SALT LAKE CITY — Dani North always expected to lose all her teeth by age 40. It happened to her mother and she figured it would happen to her.
"It is a challenge I've faced all of my life. We never had any money for dental care," she said. "It is the hardest medical service to obtain and insurances almost never cover anything dental-related."
The 28-year-old recovering addict is looking for a job and feels self-conscious about the condition of her smile. When tooth pain took her to a doctor a month ago, North opted for extraction rather than handle a potentially difficult situation that would occur with her taking the prescribed narcotic pain medication.
"When your health is not right, how do you get a new start?" she said. And she's not alone. There are hundreds within the homeless population of Utah who are in need of dental care and have nowhere to turn.
"People who don't have access to dental care and have a bad tooth are desperate for some kind of help," said Dr. Scott Youngquist, an emergency physician at University Hospital. "If the doors to dental care are closed to them, they know the one place they can go to at least get some pain relief is the emergency department."
Patients come to the emergency department with dental problems on a daily basis, he said, often tying up staff with non-emergency issues. Left untreated, tooth problems can lead to head and neck infections, as well as heart problems, which are more serious and can require more costly treatment measures.
"What could have been treated early and in a relatively straightforward fashion has now become a very expensive disease for health care in general, for Medicare and Medicaid, and for all of us," Youngquist said.
Ultimately, many without access to proper dental care end up getting multiple teeth extracted.
Christina Gallop, medical director at the Fourth Street Clinic, said dental issues affect individuals not only physically, but mentally and socially as well, as there is a stigma associated with having no teeth.
"I think people underestimate how poor dentition can affect you," she said, adding that bad teeth can signal poor nutrition, drug problems and other issues. She said 60 percent of the population served at the clinic "could use denture help."
Sidney Shipman, 50, is one of them. A regular at the clinic, he hasn't had teeth for five years.
"I can't eat, I have no way of eating, no way of chewing and I have to swallow my food whole," he said. Shipman moved from Powell, Wyo., six years ago because Salt Lake offers "better services for the homeless."
He looks forward to a day when he can ditch the liquid diet and actually smile again.
Tuesday, the Fourth Street Clinic received news it would be getting a $2.9 million Affordable Care Act capital development grant to expand services and serve more patients.
Construction is slated to begin in August and will be completed sometime in March. Officials estimate they'll be able to serve an additional 1,000 patients ever year.
"I am just smiling," said executive director Kristy Chambers. "It is exciting to see that we have the potential to really fulfill some of these demands."
The nonprofit clinic will double its size, adding three dental exam rooms and an area designated for enhanced substance abuse treatment, as well as a waiting room for the existing pharmacy. The facility will also get much-needed mechanical and seismic upgrades throughout.
As it stands, Fourth Street offers no dental services and can only cover the cost of extremely serious conditions, up to $25,000 of its total budget each year. All dental services are performed outside the clinic, by partnering dentists within the community.
One of those partners, Salt Lake Donated Dental Services, provides free or low-cost services to those meeting eligibility requirements. But they can't meet the need alone. In 2009, the organization performed 12,144 procedures, the majority of which were basic preventive or restorative measures. More than 32 percent of the procedures, however, were extractions and patients received an average of four procedures per visit, according to a Donated Dental Web page.
The new grant, which will cover only construction and supplies for the Fourth Street Clinic, is part of more than $728 million doled out across the United States to support renovation and construction projects, boost health centers' ability to care for additional patients and create jobs, according to the U.S. Department of Health and Human Services.
The Mountainlands Community Health Center in Payson also received $500,000 to purchase additional supplies and help get more patients in the door.
"For many Americans, community health centers are the major source of care that ranges from prevention to treatment of chronic diseases," U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement. "This investment will expand our ability to provide high-quality care to millions of people while supporting good paying jobs in communities across the country."
According to a report released Tuesday, the health care law has supported the construction, renovation and building of 257 health centers nationwide. The influx of funding is estimated to provide access to an additional 860,000 patients in need.
"This will definitely be a step in the right direction as far as moving people out of the ER," Youngquist said.
Twenty-two jobs will be supported during the projected eight months of construction at the clinic. The clinic will then be in need of dentists to provide care to those in need. An agreement is in the works for students at Utah's two dental schools, Roseman University and the University of Utah, to provide some of the work, leaving the eight full-time medical providers at the clinic to handle more patients.
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