Before last week, Jesse Jones-Budziszewski hadn’t looked in the mirror for more than a year. She’d taken to shopping after midnight, when the stores near her Niagara County home were most desolate. She slurred her words.
All of this because the fear and expense of going to the dentist robbed her of most of her teeth.
“I’ve been accused of being drunk and I don’t drink. I don’t attend family functions. I’ve probably missed a good four years of weddings, funerals and every holiday with my family. I’ve become OK with it because I don’t want to make other people uncomfortable,” said Jones-Budziszewski, 36, a married, stay-at-home mother of two from Wolcottsville, near Akron.
She isn’t alone. In a health care climate where dental care can be costly – and many adults are underinsured or uninsured – some patients visit the dentist only as a last resort, when desperate and in pain, because they let their oral health care slide for far too long.
“This is a very common problem in dental offices and our dental clinics,” said Joseph Gambacorta, assistant dean of clinical affairs at the University at Buffalo School of Dental Medicine.
Those who wait so long run the risk of endangering their health, relationships and job prospects – large human costs they must weigh against expenses for preventative and restorative dental care. It’s a conundrum a growing number of Americans will face as baby boomers grow older and go on fixed incomes, and government leaders continue to ignore the climbing cost of dental care as they reshape the health care system, said Andy Jakson, president and CEO of Lif MCO, which manages Lif (pronounced “life”) Dental in Amherst and Evolution Dental Science in Cheektowaga.
“You look like a rock star,” Dr. Ian Walker told Jones-Budziszewski last week as he popped in her new temporary upper denture. She will wear the denture the next two months while Evolution Dental designs and builds implants and permanent upper and lower dentures.
Jakson and his companies are providing her with a free “Smile Makeover” she won in a Lif Dental Facebook contest. But he and other dental professionals across the region say it is possible for those who need dental care to find it. Here’s how – and why it’s so important.
1. The health reasons
“If you’re not taking care of your teeth, it’s going to affect almost all aspects of your quality of life,” Gambacorta said. One of his UB colleagues, Dr. Robert Genco, is among researchers who have connected oral decay to heart disease.
Dr. Larry P. Evola, a general dentist in Lancaster who also handles neuromuscular dentistry cases, said sleep apnea can sometimes be caused by dental conditions. Diabetes has links, too. “As you lose your teeth, you’re also going to jeopardize your ability to eat nutritious foods,” Gambacorta said. “You’re not going to gravitate toward asparagus or that apple. You’re going to gravitate toward something softer and more calorie-ridden.”
2. The mental health fallout
Jones-Budziszewski’s dental woes began when she was 9, after several baby teeth that didn’t fall out had to be removed to make way for her adult teeth. She wore braces for most of the next five years to ward off an underbite. She worked during her 20s mostly in temp jobs that didn’t offer health insurance. Many of her teeth went to waste because she couldn’t afford to fix them. “There was also a genuine fear to go to the dentist from what I went through as a child,” she said, “so when I had a bad tooth, it was cheaper to just go get it pulled.”
Those decisions, and an attempt to make do with poorly fitting dentures, led to all but 11 lower teeth to be removed because of decay. She ditched the dentures and isolated herself from almost everyone but her husband, Bruce, a truck driver, and their children, Shauna, 15, and Jacob, 9. Her mother, Joanne Murray of East Amherst, cried as she described how her daughter missed two of her cousins’ weddings in recent months. “As a mom, it’s been tough on me, too, to see that my baby thinks she has to hide away,” Murray said.
“There’s a lot of other ramifications to creating a new smile than making someone look nice,” Gambacorta said. “There are some inherent benefits in doing it. If people start feeling better about themselves, they’re going to be out there in social situations. They’re not going to be afraid to take an advancement in a job.”
3. Anxiety can be addressed
The dental industry has made great strides when it comes to addressing the fear that comes with visiting the dentist. “Over the last 30 years, things have become more minimally invasive,” said J.J. Siepierski, vice president of Evolution Dental Service, the lab where Jones-Budziszewski’s dentures are taking shape. This means fewer doctor visits, more conservative treatment options and less pain.
A growing number of practices use sedation dentistry that allows anxious patients to sleep through treatments, Gambacorta said. Dentists can prescribe calming medications that patients can take before they arrive – as long as they have a driver – to ease them through a dental visit. There are numbing agents that take most of the discomfort away from novocaine shots. Evola, owner of Forestream Dentistry on Transit Road, said he has become one of the first in the region to use Anutra, a local anesthetic that works faster and less painfully than novocaine.
4. Understand the cost
Dentists have begun to offer a variety of choices to patients based on the “good, better, best” sales model during the last generation as costs have soared and dental insurance reimbursements remained flat, Evola said. “We may talk about a few things that are possibilities for patients but it’s ultimately their decision,” he said. If it’s clear money is a big consideration, he will focus his conversation on the most pressing problems, and may connect the dots for patients who might be suffering from dental-related headaches, neck pain and other issues. “You don’t want to overwhelm patients,” he said. “The tendency for people is to say, ‘Wait a minute, I just came in to get my teeth cleaned.’”
Jones-Budziszewski is getting the “Cadillac” of smile restorations, Lif Dental staff said, while the prize winner’s mother, already a Lif Dental patient, is getting a “Chevy,” or less costly version, in a new permanent denture. Lif Dental also is among offices that provide a free consultation to prospective patients and use Groupon and other discounts to help reduce the cost of preventative visits. Jakson also owns a company called Quick Pay, one of several dental financial firms that allow patients to spread out payments for more expensive procedures at little or no interest.
Those seeking more affordability can look to Erie Community College for free routine care or to the UB dental school for lower cost comprehensive care in all dental specialties, including smile restorations. Because UB has teaching clinics, handled by students overseen by dozens of the top dentists in the region, the cost generally is about half that of standard care, Gambacorta said. Those with limited means can stretch their dollars even further by applying for Medicaid, which is accepted by the UB Clinic, several neighborhood health centers in Buffalo and a small number of private dentists in the region. UB and the Good Neighbors Free Clinic in the city are among those with Medicaid specialists on staff who can guide patients through what Jones-Budziszewski and others described as a maze of rigorous and confusing paperwork.
The UB clinic handled 150,000 patient visits last year and is open to people of all financial means; Good Neighbors provides free basic dental care twice a week from 18 of the region’s top dentists who volunteer to see lower-income patients on a first-come, first-served basis. Appointments will take more time, but bring with them substantial savings. “Our typical patient hasn’t seen a dentist in two years,” said Todd Koch, executive director with Good Neighbors. “We have people come in who’ve never been to the dentist as adults. They never had insurance, so they never went.”
5. You are responsible
The way to get better dentistry is to research the office or clinic you’re considering. Make sure they can reasonably handle your concerns. If you have a fear of going to the dentist, find out what a clinic can do to help put you at ease. And ask about affordability. Because a significant investment in time, money and emotional energy comes with required dental work, Jakson and Gambacorta said it’s also always a good idea to get a second opinion – especially if you feel pressured or overwhelmed by the amount of dental work recommended.
Jones-Budziszewski knows she is particularly fortunate at this point. It comes after a decade of anguish.
“All right! I can eat,” she said as she looked in the mirror at her new temporary top dentures last week.
She said she chose to go through the entire process, allowed “before” photos to be taken, and shared her story not only for herself.
“I don’t want people to go through what I’ve gone through,” she said. “I want them to know there is a solution.”