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Mouths wide shut
Teeth arenít just for the rich, but in Maine, low-income dentistry is hard to find
BY TANYA WHITON


For assistance . . .

PREVENTATIVE CARE

University of New England Dental Hygiene Program

716 Stevens Avenue, Portland, (207) 797-8999.

Appointments available September through April/closed for Christmas holiday.

Minimum cost: $20

Reiche School Clinic

166 Brackett Street, Portland, (207) 874-8450.

Appointments available three half days per week.

Minimum cost: $5

RESTORATIVE CARE

Community Dental

813 Washington Avenue, Portland, (207) 874-1025.

First come, first serve ¾ call early in the morning on the 15th of the month.

FEDERAL POVERTY GUIDELINES

Federal poverty guidelines for 2004 will be in effect soon. The numbers below represent 2003 annual income guidelines.

100 percent $8980

150 percent $13,470

200 percent $17,960

I recently had my teeth cleaned for the first time in two years. Certain that the hygienist-in-training who saw me would have lots of bad news to report, I had not been looking forward to my visit. But Iíd reached the threshold where anxiety ó inspired by a friendís horror story about a good tooth gone bad and the thousands of dollars required to keep other teeth from joining the mutiny ó prodded me into action.

But where to go? A trip to a private-practice dentist for a simple cleaning, exam, and bitewing X-rays can, on average, cost between $106 and $136. And if my two years of neglect resulted in my needing fillings, I could end up spending from $89, for a single-surface mercury-amalgam filling, to $265 for a classy-looking composite (tooth-colored) filling covering three or more surfaces. Forget about serious problems: I didnít have the money for preventive care.

I began asking acquaintances, colleagues, and students how they afforded to maintain their teeth, and the alarming answer was that many people simply did not. In the state of Maine, access to medical health-insurance is a serious problem, let alone dental insurance. Judith Feinstein, manager of the state Bureau of Healthís Oral Health Program, explains that dental-insurance plans usually arenít constructed on the same model as medical insurance. Dental coverage is generally what insurers call a "subsidy," which means the patient pays more out of pocket.

"The consumer pays probably close to half for anything other than preventive care," Feinstein explains. And, according to a 2002 survey by the US Department of Health and Human Services, Maine ranks fifth in the country for lack of access to dental care, meaning 21.3 percent of the population goes without.

A friend did point me to one low-cast option: the University of New Englandís Dental Hygiene Program, where student hygienists will clean your teeth under the tutelage of an instructor for a reduced fee. The Dental Hygiene Program, run out of UNEís Stevens Avenue campus, ushers around 30 new hygienists into the field each year. Most of them stay in Maine, but, since dentists often have four or five hygienists on staff, there is still a shortage. The UNE students who practice their skills on the public are second and third year undergrads. (The trickier jobs go to the more advanced students.) In addition to doing cleanings, they can also take X-rays, tell you if you have cavities or other problems, and offer fluoride treatments. The rub? The process can take up to four hours, because students have to check all their data with their instructors.

This same friend had also ignored a nagging tooth, with unpleasant consequences ó she ended up needing a root canal. Fortunately, she found a dentist who would barter: the root canal in exchange for painting part of the interior of his home. The average cost of a root canal can range from $435 for an anterior tooth to $1090 for a molar. My friend spent three weekends painting her dentistís house.

Without any barter-able skills (Hey, fix my teeth and Iíll write you a poem!), I figured Iíd better step things up on the maintenance end. I called UNE, and made an appointment. Staff assistant Alan Conant, the man who answered, asked me if I had any history of heart murmur or rheumatic fever. No. Am I allergic to any antibiotics? Uh-uh. He informed me Iíd need to come in for a screening, at which point Iíd have to make a $20 down payment. My actual appointment plus the screening would cost somewhere between $20 and $60.

"Bargain?" I asked.

He didnít laugh.

So I went for my screening and booked an appointment. Another friend, it turned out, booked at the same time, so we drove out to the campus together. He didnít want to go, he said ó doesnít like metal stuff touching his teeth. The sounds, he went on. He most especially does not like the sound of metal scraping his teeth.

"Yeah," I said. "I guess most people donít."

Actually, my dental phobias arenít related to cleanings. Cleanings, I donít mind. My primary fear is that my wisdom teeth are so impacted an oral surgeon will have to chop off my head to remove them. My second fear is that I will someday bite into an apple or celery stalk and the cap on my front tooth will fall off. Cost aside ¾ and fixing either problem is dauntingly expensive; four years ago, I got an estimate of $1435 to have my wisdom teeth removed, and I donít even dare inquire about the cap ¾ I donít ever want to go under anesthesia. I likewise do not want my front toothís tender nerve exposed to the air, which is what happened when I broke it in the first place, doing the butterfly stroke in my community pool, eyes closed, no goggles. You know the rest.

At UNE, my hygienist-to-be told me her boyfriend had a cap on the same tooth, and it fell off when he was eating an ice-cream sandwich. My tongue instinctively moved to cover the tooth, protecting it from this distressing information.

The clinic at UNE is sort of like a set from the movie Brazil ó a bullpen style office, with 30 chairs in a single large room, facing this way and that. Smiling, white-jacketed students and teachers wander around with their goggles on. People of all ages and backgrounds lie in various stations, their mouths open, plaque being swabbed on their bibs, or sit upright, spit-sucking tube in hand, their cheeks bulging around Styrofoam molds filled with fluoride. Buzzing and schlurping sounds fill the air.

Once seated, I was in my own private Idaho, a little dental-care island. I was unperturbed by the other patients. My student practitioner was very friendly, as were all the people I encountered there. She checked my gums and my teeth, scraped off a bit of build-up, and, in between each step, explained what she was doing and why, which made me feel as if I were participating. When she wasnít looking, I caught some dust motes with the spit-sucking device. She was a little nervous about the polishing tool, and some tooth polish got in my hair. But other than that, things went quite smoothly.

All in all, a painless experience, and one that costs only $22. The instructor said my teeth are beautiful ¾ Iím in good shape, except for my capped front tooth. And itís a good thing, because trying to get restorative care (anything other than the preventive maintenance of regular cleanings, which I am now signed up for) is a bitch. There are very few resources for low-income folks like myself. And even people with a moderate income find paying for dental care challenging. A co-worker, who also happens to be a single mom, says she and her kid could both use a visit to the dentist, but lacking insurance, sheíll have to pay full cost. And even with insurance, finding a dentist who will accept your coverage can be challenging. In fact, just finding a dentist can be a problem, especially for people north of Cumberland and York counties.

The biggest problem facing Mainers who need access to dental-health care, says Nate Nickerson, Director of Public Health for the city of Portland, is one of simple arithmetic. Not enough dentists. When I tell Nickerson (with whom Iíd spoken a year previous about low-income access to medical health care) that Iím trying to find out how a girl can get her choppers fixed, he says, "Uh oh. Out of the frying pan, into the fire."

Mary Jude, Director of Development for Penobscot Community Health Center, which recently innovated a program called Miles of Smiles, has the same report: thereís a shortage on. In a state with no dental school, no residency program, and poor Medicaid reimbursement for dentists (the fourth lowest in the country) dentists ". . . donít feel they can easily accommodate people ¾ [they are] basically doing charity care [to take on low-income clients]. And most dentists settle in Southern Maine. Itís a little more comfortable than living on the edge of the frontier."

Miles of Smile is designed to service the frontier. Sponsored by Anthem Blue Cross/Blue Shield, Miles of Smiles is a mobile dental unit ¾ a tooth bus ¾ that services rural kids in Aroostook, Piscataquis, Northern Penobscot, and Somerset counties. A team made up of a dentist, a hygienist, an assistant, and a case manager help parents who qualify for MaineCare to get with the program. The program offers a sliding payment scale for families earning up to 200 percent of the Federal poverty level.

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Issue Date: March 5 - 11, 2004
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