00000184-2ffc-d624-afed-bfffdf3a0000A new dental-care program for the poor is more than cosmetic. It’s a vital key in preventive health care
Jeffery Engle was working in animal control for Carson City in 2009 when he was diagnosed with diabetes. He started having trouble with his vision, and he had no energy. He couldn’t keep up with the position, so he moved to Las Vegas where he took a job working security.
After he was diagnosed, Engle’s teeth started breaking off in little pieces. In the ensuing years, he’d lose a piece here, a whole tooth there. Everyone’s had those nightmares where all their teeth fall out. Living it has to be a horror. By 2013, he was down to four teeth. He took a job working graveyard and started growing out his mustache so no one would have to see the state of his mouth.
“It’s embarrassing,” the 51-year-old says. “I got divorced five years ago and I haven’t dated in the last five years due to my teeth. It’s embarrassing having people thinking maybe you’re on meth. I haven’t taken drugs or anything in my life. It got to the point where it was really embarrassing just to talk to anybody.”
He was making too much money to qualify for Medicaid, but not enough to afford private insurance. It was a grind just to pay for insulin and blood pressure medication, all while his mouth was in constant pain and he was drained from fighting off infections.
Engle’s niece, a former registered nurse, suggested he apply to be a patient at Volunteers in Medicine of Southern Nevada. The clinic is open to people whose household income is less than 200 percent of the federal poverty level (currently, that means $23,760 for one-person households, scaling up according to the number of people under one roof) and have no private or public health insurance.
At a $9-an-hour job, Engle fit the bill. He joined up two and a half years ago, and was eligible for medical services and prescriptions at the Paradise Park Clinic on Harrison Drive. But that still didn’t help out the situation with his teeth.
After Volunteers in Medicine added a second location, the Ruffin Family Clinic on Martin Luther King Jr. Boulevard, in September, though, comprehensive care became possible. The clinic expanded to offer dental services in April, and the clinic is going so far as to integrate social and behavioral services by the end of the year.
Engle was tapped to participate in the new dental program, but he wasn’t prepared for the degree of care he was going to receive. Dentists at the clinic pulled his remaining teeth (which he called a relief, even making eating easier) and are in the process of doing a full restoration, providing him with implant-supported dentures.
“When they first told me about it, I thought maybe they were going to check out my teeth or clean the few broken teeth I had left,” he said. “I had no idea until I went in there. I started crying. I didn’t think this would ever happen at this point in my life. I thought the rest of my life would be spent as a toothless old man."
The program currently has six local dentists who volunteer, headed by Dr. Lydia Wyatt, who has been practicing dentistry in Las Vegas since 2004. The clinic also involves students from Roseman University and UNLV’s School of Dental Medicine where up-and-coming dentists can learn in a real-world setting.
Open wide
The Ruffin Family Clinic is a bright and winding complex that houses new equipment, an on-site pharmacy, multiple examination rooms, and now a four-room suite for dental exams, including X-rays. More than 5,300 appointments were given to patients in 2015, and that number is expected to top 6,500 this year, including dental appointments.
It’s all in the service of providing comprehensive care, including mental health services, to underserved patients. Those types of patients can often encompass recent immigrants who wouldn’t yet qualify for Medicaid; those who are disabled who are receiving disability income but haven’t become eligible for Medicare, which typically takes two years to kick in; patients who didn’t pay into the Medicare system earlier in life; and the working poor.
Those types of people may already be suffering from ailments that are exacerbated by an inability to do things like eat a proper diet. As the clinic’s medical director Dr. Rebecca Edgeworth puts it, “When their teeth are rotting out of their mouth, I will never be able to fix their diabetes.”
There’s a growing body of research that confirms that oral health is a vital component of overall health. The clinic offers a broad swath of services, but once things escalate to the level of surgery, cancer or other major maladies, there’s a point where it goes beyond the scope. The hope is that by providing comprehensive, preventive care, it doesn’t get that far.
“Health begins in the mouth,” Wyatt says. “Anything that’s going on in the body taxes your system to cure it. If you have periodontal disease, your body is constantly trying to get rid of that infection. Your body is trying to heal it. That motor never gets turned off to rest. It’s taxing, much like cardiovascular disease. Your blood cells carry these antibodies in it and it makes the blood cells thick and heavy. It makes your arteries have to push and work hard to get that thick blood through the whole system. That makes your heart work harder. Some of the bacteria that live in our mouth we now know have high associations with ulcers, with colon cancers. Recently, within the last year, there’s been a huge correlation with Alzheimer’s disease. It’s complete care, and dentistry has to be part of it to be successful.”
Engle had molds of his mouth taken July 8. Once he gets his temporary dentures and strengthens his jaw, he’ll be able to get posts placed so he can snap the implant-supported ones into place in his mouth, and live with a fully restored set of teeth. If he doesn’t want to stay there, that means he can start taking jobs that aren’t on the night shift. He can live in the daylight again.
“They’re the greatest bunch of people,” he said of the clinic’s staff. “They sit and listen to you. They seem to really care, be concerned about everybody. I’ve never had a bad experience there. It’s always been really positive.”