SPARTANBURG, SC — Vickie Brewer would lay awake some nights crying in pain.
She was having toothaches, and without dental insurance, she had limited options for help.
In Spartanburg County, more than 24 percent of working age adults lack health insurance, according to the U.S. Census Bureau. Even among those with health insurance, 27 percent don’t have dental insurance, according to the U.S. Department of Health and Human Services.
On a recent Saturday morning, Brewer, a Greenville resident, sought out one of few available options in the Upstate.
She awoke before sunrise and drove to Miracle Hill Rescue Mission in Spartanburg to see a dentist at a free tooth extraction clinic. She was in line by 4 a.m. and waited four hours outside, hoping someone would relieve the tooth pain that had been nagging her for weeks.
“When your teeth are hurting, you don’t mind waiting in line,” Brewer said. “It’s too expensive to get teeth pulled anywhere else.”
Miracle Hill Rescue Mission holds a free tooth extraction clinic one Saturday a month, starting at 8 a.m. For adults who lack insurance or have a low income, this free clinic is one of only a few options when it comes to dental services, like pulling teeth.
Calvin Vinson, director of Miracle Hill Rescue Mission, says some start lining up as early as 3 a.m.; some even spend the night outside Friday evening. Services are offered on a first-come, first-serve basis, which means some might leave in the afternoon without being treated.
But for Patricia Hunt, who was in line with her father at 7 a.m. — “I thank God a place like this is available,” she said.
“I wish there were more of them,” she added.
Renee Romberger, vice president of Community Health Policy and Strategy at Spartanburg Regional Healthcare System, said uninsured adults really have nowhere to go for dental help.
They “fall through the cracks,” she said.
Poor dental health can lead to a myriad of other health issues and it negatively affects the economy, Romberger says. Ten percent of adults in Spartanburg County don’t have teeth in their mouths, according to data provided by the Road to Better Health Coalition, a group of health leaders committed to improving health in Spartanburg by 2018.
“Folks who have teeth in poor condition have a harder time finding a job and that affects our economy and the health and wellness of our community,” she added. “This is a problem that we have to address in Spartanburg. We can’t ignore it.”
John Daniels, 47, has a different problem.
The Spartanburg resident doesn’t need to get a tooth pulled; his problem is trying to get new teeth put in. He needs dentures. But without health insurance or an income, he has no way of getting them.
“I am a diabetic,” he said, during a recent phone interview. “I can only eat soft foods because of my teeth.”
His diabetes led to him losing some of his teeth, and his lack of teeth exacerbates his diabetes.
“I just wish there was a free dental clinic or somewhere to go,” he said.
Harvey Galloway, executive director of BlueCross BlueShield of South Carolina, said Medicaid covers pediatric dental care but adult dental was dropped a few years ago during budget cuts. He said the Affordable Care Act also doesn’t cover dental, and many people don’t select dental plans because of large deductibles.
One study by the Centers for Disease Control found 42 percent of Americans don’t get dental care because they either don’t have dental insurance or can’t afford the care because of high deductibles.
So where do uninsured adults, like Daniels, currently go with dental problems?
Many show up in the emergency room — a place that really can’t offer any definitive help.
Research conducted by the American Dental Association Health Policy Resources Center concludes the number of dental emergency room visits in the US jumped from 1.1 million in 2000 to 2.1 million in 2010.
Dr. Chris Lombardozzi, medical director of emergency services at Spartanburg Regional Healthcare System, said patients show up with oral symptoms ranging from local trauma to pain from dental decay or dental abscesses. He said acute infections and pain are typically treated with antibiotics and non-narcotic pain medication. Patients may also receive dental injections for acute relief.
But for further dental care, Lombardozzi said, patients with limited financial resources are referred to the ReGenesis Dental Clinic, which offers services on a sliding pay scale. But people living below the poverty line can’t even afford this, said George Newby, director of ReGenesis Health Care.
“If you live below the poverty line and you’re an adult, you can’t afford dentures or crowns or anything like that. Dentistry is a lot more expensive than medical care.”
Dr. Duncan Shirley, who has a practice in Traveler’s Rest, is one of the dentists who volunteers at the free extraction clinic at Miracle Hill Rescue Mission.
“I would say we usually have as many as 70 to 75 (people) out there lined up at one time,” he said.
When he is there, he tries to stay until everyone has been seen. But he says a lot of the volunteers, many whom are college dental students, just physically can’t. They get tired.
Paul Stevenson, who waited in line on a recent Saturday, said he has come to the clinic in the past, waited in line, and still didn’t get seen.
“I just have to come back next month,” he said.
Shirley said they generally cut it off at 25 or 30 people, and the people in line understand it’s first come, first serve.
Shirley says he has a “real big heart” for helping people, and participating at the clinic is about meeting a mission need here at home, rather than traveling to a foreign country.
“When you finish with someone and they thank you for all that you’ve done — that makes it all worth it,” he said. “I hate turning people away.”
Patsy Whitney, director of St. Luke’s Free Medical Clinic, said St. Luke’s currently provides dental care for its patients on a referral basis. She said 10 dentists currently volunteer to see St. Luke’s patients in their offices at no charge.
But that isn’t enough, Whitney said.
“Spartanburg is in dire need of free dental care for adults,” she said.
Children who come from low-income households can get dental care for free from Healthy Smiles.
Search for solutions
While Spartanburg leaders scratch their heads and survey plausible solutions, other counties across the state have already found answers. Galloway says there are 18 free dental clinics scattered throughout South Carolina.
In Horry County, Blue Cross Blue Shield funded a free dental clinic at Horry-Georgetown Technical College. Volunteer dentists and students in the college’s dental programs currently treat children and some adults who need limited care at a reduced cost.
“It’s a good program and we think it has a lot of potential to replicate in other areas of the state” Galloway said. “But we just awarded that grant so it is just too early to tell.”
In Oconee County, Mountain Lakes Access Health program received a $30,000 grant, some of which came from Blue Cross Blue Shield, to help fund a new Community Access Dental Clinic for low-income, uninsured adults.
“We knew access to dental care was one of our greatest needs,” said Cortni Nations, executive director of Mountain Lakes Access Health in Seneca. “We decided we needed to do something about the problem.”