Dental danger: Spotlight on the need for better access to oral care

Pam Adams

Initial reports about a Peoria County Jail inmate dying of gum disease quite naturally upset more people than the inmate's family.

Peoria periodontist Dr. Chris Couri remembers five or six patients showing him copies of the newspaper story.

"People were shocked," he said. "Nobody thinks I'm going to die from an abscess."

Subsequent tests found the 25-year-old inmate died of complications other than gum disease - the combined effects of an undiagnosed cancer and an infection - something Dr. Sue Bishop suspected all along.

"I read the stories, too," said Bishop, dental director of the Peoria City/County Health Department. "The microorganism (mentioned) is not an organism of the mouth."

The inmate, Jeremy Baksai, died last March. Many of Bishop's colleagues in dentistry were still dealing with a documented dental-related death that had occurred just a month earlier.

Twelve-year-old Deamonte Driver of Prince George's County, Md., died after bacteria from an untreated abscessed tooth spread to his brain.

Shortly before he died, his mother had lost Medicaid coverage for her children because of a bureaucratic snafu. The situation was compounded by the family's stay in a homeless shelter and the inability to find available, accessible oral care.

A Washington Post story compared the cost of a routine tooth extraction, $80, which might have saved the boy's life, to the approximate $200,000 it ultimately cost for hospitalization, emergency brain surgery and subsequent therapies.

"Deamonte's death should be a wake-up call to the nation," the

Chicago-based American Dental Association said in a statement after the boy's death. "It is a national disgrace that in 21st century America, millions of children don't have access to basic preventive and restorative dental care."

Federal and state public officials should stop "short-changing" dental programs, the ADA said after noting that "good oral health isn't just about teeth and gums. It's about overall health."

A boy's death from a decayed tooth and a young man's supposed death from gum disease don't only focus attention on poor access to dental care.

These deaths should highlight the fact that poor oral health can have far-reaching, even fatal, consequences.

Just because Baksai didn't die of gum disease, according to the autopsy report, doesn't mean it couldn't happen. Though it's extremely rare, advanced gum disease can lead to death, said Dr. Barry Simms, a periodontist with Maple Shade Dental Group.

But dentists say it's more important to remember gum disease can compromise overall health. Dozens of studies link gum disease to heart disease, strokes, diabetes, and premature and/or low birth-weight babies.

Gum disease is an infection of the tissue that supports the teeth. It's usually caused by plaque. Gingivitis, the mildest form of gum or periodontal disease, is simple to treat. But if the infection advances, the irritated tissue separates from the teeth, creating spaces, or pockets, where bacteria can breed.

Loose, damaged teeth are one obvious result of advanced gum disease. Unchecked, the infection can get into the bloodstream and travel to other parts of the body.

"Periodontal disease is an opportunist bacterial infection," Couri said. "Once it's advanced, you're in trouble."

Advanced cases are typically associated with long-term neglect or people who have ignored all the signs and symptoms, such as bleeding gums, he said.

Whether complications are the result of gum disease or cavities, Bishop said central Illinois residents aren't likely to die because of lack of access to dental care in county facilities, such as the jail or Bel-Wood Nursing Home.

The growth of dental clinics at public health departments shows the area is trying to meet the need, she said. Tazewell and Bureau counties are among the health departments that have opened dental clinics in the last five years.

"I know the resources available in the central Illinois corridor, especially for children. What we're working on now is improving access for adults on Medicaid. We don't have enough funding," Bishop said.

Heartland Community Health Center and OSF Saint Francis Medical Center's clinic provide dental care for their patients, but the availability of basic dental care for adults without insurance is limited.

While state and federal officials grapple with rising Medicaid costs, Bishop said dental care accounts for a very small percentage of the overall costs.

"It was one half of one percent when I checked a couple of years ago."

Increasing that percentage, maybe doubling it, wouldn't be a lot, she said, but it would mean a lot to dentists trying to provide care for uninsured and Medicaid patients.

Additionally, she noted, more dental-clinic services would cut down on the numbers who go to hospital emergency rooms for dental problems. She is currently studying the incident rate of such usage.

"We don't want to have untimely deaths such as Deamonte's. We don't ever want to have a situation such as his here; we don't want to have anything like that with adults, either," she said. "Give us a little more money, and we can really prevent catastrophic costs."

Pam Adams can be reached at 686-3245 or padams@pjstar.com.