John’s excellent dental adventure

Friday and Saturday, Anchorage had a mass free dental clinic. You may have heard of these events happening in other cities. I think the first of this kind of clinic that I heard about was one in the aftermath of Hurricane Katrina. The idea is that a large group of doctors and support people set up, what is essentially, an assembly line to provide basic medical services for as many low income people as possible in as short a time as possible. The one this weekend is exclusively for dental care.

The uneven availability of medical care in the United States is a national disgrace. When Obama was elected, around forty-five million Americans had no health insurance. Among the insured, many had inadequate coverage for a real emergency. A side note, rarely mentioned in the impassioned debates over Obamacare is that, even among that sub-group of people adequately insured for normal emergencies, many lack dental coverage of any sort.

Thirteen years ago in Virginia, an association of dentists, staff and other volunteers organized and carried out what was to become known as a Mission of Mercy, or MOM. Their goal was to provide free dental care to local residents who could not otherwise afford or receive care. Since that time, there have been over 70 MOM events in 26 states using the large mobile dental clinic model. While this model had been utilized many times in under developed countries, it had not been tried here at home.

The Alaskan MOM was the result of Anchorage dentist Julie Robinson and her husband David Nielson. After hearing about MOM events in other states they took on the project of organizing one in Alaska. Last year, they checked out a MOM event in Portland. It sounds like they had no problem finding people to volunteer up here. When they opened the doors this morning, they had 240 dentists and 1500 support people ready.

If 2012 was the year of bad loss in my life, 2013 was the year of bad things happening to my head. Six weeks before the boffo finale of my concussion, I lost a chunk of my lower, right, front molar. I had a filling in the middle of the tooth and that filling had been cracked for years. One day around the beginning of November, I was having a piece of cold pizza for breakfast and felt something hard. I assumed it was a bit bone in the sausage I had used for the pizza. As anyone would do when no one was looking, I worked it around to the front of my mouth, dug it out with my fingers, and checked it out. It was a long rectangular piece of tooth enamel, about the shape of a piano key. This was a serious bummer. The majority of my life had been spent in the middle class where there would have been no question about getting it fixed right away. My, apparently permanent, descent into poverty meant I would just have to live with it. Fortunately, no nerves were exposed and the only discomfort was from the sharp edges of the slot.

Fast forward four months. Now functionally homeless (living in number one sister's spare room), another rectangular chunk of my tooth sheared off. Getting my tooth fixed moved to near the top of the list of things to spend the advance on when I sell the book, though that didn't appear to be something that was going to happen soon. On Monday, Number One saw an article in the Anchorage Daily News about the MOM event and left it out for me to read with my morning coffee. The key details were this: the event would be Friday and Saturday only, the hours would be six to six, registration would start at 4:30 AM. And, they added, in other states, many people camped out the night before to make sure they got in.

Thursday night, I watched the six o'clock news and saw that people were already camping out in line. I thought about going down then, but I don't have the heavy clothes I need and am really too old to camp out on the street in sub-freezing weather. The next question was, "how early should I go in in the morning?" Obviously, the answer was, "as early as possible." But how early is "as early as possible?" There was a problem. Anchorage does have a bus system, but it is vastly inferior to bus systems in other comparatively sized cities. The first bus from our part of town, which is not a distant suburb, runs at 6:20 AM. So the question became, wait for the bus and take my chances being far down the line, or get up much earlier and walk in to get a better place in line. A quick poll on Facebook revealed a consensus for getting up and walking.

I got up at 3:30 AM and was out the door at exactly four. The temperature was 22 (-6 C). The Dena'ina Center is not quite four miles away. It took me seventy-nine minutes to get there, which is a bit slow compared to my pre-car days. At 5:20, the line wrapped around two sides of the block. Two television crews were there with their remote vans. The planning by MOM was impressive--garbage cans and frequent collection, port-a-potties, traffic control, information officers letting us know how things worked. It was a good first impression.

The line.

A group of ten of us got in at 7:25. I was number 483. At check-in, they gave us the usual clipboard with the usual questions. People in green shirts directed to some chairs to sit in. At this point, it was important to stay in numerical order. And then we waited. After all, five hundred people came in during the first ninety minutes; there was a bit of a backlog. The small group I shared a row with spent four hours waiting for the next call. At one point I went out for a cup of coffee and a muffin.

Long ago, I came up with the term "situational camaraderie" to describe that instant friendship that springs up between people forced together for a short time. People stuck in long lines, stranded by cancelled flights, or even shoved together in certain audiences form a very brief "we". This was no different. On one side of me was a world traveling engineer and his Brazilian wife. On the other was Roland (I hope he doesn't mind me using his name, a man about ten years older than me who moved very slowly, assisted by a cane. We learned that he had had surgery on his spine just two weeks ago. He spent over two hours standing in sub-freezing temperatures to get his teeth looked at.

When our row was finally called up, we went to a new set of chairs at a table where earnest young people in green shirts told us about the importance of brushing and flossing. It was a revelation. I rushed through the briefing and moved on to the next door, which led to triage.

Beyond the door, more green-shirts took us to more chairs where we waited for our numbers to be called again. Soon, a dentist in blue scrubs held up a green card and I was into triage. By now, it was almost noon, and he had been here to set up well before opening. I'd been standing and sitting in lines for seven hours and he had been standing and looking into people's mouths almost as long.

He looked at my mouth and my tooth and asked me what I wanted to do. I said, "slap some spackle on that hole tell me what to worry about next." I'm not usually sassy, but a short night and inaction had made me a little punch drunk. The triage dentist looked at my mouth some more and told me, yes the hole needed to be filled and there appeared to be some decay at the bottom that might need some drilling. I suggested that it might be muffin detritus. Everything else looked okay, he said, though I needed a good cleaning. The check-in form had asked how many months it had been since my last visit to a dentist. I wrote 36. The next question asked how many months it had been since my last cleaning. My last cleaning was about this time of year in 1988. I wrote down 312. I had hoped for a record, but the triage dentist didn't even blink. Poo.

After triage, our group broke up. That's the purpose of triage. My crappy tooth needed an x-ray, so a green shirt took me to the x-ray waiting chairs about thirty feet away. And I waited. Triage removed the people who could be helped quickly. Those of us who were referred to x-ray had a longer wait. There were maybe forty people ahead of me. I don't know if it was the triage dentists or the green-shirts before x-ray who made the decision, but, at this point, someone decided to move people with non-dental considerations to the front of the line. As soon as Roland left triage, he was escorted into x-ray. Some very old people, a woman who needed to get to work, and a woman with a baby were all moved to the front of the line. It took me a moment to figure out why, but not a long moment. This is the only place in the entire process that I heard a complaint. And it was a short lived complaint. Some guy walked up to the green-shirts to complain about people being moved ahead. Whatever they told him was enough to satisfy him. I didn't hear another complaint for the rest of the day.

And, into x-ray. Behind this curtain was another row of chairs and eight tables staffed by blue shirts. There were only four chairs, but it gave me enough time to scope out the system. The curtains at the entrance had radiation warning signs and I expected to find some kind of shielded booth for the x-rays. Instead, it was being done out in the open at the tables. One technician sat at the end of the table with a laptop and printer and the other sat at the far end of the table with an honest-to-god ray gun. It was a hand-held, cordless, x-ray gun. I asked the technician if they were allowed to run around with them after hours going "pyew-pyew" at each other. She said "no" but she thought she might. She asked me what I was reading and got a quick lecture about the etymology of the word "fossil". Surprisingly, she seemed interested.

The next green-shirt escorted me to the far side of the x-ray waiting chairs where another row of chairs was set up to wait for the routing table. This was a short wait. I went to a router, who sadly didn't have a chair at the table. We stood at the end of table he glanced at my x-ray and said, "yep, you need a filling." He waived for a green-shirt who showed me a chair literally right behind the router in front of a curtained off area labeled "Numbing." I expected a large-screen teevee set to a financial news channel, but a quick peek behind the curtain revealed more dental chairs and blue-shirts administering anesthesia.

After a few minutes I realized having a green-shirt to take us from the routing table to the numbing waiting chairs wasn't as silly as it looked. The waiting chairs were divided into different sections depending on what procedure we needed. People were plucked from the waiting chairs based on someone watching the dentists on the other side and estimating how soon a chair would open. This way, no one would end up waiting for a procedure so long that their anesthesia began to wear off. As it happened, I had a fair amount of time to wait and spent it watching the operation.

Along with the green-shirts, who were escorts and general crowd managers, and the blue-shirts, who were dental professionals, there were at least three other color-coded groups. A small number of people in pale yellow shirts assisted the green shirts in some capacity. After squinting at their name tags every time one walked by, I figured out that they were interpreters. Multilingual professionals had yellow sticky-notes attached to their name tags announcing their languages. One blue shirt had a line of languages hanging down like medals on a North Korean general. The hand-full of people in lime-green fleece jackets were organizers and sponsors. That left the orange shirts and I couldn't figure out what their role was. I wasn’t the only one watching. One of the news teams from the morning came by to get some footage of the clinic in operation. Another group of still photographers and a film crews roamed the hall from time to time collecting shots for a documentary they were planning.

The people involved tried to keep things upbeat. Several of the green-shirts were wearing funny hats. Two of the blue-shirts were wearing blue tutus that matched their shirts. Someone was making balloon animals. Not long after two kids with balloon hats went by, Sonya the balloon twister visited us. It hadn't occurred to her that Friday was a school day and that not many kids would be there. She was going around the waiting areas making flowers and hats for the grownups. A few seats down from me she made one for a very Alaskan looking man and tied it to his wrist. Next, she approached the woman sitting behind me who kept letting other people go ahead of her. While Sonya was making her flower, the three of us began talking. Sonya and I both deal with essential tremors. We explained to the nice woman the difference between those and Parkinson's. When her flower was done, nice woman finally let a green-shirt take her into numbing and Sonya made a flower for my hat.

Sonya.

Numbing didn't take long. Looking in mouth, the anesthesiologist said I had perfect anatomy. I asked him to please tell that to any single, middle-aged women who came through. He had moved to Alaska about the same time I did, so we talked about that while waiting for the drugs to take effect. I had a major attack of vertigo when he sat me up too quickly and had to clutch the chair for a minute before I could go on. I'm sure you know what happened next. A green-shirt took me to another set of chairs to wait for my number to be called. She started to take me to the extraction area instead of the filling area, but caught herself. I was glad we avoided that mistake. Because of the way they had timed numbing this wait was just a couple minutes and I was finally to the place I wanted to be. Someone was finally going to fix that tooth.

In the filling area, they had set up about twenty stations each with all the plumbing, power, lights, and tools needed for a dentist to do her work. When the dental assistant leaned the chair back I went very slowly because I was still feeling some vertigo. She gave me a white bib and I said it really needed to have a picture of a lobster on it. She told me some of the other dentists had bibs with dinosaurs on them. I wondered if I could ask her for one and decided not to. The dentist looked at my tooth and x-ray and explained to me that this might not be a simple filling. The hole was actually pretty deep. If we broke through to the nerve, she would have to stop because I would need a root canal and they weren't set up to do one. There was also a chance that the tooth was too damaged to repair at all and it might have to come out. The main point was that she was going to go slowly and give me frequent updates as we went.

It was not long before she stopped. The damage went too far below the gum line for her to fix with a filling and there wasn't enough solid tooth for a crown. Also, it and the gums surrounding it were full of infection. Sooner or later the tooth would have to come out. She wanted to give me a few minutes to think about it, but to me there was no question about it. It needed to come out and they were doing free extractions right there. I said, "let's do it." The good news was that she would do it and I didn't have to go get in the extraction line. While I waited for the dental assistant to get an extraction kit, I watched the people over in the cleaning section and decided I would forego a cleaning. I was hungry and tired and decided having a molar pulled would be enough for the day. By now the anesthesia was wearing off. I asked for more. While we waited for it to take effect, I told them interesting facts about elephant dentition and the dentist told me about a veterinary dentist she knew who had worked on an elephant with an abscessed tusk.

Dentists.

There's not much you can say about pulling teeth. Despite all of the advances in medicine over the last few hundred years, the technology of tooth extraction is the same as it was three thousand years ago. It all comes down to grabbing the tooth with some kind of metal pincers and wrestling it out. The dentist was very good at it. She explained every step she took: "Now I'm going to wiggle it forward and back. Now I'm going to wiggle it side to side. Now I'm going to pull." As soon as she clamped on to it, a big chunk of the tooth came off. After it was out, she used some smaller tools to pick out the last bits of root. And that was that.

I decided to skip the cleaning and call it a day. A green-shirt took me to the checkout table where I turned in my clipboard. They gave me some extra gauze and a little bottle of ibuprofen. The exit interviewer asked me to rate my experience and I gave them the highest numbers possible. The dentist said she had taken part in several of these MOM events and that this was the best organized one she had seen. The exit interviewer asked if I had any questions. "Yes," I said, "what do the people in the orange shirts do?" "They’re the team leaders," he explained. It was almost three o'clock. I had been there for ten and a half hours, but it was worth every minute.

The Anchorage MOM event treated about 2000 people in two days. They've already started organizing an event next year in Fairbanks.

More pictures can be found at the Alaska Dispatch site.