To boost job prospects, younger Americans seek dentures

Some areas that top the nation for unemployment also fare worst in a health measure that can keep people from getting jobs — missing teeth.

West Virginia is the starkest example. Not only did it have the highest jobless rate in June, but it also holds the dubious distinction of having the most working-age adults who have lost six or more teeth at 23%.

In fact, while most people associate lost teeth and dentures with the elderly, nearly one in five working-age adults in some Southern and Appalachian states have lost at least that many teeth, according to statistics from the Commonwealth Fund. And a study published last week in the journal Health Affairs showed 45 million American face dental care shortages, especially in rural areas. The need has spurred oral care professionals to respond with new ways to make dentures quickly and inexpensively to help those patients get back into the workforce.

Mary Deel, a 52-year-old former nursing home worker from Appalachian Virginia, saw the benefits recently when she received a free, full set of dentures made in an hour at a Remote Area Medical clinic in Wise, Va.

Without teeth, she didn't smile much and didn't want anyone to take her picture. But as soon as the dentures were fitted into her mouth, she showed them off with a proud grin in photos with dentists and technicians, saying "I'm happy…very happy."

People missing many or all of their teeth "almost become recluses. They don't go out in society. They don't apply for jobs," said Frank Tuminelli, a Great Neck, N.Y., dentist and president of the American College of Prosthodontists, experts in replacing and restoring teeth. "You give them teeth, and they feel good about themselves and go out and get a job."

For many, tooth loss is a symptom of poverty.

Nationally, more than a third of working-age adults have no dental insurance, and rates are higher in rural and impoverished areas. The Affordable Care Act doesn't require health plans to cover dental services for adults, and the Health Affairs study showed 20% or fewer dentists in some states take Medicaid, which is far more likely to cover tooth extractions than restorative dental work anyway.

Patients with the least access to dental care are also the ones most vulnerable to tooth decay and gum disease. They are more likely to smoke, use methamphetamine (which can cause a severe pattern of decay), depend on well water without fluoridation and drink lots of sugar-sweetened beverages. At the recent Remote Area Medical, or RAM, clinic, a Pepsi distributor's truck with Mountain Dew emblazoned on its side was parked next to the volunteers' snack bar it was stocking — and not far from a tent where dentists referred often to "Mountain Dew mouth" as they pulled tooth after tooth.

Problems begin early in life. Terry Dickinson, executive director of the Virginia Dental Association and founder of its Mission of Mercy program, recalled the youngest patient to have all his teeth extracted at RAM was a 19-year-old man. Of nearly 50,000 extractions performed from 2000-2014 at the clinic, Dickinson said a growing number are among people in their 20s. He always worries what this will mean for their job prospects, since "if somebody doesn't have teeth, they're not going to work in the service industry," where they have to deal with the public all day.

Michelle Turner, 27, of Castlewood, Va., couldn't bear to get more than five teeth pulled last month despite the 10 to 15 the clinic dentist said she needed to have extracted. She is hoping to get a job in retail soon after giving up a 70-mile round trip newspaper delivery job recently because it was costing her almost as much as she was earning.

She'd be willing to move hours from Appalachia to work in a store, but fears her teeth could hamper her, and wants dentures. So does fellow patient April Law, who had every one of her teeth pulled at the event. For her, being without teeth won't make eating any harder, at least; the infections in her rotting teeth were so bad the pain was shooting into her ears.

But the waiting list for free dentures at RAM was more than 600 patients long. And on the open market, dentures can cost up to $3,800 for a full set and require several appointments.

Dental professionals are hoping to reduce both the costs and the waits. The overwhelming need helped inspire the creation of Benchmark Dental Manufacturing Co., a Virginia firm that makes durable, customizable dentures in about an hour.

"We leave here feeling good but we feel like there's still so much to be done," said Gregory Gray, a company representative and Fredericksburg, Va., dental lab owner who joined colleagues in volunteering with RAM patients recently.

Tuminelli said a growing number of prosthodontists across the nation are making inexpensive, quick dentures, which usually take a day or two to make and are more likely to be available at dental schools or hospitals that serve lots of low-income patients.

But San Francisco prosthodontist Ann Wei said most quickly-made dentures have their limits. They're good for immediate needs, such as job interviews, she said, but are not as comfortable as what she called "permanent" dentures that still generally take several visits to make and fit correctly.

Both Wei and Tuminelli said technology will soon allow all types of dentures to be made more efficiently, however. Prosthodontists are now pioneering computer-based technology that uses video of teeth to help print templates for dentures.

"It's in its infancy," Tuminelli said, "but technology only gets better and cheaper in time."

That gives hope to patients such as Pamela Sherman, a 51-year-old rest stop worker who lives near Richmond, Va. She's had 10 teeth pulled, making her reluctant to smile on the job.

"If I got new teeth, I could smile again," she said. "Your smile and your face, that's what you present to the world."