So How Many Did They Pull Out Today?

Faces have been blurred to protect privacy.

Faces have been blurred to protect privacy.

5. 10. 12. 15. All of them.

What would you do if that was the number of teeth you had extracted in one day?  (Or in one lady’s case, that was her birthday present to herself.)  Unbelievable to some, but for those in these remote areas of Southwestern Virginia, doing this is their best option.

In this area, the ratio of residents to primary care providers is abnormally skewed.  Even if you do have the money, you may not have access to a doctor, let alone a dentist.  Most insured individuals do not have dental insurance. Unfortunately, financial instability and medical inaccessibility are a common combined package in Southwestern Virginia.   It is not a tough decision to forgo purchasing health insurance in order to pay the rent or afford food for your family.   Oh should I also mention that this area is infamously considered to be the “Methamphetamine Capitol of the World?”  Years on that stuff can lead to serious damage.  See

Faces have been blurred out for privacy.

Faces have been blurred out for privacy.

For two days, the VCU dental, nursing, and pharmacy schools joined forces with local dentists, health professionals, and volunteers to tackle  the problem of dental care shortage.  About a month prior to the Mission of Mercy (MOM) Roanoke, the event was advertised in the papers, at free clinics, in the emergency room, by word of mouth, etc.   One week prior to the day, ~800 tickets were distributed at the local mall.   It did not matter if you were rich/poor, had insurance/or not, need all four wisdom teeth extracted, or have a simple cleaning request.   Grab your family members, friends, neighbors, random stranger, and come on in.  On D-Day, we drove down to Roanoke,Virginia, rented out a convention center, set up our gears, and opened our doors (and emotions) to unforgettable realities.  The day started around 5 AM and did not end until the last patient left the site.   From X-rays to anesthesia to prescription painkillers/antibiotics, everything was taken care of for free.

While it was a wonderful service trip and learning opportunity, I can not help but feel angry after 9+ hours/day of: repeating post-operation and prescription consultations, pulling out bloody gauzes and replacing them with new ones,  confusing black empty sockets for bad cavities, and seeing distressed faces.   The highlighting question of the event was “so how many did they pull out today?”  We kept an ongoing tally of who will have the highest count.  For these individuals, this event would be their annual or only dental care visit for a few years*.   For an insured patient, his/her regular dentist has the option to decide between filling in a cavity versus extracting  the whole tooth.  For the people that show up at these events, the decision scale often tips to the extraction end.   Eliminating that infected tooth will prevent further infection or the exacerbation of more critical health concerns.  Given the individual’s current oral hygiene philosophy, filling a cavity will not prevent  a future cavity or keep that filling from wearing out.  In most cases, you will rarely see one infected tooth.

Resorting to teeth extraction is a quick solution to this problem but it cannot be the only resolution.  This is not preventative medical care.  The people of Southwestern Virginia deserve better.  I can not wrap my mind around how their lives will be affected at the end of the day.  Having 5, 10, or all of your teeth pulled will significantly affect your self esteem, lifestyle, and overall health.   This is a complete domino cascade, with one bad thing leading to another.   These are problems I imagine existing abroad and not in the US.   It is not okay for “qualified” individuals to be placed into a lottery pool for a free set of denture.   The denture contest winner will have to wait until 2015 before he/she get the free denture set.   I guess this is an alternative to paying ~$1700 out of pocket (that is after the 20% discount my mother received because she agreed to pay it with cash) for your own set of denture.  But that is 1+ year this person will have to go through without their teeth!

This event reminded me of an article I read in college that correlates wealth and socioeconomic status to our teeth**.  In the olden days, sugar was the marker of wealth and exclusive commodity reserved for the aristocrats.  With excess sweet consumption and infrequent cleansing, their teeth, as you can imagine, were less than appealing.  Fast forward to our modern era, unless the individual is supported by government funded health insurance, he/she will not have the best access to dental care.   Braces, regular whitening treatments, bi-annual general hygiene visits, and other dental procedures will place low on this individual’s priority list.  Sugar is no longer a spice reserved for the rich but is ubiquitous in the individual’s daily diet.

Unfortunately even with the national health reform’s slow implementation process, this type of medical relief trips will continue to exist across the country.  States, like Virginia, will have to decide whether they want to expand their health system/Medicare/Medicaid.  The people I served last weekend and others will continue to fall through the cracks.  Some will decide to opt out of getting health insurance because they cannot afford to pay its monthly premium.

In other words: Roanoke, see you again in 2015*!

* : Since MOM happened so late this year, it will almost be impossible to arrange for another event until 2015.  The finance and personnel requirements to organize and execute such an event are time intensive.

** : When I Googled to see if I could that article from college on teeth being the new marker of wealth, I ended up with this TIME article:,9171,850913,00.html

Of course, I could not read the full article but the this line stood out: “Total caries (decayed, missing and filled teeth) is highest in men from the most prosperous communities, lowest in men from the poorest.”  Who would have thought.