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The Toll of Teeth

Don’t label those without access to dentistry

What do you think when you see someone with bad teeth — big gaps or the disturbing discoloration of decay or the sunken-jaw look of too many missing teeth —  someone who covers his or her mouth when talking, someone who seems afraid to smile? Dangerous? Criminal? Drug addict? 

Well, in some cases that might be true, but in most cases it’s not. And the judgments that you and I — often unwittingly — make about people with visibly bad teeth can be a barrier to those people overcoming difficulties in their lives.

It is true that many homeless people have serious dental problems. Josie McCarthy, manager of FOOD for Lane County’s Dining Room program, which serves up to 300 free meals a day four days a week, estimates that 75-90 percent of clients have problems with their teeth. Kim Freuen, clinic coordinator at White Bird dental clinic, says that about 10 percent of the clinic’s patients are homeless and “it would be rare that we see a homeless person whose teeth are in good shape.”

Sometimes drug use, methamphetamine use in particular, is the cause of the problem. But more often, it is conditions that led people to homelessness or the reality of life as a homeless person that are the main factors. People who end up homeless often grow up in traumatic situations where they never learn the basic habits of good dental health. And once people become homeless, it’s really hard to take care of their teeth. 

“If you have nothing, everyday you’re looking for food, you’re looking for water and where you can sleep, trying not to lose your belongings,” Freuen says. “So teeth are kind of down the list.”

And once teeth become visibly bad, they become an obstacle to employment and housing, exacerbating difficulties that make it hard for people to find a way out of homelessness. Their often already fragile self-esteem is shaken and they lose self-confidence.  Maybe worst of all, they find it increasingly difficult to have routine conversations with people who react without thinking to a damaged or diseased mouth.

Chris Plourde, a 51-year-old resident at a homeless Safe Spot managed by Community Supported Shelters, ran into that sort of passive hostility when he was a student at Lane Community College. When he first started there, he described himself as “kind of chatty.” But he sensed other students recoiling from him. One teacher repeatedly avoided him. Another challenged the originality of a paper on a subject he cared deeply about and had spent a great deal of time researching and writing. All, he believes, because of the appearance of his teeth — the result of a degenerative disease that runs in his family.

“It’s a perception problem,” Ploude says. “Most of the time, it was just fear — and I couldn’t bring myself to be angry at them because they were afraid [after] seeing instances where people are homeless and are acting out in really aggressive ways. I’m like, ‘I get it — but I’m not that person.’”

But it took a toll on Ploude, who had overcome a battle with depression earlier in his life. “Then, I could say that all of that stuff originated inside of me so I felt empowered because if I’m the problem, then I could be the solution,” he says. “But this was coming from outside of me and it seemed like an obstacle that no matter what I did, I’d just get this fear. Imagine going up to someone and getting that reaction and knowing that no part of it is coming from anything you are doing.”

So what can the rest of us do to break down this perceptual wall that increases the separation between homeless people and us? Be aware of our prejudices. Hold off before labeling someone with bad teeth a drug addict or a criminal or some other dangerous type. Give them a chance to be themselves. Support agencies like White Bird and HIV Alliance that provide dental services to those who can’t get them otherwise and The Dining Room and Community Supported Shelters and the Mission that feed and shelter homeless people so they can better address issues like dental problems.

Chris Plourde has a pretty basic hope for the end result of the process he is currently undergoing to get his teeth fixed: “Simply that I would have normal interactions with others. It’s easy to take that for granted until it ceases to be available.”