The District of Columbia has run out of money to pay for dentures, causing hundreds of poor residents, including many who have had teeth extracted in preparation for dentures, to wait months for help.
The $51,000 the city budgeted for dentures was exhausted in early July, said Dr. Joseph Payne, dental health coordinator for the D.C. Commission of Public Health. Payne said he told the city's 13 operational dental clinics to inform their patients that no new dentures could be supplied.
"They've just got to wait," said Dr. G.W. Borzillo, a dentist at the city's Upshur Dental Clinic, which now has some 150 people on a waiting list for dentures. "We have a lot of people who have had extractions already. They eat the best way they can."
The program frequently runs out of money in the summer--toward the end of the fiscal year, which closes Sept. 30--because the demand for dentures among the elderly population in the District is so great, said Cheryl Fish, community projects coordinator for the Legal Counsel for the Elderly, a city group that tries to help aged Washingtonians get dental care.
"One of my clients is a burn victim who has no teeth and can't eat food," Fish said. "Her work was started, and we've been told we have to wait until the new budget year begins."
Dr. Robert Quaranta, deputy director of the city's Bureau of Dental Health, said it is not known how many patients are affected or exactly when the denture program will resume. All clinics have waiting lists for dentures, he said.
The probable resumption date is Oct. 1, the beginning of the new fiscal year, said Payne. But he noted that the city controller is auditing the program's bills to determine if there is any money left over to allow the denture program to begin sooner.
One city resident affected by the cutoff is Margaret Shephard, 63, who has been waiting for dentures since she began having her teeth extracted 15 months ago. "The clinic told me they don't have any money left for dentures," she said. "My gums are sore now and one side of my gums is swollen. I'm eating soft food. You can't eat meat."
Despite the need in the city, health officials doubt they will receive more money next year. "At this level, we're happy to get the $51,000," said Quaranta. He added, "We're one of the few municipal public health departments . . . to provide denture services. Of course, there is a tremendous demand in this city, in this country, for dentures because Medicaid won't cover them."
Medicaid, the government-sponsored health care program for the poor, does not cover dental care for those 21 years of age or older. The bulk of the dental care for the District's poor is provided by its 13 dental clinics. They are open to everyone, regardless of income, but all must pay $21.75 per visit.
Under the city's denture program, poor residents are given the dentures free but are asked to pay for the four to five visits required for fitting.
"We ask them to pay, but don't force them," said Dr. Payne, who said the bills of poor patients are not turned over to the city's collection department if it is determined they genuinely do not have the resources to pay them.
A system of sliding-scale fees has long been discussed for the clinics, and Payne said he plans to institute the system "in the very near future." A proposal to increase the cost of dental visits to $36.75 was published in the D.C. Register in April, but it has not been implemented.
The city also pays another $55,000 to the dental departments of Howard University, Georgetown University and Providence Hospital for its students to perform dental work, including dentures. But those institutions do not operate on full schedules throughout the summer and do fewer dentures than the clinics because the student dentists are just learning the craft, said Payne.
Exhausting the funds for lab services also has affected a volunteer dental program run by retired dentists. The program, run by the Emeritus Foundation, used an empty chair on Fridays at one city dental clinic. A rotating group of retired dentists staffs the program, but since it relies on the same city funds for denture laboratory work, that denture program also has been halted.
Cora Elder, a dental assistant at the Anacostia Dental Clinic, said the city-run clinic has 50 people waiting for dentures, and most call weekly to see if the program has been resumed. "Some of the people are in the middle of the process," but the clinic cannot go ahead with more lab work, she said. "All we can tell them is to wait until there's money."