Forty-year-old Curtis Cole didn’t always have terrible teeth.
When Cole was 28, he was in a serious car crash while riding in the passenger seat. He said a friend was driving on Salmon Falls Road in Rochester.
“There’s still a dent in the tree where he hit,” Cole said. “The car hit a tree, going (fast), and I went through the windshield. It cracked pretty much all of my teeth and did damage to the gums around them. The day was April 20, and it was my wife Christina and my anniversary.”
There was no money for the dental care Cole needed.
“So, I let it go and my teeth kept getting worse and worse,” said Cole, who is now a stay-at-home dad who takes care of his 2-year-old daughter, Mariah. “Eight months ago, I was in another accident, and I was hit squarely in the mouth. The pain was excruciating. I have Medicaid and my wife works and does have insurance, but we cannot afford to add me. Dental costs are not covered anyway and we could not afford it.”
For many people, basic dental care is simply out of reach.
Special insurance riders are needed before dentist visits will be covered by Medicaid. Many people can’t afford the cost, or have no health insurance at all. Medicaid, intended to help people without sufficient means, only carries a dental benefit for children, not for adults. Even many people who have dental insurance through their jobs can’t afford to pay the portion they must out of pocket for expensive procedures such as braces, implants and crowns.
Brittney Ward, a general dentist at Core services for Exeter Hospital, said a ballpark cost for services for people without insurance is likely in the area of $6,000.
“If surgical removal of the teeth are needed, it could be about $300 per tooth, depending on the dentist’s fees,” Ward said. “Then dentures could run $1,300 to $2,000 each for upper and lower dentures.
As a result, adults can be left with no access to a dentist. Many suffer through severe tooth pain, gum disease and worse.
Serious oral disease can lead to other health problems, and can even cause death from untreated infected tooth and gum diseases.
“It can lead to abscesses that can spread from the mouth into the neck and head,” Ward said. “People have died from untreated infections that turned septic,”
The ultimate answer for Cole, a Rochester resident, is to have all his teeth removed, and to be fitted for dentures. Dentists have told him his teeth cannot be saved. He is praying to find a way to make that happen. Cole thought he had found a solution when he went to a mobile van operated by Greater Seacoast Community Health.
After the use of antibiotics, Cole said, he was finally free from infection and had three of his worst teeth pulled. He asked to have all his teeth pulled and said he has no real answer why they only pulled three.
“Now my tongue sticks through when I sleep,” he said. “But I am able to get some much-needed sleep. I have to thank the ladies at (Goodwin Community Health, which is part of Greater Seacoast Community Health) and the people of the mobile bus who got me started. I feel 100% better just for what has been done. With Medicaid, I know my only option is to fight with them, and to wait in line wherever I can. So, that’s what I’ll do.”
Cole said he planned to sit down with the medical staff at Goodwin and see if they can help him make a plan. He said no matter how long it takes, he wants to keep moving forward.
“At first they told me not to become a regular patient because it would be easier for me,” Cole said. “Now I might have to do that instead because they don’t have the means to keep doing the extra dental work they were doing for people like me. I had dental students working on me. I asked if they could have the students take out all of my teeth and we could figure things out from there. I am willing to do this however they can, no matter what it is or how long it takes. Teeth are probably the most important things. I know your eyes, ears and other things are important, but teeth can really mess up all of that. You get infected like I did, you can die. The Goodwin people told me that.”
Cole said he will keep in contact with Goodwin Community Health and the mobile van staff. He said they are trying to help him apply for any grants or other funding for the dental work he needs.
“I feel so much better,” he said. “I can stand and bend over with no sharp pains. It’s a start. The infection was so bad there was swelling and at times I was delirious. I would sit on the edge of my bed and cry because I could not sleep. I could not even talk without pain. I was living on oatmeal and Jello.”
Without a way to continue services right now, Cole is in trouble again.
“My other teeth are getting worse,” he said. “I told them when I asked to pull them all that the rest of teeth would continue to get worse. I can’t really eat again. For Thanksgiving dinner, I ate cranberry sauce, stuffing and a roll, soft stuff.”
“Besides the pain, it would change my life to get this fixed,” he said. “People look at you differently when you have bad teeth. Plus, it would be great to be able to sleep again, to eat what I want, to be free of pain.”
Cole was going to Goodwin at a specified time when dental work was offered on a first-come, first-served basis for uninsured patients. That practice is no longer available. He said he is trying to reach them and has contacted another dentist to see if they can help.
Why Cole was cut off dental services
Margie Wachtel, a spokesperson for Greater Seacoast Community Health, explained.
“Until recently, the dental centers at Families First in Portsmouth and Goodwin Community Health in Somersworth provided services on a standby basis to members of the public who were experiencing dental emergencies, including many referred from hospital emergency departments,” she said. “Now, because of the staffing shortage that is affecting health care and other industries nationwide, the centers are providing emergency dental care only to their established primary-care, prenatal and dental patients.”
Greater Seacoast Community Health leaders hope that will change.
“We plan to resume emergency services for the public when staffing levels allow,” said Whitney Goode, DMD, chief dental officer at the two centers. “We know there is a big need and few local resources to meet it. Meanwhile, people can gain access to dental care by becoming a primary-care patient at one of the health centers (Goodwin or Families First).”
Information on how to become a primary-care patient can be found at getcommunityhealth.org/patient-info. The organization also provides mobile dental services two mornings each month at the St. Vincent de Paul Society in Exeter. Find details at familiesfirstseacoast.org/dental-care/mobile-dental-services.
The dangers of letting dental care get out of hand
Ward, the dentist at Core services for Exeter Hospital, said there are many health problems associated with poor dental care.
“Tooth decay, periodontal disease and oral cancer are the most common mouth related issues,” she said. “People think decay is caused by sugar but that’s too simple an answer. There is a high rate of decay associated with diet. Sports drinks and juices are a big culprit. Crackers, sugary coffees, gummies and raisins are as bad as sugary candy. Decay is a breakdown of tooth enamel by acids that are introduced through food and drink and are taken up by bacteria.”
Ward said untreated decay will lead to infection. Periodontal disease comes from infection of the gums and bone around the teeth.
“Chronic conditions like diabetes are more likely to have bad outcomes with infected teeth, because it makes it harder to control blood sugars,” Ward said. “People with weakened immune systems will be impacted. Heart conditions are harder to control. Infections from teeth can travel through the blood system.”
Ward said the danger of oral cancer is higher for people who smoke or who use alcohol excessively.
Since good dental care contributes to overall health, Ward said it should be covered by insurance. Unfortunately, it is not.
“It is completely unlike any other type of medical emergency,” Ward said. ‘Insurance dictates care and while that is not how it should be, that’s how it is.”
Legislative effort to add adult dental benefits to Medicaid
New Hampshire state Sen. Cindy Rosenwald, D-Nashua, has been working for years to add dental care for adults to Medicaid coverage. Bills failed to move forward twice and she is currently working on a new bill, one she says she has managed to get numerous members of the state legislature to sign on to as sponsors, and she hopes to introduce it again in 2022.
Rosenwald’s bill would establish an adult dental benefit under the state Medicaid program. She is the prime sponsor and said she already has the support of a bipartisan group making up the majority of the 24-member state Senate.
Rosenwald said she also has bipartisan supporters in the House.
“Two years ago, we passed this (House Bill 250), but Governor Sununu vetoed it,” Rosenwald said. “My bill was (Senate Bill 754), tabled in favor of the House bill. Last year, it passed the Senate health and finance committees, but didn’t get taken up by the House. They refused to put it in the budget conference list.”
Sununu stated in his July 2020 veto message he supported the adult dental benefit “in concept” but he could not support an $11 million expense from the state’s general fund. He called for funding the benefit in a “cost-effective” manner. Ben Vihstadt, spokesperson for Sununu, said his position remains the same.
Rosenwald said Medicaid includes a dental rider for children, but not for adults, which she said makes no sense.
“There is an emergency clause only,” she said. “There is nothing for cleaning, X-rays or general care. There is a small piece for prosthetics, but only if it is deemed medically necessary. Do you know the percentage of New Hampshire dentists who participate in charitable care? Fourteen percent only.”
“There’s a lot of interest in helping, but it’s not free for anyone,” she said. “We need to find a way to make the reimbursement rate high enough to make it worthwhile, to make dentists see the value. I believe they want to do good. They simply cannot afford it at the current rates.”
Rosenwald said she and other supporters of the legislation think adding dental care to Medicaid would improve peoples’ overall health, and even their employability.
“I personally believe that if you are not missing a mouthful of teeth, you can get a better job,” she said. “If you do, you can eventually leave Medicaid for employee insurance. So, there is a definite cost savings to the Medicaid program possible there.”
How to find dental resources
New Hampshire Dental Society: nhds.org/for-the-public/low-cost-dental-care
Greater Seacoast Community Health: healthgrades.com/group-directory/nh-new-hampshire/somersworth/greater-seacoast-community-health-oy57jxr
U.S. Dental Services: usdentalservice.com