By Liora Engel-Smith

Brenda Phillips is accustomed to pain. The 69-year-old had five surgeries that fused some vertebrae in her back following degenerative disc disease. The last surgery she had in 2007, left the Moore county resident with residual damage that makes it difficult to sit, said her husband of 49 years, Noah Phillips.

Lately, another urgent medical need cropped up: her teeth are in bad shape. It was early February when the couple learned that she needed nine upper teeth extracted. On top of that dental surgery, the woman would need dentures for her upper jaw, Noah Phillips, 73, said.

“She can’t chew, so you have to get the food ground like mashed potatoes,” he said.

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Noah Phillips is a problem solver. He once pulled out a loose tooth fragment from his own mouth with pliers. He uses similar resourcefulness to feed his wife, creating dinner shakes that consist of chicken, dumplings and pinto beans for her.

Most solid food is out of the question, he said. Brenda Phillips, a Type II diabetic, can occasionally crush soft foods, with her remaining bottom teeth.

By February, Noah Phillips had explored the options. The couple does not have dental insurance so extractions would run them $300 for each tooth, out-of-pocket.

“If it was only one I might could have done it,” he added, but the couple couldn’t afford more.

That’s when they caught a lucky break. A volunteer-run mobile dental clinic at St. Joseph of the Pines, about 20 minutes away, offered free extractions for uninsured adults several days each month. Brenda had five of her teeth removed for free and was slated to have the other four removed the following week.

That follow-up appointment never came. Coronavirus restrictions shut down the clinic and most other dental care across the state in mid-March. Most practices resumed services in the spring, but the mobile clinic, which operated four days a month in the towns of Southern Pines and Fayetteville, remains closed for the foreseeable future.

“It is a difficult decision,” said Scott Brewton, vice president of St. Joseph of the Pines, a retirement community that owns and operates the mobile clinic. “Life as we know it and all of the things that anybody would want to take advantage of has slowed down or has been put on hold this year.”

The clinic will most likely remain closed until a coronavirus vaccine is available or the county sees a drastic decline in the infection rates, he added.

With a total of more than 2,400 infections as of this week, Moore’s infection rate has been declining since the beginning of the month, NCDHHS data shows.

The closure of the mobile clinic created a gap in an already sparse safety net for adults not covered by Medicaid. Moore County’s other charity clinic discontinued its extraction program until January 2021, leaving many low-income residents with few options. Even while the program was running, its reach was limited. A local practice donated up to 10 extractions each month.

Though neighboring counties have federally qualified medical clinics that serve uninsured patients, the nearest organization or clinic with dental services is more than an hour away from Southern Pines.

Tony Price, who heads the Moore Free and Charitable Clinic, said the waiting list will likely fill three or four months when service resumes next year.

In a dental emergency, adults who are short on cash have very few options, Price said. They could work out a payment plan with a private dentist. They could also visit the emergency department for antibiotics, or look for charity care outside of the county.

The free clinic often sees clients with unmet dental needs, Price said. Patients, who may already be barely scraping by, may skip annual dental exams and cleanings for years, until tooth decay, infections and abscesses become too painful to ignore. Extraction is the cheapest and fastest option to address decay on a tooth that’s either too far gone or requires a costly root canal and crown.

“At that point, the best thing you can is to take the problem out,” Price said.

A constant need

By summer, Brenda Phillips had tooth decay severe enough to cause pain. The pain didn’t abate even with the prescription opioids she already takes for her back, Noah Phillips said.

But the mobile dental clinic in Southern Pines remained closed. Marlena Booth, who has been running the clinic since it opened in 2012, said she had received many calls from desperate patients at the beginning of the pandemic, but as the weeks turned into months, the calls stopped.

Before the pandemic, volunteer dentists would see 60 people a month for free emergency extractions. Every day she’d answer five or six calls from other residents needing the same services. Those dental needs have not gone away, pandemic or not.

“Most of these people have no funds,” she said. “They’re either retired or on a limited income and they don’t have the money to pay three, four hundred dollars to get one tooth out.”

Booth, who works for St. Joseph, thinks the mobile unit could reopen safely by only allowing in one patient at a time, rather than two. With masks, gloves and temperature checks, she said, both patients and volunteers would be safe.

St. Joseph’s Brewton disagrees. Coronavirus can transmit even when people don’t have symptoms, he said, and space in the truck would make social distancing difficult.

In the meantime, Booth has been connecting people with a charity clinic in Fayetteville, roughly an hour east.

Making an appointment there, however, could be a challenge in itself, Noah Phillips discovered.

Hurdle upon hurdle

Like the clinic in Moore County, the Fayetteville facility offers free emergency extractions on a limited basis and demand is high. By his own count, Phillips called the clinic 200 times in one day to try to make an appointment. But the lines were always busy.

His persistence paid off, however, and Brenda Phillips had the other four teeth removed in mid-October.

Noah Phillips knows it won’t be the end of his wife’s dental odyssey. Some of her bottom teeth are also decaying and will likely need to be pulled out soon. Her top gums are almost ready for dentures, he said, another expense they’d have to save up for.

“What we want to do is get the top taken care of and get everything healed up and try to give her some upper teeth and then she can eat,” he said.

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Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...