By Alex Zielinski, Staff writer
Sitting in a reclining chair in Multnomah County’s newest
dental clinic for the first time, Kenneth can’t help but smile. Despite his
crooked, gapped grin, he’s beaming today for a chance to start afresh, a chance
to take back years of dental neglect and to finally feel confident in the one
thing that has found a way to negatively affect every aspect of his life: his
teeth.
“I’ve always been self-conscious of my smile,” he says. “It
hurts my confidence and my ability to be myself. And what girls want to kiss a
guy with nasty teeth?”
Kenneth’s also dealt with years of oral pain from neglected
abscesses and infections. But the physical consequences are not the sole threat
of poor dental care. From job insecurity to inadequate education to crippling
depression, insufficient oral health seems to be a slippery slope towards a
range of life-altering issues.
With the controversial Portland pro-fluoridation measure on
the May ballot, this issue has become more relevant than ever. While some see
the fluoridation of the city’s water as a Big Brother-esque move, forcing
everyone to drink potentially contaminated water, other residents see it as a
necessity for maintaining oral health in populations who can’t afford dental
treatment.
Regardless of where you stand on the issue of fluoridation,
the issue of oral health is one that spans entire lives, affecting social,
economic and emotional development from grade school onward.
“I would visit Head Start programs in Portland where more
than half of the three-year-old kids have mouths filled with metal fillings,”
says Nichole Maher, president of the Northwest Health Foundation. “One of the
main reasons kids would skip school was for dental care, and for the uninsured,
that usually meant a hefty emergency room bill.”
According to a 2010 study by the Oregon Department of Human
Services, 20 percent of children had significant tooth decay in seven or more
of their teeth. And a 2006 report by the same department found that 16,000
school hours were lost in Oregon due to dental pain in students and emergency
visits to the dentist.
Last year, the Pew Charitable Trust’s Dental Campaign
compiled a report on the cost to states as people go to the emergency room with
dental health care problems, shifting the expense onto Medicaid and other
public programs. The report estimates that preventable dental conditions were
the primary reason for 830,590 ER visits by Americans in 2009 — a 16 percent
increase from 2006. In 2010, according to the report, the number of
dental-related emergency visits by Oregon’s Medicaid enrollees was 31 percent
higher than just two years before. That translates into tens of millions of
dollars in emergency room charges.
The American Dental Association has found that children with
untreated dental disease have difficulty learning, they miss more school days
than healthier students and their social development is impaired. As the
disease progresses, adults face fewer employment opportunities and diminished
economic returns.
Maher also saw older children struggling with self-esteem
issues due to tooth decay and other oral health problems.
“It’s heart-wrenching to see middle-schoolers have to deal
with crippling self-esteem problems based on their health,” she says. “It’s one
thing to look at the outstanding rates of oral decay and medical costs in
children, but just the mental strife alone affects how they develop.”
Children with poor oral care aren’t the only ones struggling
to maintain their self-esteem. Dr. John Bischof, Central City Concern’s newest
Medical Director, cited multiple studies that bridge feelings of low self-worth
to oral health inadequacies.
“It’s something that we haven’t paid a whole lot of
attention to in the past. It’s only in the last couple years that researchers
are finding a connection,” Bischof says.
But the stigma that goes along with bad teeth has never
faltered.
“Aside from acute pain, the judgment of people with bad oral
health brings people to our clinic,” says David Whitaker, operations manager
for Multnomah County’s newest dental clinic in downtown Portland. “It’s how our
society looks at them that hurts. It’s never the good guys in movies who have
missing teeth.”
And treatment for mental illness, potentially triggered or
inflated by poor oral health, can be a vicious circle. Bischof says that many
psychiatric medications given to patients with mental illness affect saliva
glands, leaving the patient’s mouth dry and more prone to infections. On top of
that, he adds, many people with severe mental illness are inclined to abuse
enamel-weakening substances.
“It all comes back to making access to affordable health
care a priority,” Bischof says.
Which is another roadblock in the way to oral care. The
majority of patients who have the most severe dental needs are only partially
insured, if at all. The top request from dentists at the county’s downtown
dental clinic is just to have infected teeth pulled, to prevent ongoing costs
and infection.
“It makes sense, a lot of these people neglect their teeth
for so long that it’s the best we can do for them,” says Dr. Beverlee Cutler,
the clinic’s head dentist. “Half of our work is fitting patients for dentures
or adding replacement teeth.”
The 2010 Department of Human Services study also found that
a hefty 20 percent of Oregonians over the age of 65 have lost all their teeth
to decay or infection. Additionally, a 2008 Center for Disease Control report
showed that only 70 percent of Oregonians visited the dentist in the last year.
Cutler’s view reflects these numbers. Many of her patients
haven’t been to a dentist in years, and usually don’t plan on returning for a
while, due to the cost. While she says she’d love to have a treatment plan of
routine care for each patient, she knows it’s impossible for many to commit to.
“I try to send everyone away with a toothbrush, floss and
fluoride,” says Cutler. “They don’t even need water or toothpaste, as long as
they scrub their teeth.”
This month, the Portland School Board came out in support of
the fluoride measure, linking the issue to student health and its impact on
student achievement. Northwest Health Foundation’s Maher echoed the board’s
ruling, based on her first-hand experiences.
“I grew up in rural Alaska without dental health insurance,
but I was lucky enough to have fluoride in my town’s water. I didn’t go to a
dentist until I was 14 and have yet to get a cavity,” Maher says. “I would not
be where I am today without that.”
Cutler is confident that the new clinic will continue to
attract patients in need, now that it’s in a centralized location.
“To see people who haven’t smiled in years leave here
beaming,” she says, “that’s real change.”
This article appears in 2013-03-15.