美国国家公共电台 NPR A Good Dentist Is Hard To Find In Rural America（在线收听）

A Good Dentist Is Hard To Find In Rural America 

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Let's go to the dentist now. And let's go in a rural area, where a lot of people have trouble doing that. The reality for millions of rural Americans is that getting treatment for cavities and gum disease is out of reach, especially for those who are poor. Today in Your Health, NPR's Alison Kodjak takes us to the center of Wisconsin, where that reality is beginning to change.

ALISON KODJAK, BYLINE: We're at a dental office in northern Wisconsin. It looks like a typical practice. Dentists in white coats and hygienists in blue scrubs lean over patients, their mouths wide open.

UNIDENTIFIED DENTIST: Does it hurt, pushing on that tooth?

KODJAK: So why is Jessica Stefonik (ph) so happy?

JESSICA STEFONIK: I just got dentures through Marshfield Clinic here. And it was the best experience I've ever had. It really is.

KODJAK: Stefonik is just 31. She's got three kids and lives in the tiny town of Mosinee. Like a lot of people who grow up poor in rural America, she almost never saw a dentist. Most don't accept Medicaid. And she says she didn't take great care of her teeth.

STEFONIK: My teeth were pretty much rotting out to where I couldn't brush them.

KODJAK: She spent years in pain. When she was able to get an appointment, the dentist would usually just pull a tooth and send her on her way. Eventually, she hardly had any left.

STEFONIK: I'm hiding my smile. I'm hiding my pain. I'm trying to be happy. So I found myself depressed.

KODJAK: Then a few months back, she learned about this family dental center run by the Marshfield Clinic. It was opened specifically to serve Wisconsin's rural poor. They accept Medicaid or any insurance. And if you don't have insurance, they'll take care of you anyway. The dentist here pulled the rest of Stefonik's top teeth and fitted her for dentures. The day I met her, she'd just got her new set.

STEFONIK: I can smile again. And, you know, that was the one thing I missed was smiling. I haven't smiled in probably eight years, like, a good smile.

KODJAK: And she can eat again.

STEFONIK: I'm very excited to be able to, you know, go out to eat with my family and be able to not have soup, you know.

KODJAK: Stefonik's story isn't unusual. Her dentist told me he sees a new patient almost every day who needs most of their teeth pulled. It's people like Stefonik that drive Greg Nycz. He's the man behind this clinic and nine others scattered across northern Wisconsin.

GREG NYCZ: If you've got a mouth full of broken and cracked and decaying teeth, your ability to contribute to society is impaired. And your options are impaired.

KODJAK: Nycz isn't a dentist, or even a doctor. He's the administrator of the Marshfield Clinic Family Health Centers, a chain of medical clinics dedicated to caring for the poor. And in that role, he saw people with broken and missing teeth all the time. About 13 years ago, he got a call from a young mother that haunts him to this day.

NYCZ: Her child was screaming in pain, alternately screaming and sobbing in the background. This had gone on for weeks and weeks.

KODJAK: He talked at length with the mom. She couldn't find a dentist to help because no one would take Medicaid.

NYCZ: And as we talked, it became very clear - is that she was viewing herself as a failure as a mother because she couldn't take that pain away from her child. And other mothers could. I said, no more. We're going to fix this.

KODJAK: A year later, Nycz and the Marshfield Clinic opened their first dental clinic in Ladysmith, Wis. Since then, they've built nine more. Nycz oversees them all. Greg Nycz's office is piled high with papers. There are stacks 2 feet high that cover every inch of his U-shaped desk. And there are even taller stacks on the floor.

NYCZ: Peer-reviewed journal articles - this is the surgeon general's report, which I refer to quite a bit.

KODJAK: That surgeon general's report is dog-eared. It's highlighted. Pages are marked with Post-its. He actually got it signed by the author. And that report, published in 2000, described the sorry state of oral health in America. Nycz flips it open and reads.

NYCZ: (Reading) Those who suffer the worst oral health are found among the poor of all ages, with poor children, poor older Americans particularly vulnerable.

KODJAK: That report gave Nycz and his Marshfield Clinic colleagues ammunition to launch a massive effort to bring dental care to the poor. They secured state and federal grants, private donations and lobbied for better Medicaid payments.

Most of rural America is classified by the federal government as being short on dentists. But today in northern Wisconsin, thousands of low-income people come to these clinics for cleanings, fillings, root canals and whatever else they need.

JANE KOPPELMAN: Greg is a visionary.

KODJAK: That's Jane Koppelman of the Pew Research Center.

KOPPELMAN: He's taking what we know about science, and he's applying it to practice.

KODJAK: What we know is that oral health is closely tied to overall health. Research shows that bad teeth are linked to a host of problems - heart disease, infections of the heart and even premature birth. At the Marshfield Clinic centers, dental care is treated as another part of general health care. Dental and medical records are combined. Patients who come to the dentist get their blood pressure and blood sugar checked. And doctors at the health centers routinely look into patient's mouths.

If there's a problem, they refer them to the dentist.

UNIDENTIFIED DENTIST: Is that hurting there?

UNIDENTIFIED PATIENT: Yep.

KODJAK: Nycz wants to build two more clinics. And then the next phase, he wants to change the culture so people come to his clinics for regular checkups.

NYCZ: We have to try to get beyond the kind of thinking that a lot of people still, in northern Wisconsin, have, which is - when do you need to go to a dentist? - when my teeth hurt.

UNIDENTIFIED RECEPTIONIST: Looks like that's a 50-minute appointment. Do you care who he sees?

KODJAK: At the Marshfield Clinic center, Stefonik is ready to show her daughter Kylie her new smile. We walk to the waiting room together.

STEFONIK: She knows I'm getting my teeth, but she hasn't seen me yet, so.

Do you like them?

KYLIE: They're awesome. They look real. And it looks way different.

STEFONIK: Yeah (laughter).

KODJAK: Stefonik says she now takes her kids for regular checkups. And the little girl's teeth are shiny and white. Alison Kodjak, NPR News, Marshfield, Wis.