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Jim Kenyon: The Root of the Problem

Sunday, June 07, 2015
After meeting Lisa Simon in downtown White River Junction a few days ago, I can’t stop thinking about teeth.

I blame Simon.

She’s very passionate about teeth, which might be expected, considering she graduated from the Harvard School of Dental Medicine just last year. But Simon’s interest in dentistry goes beyond crowns and root canals. When she looks into a patient’s mouth, she also sees income inequality, lack of access to affordable health care and the hardscrabble lives that many people endure daily.

That’s because Simon’s patients almost always are poor. They have teeth that are rotting, broken or missing. Many suffer from chronic dental infections that can exacerbate heart disease and other serious medical conditions. The poor and uninsured “learn to live with a level of pain that most of us would find intolerable,” said Simon.

And it’s not just the physical discomfort. A person’s teeth, or lack of teeth, can hinder their ability to find a decent-paying job, make friends or enjoy a pleasure as simple as eating an apple.

In our society, “We judge people by their teeth,” said Simon. “We see someone with bad teeth, and we think they only have themselves to blame for not brushing enough. But these are people who need to be supported, not shunned.”

Which explains how Simon ended up volunteering at the Red Logan Dental Clinic this month. Red Logan, located in the basement of its sister Good Neighbor medical clinic in downtown White River Junction, is one of the Upper Valley’s social service gems. The clinic, named in honor of an Upper Valley dentist known for his charity work, has been around since 1996.

Last year, Red Logan’s volunteer dentists, dentists-in-training and dental hygienists saw 657 patients, who accounted for more than 1,100 visits. Five days and one evening a week, the volunteers fill cavities, take X-rays and perform cleanings.

All for free.

Red Logan cares for uninsured adults on both sides of the Connecticut River whose household incomes go up to 250 percent of the federal poverty level. For a family of four, that can be nearly $70,000 a year.

It’s no surprise the need for services far exceeds Red Logan’s capacity. New patients typically wait three to four months for an appointment. Exceptions are made for people “in crisis,” but that’s a category most patients fall into at one time or another.

Red Logan received a tremendous boost a few years ago, when Harvard and Boston University began sending dentists-in-training to White River Junction for three-month residencies. It was an opportunity for their students to treat patients in a rural area under the tutelage of Upper Valley dentists at a clinic with state-of-the-art equipment. (The late Jim Jeffords was the patron saint of Good Neighbor and Red Logan, funneling federal money the clinics’ way while representing Vermont in the U.S. Senate.)

In exchange for free labor, Red Logan provides housing for two students at a time. (The owners of Timberwood Commons, a private housing complex in Lebanon, give the clinic free use of a two-bedroom apartment.)

When Simon heard a couple of years ago about the Harvard-Red Logan partnership, she quickly signed up. As a Yale undergraduate student working for a summer at a youth camp in Orford, she grew to appreciate what the Upper Valley offered in terms of hiking and biking.

After finishing dental school last spring, Simon continued her training with the Cambridge Health Alliance, the city of Boston’s safety net for underserved populations. This month, Simon had a break in her work schedule, so she contacted Hilde Ojibway, Good Neighbor and Red Logan’s former executive director and current interim development officer.

Could you use help for a couple of weeks?

Absolutely, Ojibway said. She even offered Simon a spare bedroom in her house. “Lisa is amazing,” said Ojibway. “She’s so passionate about serving the underserved.”

Simon grew up in Southern California. Her mother is a retired special education teacher and her father runs a nonprofit organization that, among other things, helps out with Special Olympics. “I grew up in a house where you do what you can” for people who are less fortunate, she told me.

Getting Simon to talk about herself is, well, like pulling teeth. I didn’t learn until an hour into our conversation that next month — at the ripe old age of 26 — she’ll join the faculty at Harvard’s dental school.

“We have a lot of terrific students, but Lisa stands out,” said Jane Barrow, the school’s assistant dean of global and community health. “She could write her own ticket. Any (private dental practice) would love to hire her, but she wants to go where she’s needed. That’s what makes her happy.”

While teaching at Harvard, Simon will volunteer one day a week at the Suffolk County jail in downtown Boston. In the summer of 2011, she worked at a jail in western Massachusetts, which led to her writing about the “link between socioeconomic status and access to dental care” for the Harvard Dental Bulletin. “Any doubts I may have had about the importance of dentistry as a primary care specialty,” she wrote, “ were obliterated upon seeing inmates enter in distress and pain and leave pain free, and in some cases, able to eat for the first time in many days.”

Last week, she supervised two Boston University “externs” at Red Logan. Their patients included a man in his 20s who “drank so much soda when he was young” that he destroyed his front teeth.

Another patient was an elderly man who had nine teeth pulled. He’s going to need dentures, which isn’t all that uncommon in Vermont and New Hampshire. Roughly one in five residents age 65 and over in the two states have had all of their teeth (32 in all) removed, according to data compiled by the U.S. Department of Health and Human Services.

Unfortunately, Simon couldn’t guarantee the patient that he’d be getting dentures anytime soon. Red Logan isn’t in a position to provide dentures, which can cost $2,000 or more. Medicaid, the federal-state health insurance program for the poor, won’t pick up the tab in either state.

Vermont’s Medicaid program covers only a small amount of dental care, such as fillings, annually. New Hampshire doesn’t even do that. It only pays dentists to pull teeth. How crazy is that?

“Dentistry is the most broken part of our broken national health care system,” said Simon.

But not so broken that compassionate dentists like Lisa Simon and clinics like Red Logan will stop trying to fix it, one tooth at a time.

Jim Kenyon can be reached at

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