Week of March 2 - March 8, 2008

Dr. Folse, DDS, focused the American spotlight this week on the sad state of national dentistry in a number of areas including the dentistry of dementia. In one day, the Washington Post has made him a national figure known as "The Dentist of the Back Roads." According to the American Dental Association, national policy makers started calling Dr. Folse the same day the article hit the papers. 

 Excerpt from this week's Washington Post:

Dr. Gregory Folse checks the chart of his next patient. The 74-year-old man suffers from dementia and is delusional. Sometimes such appointments "can get pretty wild," the dentist says.

But he thinks that everything, not just dental school, but also his years as a cowboy and his experience riding along with his country doctor grandfather, Phillip Robichaux, prepared him for this work.

A nurse gently but firmly brings the patient. His gum disease is advanced, and some of his teeth are so loose he could swallow them or inhale them. A timely $100 extraction can save $50,000 worth of surgery, hospitalization and complications.

"Those are bad. I'm going to take those out for you," Folse says. At first, the man balks.

"How bad?"

"They are real loose."

"Not to me."

"I want to take 'em out. I don't want them to make you sick. They are infected."

Folse does not take no for an answer. He leans in, projecting calm authority. He doesn't wear a mask or safety glasses. He leads by example and nonverbal cues. When Folse opens his mouth, the patient opens his.

He gives the patient shots of local anesthetic.

"Great job," the dentist says. "You are doing a great job."

And slowly, carefully, he draws out the worst of the man's yellow teeth.

"The others are in horrible shape," Folse says. "But these three were life-threateningly loose."

The nursing homes on Folse's circuit pay him a monthly stipend of $6 a patient.

 Welcome to America's $6 dental reality.

People new to Alzheimer’s might think oral care is a minor issue. But it turns out that oral health becomes, if anything, even more important, because it affects a person’s ability to eat as well as their general health. A healthy smile also dramatically affects a person’s sense of dignity.

The challenge is complex. Patients may be less than cooperative while the importance of dental care grows. Costs can be daunting and Medicare does not cover general dental costs. Here are links that help patients, caregivers and professionals navigate the challenge.

For Caregivers

In "Dignity & Dentistry", Dr. M. David Tannenbaum, DDS, discusses the balance between practical Alzheimer's realities, optimal care, and a person's dignity.

Scroll down to "Type of Dental Treatment" at the England's Alzheimer's Society site to read about a caregiver's dentistry responsibilities in the three main stages of Alzheimer's.

Low Income Assistance

Donated Dental services (DDS) extends the extraordinary compassion of over 12,900 dentists and 2,700 dental laboratories across America. DDS tends to the essential and comprehensive dental care needs of the nation’s most vulnerable people; disabled, elderly or medically-compromised individuals who cannot afford necessary treatment nor get public aid.  DDS patients have slipped through the cracks of Medicaid and Medicare programs with nowhere else to turn.  

Medicaid offers some dental assistance, which varies depending on which state you live in. Here is a state-by-state list of contacts who can help you with Medicaid dental coverage.

If you are uninsured and would like to do something about it, the definitive place to start is CoverTheUninsured.org . This not-for-profit site sponsored by the Robert Wood Johnson Foundation has state-by-state guides on low-cost or no-cost insurance coverage for people living on low-income.

For information about reduced-cost dental treatment, contact your local dental school. Dental schools often have clinics that allow dental students to gain experience treating patients while providing care at a reduced cost. Experienced, licensed dentists closely supervise the students.

The Bureau of Primary Health Care, part of the Health Resources Services Administration, has federally funded community health centers that provide dental care.

Clinical Trials

The National Institute of Dental and Craniofacial Research sometimes seeks volunteers with specific dental, oral, or craniofacial conditions to participate in research studies, also known as clinical trials. Researchers may provide study participants with limited free or low-cost treatment for the particular condition they are studying. For further information, please see Clinical Trials.

Find a Dentist

The American Dental Association Listing of Dentists

Join the Discussion

If you are looking to discuss any dental issues beyond the scope of these links, please visit our Discussion Boards. Here are links to dental topics recently posted by our readers:

Cleanliness and dental care

Dignity & dentists

 In Conclusion

Dr. Folse is now working with Congress, Medicaid and the American Dental Association to better the current state of affairs. "I can't donate enough services to meet the needs of my patients. Nor can dentistry. Hopefully, our policy makers in DC (the nation's capital) will finally understand the need for government to step up to the plate and help our profession assure access for this needy and vulnerable population."

In the meantime, keep in mind the advice of Dr. Paul Ackerman, DDS, who has been in practice for 30 years. "Your or your loved one's dentist is the key to oral health. Use one who knows to treat an Alzheimer's patient gently, with extra kindness and respect. And be sure to get to that dentist for a checkup twice a year."

Peter Berger, Alzheimer's Weekly

Reviewed for medical accuracy by
Dr. B. Ancselovits, MD, Geriatrician, Alzheimer's Weekly

Sources:

Washington Post, "Dentist of the Back Roads", February 23, 2008

American Dental Association, "One dentist's story spotlights needs of vulnerable populations", February 25, 2008

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