Tuesday, November 17, 2009

The Teeth of Disadvantaged Folks

When I first started working some 3-11 shifts in a shelter somewhere around 1979, a major problem was how the women would get dental care. A few went to dental schools for major work, though I think that was very costly and can't imagine how they managed it. Most, I assume, just ignored whatever difficulties they had.

There were clinics in the men and women's sides where nurses took care of various, relatively simple, health problems and sent guests (the term used for people who were homeless) off to Boston City to see a specialist if necessary. But there was  no free dental care until Healthcare for the Homeless came in sometime after 1984. I could probably reconstruct just when this was because I had taken a year-leave-of-absence from teaching and was working as a co-ordinator in the women's clinic. Just as I left for an artist-in residency, for the summer, to very reluctantly go back to teaching in the fall, the Robert Wood Johnson sponsored a major healthcare initiative and Healthcare for the Homeless began to offer services in the shelter. In some ways that ultimately wasn't good for the nurses clinic where I'd been working -- the first nurses clinic in a shelter in the country -- because eventually it was taken over and a male doctor (add some shuddering in here) became the major figure instead of the more radical and egalitarian nurses, women and men. But, aside from that, many advantages came along including access to dental care.

Out at the track, once Jim Greene and Shirley Edwards started the 8th Pole to bring a Healthcare for the Homeless doctor and nurse to the backside two mornings a week, Shirley was able to set up regular Thursday morning dental visits. And that's been well used. One of my favorite people, a real old fashioned and pretty old groom, the kind who touches every part of the Thoroughbred in his charge every day to check for hot spots and other potential problems, was able to get teeth this summer so he can go back to Pennsylvania this winter and show off to his new lady. (She's only fifty and he lost quite a bit of weight last winter after he met her. Shows to go you!)

It's so common to see someone on the track who's missing front teeth, as if it's a marker. Maybe it's poor eating, maybe drugs, maybe carelessness.

I am missing teeth, also, but that fact has been covered up by a permanent bridge. And my teeth look like those of a poor person, crooked, mismatched, rather discolored, though I've put a great deal of money into them over the years. Many dentist visits. Any number of gold crowns. 

I see Lyn four times a year, my dental hygienist whose children are now grown up, whose son has finished with college and is still looking for a real job, whose her daughter is married with two children and working, and who herself is in an extremely happy, relatively new, second marriage. I suppose she's seen many changes in my life, but she has the opportunity to talk more, to tell me stories. 

For the last two sessions, she tried a new instrument that uses high-power water pressure. So that instrument, combined with something that numbs the gums, makes this teeth cleaning process fairly easy. And not that long ago, she worked seriously on my front gums in the hope that I will avoiding any dealings with the dreaded periodontist. 

This time she said, "Oh, the digital must be so much easier than when you had to develop the film." It seems to amuse her that I take photographs. And it amuses me, too. A good distraction. Last spring she said, "Is that the Lumix? We're thinking of getting that camera for our trip to the Galapagos. Do you like it? Can I see it?" They did get the camera and, the next time I saw her, she said she'd taken some video of the slow tortoises and was perfectly pleased with the clarity of the images.

I don't like dentists, because I'm afraid of Novocaine and have to take a quarter of a valium if I'm going to have it. (Then I'm embarrassed that I don't die from the injection and that it really doesn't even hurt. It's just anxiety, old anxiety from god knows how long ago that won't go away.) 

My former dentist retired a couple of years ago because he needed knee surgery, an operation that unfortunately didn't allow him to go back to bicycling or running, though he can walk pretty well. I'd seen him for years and, in that way that so often happens, a friend knew someone in the hospital community who knew that he'd had jaw or mouth cancer (I forget which) when I first started seeing him. But I've watched him grow old in quite good health. Just this last glitch. His wife was a photographer and I'd comment about her experimental work that was displayed in the office. (My eye doctor is a photographer and seeing him involves making comments about all his precise images, too.)

I've been privileged to have had Lyn, a good dentist, good dental care, the aid of Valium, and now have an insurance plan that pays a tiny bit of the astronomical cost of dental care. And my teeth still look awful.

But I am totally privileged compared to so many people who have less money to spend on this type of care, don't have dental insurance or don't have any access to dental care.

My father, when he got old, had the teeth of a jack-o-lantern, horrible, discolored teeth. He'd vowed never to darken the door of a dentist's office and didn't. He was stubborn. I imagine that my teeth will look as ghastly if I get to be eighty-nine, but hopefully I won't have his bad attitude. Teeth are just another damn part of the general maintenance that we have to be diligent about. Alas. 

What's really interesting is that after I wrote this I read the Tuesday Science NY Times section and Jane Brody had an article in implants (I didn't read it) and next to it was an article about the First Mention of Fluoride, 1931 (before I was born) and when it was recognized for use in the water supply, 1951 (I was twelve.) I think that Fluoride has probably made a significant difference to the health of teeth, though I have no idea what else it might have done that might not be as beneficial. 

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