For Those in Need, Service With a Smile

The dental office now has equipment more advanced than in some private dental offices. There is digital radiography -- computerized X-rays that Stangel can show the patient on a chair-side monitor, pointing out areas on the screen with a wireless mouse and keyboard. The chair-side monitors also have Internet access, allowing the dentist to research information to show the patient during the appointment.

The patients at SOME's clinic often have more advanced illnesses than are seen at the typical dentist's office. "Most patients present with very debilitated mouths -- something I hadn't seen for years before I got here," Stangel said.

Among working middle-class individuals in industrialized nations, tooth decay and cavities are generally declining, "but if you look at low-income and homeless individuals," he said, "oral disease is rampant."

The causes are many: a drug- or alcohol-dependent lifestyle that doesn't include dental appointments, a poor diet, and, in the face of limited public benefits coverage, not being able to afford private dental providers.

Good dental care is important for reasons other than healthy teeth. Several diseases show symptoms in the mouth. For example, Stangel said, for patients who have HIV, the tissue in the mouth -- the cheeks, the area under the tongue and the back of the throat -- can be more susceptible to developing infections.

"It's really a gateway to what is going on to the rest of their bodies," Stangel said. "Someone who's not taking care of their oral environment is not taking care of the rest of their body."

Graves, the patient with the two decayed teeth, was having tooth reconstruction on a recent day, one of several appointments she had had with Stangel to restore her smile.

Stangel asked Graves how she was doing and, after small talk, explained he would work on one tooth and have her come back to complete work on the second.

The dentist began by removing the temporary material that surrounded a brown-tinged tooth. Then he applied three different solutions, including a primer and a resin, to its surface. Next he filled out the tooth with composite material and used an LED light to harden the light-sensitive substance. Finally, he sculpted and shaped the reconstructed tooth, making fine lines so it resembled a natural tooth. The process took about 30 minutes.

Stangel pulled out a mirror and showed Graves the results.

"Oh man, wow!" Graves said. When she first arrived at the dentist's office last year, she said, she held her hand over her mouth when she spoke.

"I'm so excited, it's like brand new again," she said. Next week, the Extra will look at the city's "medical homes" initiative, which aims to ensure that every District resident has a place to go for health care.