On Monday nights, the waiting room outside the Columbus Health Department dental clinic bustles with people. Kids toggle on tablets and phones while the adults peruse the vending machines or read one of the free magazines left out on the table.
Late into the evening, when most people might be home after a long day at work, people like Connie Seymour come to this clinic – open only one day a week – to see a dentist.
Seymour wears a blue and white flannel, her hair pulled back in a neat ponytail. She says she prefers the late hours. Like many people here, she can’t come during the day because she can’t offered to take time off from work.
Seymour, 49, has raised 10 kids, two of whom come from foster care. A waitress for the last 35 years, Seymour is also her home’s primary breadwinner and says she’s familiar with putting her family’s needs before her own, especially when it comes to dental.
“If you’re not making enough to live on as it is, getting to the dentist is not a priority,” Seymour says. “Eating, paying your bills, getting to work every day – those are priorities.”
Lost Teeth, Lost Wages
Ohio is one of just 15 states that offer comprehensive dental care for Medicaid recipients, but Seymour says she makes too much to qualify. Her work does not offer dental insurance and she can’t afford it on her own.
Caught in the middle, Seymour is one of the 74 million Americans who lack dental insurance—triple the number of people who lack health insurance. Not seeing a dentist regularly can mean fewer job opportunities and lost wages, but for Columbus residents who struggle financially, accessing those services don’t come easy or cheap.
For the last two years, Seymour says cost prevented her from seeing a dentist. It wasn’t until she came to Physicians Care Connection, one of the city’s only free dental clinics, that she could finally get attention.
After waiting an hour, an attendant calls Seymour to the back where she’s seen by Dr. Hua-Hong Chien. As he leans her back in the dentist’s chair, she points out her primary concern: Last week, after having a tooth pulled due to decay, the site became infected and she wound up in the emergency room.
“[The doctors] believe I either had something left up in there, or I ate something and it got caught up in there and it caused an infection,” Seymour says.
Seymour pulls out her phone and shows a picture she took. Her face is so swollen, she’s barely recognizable.
In a 2016 report, The Kaiser Family Foundation said that employed adults lose an estimated 164 million hours of work each year due to oral health problems or dental visits.
“Adults who work in lower paying industries, such as customer service, lose two to four times more work hours due to oral health related issues than adults who have professional positions,” wrote authors Elizabeth Hinton and Julia Paradise.
Seymour missed several days of work due to the pain, and now she worries about her paycheck.
“My bills don’t stop because I took a day off of work to go to the dentist. And they don’t care that you had to make a dentist appointment,” Seymour says. “It’s a struggle, trying to catch back up.”
Life Without Dentists
People who lack dental insurance often wind up in the emergency room, where they may end up paying a hefty medical bill out of pocket. A study by the American Dental Association shows that in 2012, a patient comes into the ER every 15 seconds for a dental emergency.
Brian Pierson, director of community outreach at Mount Carmel hospital, says they try to refer these patients to a dentist, because an ER can only offer pain medication.
“There are more medical clinics then there are dental clinics for folks, so it’s a very complex issue,” Pierson says. “It’s even more complex when we’re talking about prevention.”
Columbus’ lower income neighborhoods disproportionately lack access to dental care. According to U.S. Census data, residents in lower-income neighborhoods more likely to have lost teeth due to decay or gum disease.
In Linden, for example, just under half of people over 65 report losing all of their natural teeth. A majority of residents say they haven’t seen a dentist in a year.
Pierson says poor oral hygiene affects more than just your smile. It can lead to chronic oral infections, diabetes as well as heart and lung disease. The inability to chew certain foods, like fresh fruits and vegetables, can affect your diet.
“I really believe a person who loses their teeth as a result of periodontal disease, and doesn’t have access to dentures, is really dealing with a disability,” Pierson says.
After two years without a cleaning, Seymour’s untreated cavities progressed further, to the point where she’ll lose another three teeth.
“That prevents me from getting to eat some of the things that other people get to eat,” Seymour says.
Depending on what neighborhood you live in, though, economic segregation can make even visiting a dentist physically challenging. In Columbus, lower-income neighborhoods have far fewer dental clinics. Linden has just four, and none offer affordable services for people like Seymour who lack insurance.
In comparison, more affluent areas like Clintonville offer nearly two dozen dentists.
More Than A Smile
At The Ohio State University College of Dentistry, patients can receive care from dental students at a fraction of the normal cost. As the only state-supported dental school, says dean Patrick Lloyd, Ohio State sees patients travel from all over the state seeking care.
He says transportation is a barrier to accessing a dentist, especially if a patient doesn’t own a car or live near a bus line.
“I think people in poor communities struggle with physically accessing care,” Lloyd says. “We talk often to patients who come to the school, ‘Was it easy to get here?’ And for some it is not.”
That’s a significant issue for low-income patients, who often depend on a healthy smile to find work. If you’re missing teeth, Lloyd says, people tend to think of you differently.
“People may not look at you the same way to offer you a job, whether it’s a teller at a bank, a server at McDonald’s,” Lloyd says.
“Visibly damaged teeth or tooth loss can also harm job prospects for adults seeking work,” the Kaiser Family Foundation reported.
Just off her shift at the Olive Garden, Seymour says a healthy smile and a clean, professional appearance is crucial. You wouldn’t know it by looking at her, but on the left side of her mouth, she has a bracket of false teeth.
When the bracket broke, she knew it needed to be taken out and repaired – but she couldn’t show up to work without teeth. So she waited for eight years.
“It would take about two weeks to get it back,” Seymour says. “Well, therefore, I’d be without my front tooth and that was not an option for me. So I just kept buying Fixodent and wearing it the way it was.”
Seymour says she’s seen what happens when someone with poor or missing teeth comes to her restaurant seeking a job.
“I see management not taking them because of that appearance, which is unfair, but I get it,” Seymour says.
After all, she says, regular dental care is not an option for people like her.
“When I smile, that’s the first thing I think about it: ‘Wow, they probably think I didn’t take care of me,’ and it’s not about not taking care of me,” Seymour says. “It wasn’t anything that was in my control at that time.”
