $1000.00 a year – this amount will buy you about half a root canal. You have to wait until next year to get the other half, ha ha . Thanks Delta Insurance. Oh, yes, the “President” of the local dental society, who practices dentistry does not accept Mass health. Its too lowly for him. Doesn’t pay enough.

    Why cannot dental be part of obama care or any *&^%$ major health care plan? Because the dental lobby doesn’t want its guild members to lose obscene profits. Same ole, same ole.

    The dental industry needs price controls. $5000.00 for one implant and about the same for a root canal.

    Highway robbery and shameless behavior by the entire industry.

  • http://twitter.com/JXDiem John

    SOMETHING has to be done babout this! I have disabilties and am an Insulin Dependent Diabetic. I lost my Masshealth benefits and that included dental care. Now I have pain in my mouth everyday and it hurts to eat and my jaw makes clicking sounds! I dont know what to do!

    • http://twitter.com/AndreaSons Purple Oreos

      I have really bad teeh, almost every one of them has cavities and now the tooth I eat with on my right side is giving me problems and I can’t hardly eat anymore, The only thing I can do now is eat Yogurt and drink stuff, I feel where your coming from.

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    • sonia

      sorry for you, I know how you feel. None of us know what to do. Nobody cares. Its all BS. There should be some way that ordinary folks can pool their fund to help each other, like a people’s dental insurance company or something, don’t you think?

      Is there a dental school near where you live? You might try and get them to look at you.

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  • massmom1960

    This is the state of our economy. Cut out dental benefits for those who need them most !! WTF?? It is crazy to cut ANY medical benefits but please….no dentures ?? people need to eat, to smile and to secure a job !! All of these can be done with dentures. People are not asking for implants or veneers. Just basic dentures. The elderly are of the “greatest generation ever” and all they want to do is smile and eat a decent meal. Is that too much to ask DEVAL PATRICK ?? You had the power to reinstate these benefits and you did not. You were too busy with your tours and your book deals. People suffer daily with dental pain, I bet you got a great dental plan that we, the tax paying people of Massachusetts give you as part of your benefits. I voted for you when you needed me, now we need you are you won’t help us. The unemployed, the elderly, the disabled. need basic dentures !! Are you listening ? I guess not, you are too busy with other things like getting your friend Barack re-elected.

  • mandi

    And if you go to the ER for your teeth all they can tell you to get it fix is if you go into boston and one of the denist school you can get all fixed for free (because it getting done by students) and you have to sit there all day and that if you can even get seen.They make no appt it frist come frist serve so if you dont get seen that day you have to go back the next and miss another day out of work. Oh what fun.

  • Ken Smith

    Hello, My name is Kevin. I was in an auto accident over twenty six years ago. Today I am finally living on my own. After years of qualifying for Masshealth and paying for alot of my own dental, twenty three years worth, I got. I used Masshealth once for dental, then, that was it. Who the FXXK are they to end dental. I’m sure they have dental included in there benefits. ” Oh, but they are politicians, THEY DESERVE IT.”  NOT………………….. Think about that at the next election…………      

  • jefe68

    The Dental industry is one of the largest ripoffs. The average dentist charges about $1500 to $1800 for a crown. It takes them about 40 minutes to prep the tooth. Another short visit to fit the crown. The crown costs about $20 to $30 to make or less. In all the crown cost the dentist very little. They are making a huge profit here on all their services. Of course they will go on about overhead and insurance costs and what not. I know it’s not cheap to run an office, but charging people $1500 for what amounts to about an hour and a half of work and a crown is absurd. Dental insurance is also a huge scam.

  • jefe68

    …and then what?

  • Leprechaun9

    I’ve been dealing with a complete lack of dental care for a number of years now by using DenTek temporary filling material (available at Wal Mart  & other pharmacies for about $3 for ~10 or so fillings) every night as they wear down quickly during the day. I’ve also eliminated as much sugar as possible from my diet- HUGE difference in pain, inflammation, chewing ability and periodontal (gum) and cariogenic (cavity) disease progression. I brush and floss at least once a day just before going to bed with generic Listerine (equivalent ingredients) mixed w/ 1:2 ratio  hydrogen peroxide 3%. & a toothpaste with flouride & an antibacterial zinc compound (Crest Pro Health ~ $4/tube but worth it if you can afford it) Every psych med out there may or may not help you, but it seems they all are GUARANTEED to do one thing very, very, well: destroy your dental health by drying up your saliva, and in some cases inducing bruxism (teeth griding) at night. Peace to all and good luck, better health. This is just a stopgap self-treatment, I know, but I felt compelled to write as a real healthcare reform remedy may take months or years or may never come; we have to do and share all we can in the meantime.

  • Mapejrano

    I agree that dental care is important for overall health, and want to add a comment on the value of regularly brushing and flossing one’s teeth.  These simple, cheap actions will prevent a lot of grief!!  I’ve gotten through thirty years of adult life with little dental trouble just because I brush and floss my teeth regularly, and I taught my daughter to do the same.  She’s now thirteen, has never had a cavity, and we’ve never spent a penny on her at the dentist (the occasional checkup is free).  Brushing your teeth won’t heal cavities, but it may well keep them from developing.  Flossing is helpful against gum infection.

  • Bettayd

    People die from tooth infections and become starved or malnourished because they can’t chew. This will not be a civilized country until we provide basic Dental and Mental health benefits along with other medical benefits. That “Health Insurance refers only to the body, but not the mouth or brain is ridiculous. 

  • http://www.curetoothdecay.com/Tooth_Decay/tooth_decay_overview.htm JSP

    I don’t think we should blame the government for this. Our teeth is our part. It is ours and it is righteous to take responsibility on it. I believe that having an excellent nutrition and buying a toothbrush are enough to have oral health. I know it’s not as simple as that but once we take a grip on our life and strive to achieve oral health, we can avoid those situations stated above. I was really disheartened by the actions of dentists on this. I hope they find their ethics and apply to the community. At least, educating the people would be highly appreciated. They can give out educational pamphlets or even recommend useful books like “Cure Tooth Decay” by Ramiel Nagel (this is a great book on healing tooth decay naturally). Doesn’t the local government has community dentistry departments? That would be a great way to involve dentists with the people. There will always be ways. All we have to do is be determined to satisfy our needs. 

    • None

      You can’t brush away cavities.  Anyone who says otherwise is lying.

    • wellwellwell

      Education is just what we have deprived people who are now under State care, hon.  You need a lesson in the sociology of society.  WHY mentally ill people are not taking care of themselves should be everyone’s resposibility.  Why?  Because it’s roots come from the child neglect, indifference and apathy of others.  Please try to do your part to be the solution, not the problem…

  • Corey

    Conservatives don’t care about the needy, let alone the mentally ill. To them, thier god made this man mentally ill for a reason and they are not to blame nor coddle him. He needs to pulls his boots up with boot straps (or whatever that sayn is) and get over it, in their mind.

  • http://www.facebook.com/profile.php?id=1286586209 Laurie Norton

    Dental health has been shown to been one of the most important factors in longevity, good nutrition, and overall wellness.  If we want Americans healthy we need to take care of their mouths as well as the rest of their bodies. (If you’ve suffered serious dental pain, you know compassion is another important reason to help the indigent get this care!)

  • Bombeck

    Dental issues can ultimately manifest themselves in other parts of the body causing significant illness.  Dental care is as important as any other health care.

  • None

    It’s easy for government to cut health care for others given they are fully covered with gold plated benefits (and teeth).

  • Jontod1

    OOPS,
    teeth are what the hollywood type have!

  • Jontod1

    Dental care?
    What?
    I am sorry, but teeth are not part of the human body!
    Teeth are what the type have!
    Real people do not need teeth!

    Oh, wait a second.

    Yes they do!
    We need teeth to eat!
    Why are teeth considered different from any other body part?
    That is stupid!

    Sure, people can spend unnecessary money on there teeth, but the basic things need to be covered for everyone!

    The only people that disagree with this fact are republicans!

    Republicans know what is better for every one and every thing!
    NOT!
    Vote democrat if you like people!

    Vote republican if you are not smart!

    • Jontod1

      Teeth are what the hollywood type have!

      • kane

        you are so right.

    • Nldel55

      Vote democrat and fix everyone elses teeth on your pay check BUT your own especially if your a white American male!

  • OUTof BOX

    Been here, done this!  I have set my own leg with the help of a vet, had water drained off the knee by a mortician, and now  I am “doctoring” a gash that most people would have stitched.  I pulled or let a lot of teeth fall out.  I had the remaining teeth pulled and paid for a set of ill-fitting ECONOMY Dentures which I rather gum my food. I accept my choices as my own.  What makes me MADDER then hell are all the Corporatioms and Individuals who CHEAT the system making it UNAFFORDABLE for the rest of us! 

    • Bigleroygym

      wow…i have just one question…are u insane or just a Republican? hahaha!

      • OUTof BOX

        I am a broke Thoreauvian!

    • rosa

      Dentists are charging way too much. I don’t see how they can sleep at night. The government needs to wake up and do something.

  • Trenalg

    It’s very easy to understand why insurance companies and dentists will gladly pull out your “permanent” adult teeth, but won’t instead fix them: it’s far cheaper to just get rid of your teeth, and for that matter, get rid of you, with your mouth full of challenging dental work needing to be done.  It shouldn’t be this way, but it is, because let’s face it, insurance companies are in it to GET not give money, and lots of dentists are guilty of this too.  It would be interesting to poll all the dentists, to see if they would (anonymously, of course) tell whether they’re  in it for the money or because they actually care about the health and well-being of their patients.  When my son was under a year old and required surgery for a skull fracture from a fall downstairs, I overheard the dr. in their break room at the hospital, when my son was in intensive care, say to a colleague: “If it weren’t for the $200,000 per year I’m earning here I would not do this.

    • dondi

      What a shame. People were supposed to go into medicine because they had a desire to heal other people. Its all rotten now. No compassion. Just show and money and putting on airs if you have the money. The dental industry needs to be heavily regulated. It needs price controls. Anyone charging more than $700 dollars for a root canal (which will eventually fail anyway, they all do) should be penalized.

  • http://nancib.wordpress.com/ BostonPeng

    This is a problem that’s been needing fixing for years. I actually avoided going to the dentist for years because of losing dental coverage and now my dentist wants to get me dentures to help me eat more easily through several missing teeth that got pulled because there was no money to fix them. Of course there’s no money for dentures and I’m praying I don’t lose more teeth because I recently broke a tooth in back that has to come out, and it’s right where I chew so I’m having to constantly remind myself not to chew there.

    There’s one thing that our elected officials never seem to remember: Poor oral health impacts the rest of your health, and I’m not just referring to losing so many teeth you can’t eat properly. If you let a problem tooth go too long you put yourself at risk of heart problems, and that’s an even more expensive trip to the ER.

  • JD

    This experience is also in line with people who DO have dental insurance.  Much cheaper to get teeth pulled vs. fixing them.  I have spent a lot of money out of pocket the last year getting a lot of dental problems fixed – this makes me thankful I have the savings to do it regardless of how much I hate having to pay thousands of dollars for dental care…. I don’t understand why dental care is any different than medical care as far as insurance goes – it should be just as important.  

    • Peoplesuck123

      It’s all about the “$”. NOBODY CARES, ANYMORE. The world is falling apart. Who can make more money than the other…………

  • Pghyes

    Great article.  I work with adults with developmental disabilities. It is so hard to even find a good dentist that takes masshealth! It is crazy that mass health will cover “pulling teeth” but not cover fixing them!

    • growl

      Exactly. The dental work performed for Mass health holders is (a) Below standard (c) condescendingly provided; smirks, I feel so sorry for you and other such attitudes) (d) appointments delayed, so you end up losing your teeth, just having to wait.

      The wasteful community centers are even worse. Crappy unprofessional staff, same snotty behavior, delayed appointments so you end up losing your teeth to growing cavities.

      Shame on you dental industry. May spit and teeth shower you.

  • Lesliej961

    So many people on MassHealth can’t get some basic care for their teeth. I think it’s ludicrous that MassHealth is willing to pay for a tooth extraction but not for a filling. Oral health affects physical health as well. I heard a story about someone with a disability who had no teeth and choked on his food and died. That was completely unnecessary.