Research increasingly links oral health and overall health. Dental disease is correlated with bad pregnancy outcomes, heart disease, and other serious illnesses. And studies haven’t even measured the way that painful or missing teeth can contribute to unhealthy diets that promote obesity, diabetes, and other chronic diseases. Every few years, the country gets a shocking reminder of how the mouth is connected to the body when a patient dies from a brain infection linked to an abscessed tooth. The story of Deamonte Driver, a Maryland 12-year-old who died after his mother tried—and failed—to get him care for his dental emergency, was national news in 2007. (Now Prince George’s County, where Driver lived, has a mobile clinic like the one in Hazard that tours schools and supplements the private system.)
Stone, the dentist who runs the Hazard-based mobile unit, grew up in the Kentucky mountains and wanted to return once she had paid her student loans. She works for a federally qualified community health center—one of 1,124 clinics funded by Washington to provide medical and dental care to underserved communities. That allows her to treat children who have Medicaid or no insurance without worrying about financial stability. But Stone’s situation is rare in the profession; the average new dentist, after all, graduates with debt exceeding $150,000 and then must take out additional loans to purchase or build a practice. Young dentists, sensibly, gravitate toward jobs that pay the bills.
Stone, 40, knew that children in Eastern Kentucky weren’t getting enough dental care, but she was still staggered by the prevalence of dental disease when she began examining them in 2004. Large numbers of the kids had never seen a dentist. Half had untreated tooth decay, and nearly 20 percent had urgent needs—more than six cavities or an active abscess. She and her staff “cried a lot,” she recalls. Crisscrossing four counties in her van, she painted fluoride on all the teeth and sent notes home with the children who needed immediate attention. In the early years, only 8 percent of those youngsters with urgent problems got the care they needed. The job was like fighting a forest fire on a mountain, she says. “I felt like I was standing here on the line of the fire with a squirt gun.”
A few dentists practice nearby, including one whose office is in the “mall” on Hazard’s deserted Main Street. But Stone doesn’t know anyone local who treats Medicaid children with complex needs. She ultimately recruited a dentist from 50 miles away. Seth Hyden spends one day a week at the Hazard Appalachian Regional Healthcare Medical Center, where he puts his patients under general anesthesia and fills cavities. He gets Stone’s neediest cases, although sometimes the patients don’t show. MacKenzie Doolittle, for instance, doesn’t qualify for Medicaid, which would have covered Hyden’s hospital-based care; that may explain why she didn’t make her scheduled appointment.
Over time, Stone has increasingly focused her attention on children in the Head Start program. Her clinic travels to elementary schools annually, but she visits day-care centers three or more times a year. There, she hopes to arrest decay before it sets in by applying fluoride to children’s teeth as they lie on her lap. “We’re the ones over here on this mountain that’s not on fire, trying to soak it down,” she said. She hopes that prevention will lead to better population health, even if she can’t help every kid who develops dental disease.
On this Monday, she gets a glimpse of what happens when prevention fails. Two brothers step into her van, which is parked outside A.B. Combs Elementary School. Both have black baby teeth rotted nearly to their gums and molars with visible pits. Nick Owens, 9, has 15 cavities and an abscess above a front tooth. When Stone presses on the swollen site of infection, it oozes pus. Nick’s brother Coy, 8, has seven cavities and an adult tooth growing behind his gum line. He’s lost so many baby teeth prematurely that the remaining ones have spread out, leaving no room for the adult replacement that later arrived. Four other adult teeth show telltale chalky white spots, early signs of decay.
“Are you a pop drinker?” Stone’s hygienist, Pam Cornett, asks Coy.
“Yup,” he says. “Dr. Pepper.”
Nick, sitting at the edge of the chair with his arms across his chest, chimes in. “My mom says after school, she’s going to take me to the dentist,” he says. The family will try, anyway: The Owens brothers, after all, live in rural America.
This report is part of an ongoing series supported by a fellowship from the Association of Health Care Journalists.
This article appears in the May 5, 2012, edition of National Journal.