Denise Evans walks away from the popular hangout spot and takes a smoke break off to the side of the 7Hills Homeless Center in Fayetteville. A brick bench sits along the corner of a slab of concrete next to the building. She sits and smokes her cigarette, in no hurry.

Denise has come to 7Hills for the past 35 years. Even though she hasn’t been homeless for the past year, she either takes the bus or walks from another part of town to visit. Her friends are here. She considers them her family.

“If I don’t show up at least twice a week, they start freaking out, thinking I’m dead or that something bad has happened to me,” she says.

Denise talks to her friends, smokes cigarettes with them, gets lunch at the local church with them or dines at the shelter.

“They had everything really soft today,” Denise says on this Wednesday in April.

Denise and her friends eat ham, mashed potatoes and fruit salad. She can chew everything pretty well, but sometimes, she can’t. Denise, like many homeless and low-income individuals, endures worsening dental conditions. In fact, she has no teeth at all – and hasn’t since 1979.

Having no dental care can lead to serious health problems, not to mention everyday struggles, such as chronic pain, infections and the inability to eat certain foods. Those may seem like good reasons to fix the problem, but for people who aren’t certain where their next meal or shower will come from, dental care is nowhere near the top of their priority list.

“I never did think about it,” says Denise’s fiance John Smith, who has severe dental problems of his own.

Teeth never seem like a big deal, that is, until they become a big problem.

“A lot of people don’t think about it until it’s too late because they have to give something up to get it done,” Denise says. When a pack of cigarettes, a tent and a sleeping bag are all a person has, it doesn’t seem like there’s anything that can be given up.

Denise has found that employers shy away from hiring people who have noticeably bad or missing teeth.

“If you don’t look right, they ain’t going to hire you,” Denise says. “If they know that you’re homeless, forget it.”

While spending time with her homeless friends, Denise has seen people, all too often, get discouraged because their appearance, including their teeth, does not make them the most desirable candidates.

“They need a job, too, and a life,” she says. “It was to the point where you didn’t even want to go into an office because you knew you were going to get turned down. You know why they’re doing it by the way they’re talking and acting toward you.”

 

Everyone at 7Hills gets quiet and looks up from their newspapers, magazines and card games when one of the employees says she has an announcement. She announces that the shelter is moving locations, and the new building will be next to the police station. The silence is even more acute.

“April Fools!” she says. Everyone erupts in laughter. She got them good.

 

For one man at 7Hills, Nate*, his periodontal disease didn’t become visible until a year ago. Almost four years earlier, he was diagnosed with diabetes, which increases the risk of developing the gum disease. The disease starts as gingivitis, which is caused by a lack of dental care and cleaning. When the disease is allowed to worsen, it turns into periodontitis. At that point, gums start to pull away from the teeth and form spaces that get infected. The bone and connective tissue that hold teeth in place start to decay, and eventually, teeth fall out or have to be pulled. He has already lost a few teeth, and more are loose.

“I’d like to hang on to them as long as I can, but eventually, it’s going to come down to the point where I’m going to have to have them all pulled and then figure out if I can get some kind of insurance to pay for them because I can’t pay anywhere from $6,000 to $10,000 for teeth,” he said.

Nate can’t stand that people notice his teeth are missing, but strangers get freaked out when people initiate conversations about their health problems, he said. If they only knew that this isn’t really what he looks like.

The lack of dental care for the indigent is a severe enough problem that staff members at the local hospital,  Washington Regional Medical Center, have jumped through hoops to help. A glimmer of hope, a mobile dental clinic, drives into the homeless center’s parking lot every Thursday. A complete dentist’s office operates inside a truck.

Offered through the hospital, the mobile clinic is for people who do not have regular dental insurance. Roughly half of the 18 patients who come in each day are homeless, hygienist Elaine Glass said.

“Unfortunately, most of them, by the time we get to them, are needing full-mouth extractions,” she said.

After being built for more than a year, the truck started treating patients in July 2014. The state’s Dental Corporation Act, which prohibits hospitals from hiring dentists, made introducing the clinic an obstacle, she said.

The dentist, Jamie Moore, has a contract with the hospital but is under the umbrella of another dentist who has a home office. The dentist is not technically an employee of Washington Regional. Wal-Mart pays for the clinic, including the truck and staff salaries.

When people have chronic dental problems they cannot afford to fix, they resort to quick fixes that don’t eliminate the problems, but make them easier to live with. Some people only eat soft foods, which makes it a challenge to get enough nutrition. Being homeless or poor makes it even harder.

Others go to the emergency room, where they know they’ll get something to ease the pain, Glass said.

Last year, more than 1,000 of the 55,000 people treated at the Washington Regional emergency room were there because of dental problems, said Kyra Guthrie, the clinic’s program manager who doubles as its receptionist.

Emergency room staff refer people with dental problems to the mobile clinic. There, patients are given no medication until they are treated.

“We want them to actually fix the problem and not just delay it,” Glass said.

The dental clinic parks at LifeSource International in south Fayetteville on Mondays and Tuesdays, at The Manna Center in Siloam Springs on Wednesdays and at 7Hills Homeless Center in south Fayetteville on Thursdays. It also visits Eureka Springs once a month.

The purpose of moving around is to reach more patients near concentrations of homeless people on the south side of Fayetteville.

The hospital is on the north side of town, and 10 miles takes on a whole new meaning to people who do not own a car or have money for a bus or cab. The dental clinic doesn’t provide dentures, which is ultimately what people who have gone too long without dental care need.

 

Until 1979, Denise had beautiful teeth. She still has nightmares about the night she lost them.

Her former husband, who regularly abused her – mentally and physically – tied her to their bed and beat her until the neighbors called the police. Along with the other injuries that kept Denise in the hospital for months, her teeth were knocked out, and the broken pieces that remained had to be cut out. Doctors had to break her jaw and wire it shut.

While Denise was in the hospital, her four children stayed with her aunt. Afterward, a friend brought Denise and her children to 7Hills, which was an overnight shelter at the time. They lived there for three years.

“He goes, ‘Well, since you did that behind my back, I want a divorce.’ I go, ‘You got it,’” she says.

Denise sought counseling while in recovery but didn’t find it helpful. The only counselors she had access to were men who she felt did not understand what she had been through. The emotional and physical trauma lingered and was present every day.

People couldn’t see the emotional trauma when she talked or smiled, but they could see that her teeth were gone, a reminder of what had happened. That made it all the more difficult to live life normally.

“I got to the point where I would stay in my room,” Denise says. “I wouldn’t come out. I wouldn’t let people in or out of my home. I didn’t want to be around nobody.”

Even after making significant progress in recovering from years of abuse, Denise was reminded – any time she wanted to bite into an apple or smile really big without thinking – that she had no teeth and that everyone could see that.

“It’s worse than self-conscious,” she says. “People shy away from you like you’re some kind of disease.”

John nods along as Denise smokes another cigarette at a picnic table just outside the shelter’s entrance. They have just come from lunch at one of the churches where John got a coffee mug with Eeyore from Winnie the Pooh printed on the side. He twirls it around, looking down at it.

“They think you’re on drugs,” he says.

Denise had dentures for a brief period, but they were stolen when her home was robbed.

“They took my teeth – plain and simple,” she says.

In the years that followed, dental health was put on the backburner, yet it remained at the forefront simultaneously. The chronic pain in her mouth, the inability to eat hard foods, the way she looked with no teeth – those problems never went away.

“You never get used to it,” Denise says. “Even when you get dentures, you don’t get used to it. It’s just something you got to do.”

She often takes Tylenol or ibuprofen to help with the pain, but she only takes medicine when it’s bad enough. Otherwise, she’ll build up a tolerance, and the pain relievers will no longer work.

“It’s every day,” John says. “You can’t eat right.”

Denise and John go way back. He was married to a friend of hers, but when they divorced in 2006, John became homeless. He remained so until he started dating Denise, and she invited him to live with her three months ago.

“I kidnapped him,” she jokes.

Dental insurance or paying for a dentist have never been options for Denise or John. More pressing matters, such as living on the streets, have demanded their attention.

“Why was I homeless? I had a heart attack and lost my place – plain and simple,” Denise says.

Her heart attack happened three years ago. Consequently, she was unable to work and became homeless for the second time.

The mobile dental clinic is still fairly new, and although dentures are something staff members want to offer in the future, there is not a definite time frame for when that will become a reality.

If Denise ever gets free dentures, the chronic dental health problems that she’s lived with for 35 years will stop being an everyday hurdle. Until then, she puts out her cigarette and goes back inside to visit her friends.

 

*Name has been changed

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