Missing Teeth

Dental Care for the Homeless

originally published October 18, 2006

As night temperatures began to drop, a homeless person who identified himself as Howard could no longer ignore the nagging pain in his right jaw.

“It has just gotten to a real sensitive place where it really hurts,” he said, as he lay on an examining table at the Athens Nurses Clinic, waiting for an oral anesthetic to take its full effect. “This weekend the toothache got real bad. As the weather gets cooler, it gets really bad.”

Lucky for Howard - who, like thousands of area residents, doesn’t have the resources to pay for health care, let alone dental care - the Athens Nurses Clinic offers a limited amount of free dental services four times a month. Minutes later, Howard had his tooth extracted, leaving him four teeth short of a full set.

“I’m so thankful for a place like this,” Howard said, referring to the clinic located at 496 Reese St. just west of downtown. “A lot of people are having dental problems and they have no place to go. We need a lot more of these places.”

Howard’s sentiments are not isolated. A 2006 survey commissioned by the Athens-Clarke County Department of Human and Economic Development found that dental assistance was the service the city’s 475 homeless people wanted the most, but least expected to get. “Dental care is a huge need,” says Courtney Davis, Executive Director of the Athens Area Homeless Shelter. “Our clients traditionally have not had dental care for the bulk of their lives. It’s so low on their priority list. There’s more pressing needs, like food and shelter. Dental health really falls by the wayside.”

Because dental service is often not considered a “pressing need,” poor people are more likely to suffer from gum disease and other problems that spell trouble for their teeth. “Their general health is typically not as good,” says Dr. Jim Morang, a retired dentist who volunteers each month at the Athens Nurses Clinic to perform extractions. “That includes their dental health. They don’t brush, don’t eat well, and don’t have a regular dentist or oral hygienist.”

In addition, Morang says people on the street are more likely to use tooth-destroying illicit drugs such as methamphetamine, which, according to an American Dental Association report, leads to teeth that are “blackened, stained, rotting, crumbling or falling apart.” Says Morang, “It can wipe out the whole mouth.”

Morang spends two Fridays each month volunteering his services at the clinic. He starts early, sees as many as 20 patients each day, and says he stays “until all patients are treated.” Another dentist, Dr. Doug Cleveland, comes to the clinic twice a month and provides other services in addition to extractions. The clinic served 2,431 patients between January and August of 2006, with 321 patients receiving dental care.

Another facility offering free dental care is Mercy Health Center, located on Park Avenue near Athens Regional Medical Center. While the Athens Nurses Clinic provides walk-in services, Mercy only treats patients who make appointments. Each Tuesday afternoon, the center accepts phone calls to schedule appointments. “We get several calls each week about dental care,” says Director Tracy Thompson. “Our waiting list for dental care is never less than 100 patients.”

Like the Athens Nurses Clinic, Mercy relies on the pro bono services of area dentists. Athens oral surgeon Dr. Stanley Satterfield, who serves as Mercy’s dental director, is one of 23 area dentists who will volunteer at least one day at the clinic this year. Several other area dentists chip in with money or equipment. So far, the center has provided 256 patients with dental care in 2006, but the need far exceeds demand. “Our six upcoming dental clinics are all packed,” Thompson says. “There are very few places that offer free dental care.”

For those fortunate enough to receive services, it is often too late. “Our goal is always to save the tooth,” says Deb Williams, nurse manager of the Athens Nurses Clinic. “But by the time they come in due to severe pain, the tooth is beyond repair and the only recourse is extraction.”

In addition to making chewing more difficult, lost teeth make it considerably harder to break out of poverty. “Clients mention to me how self-conscious they are about teeth,” says Davis, who runs a job-training program at the homeless shelter. “They’re very, very, very self-conscious about the way they present themselves to potential employers.”

And while Davis would like to believe this wouldn’t dissuade a potential employer from hiring someone, “appearance is clearly an issue,” she says. “There’s a stereotype about poor people not having teeth. It sends a signal to potential employers that they may be poor.”

For preventative care, Williams says low-cost cleanings are sometimes available from students in the Athens Tech dental hygiene program. However, patients will have to find transportation to the school, located north of town on Highway 29. Regular brushing and flossing also help people hang onto their teeth, but homeless people often have other concerns.

“If you have five dollars and must decide between a toothbrush and toothpaste or transportation or food,” Williams says, “your teeth will likely not be your top priority.”

Joe Dennis

joe.dennis@yahoo.com