Fluoride Action Network

Forgotten teeth: The elderly and the disabled

Source: Press-Register | Staff Reporter
Posted on December 24th, 2000
Location: United States, Alabama

Searcy Hospital, the state-run mental facility in north Mobile County, has a dentist and two hygienists on staff. They provide regular checkups, cleanings, extractions and other work, said Melanie Beasley, spokeswoman for the state Department of Mental Health and Mental Retardation.

At centers for developmentally disabled and retarded adults around the state, including the Albert P. Brewer Center in west Mobile, a few local dentists volunteer their time to see patients.

Some parents and advocates, however, say it’s not the dentists who are the problem, but the underpaid direct-care staff members who fail to check mouths and brush residents’ teeth regularly. In addition, many patients’ medications can cause gums to bleed or teeth to turn dark. The patients also can be extremely difficult for dentists and workers to handle. Some require sedation.

“It really is a complex issue, and probably one of the most overlooked aspects of health care in the state,” said Jim Sears of Mobile, an attorney whose stepson is mentally retarded. Sears is a former special education professor at the University of Alabama who has been involved in mental health issues for 30 years. “A lot of the workers just do not attend to the residents’ needs like they should.

“On things like this,” Sears said, “the state of Alabama has always taken an attitude of ‘Let’s do just what we need to barely get by, and no more.'”

Outside the state-run institutions, mentally ill people’s needs are often met only after they complain repeatedly of a toothache, say those who work and live with patients.

“Regular checkups would forestall a lot of problems, and they wouldn’t have to get dentures,” said Sue Betbeze, president of the local affiliate of the National Alliance for the Mentally Ill. “There are numerous mentally ill people who feel pain, but there’s no provision made for them.”

“We have a hard time finding dental care for people,” said Tuerk Schlesinger, director of the Mobile Mental Health Center, which oversees 355 residents at the center and more than 7,000 people who live in group homes or on their own.

The state provides about $74,000 to mental health services in the state to meet the dental and other health needs of more than 100,000 uninsured patients across Alabama, Schlesinger said. That doesn’t go very far, and the Mobile Mental Health Center often doesn’t even bother seeking the funding.

When residents’ needs are recognized, it’s difficult finding a local dentist who’ll see them, especially if the patients are on Medicaid, say residents and their parents and caregivers.

“I can’t get anybody to take me now,” said Michael Warlick, a 20-year-old who lives in a group home and receives Medicaid payments for disability. “Everybody I talk to says Medicaid won’t pay. It’s not fair.”

Handicapped find little access

Many physically handicapped children on Medicaid face similar difficulties. Dylan Nolan, 8, suffers from cerebral palsy. After his teeth rotted from the medications he’s taken since birth, he had to be driven to Birmingham twice last winter to get the teeth pulled, said his mother, Jewel Woods of Mobile.

No local dentists would undertake such extensive work, which required anesthesia and oral surgery. The family had to make the five-hour drive, but was able to stay free-of-charge at the Ronald McDonald House at the University of Alabama at Birmingham.

“Our concern about sending people to Birmingham is that it’s a five-hour drive with a child,” said Dr. Susan Ashbee, the pediatrician at the Mostellar Medical Clinic in Bayou La Batre. The clinic, which lies at south end of Mobile County, has a dentist, but is not equipped to see very young or handicapped children who need anesthesia.

“A lot of the people we see don’t have much money. So now they have to drive, they have to buy gas, and they probably have to spend the night,” she said. “And their cars aren’t usually in the best shape.”

One remedy would be for more local dentists and oral surgeons to agree to see more low-income patients, she said. “We need to put the pressure on the local dental society, in a positive way, to come back into the picture and help out with some of these kids,” Ashbee said.

Aging population, growing problem

Elderly people in nursing homes and assisted-living facilities often receive no dental care, unless their families take them to the dentist, said Sutton and others who work with the elderly.

“Just go to any facility and you’ll see these poor people with the worst breath, because they don’t get any care,” Sutton said. “And their dentures don’t fit anymore a lot of times. It breaks my heart to go in there and hear those plates clacking.”

Some nursing homes are more attentive than others when it comes to dental care.

At Allen Memorial Home near downtown Mobile, for example, Dr. Alex White comes out once a month to check and clean residents’ teeth, bringing his examination chair and other equipment with him. For more extensive procedures, residents are taken in the home’s van to his Airport Boulevard office, said Sister Judy Dusellier, director of social services at the home.

“A lot of people don’t get dental care until they come live here,” she said.

Having a dentist come to the home is a particular blessing, said Debby Dwyer of Spanish Fort, whose 90-year-old mother, Mary Dwyer, is a resident at Allen Memorial.

“It’s hard to get her to the dentist’s office,” Dwyer said of her mother. “It’s very stressful on her every time we have to move her, so it’s great that he can come out here.”

At many nursing homes, no transport other than an ambulance is available. Medicare and Medicaid won’t pay, and that can cost the resident’s family as much as $600 just for a ride to the dentist, elderly advocates say.

Advocates, relatives and care-givers of the elderly don’t completely blame federal and state programs for the trouble. “There are no easy answers to this,” Sutton said. “But the families of these people have to take some responsibility.”

Outside of nursing homes, the problem in many cases starts long before people grow old.

Most low-income people decide against saving their teeth, said Gibson, of Pine Apple, because it’s too expensive. Instead, they get their teeth pulled. In some cases, pulling all of an elderly or disabled person’s teeth and replacing them with full sets of dentures actually makes it easier to care for their mouths, families and dentists say.

“I rarely do crowns. I do a lot of extractions,” she said.

Then, those who can afford dentures get them, just like the ancient Etruscans did. The only difference: Dentures these days are made of ceramic or plastic, not gold or animal bone.