The True Cost When You Can't Pay

Tooth decay begins in poverty, keeps people in poverty


It's a small piece in the puzzle of poverty, a piece as small as a tooth.

A child raised in poverty can be doomed to stay in poverty if his or her parents can't afford proper dental care.


Payson dentist Bill Blackmore examines the teeth of Levi Neal after a sports-related injury.

Children from low-income families may grow into adults whose teeth are rotten or crooked and those teeth create an impenetrable wall that separates them from higher-paying jobs.

Arizona State University Professor Laura Peck, who co-authored a study titled "The latent and sequential costs of being poor: Exploration of a potential paradigm shift," said an individual with visibly bad teeth will have trouble finding employment in a field where he or she will have to meet the public.

Steven Booth, a Payson dentist, said he would never hire a person who was missing a few teeth.

"You perceive them as being a less caliber of applicant," Booth said. "It's not right, but we are all guilty of that."

Kim VanPelt, director of health policy for the Children's Action Alliance, a nonprofit research, education and advocacy organization dedicated to promoting the well-being of Arizona's children, said some of the pictures she has seen of children who need dental work have been nothing short of shocking and horrifying.

"Some of them have unbelievable decay," she said. "It sets them up for health problems and stigma.

"What is unfair is, it sets children up for a lifetime of challenges."

Peck said employers usually require that their workers have a nice, clean appearance, and oral care is included in that equation.

Employers of professional and service-level jobs will rarely hire someone with visible tooth decay.

The jobs that are available are behind-the-scenes jobs, like a warehouse worker, where the person will never interact with the public, the ASU professor said.

The cycle of poverty continues as the worker is only hired for low-paying jobs without benefits, and little hope for promotion into more visible, management positions.

Booth said cosmetic surgery could correct the teeth aesthetically later in life, but added paying $10,000 or more for the work would be the price tag, an investment many cannot afford to make.

Peck said a big part of the problem is the working poor's limited access to insurance coverage in rural Arizona.

She mentioned that some low income people refuse to go to the dentist because of the cost, and those who do go, will often opt to have a tooth pulled over a root canal because that is all they can afford.

Booth said dentistry is still perceived as a discretionary luxury, rather than a necessity, by some, especially by families with little money.

He said a child who does not go to the dentist will be mostly affected as an older teenager or young adult.

"The consequences don't start showing up until (later)," he said.

The Arizona Healthcare Cost Containment System will pay for a tooth to be pulled, but not for root canals or any other form of cosmetic surgery.

By contrast, Peck said, a professional person with a good income will generally pay to have a root canal, rather than lose a tooth forever.

In the study that was published in the Journal of Poverty, Peck pointed to an example where a person managed to save $68 for a cleaning at an office that was having a special.

At his cleaning, he was told he had a cavity, and he chose to wait for treatment until he could no longer stand the pain.

Booth said that is the worst thing a patient can do.

He said a person who waits until pain can see the dentist bill increase from $200 to $2,000.

Ernie Russell used to hate looking into a mirror because of the shape and condition of his teeth.

Russell, a real estate agent, said in his younger days he got into a lot of fights, which led to a mouth of broken teeth.

His teeth were so bad he would have headaches.

Russell, who had his teeth redone by Chris Winterholler, co-owner of Payson Dental, said his teeth were reconstructed prior to becoming a real estate agent.

"I would probably still be a Realtor (without my teeth reconstruction), but I would not be as successful," he said.

He said many people he met felt intimidated by him because of his teeth.

When he worked for Qwest, he would cover his mouth when he had to speak.

Russell cleaned out his life savings for the cosmetic surgery that cost $20,000. He has never regretted it.

"It has helped me immensely. People are now commenting on my smile," he said. "It gave me an extreme amount of confidence."

Letica Gagnon is another person who had cosmetic surgery done on her teeth by Winterholler.

Gagnon said she always had a gap in her teeth, and, as she got older, the gap started increasing in size.

She had a habit of grinding her teeth and wore them down.

"For me, it was mostly self-confidence," she said, adding that her new look gave her the confidence to go into acting.

Gagnon spent about $10,000 on her new look and said it was well worth it for several reasons.

"I never wanted to smile. I would not want to show my teeth," she said.

Bill Blackmore, a dentist with Frontier Dental Arts, said he sees at least one patient a day between the ages of 30 and 70 who has serious dental concerns.

Blackmore said the cause of the tooth decay is twofold.

They were poor and could not afford to go to a dentist or access to a dentist was not easily available for people living in remote areas.

In the conclusion of the study done by Peck and Elizabeth A. Segal, they wrote that it is nothing new to be treated as a second-class citizen by virtue of being poor and being unable to afford health care.

But, VanPelt said, there are programs for children if income guidelines are met.

Arizona Health Care Cost Containment System (AHCCCS) will provide dental coverage to children in a family of four whose household income is no more than the poverty level, which is slightly more than $18,000 a year.

Peck, however, said AHCCCS will only pay for what is absolutely necessary, such as an extraction instead of a root canal.

VanPelt said there are 250,000 children in Arizona who are not insured, and 70 percent of them would qualify for AHCCCS.

More and more people in the dental industry, she said, are maintaining that dental care should begin before a child has his or her first birthday.

Families with children under 18 years of age can call (877) KIDSNOW to see if they qualify for free treatment.

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