Spokane7
65°
April 2, 2011 in City
Cuts in dental care painful for patients
Employment prospects, overall health threatened by lack of access
Edison Gaviria tells dentist Mostafa Kabbani of his tooth pain at Grins & Giggles Family Dentistry last month in Spokane Valley.
(Full-size photo)
Ivory Hendry finally called the dentist. An excruciating toothache made her do it.
She hadn’t eaten for a week, struggled to sleep and became ill when taking medicine on an empty stomach.
She had visited Providence Holy Family Hospital’s emergency room three times already, crying for relief, and each time she was offered a temporary dose of mercy: painkillers and antibiotics to treat the abscessed tooth, and a list of dentists who would treat someone like her – poor, jobless and desperate.
“People like me, are we just supposed to live with rotting teeth?” she asked. “I don’t get that. I’m not a number; I’m a human being who needs help.”
Perhaps, but these days Hendry is a statistic.
She is uninsured. She is a debt problem for local hospitals. And she is among the throngs in Spokane with teeth problems.
Last week a low-cost dentist, Dr. Mostafa Kabbani, pulled the troublesome molar that had swollen Hendry’s face.
Gum disease linked to illness
While relieving pain is serious, stopping infection is a deeper public health concern. Study after study links tooth infections and gum disease to major health problems such as heart disease and diabetes.
Two years ago a New York University study found that 90 percent of people with gum disease are at risk for diabetes. The study also concluded that at least half of those at risk – many of whom are poor – could be screened in dental offices.
And yet dentists aren’t a major factor in health reform efforts. The vast majority do not sign Medicaid contracts with the state, opting to donate time and equipment to help treat the poor rather than incorporate them into their business model.
It’s a scenario that has helped dentists escape the below-cost reimbursement dilemma of their medical peers in physician clinics.
“Dentistry is the last bastion of free enterprise in American medicine,” said Dr. Ronald Inge, dental director of Washington Dental Insurance.
Dr. Blake McKinley, president of the Spokane District Dental Society, is relieved that dentistry was not a part of the federal health reform.
He isn’t a fan of the law, believing that it may be unconstitutional. But he also dislikes anything that comes between health care providers and patients.
“Any time you get government or insurers involved in the decision-making about what’s best for your health care, it’s not a good thing,” McKinley said. “As time goes on, the relationship will become diluted.”
Vastly improving this region’s oral health, however, is within government’s reach – by fluoridating the water supply, he said.
“Until we get decision-makers willing to listen to the facts and act upon them … we’re stuck,” McKinley said. “It’s unfortunate.”
The lack of water fluoridation is regarded as one of the region’s greatest setbacks to public health. Dentists and most health officials believe some of the region’s abysmal oral health statistics could be improved by adding trace amounts of fluoride to the municipal water system, as is done in other major cities. But Spokane voters have rejected previous attempts to do so.
“We’re talking about an ability to reduce the decay rate in teeth by 60 percent,” McKinley said.
Now, Washington state has eliminated Medicaid dental coverage for more than 460,000 eligible adults as part of deep budget cuts. Children can still receive care.
Job prospects dim
Good teeth, besides being an important part of overall health, are also key to economic health: job prospects are grim for those with missing or rotted teeth.
“It’s almost impossible to find work,” said Nina Kindam, a social worker at Health for All, a division of Community Minded Enterprises in Spokane. “We have got to find a way to help.”
It’s especially important now that dentures are no longer covered by the state, she said.
Take Robert Knox. He has worked his entire life, but found himself down on his luck in the last few years with a mouth full of broken and decaying teeth. He had them pulled and was then told Medicaid wouldn’t pay for dentures.
Embarrassed about how he looked, he resorted to begging for help from the Catholic Church.
“They helped me,” Knox said. “I’m not sure what else I could have done.”
Knox is back to building wooden pallets.
“I was really worried,” he said. “A lot of people won’t do business with you if you don’t look a certain way.”
Said Kindam, “We need to get people’s teeth fixed so they can be employable.”
Patients turn to ERs
Hospital emergency rooms are busy with people in dental crisis. Case numbers have more than doubled in the past five years, taxing hospitals with unpaid bills and few treatment options.
Every day about 20 people with dental emergencies visit Holy Family seeking help, said Robin Arnold, an emergency room manager.
And yet there are some grass-roots efforts to treat the poor, with more planned.
Kabbani’s office opened last year in the basement of the Spokane Valley Partners building along East Broadway Avenue, offering a 50 percent fee discount and evening and weekend appointments to accommodate work schedules.
The low-cost care is a big deal for people like Edison Gaviria.
During a stressful moment studying for college finals earlier this month, Gaviria bit into a pencil and cracked a tooth.
The 26-year-old works at a day care while going to community college.
“My dream, my goal, is to be a physical therapist,” he said. “I am good with people and I want to help others.”
He is fit and driven, but as a student, every dollar counts. Without insurance he can either pay hundreds of dollars to have his tooth fixed or risk an infection and then a likely extraction.
Kabbani said many of his uninsured and former Medicaid patients are in similar straits.
“Many of them want to pay,” he said. “But dental care is expensive.”
He is able to offer discounted care by continuing to treat children who are still covered by Medicaid, treating insured patients and providing emergency care to adults, he said.
He has plans to open part-time clinics in the East Central Community Center by the summer and then offer hours at West Central Community Center by the end of the year.
The Yakima Valley Farmworkers also is opening a large clinic for the poor in the Northeast Community Center that will draw upon dentist volunteers.
For some time, many people without dental insurance have relied on the Community Health Association of Spokane. The CHAS clinics, however, have been hit hard by budget cuts.
“It’s difficult,” said Dr. Melissa Rehling, dental director for CHAS, “because we’ve learned that you can’t really separate the body from the mouth.”
Parishes giving $1.5 million toward settling sex cases 
dataxman on April 02 at 5:55 a.m.
What was the cost of three trips to the emergency room? What was the cost of extracting the tooth? Exactly how are we gong to get a handle on medical costs when we have people Ivory Hendry making ignorant decisions like this - decisions that cost the rest of society billions a year in wasted medical dollars
dukkandpooh on April 02 at 6:59 a.m.
I have nothing but sympathy for these folks. I’ve been there. I have great insurance now, but it’s a helpless feeling to be without it and be in agony.
njhollingsworth on April 02 at 7:12 a.m.
dataxman: you are heartless. probably the same type that believes in Supply-side economics and the tea party. tax the rich…share with the poor
Lulubelle on April 02 at 7:47 a.m.
Dr.McKinley says he isn’t a fan of health care reform and is glad dental care isn’t included because he believes it may be unconstitutional but he also “dislikes anything that comes between health care providers and patients”
Uh-huh……….we’re buying that one. Dr Mckinley dislikes anything that comes between his pocketbook and the fees he charges patients and their for profit insurance companies.
Ninch on April 02 at 8:20 a.m.
The story confused me because in those three emergency room visits, Hendry was given “a list of dentists who would treat someone like her – poor, jobless and desperate.” Why did she wait even one day? Then a college student cracks his tooth on a pencil and every dollar counts… yet one can get additional “financial aid” for medical circumstances. Why not apply? My favorite is “gum disease” which anyone of any income level can get and treat… which requires not so much money but rather knowledge and diligence in oral care. And fluoride does not prevent gum disease.
Lack of dental “insurance” is not the real problem, but rather access to dental services. Even if one had Medicaid it is difficult finding a dentist who accepts such a program with their low reimbursements. Luckily my local community clinic has a program that allows uninsured persons to pay according to their means… which is a workable market place solution.
Ninch on April 02 at 8:27 a.m.
BTW: Lulubelle… nothing wrong with for-profit insurance companies or dentists…. or keeping the bureaucrats out of our personal decisions, especially in health care. Government providing safety nets for the most needy is accepted by most, but when the government takes over a program, there are no more choices for anyone.
opiemuyo on April 02 at 9:01 a.m.
So If I make poor lifestyle choices I may not get a job, which in turn I earn no insurance, and I will suffer because of it.
I think I will have my teenager who is failing her classes read this article. Make proper choices, my child or this may happen. Then you work hard, stay out of trouble , get a good job, and then the hippie have nots want to penalize you for doing the right thing, and take away your hard earned reward.
dataxman on April 02 at 9:54 a.m.
njhollingsworth - the rich are taxed and it is shared with the poor now. You know the expression - you can lead a horse to water…
This woman is that horse. Unless you are willing to fund a program to follow the stupid around making sure they make proper choices, then we will always have people that waste money going to a doctor instead of a dentist.
nitro71 on April 02 at 10:49 a.m.
A lot of people in Spokane need to start making hard decisions about their own health. Do I buy drugs and liquor or take care my health and kids? Do I brush and floss daily because I know I don’t have dental care or do I not take care my teeth?
hunternomore on April 02 at 11:21 a.m.
So funny—comments. As to no_bs, what will happen when there are no more POOR to tax? Remember France? It could happen here.
cryssT on April 02 at 11:33 a.m.
The median expected salary for a typical Dentist in the United States is $133,039. http://www1.salary.com/Dentist-Salary.html
The median expected salary for a typical Dental Hygienist in the United States is $61,686.
And then there are Dental Surgeons, since most Dentist no longer pull teeth.
So why can’t the hospitals have a Dentist or Dental Surgeon on call to pull the tooth then and there. If you haven’t lost teeth don’t be glib about why people wait and wait to get their teeth pulled. Dentures help with chewing but really aren’t the same as teeth.
Bruce (aka thatoneguy) on April 02 at 11:57 a.m.
My dentist’s assistant went to school in Seattle but told me that they send people over here to get hands-on training because people’s teeth in western WA are so much better than over here. They can’t find enough patients over there for the students to practice on, so they send them here where there is plenty of tooth decay, gum disease etc. (I couldn’t ask her why she thought that was. My mouth was full.)
crazyivan44 on April 02 at 12:38 p.m.
It is obvious that Mr. Stucke has an agenda from the way the first few paragraphs are phrased, they are not objectively written in any sense. I agree with above comments about not taking advantage of the programs offered. It sounds like it isn’t what they wanted so someone has to speak out about how horribly unfair things are, oh my!
There are public programs, there are churches, there are non-profits. What is lacking is the personal accountability for many to actually humble themselves and use these services. Maybe life dealt you a bad hand, but that it is not the responsibility of anyone else to help you out. To do so is out of the goodness of their hearts, and there are resources available that WILL help.
leekinny on April 02 at 2:26 p.m.
People do have, however they vision it, a responsibility for themselves, family, community, country and God, as they see God, but for a variety of reasons both legitimate and illegitimate within ones control and outside of it, these responsibilities may become compromised. The conservative Republican mantra of ‘individual responsibility’ is designed to absolve oneself of any responsibility except for those so conveniently cherry-picked while easily lowering the dignity and humanity of those in need.
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Political use of the term ‘Individual responsibility’ means everyone else’s responsibility but mine. It’s an ideological principal embraced by modern conservatives that is designed to protect the conscience of the individual or group from social or religious liability. It’s used to absolve one from long held Judeo-Christian principles such as, ‘by the grace of God go I’ and ‘to those who have been given much, much is expected’. It implies that the gifts from God which we all possess in one form or another have been distributed in equal measure with similar qualities. It’s been used as an excuse from responsibility from everything from the homeless addict to the poor and those with mental and physical illnesses, to such extremes as victims of natural disaster. They believe that families and churches should be the sole suppliers of aid to those in need and never the government.
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We work best when we pitch in as a nation to solve these problems together. That way the areas of our nation of large areas of poverty are able to be helped. The radical conservative way would only mean a lot sicker under nourished people many of whom will end up on the street. I suppose the conservatives would just end up passing laws to outlaw the poor homeless then put them in a jail-type setting so they are no longer visible. If they are not visible they will be able to claim success. Remember the truth doesn’t matter to this current bunch of conservatives. All that matters is creating a perception of success to placate their supporters and those under their thumb.
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We can do much better as a society in taking care of the most vulnerable among us. It’s a sinful crime the way the conservative Republican right would have the poor, sick and disabled of this nation treated. It’s shameful. The safety net is full of holes and requires better stewardship from our nation’s leaders.
The temptation to give into rationalizing away someone’s humanity is often great but it’s also always wrong; always sinful.
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dukkandpooh on April 02 at 2:56 p.m.
Well said, leekinny.
“He who is kind to the poor lends to the LORD,
and he will reward him for what he has done.”
Proverbs 19:17
Bruce (aka thatoneguy) on April 02 at 5:21 p.m.
Thank you, leekinny.
misjustice on April 02 at 6:25 p.m.
@ leekinny, great post!
maria on April 02 at 7:27 p.m.
thatoneguy: Skoal brother, Skoal.
MsJ, did you get my message? Ferkin’ rain is coming for Sunday. : (
crazyivan44 on April 02 at 8:30 p.m.
leekinny, do you really think that because some of us write on here that government should be limited that we do not personally go out of our way, and encourage family, friends and strangers, to go out of their way to personally help people in need? Do you really think that because we expect personal accountability from everyone that we sit here with a “sucks to be you” attitude and only care about our bank accounts? Can you point to a single instance in the Bible where Jesus does not hold people accountable for their actions? Can you point to a single instance where He called upon the government to provide everything for folks? He healed the weak and the sick personally, and he called upon His followers, not their government, to come to each other’s needs.
Can you point to where I said “haha too bad for you” anywhere in my post? Can you point to where I said nobody should help this person? The verse quoted by dukkandpooh is right on, and it refers to the individual and the body of individuals, not a government entity. I in fact personally give much of my time to helping those sick and in need on a continuous basis because I believe it is the right thing to do and I gain satisfaction knowing that I can help others, and I firmly believe that we have a social and cultural issue the needs to be fixed to encourage others to do the same, not simply make it a government object to burden everyone’s lives with bureaucratic nonsense that squanders money trying to “help” when we can, and should willingly, care for our neighbors ourselves. It seems to me the only thing convenient is casting this burden off to government in the first place.
“Individual responsibility” to me means if you don’t want to help yourself then there is nothing on this world that can help you. You can’t make the horse drink and you can’t teach someone to fish if they don’t care and/or don’t have the desire. If someone adamantly does not want to help themselves, and someone else in need does, and you focus your energy on the individual that refuses to help themselves then you have two people that you have failed to help instead of one. I don’t really see how this is a political issue.
Dazzeetrader11 on April 02 at 8:35 p.m.
Go read your dental policy. It’s got a huge deductable.
You’ll pay for your dental care if you have insurance or not.
People do need to brush, rinse and watch what they eat. Personal responisblity des matter. I’d bet that the medicaid, indigent types have much beeter access that most of the insured do.
We pay for those lil mongers teeth and pay for their kids’ teeth too. You pay cash. I do too. I have any hope of dental insurance up 5 years ago when I discovered policies cover very little but soak up lots of payments. Now, I write checks as needed. No way out of it. Unless you’re on a welfare program, you have to take care of yourself.
ChefGus/ John Olsen on April 02 at 8:36 p.m.
Thank you LeeKinny
Ivory Hendry on April 04 at 4:54 p.m.
wow.. i deffenately don’t recall saying i was poor & desperate..
my words were totally miss read…it’s easy to say things like
“she should spend her money on her health instead of drugs & alcohol as
nitro71 so boldly put it “.. well how about this.. not everyone is a drug addict..
i didn’t wan’t anyones pitty or anything i was just saying that it was nice that they had a low income dentist..
i feel i was just delt a hard hand in life..but honestly i keep my faith no matter what & i don’t just sit around doing nothing
.. my son is almost 1 and i am trying everything i can so that he won’t ever have to go thru what i have..
all this article was supposed to be about was the low income dentist clinic .. not a pitty fest for a poor girl
.. to give a voice to those who are to shy to say anything for themselves..
PLEASE KEEP IN MIND WHEN YOU RIGHT YOUR HARSH COMMENTS ..WE ARE HUMAN BEINGS .. BE CONSIDERATE ..
i went to the dentist & Mr. Stucke was there so he interviewed me .. it’s not like i went looking for it !!
<3 With faith in god all things are possible <3