The Tooth Angels

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Story and photographs By Maura Ewing

It’s a bright morning in rural central Maine, and Susanne LaVallee is organizing stacks of paper and filling out dental charts inside an RV parked at Livermore Elementary School. The motor home smells of fluoride and cleaning supplies. Soft country music drifts from a portable stereo seated on what once was a kitchen stove. LaVallee pauses and gives her quarters a sweeping glance. “You can see a little bit of the blue carpet,” the fifty-three-year-old dental hygienist says, gesturing toward the shiny linoleum floor. “Oh, my god, that was a job from hell. My husband pulled out a million little staples from the carpet.” She walks around a dental chair to the front of the vehicle. “The table was here, and there was another sitting area in here. That was all taken out, and the bed had to be taken out. The bathroom is still here; it could be used again if anybody ever bought this and wanted to use it as a camper.”

The fifteen-year-old RV hosted its last family vacation five years ago when LaVallee bought it through an ad in Uncle Henry’s and converted it into the office of Maine Dental Health Out-Reach, Inc., which brings dental cleaning, fluoride treatment, sealants, and temporary fillings directly to children from low-income families. Within the community, LaVallee and her team of hygienists — Tracy Crocker, Sherry Laliberte, Tracey Jowett, Hania Benson, Lisa Boulet, and Amy Stevens — are known as the Tooth Angels.

Returning to her paperwork, LaVallee examines the record of a seven-year-old patient. She rubs her short hair and counts the decay. “One, two, three, four, five . . . twelve cavities.” She looks up. Her glasses slump halfway down her nose, magnifying dark circles. “I don’t want to say that I’ve seen so much of it that it’s not an issue — some of the stuff is still shocking — but someone who’s come straight out of private practice is mind-boggled in here.” She considers Lisa Boulet, who joined the team just a few months ago. “She doesn’t cry as much as she used to.”

In the operatory at the back of the van, Boulet, 43, is actively engaged with a squirming seven-year-old girl, whose giggles interrupt the buzz of an electric brush. The girl sits on her knees, bouncing on the end of the reclined dental chair. Boulet stands next to her, holding a book as if to start story time. “Let me show you what juice does to a baby’s teeth.” She displays a glossy, graphic photo of blood-red gums with dark stubs where there should be teeth. “See? That’s what’s happening to your teeth right now.”

The girl scrunches up her face. “They look exactly like that,” she says.

Boulet’s eyes widen with concern. “Whose do? The babies’? Both the babies’ do?” she asks, referring to the girl’s siblings.

The little girl sticks her chin in the air, “Mmhhhm.” Boulet yells to LaVallee, “You hear that? Both her brother’s and sister’s teeth look exactly like that!”

LaVallee walks over and takes the girl’s chart. She cracks her back and prepares a letter to the girl’s mother with a diagnosis of eight cavities. Two years ago she sent a similar letter home with the girl with a referral to a dentist who had agreed to fill the cavities under MaineCare, Maine’s Medicaid program — not an easy find.

The girl never made it to the dentist. Her decayed teeth remain unfilled.

The boxy white RV of Maine Dental Health Out-Reach navigates highways and back roads to treat schoolchildren within a forty-five minute radius of LaVallee’s home in Winthrop on the outskirts of suburban Augusta. Reaching into some of Maine’s poorest counties, it is an area where gap-toothed smiles are endemic. Historically, dental offices in Maine have been found mostly in urban centers, leaving rural families on public assistance with few affordable options for preventive and emergency dental care. Recently dentists have been given more incentive to serve low-income patients, but there is still a long way to go. A recent study by the Muskie School of Public Service at the University of Southern Maine in Portland found that dental disease is the top reason for emergency room visits among MaineCare patients. Nearly half of the visits from MaineCare recipients between the ages of fifteen and forty-four were for emergency dental work. Nurses and doctors can prescribe painkillers for a throbbing jaw or antibiotics for infected gums, and oral surgery attendants take calls to perform extractions, but most hospital ERs do not have dentists on rounds, and nobody is trained to fill a cavity.

The consequences of poor dental health can be severe. Not only are dental problems linked to heart disease, diabetes, and other ailments, but missing or rotted teeth carry a stigma and are often viewed as signs of social ills like poor parenting, lack of education, and low intelligence.

LaVallee goes to great lengths to get kids seen by a dentist who will fill their cavities at no cost to the parents, but, often, as with Boulet’s patient, the appointments are not kept.

Over the next month she and her team of five dental hygienists will provide preventive care for more than one hundred students at Livermore Elementary. By the end of the school year, they will have been to thirty-four schools in central Maine and provided care to more than six hundred children.

MaineCare reimburses the Tooth Angels only for cleanings, fluoride, sealants, and oral hygiene instruction. During the 2008-2009 school year, they performed about thirty thousand dollars in procedures not covered by the state, such as resealing baby teeth. A few private donors help bridge the gap, but when the clinic’s finances fall below ten thousand dollars, LaVallee forgoes her own salary. “I figure when I can’t go to the grocery store, and I can’t pay my heating bill, then something needs to change,” she says.

LaVallee founded the Tooth Angels after the sudden death of her former employer, Farmingdale dentist Thomas Lee, who spent much of his career in public health. She decided to take his vision of accessible care one step further. “I had to take a loan out on my house to buy this equipment. That in itself was crazy,” she says. “I’m not here just for myself to gain as much as I can out of this lifetime; I’m here to help other people as much as I can. That’s the name of the game to me. That’s not easy in this day and age, because that’s not how the majority of people think. It’s a me-me-me society.”

Back in Livermore, LaVallee walks out of the elementary school hand-in-hand with ten-year-old Jean. The boy’s small legs break into a jog, and he hangs on to her hand as they make their way past the playground to the RV. A girl runs to the playground fence and squeals, “Are you the dentist?” A boy runs from the bottom of the slide and asks. “Are you going to get me today?”

“I’m the hygienist,” LaVallee responds. She checks her list for the boy’s name. “You are on my list — I don’t know, honey, I’m going to be here for a month.”

Inside the RV, Jean climbs onto the chair. LaVallee pokes a small silver scraper into his mouth. “See those spots honey? Feel how they’re a little rough?”

Jean peers into the mirror and feels his front teeth, putting his finger over dark stains. “Uh-huh.”

“That’s those bugs that have been there long enough to actually harden on the side of your tooth. It’s called calculus. Why they called it that I don’t know.”

Her patient’s socked feet barely reach half way down the chair.

She asks him, “So what are you drinking that’s dark? Tell me you’re not a coffee drinker. Do you drink tea?”
 
Jean shrugs.

LaVallee sighs. “Beautiful teeth. Do you want to keep these teeth beautiful?”

His eyes widen, “Yeah.”

“You need to meet your tooth brush!” She sings as she reaches for a packet of pink prophy paste, “Brush, brush your teeth, brush them twice a day! In the morning and at night, keep decay away. . . . ”

The buzz of her electric instrument stops conversation. The boy sits as patient as Buddha while the hygienist preserves his smile. An hour later, she sends Jean back to his fourth grade classroom with a bag of toothpaste and floss and three toys that he picked from the buckets LaVallee keeps filled for her young patients. LaVallee leans on the empty operatory chair. “I can’t tell you how many kids we see that are in such better shape than when we first saw them. Temporary fillings are placed on decayed primary molars, these teeth fall out, and permanent teeth replace them, then those teeth are sealed to prevent decay. Some of the worse-case kids I saw back in 2003 are cavity-free right now. Knowing what our program is providing these children is what keeps me going. In the 2009-2010 school year, our statistics showed us that repeat students have an 81 percent decrease in new caries rate compared to students coming into our program for the first time.”

LaVallee navigates an area where dental health is not at the top of anybody’s priority list. With each patient she cleans, she prevents or postpones a marred smile and the fate of wearing one’s socio-economic status on one’s face. She is helping foster a generation that will not wait in the emergency room with rotted teeth to be pulled.