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For Many, Dental Care Is Pulling Teeth

Dr. J. Rosenfeld, a dentist at the Richmond Health Center, sutures Floyd McGee's mouth after extracting a tooth.
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Dr. J. Rosenfeld, a dentist at the Richmond Health Center, sutures Floyd McGee's mouth after extracting a tooth.
 
Without insurance and regular dental checkups, patients left with few options but extraction

Floyd R. McGee can no longer eat meat. Or peanuts. At 56, he’s decided to do something about it; he’s going to the Richmond Health Center to have one of his teeth pulled.

“You can see his teeth aren’t looking too good,” McGee’s dentist, Dr. J. Rosenfeld said, motioning to a ginger-colored, lower front tooth. “We’ll be taking out an incisor today.”

Treating tooth decay by pulling the tooth is usually a last resort, but for Americans who lack accessible dental care, it is a common choice.

“It’s rare that we have a day where we don’t extract a tooth here,” said Dr. Ron Power, another longtime dentist at the Richmond Health Center’s dental clinic.

Dental decay is generally preventable.

“We try to teach people how to take care of their teeth because with good checkups, kids and adults would have minimal decay,” Power said. “Brush for at least three minutes, get your cleanings, floss regularly. Get seen by someone every six months.”

But dental coverage is often one of the first public benefits to get cut. Depending on the study, it is estimated that for every person that lacks health insurance, two to three people lack dental coverage. People without coverage are more likely to delay dental care because of the costs, according to a 2009 study published by the Access Project.

In July, 450,000 Medi-Cal recipients lost their dental coverage, according to estimates by Health Access California, a health care advocacy coalition. Afterward, the New York Times reported that emergency rooms in several counties reported an increase in emergencies related to untreated dental conditions.

Bad oral hygiene has consequences that affect more than just the teeth. When people have poor oral health, the bacteria build up in their mouths and can enter the bloodstream. This can contribute to a number of health problems including stroke and heart attack. Studies have also found a correlation between poor oral health and an increased risk of death.

Power stressed that it’s almost always better to save a person’s natural teeth than get “new” ones.

“Why save your tooth instead of getting dentures?” he asked. “Let me cut your hands off and give you prosthetic hands. It’s the same thing with teeth. Dentures don’t work like regular teeth.”
“There are many times a tooth is savable but the patient chooses to have it removed instead of saved,” he said. “Sometimes, it’s because they’ve been waiting three days and the pain is unbearable. Many times, there’s some financial reason. We always encourage patients to save their tooth if they can. … But sometimes, benefits will only cover tooth removal. It boils down to dollars and cents.”

By the time McGee set foot in the dental clinic, the majority of his teeth needed work. Though he was only having one tooth extracted during this visit, he eventually plans to have them all out and get dentures. Any other option would have cost him thousands of dollars.

The Richmond Health Center’s dental clinic is part of a countywide effort to provide dental care and prevention services to people who might otherwise not be able to see a dentist.

“All our patients have to go through a financial counselor to get clearance,” Power said.
“Most of our patients aren’t working right now. If you are working, you likely don’t qualify for our services, but we’ll tell you to get your work done at a dental school or a couple other practices if money is tight.”

The clinic serves around 14 patients a day, providing a broad range of services, from fillings to fluoride treatments.

McGee sat in the dentist’s chair with his hands folded above his stomach and his eyes wide open. He had already been anesthetized and was ready to lose his tooth. Rosenfeld went to work, removing some of the surrounding tissue. An instrument whizzed in McGee’s mouth, sending up a fine spray of dust.

“That’s looking good now,” Rosenfeld said, readying a tool that looked like pliers. “The tooth might break when I pull; it’s rotted through. We’ll see.”

He rocked the tooth back and forth slowly to loosen it. McGee crossed his feet and closed his eyes.
“There it goes,” Rosenfeld said as he finally yanked out the tooth. He cleaned the area and sewed it up, telling the patient to come back to get the stitches removed.

McGee walked to the front of the office, putting his fingers near his mouth occasionally. Rosenfeld walked up from behind and gave him a gold dollar coin in an envelope.

“You had your tooth out, and the tooth fairy said to give you this,” he said with a smile.

McGee smiled back and took the coin. Rosenfeld told McGee he needed to come back for another appointment, this time for an hour instead of thirty minutes, to extract more teeth.

“I’ll see you soon,” Rosenfeld said, leaving McGee to schedule at the front desk.

And he will.

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