By Bill Turque
Washington Post Staff Writer
Monday, June 12, 2006
There are moments when the pain is so intense that it overtakes all of Jim Overgaard's senses. It roars through him in palpable waves, with its own taste, sound and color.
"It's brown," he said. "I don't know how else to describe it. It's just brown."
Overgaard is a 62-year-old homeless man with bad teeth and few options in Fairfax County for getting them fixed. Treatment has often meant long treks to the District or taking care of it himself. When you're homeless, home dentistry is a pair of pliers, which he once used to extract two teeth. By his own count, he has about 12 healthy ones left.
At the moment, his upper right canine is broken off and has become abscessed. Medicine has held the pain in check, but it will run out in a few days. Then the pain will start, as it has before.
"It's bad. You howl. There's no way out of it," said Overgaard, a frail man with frizzy gray hair pulled back into a tight bun who carries a walking stick he occasionally uses to whack cars that don't heed pedestrians.
He is among the slightly more than 2,000 homeless people in Fairfax, about half of them single adults, according to the most recent survey. They contend with myriad medical issues, including drug and alcohol addiction and depression. Dental problems are among the most insidious and undertreated.
Years of hard living and neglect have created mouthfuls of cracked, broken, blackened and rotted teeth as well as bleeding gums. For people with already-weakened immune systems, dental infections can be life-threatening.
For most homeless adults in Northern Virginia, dental care is difficult to find. Medicaid in Virginia does not cover dental work for adults. Fairfax employs three 20-hour-a-week nurse practitioners who visit homeless shelters, but they are not set up to deal with serious dental issues. Shelter social workers try to get serious cases to dentists who will work for discounted rates, but there are few.
"To be perfectly honest, resources are scarce for dental care," said Michelle Milgrim, assistant director for patient-care services in the county's health department. The county is developing a program to more aggressively extend health services to the homeless, especially to those like Overgaard, who resist going to shelters.
Stories of dental calamities are legendary among social workers who deal with the homeless. Marte Birnbaum, director of the Embry Rucker Community Shelter in Reston, recalled a man who tried to use Super Glue to keep his dentures in place. Many have teeth so vulnerable, Birnbaum said, that the shelter tries to keep a supply of soft, canned fruit so that clients avoid losing them to apples and other firm produce.
Overgaard, currently staying with a friend of a friend in Falls Church, went to the Fairfax Department of Family Services' offices in Baileys Crossroads on Tuesday to find help.
A social worker gave him a phone number for the county's Department of Human Services. The woman who answered said that the place closest to him, the Northern Virginia Dental Clinic in Falls Church, wasn't even taking names for its waiting list at the moment. It also charges $30 for a visit, money that Overgaard said he does not have.
Getting help from Northern Virginia Family Service, a nonprofit organization based in Oakton, posed other hurdles. It sets up appointments with dentists at reduced rates, but it requires financial information and proof of local residency, a problem for Overgaard, even though he has lived in Fairfax for more than 15 years.
"Madam, I need to have this tooth pulled before it kills me," Overgaard told the Human Services woman on the phone, the frustration in his voice rising. "No, I haven't got any money. . . . I've been homeless for the last 15 years."
The other options, Washington Hospital Center and Howard University College of Dentistry, are in the District, a long haul on public transportation for someone in poor health, and they also cost money. The National Institutes of Health is free, but it will yank only wisdom teeth -- as part of a pain study.
If Overgaard lived in the District, he would have access to a new city-funded program that provides dental care to the poor and homeless.
Overgaard is angry when he finishes on the phone.
"It's sick."
Overgaard's teeth have crumbled. So have his fortunes.
He was born in Chicago and grew up in rural Wisconsin. According to his sister, Tera Mauer, he came within a few credits of graduating from Syracuse University in the mid-1960s. He had held a series of jobs, including one for a manufacturer of medical supplies. He was selling cars in Northern Virginia when his marriage fell apart in the mid-1980s. His wife and three children moved to Minnesota.
"I failed them," he said. "I never made enough money to keep the family together. Facing child-support payments, he fell behind on his rent and lost his apartment, then his car and ultimately his job. Trouble with the IRS followed. He has drifted in the years since, through a succession of friends' couches, apartment house basements and parks.
He is well-read and carries himself with a quirky formality. "I try to avoid taking advantage of the public exchequer," he told the Human Services worker on the phone. Conversations include long digressions into plans for new engines or reactors.
"Jim is a dreamer," his sister said. "He's always had dreams of discovering something or re-doing something and making it into something more wonderful."
On Friday, after inquiries by The Washington Post about dental care for the homeless, a Human Services staff worker told Overgaard that the department could give him a check for $170 to cover treatment at Howard.
That was fine, he said, but it wasn't completely the point.
"These people are falling all over themselves now that somebody is looking," he said. "This isn't about me. It's about suffering people."
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