Dental care for poor poses looming crisisHealth officials say need growing with few low-cost options
Sunday, March 26, 2006
by Judith Graham
Don't ask Shirley Jones to smile. It's too embarrassing.
Jones, 51, doesn't want people to see that she has only five teeth left, a deep source of shame.
Some of her teeth fell out; others were pulled as Jones' gums rotted away during years of living without dental coverage or routine dental care.
Now, this unemployed home health aide needs dentures, but she can't find a clinic that will charge rates she can afford. "What can I do? I call and call, and no one will take me," said Jones, who lives in Evanston.
Dental care for the needy remains painfully scarce in the Chicago area, leaving tens of thousands of people with untreated cavities, toothaches and bleeding gums.
The ailments are distressing in themselves, but research also has linked them to serious conditions such as heart disease and premature birth, and they can worsen the effects of diabetes.
"Just as the knee bone is connected to the hip bone, the mouth is connected to the rest of the body," said Lewis Lampiris, chief of the division of oral health at the Illinois Department of Public Health.
Yet low-income consumers encounter many obstacles to getting dental care: no insurance, a shortage of city and county services and a "pay up front" policy by most private dentists.
The problems have worsened as more Illinoisans find themselves lacking any type of health insurance and paying more for medical care, putting an extra strain on family budgets.
An estimated 1.8 million state residents are uninsured; of those with medical coverage, as many as 40 percent don't have dental insurance, experts said.
"The needs just keep on growing," said David Clark, associate dean at the University of Illinois at Chicago College of Dentistry.
There have been some noteworthy improvements since Illinois held a summit on dental care in 2001. More community health centers are offering some dental care. Several suburbs have started dental clinics. And the first dental center for uninsured patients opened recently on the city's Northwest Side.
Meanwhile, the Chicago Department of Public Health expects to supply sealants and other treatments to 50,000 schoolchildren this year, a big jump from years past. More children and families also have dental coverage through the expansion of Illinois' KidCare and Family Care programs.
But experts acknowledge that these efforts are only a drop in the bucket.
"We can't possibly meet the demand," said Sidney Thomas, acting chief operating officer of the ambulatory health network at Cook County's Bureau of Health Services.
Stroger Hospital, the centerpiece of the county's system, gets 7,000 calls a month from people who want to see a dentist, but its clinic has only 777 monthly appointments, he said. Even then, in-demand services such as dentures simply aren't available.
Of 24 community-based health clinics run by the county in Chicago and its suburbs, eight offer dental care. Finding community resources for patients is "extremely hard," Thomas said.
The outlook isn't any better with the city's public health system: Just two medical clinics offer general adult dental services, in Englewood and on the Lower West Side.
Hospital emergency rooms typically don't have dentists on staff, and since Northwestern and Loyola Universities closed their dental schools, only UIC sponsors clinics that offer low-cost services.
Despite the expansion of dental coverage for children, 32 percent of 3rd-graders in Chicago had untreated dental decay, according to the latest statewide survey, completed in 2004. The figure was 38 percent in suburban Cook County and 37 percent in rural areas.
No comparable data exist for adults, but it's likely "the situation is even worse" for them because of limited insurance coverage and restrictions in public programs, Lampiris said.
Illinois Medicaid doesn't pay for dental cleanings for adults or preventive exams of any kind. Men and women can get root canals on their front teeth, but not their back teeth. The program will pay for pulling teeth but not for gum surgery.
Also, because Medicaid pays only about 38 percent of market rates for adult services, few dentists chose to participate, said Greg Johnson, director of professional services at the Illinois State Dental Society.
A key recommendation from the 2001 summit was boosting Medicaid payments, but that hasn't happened, with one exception: Because of a legal settlement, Medicaid in January started paying market rates for preventive dental services for children.
"This is an enormous public health crisis," said Dr. Lee Francis of Erie Family Health Center, which recently started a new dental clinic with a $900,000 grant from the state.
In the communities Erie Family Health serves--Logan Square, Humboldt Park, West Town--poor Hispanics have been neglected. A recent survey showed that only 38 percent of residents had seen a dentist in the last year, about 56 percent of adults were missing teeth and 63 percent had untreated cavities.
More than 90 percent of private dental offices in the area don't have Spanish-speaking staff members. Even with five dental chairs in its new facility, "we'd need seven times that number to take care of our existing patients," Francis said.
The situation is equally grim in Englewood, where eight volunteer dentists staff the Free People's Clinic in the basement of a church rectory next to a vacant lot. This private clinic, which relies on foundation support and minimal patient fees, is separate from the city's clinic in the same neighborhood.
Edward Schaaf, 74, a whimsical dentist with wispy white hair, has been donating his services here for 19 years. "These people need the care," Schaaf said. "It's a labor of love."
More than 40,000 people have no medical or dental insurance in Englewood, and this is one of the few places where they can get free or low-cost services, clinic director Laura MiSweet said. For every person seeking medical care at the clinic, five people seek dental care, and there's a three-month wait for non-urgent conditions.
It's not uncommon, Schaaf said, to have older people walk in the door with 20-year-old dentures that don't fit. "It does so much if you can fix the problems and do something for them cosmetically," Schaaf said.
On a recent Monday night, Ozella Cunningham, 61, was sitting in the waiting room planning to be fitted for "partials," a denture-like replacement for several teeth. A retired postal worker, Cunningham became disabled more than 20 years ago because of a nerve tumor. Her monthly income is about $1,000 after taxes--enough to live on, frugally, but not enough to afford expensive dental care, which her retiree health insurance policy doesn't provide.
In the last year, Cunningham has been fitted for a cap and had two root canals at the clinic. "This place has been a lifesaver," she said.
Nearby, Samaria Doll, 52, the widow of a deceased Cook County sheriff, nodded her head.
Doll hadn't seen a dentist for "I don't know how long" before finding the Free People's Clinic in 2003. Then, she had all the teeth on her upper jaw--the few that remained, that is--pulled out because they were grossly decayed and her gums badly diseased. Dentists installed dentures on the top and a partial plate on the bottom. On this day, Doll had come in because one of her false teeth had broken--she was carrying it in her wallet.
Doll lives on her husband's pension, about $900 per month, and has health insurance through Blue Cross Blue Shield but no dental coverage. If not for Schaaf and the clinic, she said, she'd be sitting home "with no teeth, bald mouthed, and feeling real bad."