Dentist of the Back Roads

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A Bite Out of the Bayou

Dentist Gregory Folse provides dental care to underserved elderly patients in and around Lafayette, La.

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Folse does not take no for an answer. He leans in, projecting calm authority. He doesn't wear a mask or safety glasses. He leads by example and nonverbal cues. When Folse opens his mouth, the patient opens his.

He gives the patient shots of local anesthetic.

"Great job," the dentist says. "You are doing a great job."

And slowly, carefully, he draws out the worst of the man's yellow teeth.

"The others are in horrible shape," Folse says. "But these three were life-threateningly loose."

The nursing homes on Folse's circuit pay him a monthly stipend of $6 a patient. He serves as their medical director. With an office manager who keeps track of the caseload and a young part-time dentist and hygienist, Folse provides exams, responds to emergencies and tries to meet the overwhelming need he sees.

"It's way worth the money we pay," River Oaks' director, Guy Sarver, says.

Sarver sees an irony in the lack of Medicaid dental coverage for the old and poor in Louisiana and many other states. "They'll pay for eyeglasses or penile implants. But they won't pay for teeth."

Dental benefits vary by state and often by year, based on budgetary decisions. Louisiana covers only dentures.

Maryland's dental services for senior citizens under Medicaid are confined to emergency and trauma care. In Virginia, adults are limited to medically necessary oral surgery and extractions when infections compromise their health. The District recently introduced a comprehensive dental package for adults. A few states offer nothing.

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In 1965, when President Lyndon B. Johnson signed the Medicare and Medicaid bill into law, neither program included routine dental care.