Medical Examiner

The Fellowship of the Messed-Up Mouth

June Thomas and her editor Laura Helmuth talk about the challenges of reporting on dental care, poverty, and more.


Photo illustration by Slate. Illustraton by Charlie Powell. Photo by Thinkstock.

This story is part of a special Slate Plus feature package on “Disrupting Dentistry.” Be sure to check out the other Slate Plus exclusives related to this story, including a full audio version of the piece and an inside look at June Thomas’ longtime interest in dentistry.

Laura Helmuth: I want to start off by saying that you have a beautiful smile, June. But it hasn’t always been that way. Can you remind people of what your smile looked like when you were younger?

June Thomas: I don’t think most Americans can imagine. There was lots of open decay, and I had giant holes in my mouth—Swiss cheese teeth, basically. It was horribly painful, and I was very self-conscious, but I could still compartmentalize it somehow. I pretended it was normal to have teeth like that.

But I still have some shame about it, actually. After all, it was something I caused. It was partly that my family knew nothing about taking care of their teeth—they grew up in an era and community where it was quite normal, even expected, to have your teeth extracted and to get false teeth. It was considered a favor you were doing yourself, and furthermore, it was something that happened in your early 20s as a matter of course. You didn’t bother to try to keep your natural teeth. Even now if I tell my mother I’ve gone to see the dentist, she’ll say, “Why don’t you just have them out?”

Helmuth: For a lot of people, it’s not a matter of basic appearance or wanting to look your best, but it’s really a matter of being disabled by excruciating pain.

Thomas: If you have the teeth that I used to have, it’s very hard to get a job. It removes you from middle-class society, it causes feelings of shame and embarrassment, and it’s very difficult and very expensive to fix. I realize very few people have that opportunity. The fact that I had the money and a very patient dentist in Seattle, as well as the ability to get my teeth fixed over a long period of time (since I have the type of job where I can take off for appointments) is so rare.

So now whenever I see people in the same situation, it’s like the fellowship of the messed-up mouth. It’s not exactly a nod or a wave like you do with someone who drives the same kind of car as you, but there’s a feeling of fellowship and an indication sometimes that you know what it’s like.

Helmuth: Teeth and vegetables are really the only two things that Americans feel superior to the British about. But in your investigative long-form story, you show that teeth are an American problem too. Poor children, even if they have insurance or live outside a remote area, can’t get basic dental health care. So they’re suffering from excruciating pain, from unnecessary loss of ability to use their teeth. You’ve uncovered that this is a huge problem in the United States and you found this amazing group that’s actually doing something about it.

Thomas: We know that there are at least 130 million Americans who don’t have dental insurance, but there are also nearly 47 million, kids mostly, who do have dental coverage that is provided by Medicaid or CHIP. Nevertheless, it’s very difficult even for them to find a dentist who will treat them. This is not because dentists are horrible or mean people—they’re not. But the payments are too low for most dentists to get involved, they say. What that means is in some states, only 10 percent of private practice dentists see any Medicaid kids. So 47 million kids have the coverage, but only about a third of kids have any kind of dental treatment in a year.

Helmuth: You found a clinic in Alabama that is treating some of the poorest kids in the poorest parts of one of the poorest states. How did you find the clinic?

Thomas: I move in dental circles. I’m very interested in dentistry—I’ve done a few other stories about it—and I subscribe to ADA News, the news publication of the American Dental Association. I also pay attention to both the dental press and when the mainstream press covers dentistry. A couple years ago, PBS’s Frontline did a documentary about dentistry called “Dollars and Dentists.” It was about the access problems that poorer Americans face when getting dental treatment. They were very negative about certain things, but one part of the show that was unremittingly positive was about this practice in Alabama called Sarrell Dental, which predominately treats kids with Medicaid and CHIP coverage—that’s about 90 percent of its patient base.

Helmuth: So you went to Alabama. And how long did you spend down there?

Thomas: I spent a week there. Sarrell Dental is based in Anniston, Alabama, which is kind of a sad place—there was an ecological disaster there, and some terrible things happened in the city during the civil rights era. It’s slightly run-down. I don’t want to exaggerate its troubled history or present. But it’s not the kind of place you would go looking for something tremendously innovative that’s shaking up an entire little world.

I spent some time with CEO Jeff Parker and his team in Anniston, but also we went around to five clinics around the state—and all five were very different. Bessemer was a place that I hadn’t really seen in America—the neighborhood is very run-down, and shotgun shacks were the predominate kind of architecture around the clinic. But the appearance of the clinic spoke to the way that the organization is valued. Though the area was very run-down, the clinic itself had not been touched in any way—no tagging. It was pristine on the outside and on the inside.

Helmuth: It sounds like all of the people you met at every single clinic were all absurdly dedicated. In your piece, you called them “evangelical” in their beliefs. They were very positive and happy. And it kind of made them sound like cult members.

Thomas: I know, I know.

Helmuth: You must have been looking to burst the bubble. Or find out if there was a super-secret ugly backstory. But was it really genuinely a good thing?

Thomas: As a journalist, you know that if you can be critical, it actually sells the story better. Because you don’t want to seem like you’re in the tank.

But I have to say that they kind of put me in the tank, a little bit. Everyone I met at all levels of the company was incredibly dedicated, incredibly positive, and very committed and happy to be there. Everybody was able to articulate the mission of the company, and they all bought into it. If they were acting, they were all really good actors.

Now to be fair, Sarrell is a really well-paying company. They say that they pay their clinicians (dentists, dental assistants, dental hygienists, etc.) the highest rate in the state. So that is a factor that I don’t discount, but I don’t think that’s the whole story. I think that people who work there are very proud of providing care to kids because that is, unfortunately, so rare.

Helmuth: When I was editing the story and reading your details about how Sarrell makes it work, I wanted to evangelize for Sarrell, too. Why can’t we just do this everywhere and solve the problem of children not getting dental care?

Thomas: As the piece states, there are dental practice acts that get in the way. But perhaps the bigger problem is the two-worlds aspects of dentistry: A lot of people (and these are the people whose voices are heard louder and count more, perhaps) don’t realize that there are problems in the field, because they themselves have taken care of their teeth and been able to go to the dentist.

The baby boomers are starting to retire. And I’m not sure if people realize that Medicare—which a lot of people rely on for their health care after they retire or turn 65—doesn’t have any coverage for dental care. Teeth do wear out, so they’ll probably need to have some procedures done on their dime. And it is very expensive.

As people get to be 65 and are responsible for their dental bills (if they want to hold on to their teeth, that is) maybe there will be some move toward a clinic setting—a shared environment where lots of people go, rather than a one-doctor, two-chairs kind of situation. Perhaps there will be places that are more economically efficient, more organized in a way that will allow dental care to be less expensive. That’s my hope.