Dentist of the Back Roads
Saturday, February 23, 2008
T he cane fields and the bayous of Louisiana's Cajun heartland whir past the pickup's cracked windshield. Gregory Folse is at the wheel. He wears green scrubs. His dental instruments and a grinding tool he uses to repair dentures are stowed behind the seat.
Most of his 1,800 patients are too fragile to go out for dental appointments or denture fittings, so he goes to them, riding a circuit of eight parishes.
They represent a cross section of the region's elderly, poor and disabled: Cajun fishermen, retired farmers and oil field workers, younger people crippled by illness or trauma, frail Hurricane Katrina nursing home evacuees, including one who floated on a mattress for seven hours and lost her dentures. There was a madam, too, but she has gone to her reward.
Many, until he sees them in nursing facilities and isolated homes, have not had an oral exam for years. When Folse looks into a new patient's mouth, he often finds decay, rampant infection, the broken stumps of ruined teeth, even oral cancers.
The pain and disease speak to a lack of dental benefits and dental care.
Evidence links oral disease to heart and respiratory problems, and studies show that the old, frail and poor have the worst dental conditions of anyone in the country.
Most of those who had dental insurance during their working lives lost it when they retired. Medicare, the national health insurance program for senior citizens, does not cover routine oral health or dental services. Private dental insurance is limited and too costly for many. And the price of dental care can overwhelm people on fixed incomes: A pair of dentures can cost hundreds, sometimes thousands, of dollars.
Most of Folse's patients are on Medicaid, the public health-care program for the poor, which offers a scant patchwork of dental benefits.
Even in states that subsidize some care, there is a shortage of dentists who will treat seniors and the homebound and who are willing to accept Medicaid, with its complexities and historically low reimbursement rates.
In Louisiana, for instance, fewer than 50 of about 2,000 dentists provide dentures, said Ward Blackwell, executive director of the Louisiana Dental Association. Fewer than five attempt to meet the broader oral health-care needs of the frail and old in nursing homes.
Folse estimates that he donates more services than he bills to Medicaid. But he draws deep satisfaction from his work -- and sometimes a sack of crawfish along the way.