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The Mortal Peril of a Toothache

Last night I was watching the most recent episode of Call the Midwife.  For those not familiar, Call the Midwife is a historical fiction TV series that takes place in post WW II London and follows the lives of a small group of dedicated midwives.  In this particular episode, midwife Trixie was called to the house of Crystal, a very pregnant patient who was in a great deal of pain.  However, this was not the pain of early labor, but the pain of toothache.

Crystal, a mom of four with number five on the way, lived in a one room apartment with her family, and a quick look in her mouth revealed infection and rampant decay.  The smiles of her husband and children also revealed that she was not alone in the state of her oral health.

To make a long story short, Crystal’s doctor recognized the threat to her life and that of her baby’s life and sent her to have a dentist remove all of her teeth.  While Crystal’s story took place some 50+ years ago, the same tale still repeats itself in communities all across Maine and the United States. Dental disease is prevalent in impoverished communities for a number of interrelated reasons, including the high cost of care, lack of insurance coverage for adults, low Medicaid reimbursement rates for children’s coverage, poor diets and limited understanding of the importance of oral health.  

All of these issues and more are explained in a new book called Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America by Mary Otto, a former reporter with the Washington Post.  Otto was drawn to the story of oral health by the 2007 death of a young boy named Deamonte Driver. Deamonte’s story is very similar to Crystal’s, but unlike Crystal, Deamonte didn’t live in a place with a system that could recognize and address the danger he was in due to the disease and infection in his mouth.  Instead, Deamonte’s infection spread to his brain and took his life at age 12. Otto’s book tells Deamonte’s story and the story of others living in poverty who struggle to gain access to dental care in America.  She also outlines the steps some communities are taking to improve access to oral health care.

The Maine Oral Health Funders (a group of Maine-based philanthropies that fund oral health projects) are currently supporting community-based efforts to improve oral health for children in Maine using some of the very same approaches that are mentioned in Teeth.  Through these projects we are learning that some simple approaches, such as deploying community health workers to guide people through the system, can be very effective.  We are also learning that there are still many barriers to achieving optimal oral health, particularly in communities with high rates of poverty.

The circumstances that allow a child in the wealthiest nation in the world to die from a decayed tooth are no doubt multi-faceted and complex.  Mary Otto’s book shines a light on those factors and provides insight into what steps we might take as a nation to make sure we never lose another child from tooth decay, a completely preventable chronic disease.  

 

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