Willie Freeman says he used to avoid smiling, and if he did, it was in a way almost no one could see, with his mouth closed. He was embarrassed of his rotten teeth.
“I wouldn’t go around people and if I did smile, you know, nobody would see me smile,” said Freeman. “My teeth was so messed up, you know, I had gaps everywhere,” he said sitting in an office at Little Rock’s low-income, non-profit Harmony Health Clinic, waiting for an appointment.
Freeman is in mostly good health in other ways, but it wasn’t until his fifties that he found a free way, at the community clinic, to get his rotting teeth pulled out and replaced with fake ones.
“Now I don’t mind smiling,” says Freeman. “Since I went through all this and they helped me, I have a better outlook in my life.”
“To me it was a blessing because they did it out of their own heart. You know, because nobody ever done that for me before anyway, so I couldn’t believe they’d done it for me for nothing.”
Dental health is a challenge in Arkansas and though it is worse than a decade ago, some strides have been made in treatment.
According to data from the Arkansas Department of Health, 64 percent of Arkansans had evidence of cavities in 2016, up eight percent from 2008.
Overall, just over half, or 51 percent, of state residents have dental care benefits compared to 64 percent nationwide. Among those who have cavities, 18.7 percent remain untreated and 2.4 percent are in need of urgent care, down from 8 percent in 2008. That year, almost a quarter of adults in Arkansas 65 years and older had lost all their permanent teeth.
While Arkansas has seen one of the greatest drops in the rate of uninsured people nationwide since the expansion of Medicaid through the Affordable Care Act, dental benefits have not significantly changed. Medicaid pays about $500 a year for dental work for beneficiaries.
So what’s at stake with oral health?
Chronic oral infections are tied to heart and lung disease, stroke, premature birth, low birth rates, and diabetes, and there are great disparities between demographic groups, according to the Arkansas Center for Health Improvement.
Department of Health Director of Oral Health Lindy Bolen says everything from social life, to self-esteem, to finances, to the state of our bodies overall.
“Our smile says a lot about us. It’s a presentation,” says Bolen.
He says losing a tooth is a “cascading event.” And that’s hard for adults and kids alike. Bolen says kids can be teased for “having black teeth, or gnarly teeth, or chipped teeth,” he says.
“If you’ve lost your permanent teeth, there’s nothing coming in. they may be hard pressed to get a replacement, an artificial replacement,” and we need front teeth to enunciate.
“So their speech, their self-esteem in front of other people, their ability to get good nutrition, to properly chew food, all of those things play a factor.”
What does it take to lose a tooth?
Bolen says it’s a combination of diet and hygiene. He says some parents put kids to bed with a bottle, not of milk, but of Mountain Dew or sweet tea. And he says many families don’t model to their kids how to care for their teeth by brushing and flossing, what he calls creating a “dental home.”
“You’d be surprised how many people in a household, in a poor household, they don’t have a toothbrush for each individual. They may actually be sharing the same toothbrush,” says Bolen.
“They may have had the same toothbrush for 6, 9 months. They don’t know how to use a toothbrush.” In fact, dental decay is the most chronic childhood ailment in Arkansas, according to the center. “
Some people view teeth as just, ‘well it’s there and if I get a cavity or a filing or it starts to hurt, I’ll just take it out. I can live without my teeth,’” he says. “If that is not a part of the adult mentality, and they’re more of, ‘I’ll just take it out when it starts hurting me,” it’s passing on to the kids the same way.”
It’s estimated that children who receive Medicaid and have a visit to the dentist before the age of one spend 40 percent less on dental repair over the course of a lifetime.
Tooth decay is a problem that begins at a very young age: the result of diet, poverty, and a lack of education that can be a lifelong, visible status marker, with wide ranging health impacts on the whole body.
And once the deterioration begins, it is difficult to address even if one has coverage.
“Dental insurance is great for those who are already in good shape, because it’s going to pay for your preventative visits. And If you do have some injuries and decay or you need one or two teeth fixed, they’re going to offset some of those costs,” says Bolen.
“But for someone who has got major issues, you’re going to reach the limit of what that dental insurance is going to pay per year and then it stops.”
This June, an Arkansas Children’s Hospital RV sits parked in a nearly empty Head Start parking lot in Little Rock waiting on a slow summer’s day wait for kids who might drop in for an appointment.
It’s part of the hospital’s Dental Outreach Program, which sends a mobile dental clinic to schools and daycares around the state for kids who might not otherwise make it to the dentist.
Jamie Schildknecht, age 3, sits in the dental chair by 9:30 a.m. She is the niece of one the program’s staff members and is the first patient of the day.
Children’s dentist Lara Udoug says she performs most routine dental procedures, fillings, extractions, cleanings, and stainless steel crowns on the van, unless kids require heavy sedation for other procedures. She says she sees kids that haven’t had their teeth cleaned in a while and may have a couple of cavities.
“These kids, sometimes they have orange, they have green, they have different shades that just mean they have not brushed in perhaps months or can’t even remember. You know, we’ll show them what’s on their teeth and a lot of times they’re not aware and you can tell they’re embarrassed.”
Sometimes the kids say they are in pain, and while their parents know about it, they may be waiting to save up the money to pay for care. For kids that have extensive decay, she puts a metal crown on their tooth as a long-term replacement until an adult tooth grows in.
She says the children don’t seem to mind having visible metal in their mouths.
“In fact, a lot of times the kids are excited about having silver teeth.” “As soon as we put one on they can’t wait to run into their classroom to show their friends.”
The goal of the program is to bring dental services to where kids are, to educate them and their parents, and to connect them with regular providers in the community.
The state has made some recent headway for long term improvement as well. In 2011, the Arkansas legislature mandated statewide fluoridation.
The insurance provider Delta Dental, which holds 95 percent of dental insurance plans in the state, has funded the fluoridation of many parts of Arkansas through its foundation. The Arkansas Department of Health says 65 to 85 percent of the state now has water with fluoride added, a mineral shown to help prevent dental decay.
According to Delta Dental, Central Arkansas accounts for 41 percent of claims, Northwest Arkansas 39 percent, Northeast Arkansas 9 percent, and Southern Arkansas 11 percent.
*Editor’s Note: The Delta Dental Foundation is an underwriter of Arkansas Public Media. They do not have any influence over news reporting or broadcasts.
This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State news with context.