Battle to improve oral health in Appalachia faces many cultural, economic, governmental obstacles

From southeastern Kentucky, Ian Urbina of The New York Times writes of the poor oral health of Central Appalachians -- "everyday people who are too busy putting food on the table to worry about oral hygiene. Many of them savor their sweets, drink well water without fluoride and long ago started ruining their teeth by chewing tobacco and smoking."

The story also blames "inadequate access to dental care or the inability to pay for a dentist," and notes that less than a fourth of Kentucky's dentists accept clients of the Medicaid program for the poor and disabled, partly because the reimbursement rates for adults and children, respectively, are 65 and 50 percent below market rates. Urbina also cites "widespread use of chewing tobacco and a pervasive assumption that losing teeth is simply part of growing old. West Virginia, for example, which has the highest proportion of people over 65 without teeth, also has one of the lowest percentages of adults who visit the dentist at least once a year."

Dr. Edwin Smith of Barbourville, Ky., "is trying to catch these problems before they progress," Urbina reports. "Each week, he drives his mobile clinic, Kids First Dental Care, up the windy Appalachian roads to visit schools and to provide free check-ups to children in the poorest counties of Kentucky. Dr. Smith paid about $150,000 of his own money to build the mobile clinic inside an 18-wheel truck. The clinic has a staff of seven and operates with private and Medicaid financing."

Urbina relates some of Smith's horror stories, which include tooth-eroding methamphetamine, "the shame of a 14-year-old girl who would not lift her head because she had lost most of her teeth from malnutrition, and the do-it-yourself pride of an elderly mountain man who, unable to afford a dentist, pulled his own infected teeth with a pair of pliers. He has seen the brutal result of angry husbands hitting their wives and the end game of pill-poppers who crack healthy teeth, one by one, to get dentists to prescribe pain medications."

Medicaid doesn't pay for root canals and dentures, so people who lose all or prominent teeth find it hard to overcome the economic disadvantages that may have contributed to their problems in the first place. "Try finding work when you’re in your 30s or 40s and you’re missing front teeth,” Jane Stephenson, founder of the New Opportunity School in Berea, which provides job training to low-income Appalachian women and helps them buy dentures, told Urbina. "She said about half of the women who go through the program, most in their 40s, were missing teeth or had ones that were infected. As a result, she said, they are shunned by employers, ashamed to go back to school and to be around younger peers and often miss work because of pain or complications of the infections." (Read more)