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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

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. (Dan Pelle)

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.”