By John Duke, Contributing Columnist
Twice a month the Medical Teams International mobile dental
van comes to Outside In to treat homeless youths and other patients within our
homeless youth services.
Even though the van has the ability to do cleanings and
preventive care, they mostly do extractions and emergency care for our clients.
For every homeless youth and low-income adult that gets an appointment, there
are five who do not because the need is so great. Slots are so limited that we
prioritize by intensity of pain and level of illness. It concerns me how many
people I see in dental pain, especially when all dental disease and decay is
preventable.
When I first started working in homeless medicine, a mentor
of mine who worked with older homeless people told me that he could tell a lot
about the general health of a homeless person by looking at their teeth. I
think about my mentor’s words decades later as I see homeless youth packing a
cavity with tobacco snuff to ease the pain.
There are thousands of people in our community with no access
to dental care at all. Homeless youths often grew up poor and many have never
had dental insurance or have ever seen a dentist. Sleeping on the streets, in
squats and shelters, homeless youth have very little control over personal
hygiene or what they eat.
At Outside In we see blackened and missing teeth all the
time. It is a serious health problem. It is an employment problem. It is a
barrier to getting off the streets and joining mainstream society.
When youth have untreated decay and are in pain they miss
school, have trouble eating and speaking, deal with the embarrassment of tooth
loss, and have life-long health issues and costs. Addressing dental decay is
also remarkably expensive. A 10-year-old child who develops cavities will pay
more than $2,000 over a lifetime to take care of just one of those decayed
teeth —— a tremendous burden for all people but particularly lower-income and
homeless youth and families.
Just this year Outside In opened a school-based health
center at Milwaukie High School. I already knew the dental health crisis was
bad but the biggest eye-opener for me was seeing how many children, from that
beautiful school in a nice suburban community of Portland, also have bad teeth.
Our dental health crisis isn’t just affecting Portland’s low-income
communities, people are suffering across the board.
Our dental crisis is also telling when we compare Portland
to other major cities in the Pacific Northwest. For example, we know that
Portland kids have 40 percent more decay as compared to kids in Seattle, which
is fluoridated. The solution is a combination of education, better access to
dental care, and fluoridated water. For a crisis of this magnitude, we need to
use all the tools available.
Brushing with fluoridated toothpaste is a start, but it’s
clearly just not enough. Fluoridating our water ensures that every family has
access to a safe, effective and affordable cavity prevention measure,
regardless of income, ethnicity or education level. It’s time Portland makes a
different choice, the community choice. It’s time to fluoridate our water as an
investment in children’s health, educational success, and social justice.
Studies have shown that fluoridated water reduces dental
decay by at least 25 percent percent. There have been more than 3,000 studies
of its safety and effectiveness. Fluoridated water has been used for more than
65 years and over 200 million Americans currently have access to it. In fact,
Portland is the largest city in the country yet to enact water fluoridation —— and
our children’s teeth are paying the price.
To help with the dental health crisis new clinics are
opening —— but they can’t keep up. We need to do more to prevent Portlanders
from needing urgent care and painful extractions in the first place. The volunteer
dentists on the Medical Teams International dental van and the dedicated staff
at the new Multnomah County Billi Odegaard Dental Clinic are heroes. They are
trying to help and heal people each day. The big problem is that they are
fighting a fight that cannot be won one mouth at a time. There are too many
barriers for low income people —— we are living in a society where there are
extreme disparities in access to dental care. Education, access to more care,
and healthier foods are all an important part of the comprehensive dental
health program we need in Portland but it only makes sense that our community
should take the precaution of fluoridating our water to give everybody a better
chance at having healthy teeth.
Outside In has weighed the arguments for and against water
fluoridation. We love the uniqueness of our community and our patriotic leaning
toward what’s “weird,” but when weird ends up hurting children and those who
can’t afford dental care, weird becomes “wrong.” This is one area where the public
health data is irrefutable.
Every major health care organization in the country, from
the Centers for Disease Control and Prevention to the National Institutes of
Health, has come to the same conclusion: Fluoridation is safe and effective. It
is time for Portland to embrace the norm when it comes to protecting our kids.
It’s time Portland makes a different choice. It’s time to fluoridate our water
as an act of social justice. Please join me, Outside In, the Coalition of
Community Health Clinics, Medical Teams International, and over 80 other
organizations in endorsing a YES vote on ballot measure 26-151 on or before May
21.
Visit www.HealthyKidsHealthyPortland.org to learn more.
John Duke is the Clinic and Health Services Director for
Outside In.
Read the counterpoint argument on fluoride here.
This article appears in 2013-04-26.