By Mary Otto
Tuesday, August 3, 2010; HE01
On a weekend in late July, at the free annual open-air health clinic held here in this Appalachian community, a total of 2,643 teeth were extracted. Each one bore mute and personal testimony to the isolation of this rural place, and the defeats and losses of its people.
"Each tooth has a story," said dentist Terry Dickinson quietly. He was standing just outside the huge tent at the county fairgrounds where more than 50 folding dental chairs were filled with patients and hundreds more people waited in the sweltering heat for care.
The massive national health-care overhaul signed into law earlier this year included some gestures toward broadening access to dental care for children. But it contained scant mention of the broken dental care system for their poor elders.
"You still have this big huge hole for adults," said Dickinson, who runs the state dental association in Richmond and oversees the dental volunteers. "You see it here."
This was the 11th year for the free Wise clinic, led by the Knoxville-based medical relief organization known as Remote Area Medical. RAM specializes in getting care to isolated, impoverished and ravaged places. But after parachuting into disaster zones around the world, RAM's founder, adventurer Stan Brock, realized some of the deepest need lay in Knoxville's own back yard. So each year an army of volunteer health-care providers from many medical specialties descends upon Wise, setting up exam rooms and surgeries, a laboratory and a pharmacy. Then they go to work, offering gynecological exams, vision and hearing tests, diabetes and cardiology care, chest X-rays and cancer screenings. They stitch up wounds and remove cysts.
But this year as usual, the majority of the 2,347 patients who came to the clinic in Wise, who slept in tents and in trucks and who lined up at dawn each morning, wanted to see a dentist.An imperfect solution
Dentists, especially those who serve the poor, can be scarce in these rural places. And even after the health-care overhaul, public and private insurance coverage to help pay for the dental care can be hard to find. Medicaid, the government health plan for the poor, entitles children to routine dental services, but not adults. Meanwhile, private dental benefits are also often out of reach. More than 100 million Americans lacked dental coverage even before the recession and its attendant job losses.
Paying for care out-of-pocket is an option for some people, but for the financially stretched, dental work can take a back seat to other needs, such as food, fuel and housing.
"I just can't afford it," said Lucinda Honaker from the town of Honaker, Va., named for the forebears of her husband, Charles, a miner disabled 10 years ago by diabetes. Their children have a dentist, but she and her husband do not.
"The kids have got Medicaid, but no one will see us," Lucinda Honaker said. The family lives on about $800 a month. So dental problems steadily progress, causing infection, pain and difficulties with speaking and eating. Ultimately the only answer is extraction, but it can be an imperfect solution.
Charles Honaker had his infected teeth pulled two years ago at a RAM event, but he is still on a long waiting list for free dentures. With the help of the family vegetable garden, he is trying to eat right to keep his diabetes under control.
But without teeth he finds it hard.
"For the stuff I've got to eat, I need teeth," he said. In the meantime, he just cuts his food into tiny bits and swallows the small pieces whole.
For many other poor people, cheap, sugar-laden foods and sodas have become dietary staples that play havoc with the teeth. And tragically, the bacteria that feed on the sugar and actually cause the decay are transmissible, so parents, by sharing a spoon or testing the baby's milk, can pass their legacy of dental disease on to their children. In places lacking preventive care and oral health education, decay easily runs rampant.'Rugged dentistry'
Growing up as the children of union miners, the Honakers, like many of their neighbors, received good dental care. But many of the mines have closed, and the jobs and benefits have disappeared. The economic downturn has made life even harder in the past two years. In fact, this annual clinic has become the only source of dental care for many local people.
"It's rugged dentistry," said North Carolina dentist Brittany Semones, pausing amid the mountains of stainless-steel instruments sterilized and set out for the volunteer dentists on long folding tables.
Semones said she misses the comforts of her own instruments, but this clinic is important to her. "It's rewarding," she said. "We get a lot of hugs." As if on cue, Semones finished with a difficult extraction and her patient, Dianne Stiltner, a 54-year-old woman from Prader, Va., rose from the chair and embraced Semones.
Likewise, Charles Fogarty, 42, a disabled forestry worker from Big Stone Gap, Va., said he was deeply grateful for the expert care he found at Wise. He said he once pulled out one of his own aching teeth with a pair of pliers.
"I've had a pretty rough life," he said.
A handful of volunteer dental technicians, who converted the fairgrounds' wood-and-cinder-block concession stand into a dental lab, worked into the night at their alcohol lamps, shaping wax gums and placing artificial teeth, building the temporary "try-in" models for patients to test before receiving their permanent dentures.
The process was slow and painstaking and the waiting list dishearteningly long.
But working steadily, the technicians finished several dozen free dentures.
One of the lucky recipients was Grundy, Va., homemaker Teresa Casey, 48, who was left toothless after a six-year struggle with cancer and a degenerative bone disease. Casey had the broken stumps of her teeth extracted last year but could only dream of raising the several hundred dollars she would need to buy dentures.
"That's my whole income," she said.
On Saturday afternoon, Salem, Va., dental technician Tim Zuber and Bristol, Va., dentist Scott Miller presented her with a shining set of try-ins. She slipped the pearly artificial teeth into her mouth, and the wages of disease and worry fell away from her face. The hollows disappeared from her cheeks. They handed her a mirror. As she recognized her long-lost self, she began to weep.
Then it was Sunday morning.
"We are running out of time," said the dental association's Dickinson, looking out over the remaining patients.
Wallace Huff, a dentist from Blacksburg, Va., was doing a final consultation. The patient was Lee Rash, a 23-year-old welder, a new father, just laid off from work.
Huff showed him his X-ray. "You've got some beautiful bones, a beautiful mouth." But there was also bad news, the dentist said. A rotting tooth.
"If you don't do something with that soon, it's going to abscess," Huff told the patient. The young man went and sat down to await his extraction.
And Huff paused to gather his thoughts. The dentist said he has been volunteering for 10 years here at Wise.
"I came here because people need help desperately. A lot of people are hopeless. Their teeth are beyond what we can restore," he said.
Huff hates pulling out teeth. But, he acknowledged, sometimes that is the only thing he can do. Then his eyes filled with tears. "We cannot leave these people in pain."
Mary Otto is a freelance health writer and editor in chief of Street Sense.