It's a troubling scene that plays out more than 3,000 times a year in Springfield's emergency rooms: A patient, often an adult, rocks back and forth on a stretcher, holding his jaw while suffering through a severe toothache.
He is seeking a cure a physician can't provide.
Almost 10 years after then-U.S. Surgeon General David Satcher bemoaned a "silent epidemic" of dental and oral diseases among certain groups and called for a national effort to improve oral health among Americans, access to dental care remains difficult for many low- and moderate-income residents of central Illinois.
Few private dentists accept Medicaid, due to delayed payments that don't cover the costs, and finding one who does often means long trips the patients have neither the time nor health to make.
As the economy sags, the problem seems to be growing in Sangamon and adjacent counties, especially for adults, who qualify for fewer and less-generous safety net services than children.
One symptom of the problem is the number of people showing up at emergency rooms with dental pain. St. John's Hospital served 1,975 such patients, or 3.3 percent of its total emergency department volume, in the most recent fiscal year, compared to 1,692 the previous year.
At Memorial, dental patients make up about 2 percent of all ER patients - 1,400 such patients in 2009, up from 906 in 2006.
"You know they're in serious pain - it's comparable to migraine-headache pain," said Dr. Dennis Adams, who has spent years staffing Memorial Medical Center's emergency department.
Because local ERs aren't prepared to pull teeth or fill cavities, the best these doctors can do is give people medicine to dull the pain and fight infection.
"We're sort of putting bubblegum in a dam," said Adams, who has seen chipped teeth in the mouths of patients who have tried, and failed, to pull their own teeth. "It's pretty sad," he said.
Often turned away
Adams and his fellow physicians suggest that adult patients seek out dental clinics, some in Springfield but some as far away as Alton and Chicago, that are willing to accept Medicaid, charge reduced fees or provide free care.
But doctors know their patients may be turned away or face daunting waits and transportation challenges as they choose between dental care and other necessities.
"It's hard to imagine the pain they are in," said Connie Marzinzik, supervisor of St. Clare's Health Clinic at Springfield's Catholic Charities agency, which provides limited dental services to uninsured adults with the help of a handful of volunteer dentists.
Springfield resident Nancy Suddoth, 52, a former schoolteacher who is now disabled, faces almost daily dental pain. She has been frustrated by the dearth of local dentists willing to accept Medicaid or provide free or low-cost care.
"I don't understand how they can sleep at night knowing that people in this town need so much," Suddoth said. "This is the capital city of Illinois. It is a big enough town that we should be able to have dental care."
Springfield's Capitol Community Health Center, 2239 E. Cook St., is the region's largest single provider of dental care for the poor. But beset with requests from patients and facing a loss of several dentists, the center all but stopped taking new appointments for adult dental patients in September 2008.
The center now has four dentists on staff - the most ever - but administrators have decided to keep focusing on pediatric patients.
There are no plans to accept new patients older than 20, except after people seek dental care at hospital ERs or in other emergencies, until late 2011. That's when a $6 million expansion of Capitol Community's medical and dental facilities is expected to be completed.
The expanded facilities would help the clinic's staff better handle the "tremendous demand," center executive director Forrest Olson said.
Capitol Community began offering dental services in December 2004, when it moved to its current location.
"As soon as we opened, the phone lines were virtually swamped the very first day," Olson said. "The need is so tremendous that we've never come close to meeting it."
Much of the problem locally stems from the fact that so few private dentists accept Medicaid, the state and federal health insurance program for certain low- and moderate-income people.
Decades of low and slow payments to providers have made the program unpopular among dentists, most of whom still practice solo or in small groups and can't afford to lose money on Medicaid, said Greg Johnson, executive director of the Illinois State Dental Society.
The Illinois Department of Healthcare and Family Services and state dental society say only 27 percent of the state's 8,000 dentists have signed up to bill Medicaid, and perhaps as few as 10 percent regularly serve Medicaid patients.
Even a 2006 court order that substantially boosted Medicaid payments for preventive services for children hasn't made much of a dent in dentists' participation, Johnson said. Neither has federal stimulus funding that ensures Medicaid payments to dentists are processed within 30 days, he said.
Medicaid still pays dentists, on average, 55 percent to 70 percent less than what they receive from private dental insurance or private payments, Johnson said. The average dentist earns $186,000 a year in the Midwest, according to the state dental society.
Dental care accounts for $224 million, or 1.6 percent, of the state's $13.7 billion Medicaid budget.
Won't accept Medicaid
In Sangamon County, 37 of approximately 100 dentists have signed up to bill the Medicaid program, but just eight accept new Medicaid patients, and only two of them are accepting new adult Medicaid patients, state officials said.
"This is not a problem that's unique to Illinois," said Theresa Eagleson, Illinois' Medicaid director. "We're trying to do what we can to help make that better."
Tanya DeSanto, a Springfield dentist who is president of the regional G.V. Black Dental Society, blames the state.
Local dentists often receive calls from patients who are on Medicaid or uninsured and are in pain, she said, but many of them prefer to treat patients for free in their own offices rather than deal with Medicaid.
"We deal with it every day," she said, adding that she doesn't accept Medicaid but did at one time. "The need is almost untouchable. Everybody does their own thing to deal with it in their own way."
The public may not understand the financial pressures dentists deal with, DeSanto added. Capitol Community's dental program, she said, has "made a big difference, but it's not enough."
DeSanto is working with the Sangamon County Medical Society on an "access project" in which dentists and doctors would provide more free care to needy patients in their offices, but she said the dental part of that project isn't close to being activated.
'Didn't plan to be disabled'
In the meantime, people such as Nancy Suddoth and her friend, Susanne Roa, worry and suffer.
The women, both single with no children, live in the Near North Village apartment complex in downtown Springfield. Both are unemployed and have physical disabilities that qualify them for Medicaid. They have tried to support each other in their struggles to find dentists willing to serve them.
Roa, 62, a former clerk-typist and health-care technician, has chronic back problems, osteoporosis and fibromyalgia. She rode with Suddoth to a dentist in Edwardsville for dental care paid by Medicaid, but would have had to go to Chicago to find a dentist willing to complete the work she needed.
Her back problems make long trips out of the question. And last summer, an infection in Roa's lower lip - a problem that doctors told her might have spread from her decaying teeth - put her in an intensive-care unit at Memorial Medical Center for six days.
After a slow recovery at home, an aunt in Charleston responded to Roa's desperation by loaning her $4,000 - money she doesn't think she can ever repay.
She spent all the money to have dentists in Jacksonville and Springfield complete the dental work and make an upper denture. Roa raved about the skill and kindness of the Springfield dentist, who required advance payment.
But with no more loans from relatives likely, Roa worries about her lower teeth, which also need work.
"I don't know how I will ever get anyone to look at them," she said. "I see no possible way."
Roa said there has to be a better way to handle the dental needs of poor people like her.
"I didn't plan to be disabled and on public aid," she said. "I would work if I could. One disaster can wipe anyone out, and you could end up living like I do. I hate it."
Suddoth, who deals with spinal stenosis, depression and fibromyalgia, was hoping to resolve several dental problems with a dentist at Capitol Community Health Center. But the dentist left and Capitol Community stopped making new appointments for most adult dental patients in fall 2008.
Soon after that, an infected tooth sent her to the St. John's ER, where she received an antibiotic and two pages of local dentists to call. She called all of them. None accepted Medicaid or offered to serve her for an affordable price, she said.
"They don't do payment plans," she said. "They want their payment up front."
She had some dental work done at the Edwardsville dentist's office. Then she was encouraged when she applied for and received a $500 dental grant from Sangamon County Community Resources.
But Suddoth said the Springfield dentist who accepted the program's voucher performed only an examination and X-rays. The bill was over $200, and the dentist recommended thousands of dollars' worth of work. Suddoth said she couldn't afford it.
"She said, 'If your situation changes, call me,'" Suddoth said. "Yeah, like I'm going to strike oil."
On a lark, she called Capitol Community this month. After she complained about her jaw pain to a staff member, she was surprised to get an appointment the same week
She received a $15 exam from Capitol Community dentist Lisa Baines, but left disappointed because Suddoth learned she needs a crown on an ultra-sensitive tooth. Capitol Community, because of cost, doesn't provide crowns.
The tooth could be pulled, but because of the angle of the root, Baines told Suddoth that an oral surgeon needs to handle the job. No Springfield oral surgeons accept Medicaid.
Suddoth left Capitol Community with a prescription for pain medicine and an antibiotic. She hasn't decided what to do next.
"I'm just ticked off," she said.
Months of frustrations over dental care brought her to tears recently when she said she would like to receive back surgery that might allow her to return to work someday.
"I don't want to be on Medicaid the rest of my life," she said.
Living with the pain
Both Cory Griffith, 34, and his pregnant girlfriend, Nicole Eneix, 27, who live with their 19-month-old son in the basement of Eneix's parents' home in Springfield, have ongoing dental pain.
Griffith, a former U.S. Marine, has a full-time job, but his employer can't afford to offer health or dental insurance. He can't afford a private dentist, and his veterans' benefits don't cover dental care.
Cavities that need filling have given him headaches since 2005. He said he couldn't get an appointment at Capitol Community.
"My teeth are really bad," he said, pointing to his mouth. "This whole left side is really mangled."
Eneix, an unemployed clerical worker, is covered by Medicaid through Illinois' FamilyCare program, and she knows from X-rays in 2008 - when she had dental insurance through her job - that she has an impacted wisdom tooth.
She was pregnant with her first child at the time and wasn't in pain, so she delayed getting the work done. After her son was born, she still had dental insurance but didn't have the $500 cash that a local oral surgeon required up-front; she would have been reimbursed by insurance later.
Now Eneix is on Medicaid, and the wisdom tooth has started to hurt. She was able to get into Capitol Community, and the dentist told her the impacted tooth and two other teeth now need to be pulled, but Capitol isn't equipped to do the work.
Eneix was referred to a dentist in Chicago, but she can't imagine traveling with a 19-month-old to Chicago while her boyfriend works. Instead, she plans to wait at least until she delivers her second child in late June.
She hopes a prescription for antibiotics she received from Memorial ExpressCare keeps the pain at bay. She said she knows her low-level dental infection could pose a risk to her unborn child.
"I worry, but I try not to," she said.
Griffith said he and his girlfriend aren't looking for a handout but want "a way to get in the door."
Follow-up care sometimes elusive for children
More than 1,000 Sangamon County children receive free dental examinations and have sealants applied to their teeth each year as part of an in-school program funded by the state.
But that doesn't mean follow-up care, such as fillings or extractions for children, is affordable or easily accessible, public-health advocates say.
"Parents can really struggle," said Lisa Bilbrey, a Springfield dental hygienist and statewide coordinator of statewide IFloss Coalition.
Few local dentists outside those at Capitol Community Health Center accept Medicaid, which includes the state's All Kids program, Bilbrey said.
The ongoing nationwide problem of dental access for low-income children received renewed attention after the 2007 death of 12-year-old Deamonte Driver.
The seventh-grader in Prince George's County, Md., died from a bacterial infection that spread from his rotted teeth to his brain when he couldn't find a dentist who would accept Medicaid and his mother couldn't afford an $80 tooth extraction.
In Springfield, 52 percent of second-graders in a program that provided them dental sealants, and 16.7 percent of seventh- and eighth-graders receiving free and reduced-priced lunches, had untreated tooth decay in 1999.
The data, part of the Sangamon County Oral Health Needs Initiative 2000, haven't been updated, according to Tonya Sandstrom, oral cancer prevention educator at the Sangamon County Department of Public Health.
Capitol Community Health Center has improved access for children, center executive director Forrest Olson said.
Liz Reid, a registered nurse at Grant Middle School, said Capitol Community has been able to treat students she has identified with suspected tooth decay, and a Springfield dentist she knows has accepted patients she has referred.
That dentist didn't return a call from The State Journal-Register. Private dentists often don't want to be identified in the news media as accepting Medicaid for fear of being deluged with patients, according to the Illinois State Dental Society.
Children on Medicaid who need complicated treatment, such as multiple extractions or sedation during treatment, often are referred to Chicago or the Southern Illinois University School of Dental Medicine in Alton.
Safety-net dental resources
*Capitol Community Health Center, 2239 E. Cook St., Springfield, 788-2301. The clinic, operated by Central Counties Health Centers Inc., offers primary care medical services and general dental services, including cleanings for children and fillings and extractions for children and adults. The center has four dentists and two dental hygienists.
The clinic provided 11,949 dental visits to 5,306 patients in 2009, about 65 percent of them children. The clinic accepts Medicaid. Uninsured patients are charged based on a sliding scale; the most common fee paid for a visit is $15.
Appointments are being accepted for new pediatric patients and adults 20 and younger. Other adults can be seen in emergencies, such as when patients have first sought help at local hospital emergency rooms.
The dental clinic performs a lot of extractions on adults, but cannot provide preventive care for adults, Capitol executive director Forrest Olson said.
The clinic severely restricted new adult dental appointments in September 2008 and doesn't plan to "open the spigot again" until a planned renovation is complete in late 2011, Olson said.
*Maple Street Dental Clinic, 109 E. Maple St., Gillespie, (217) 839-4110. The public clinic operated by the Macoupin County Department of Public Health offers basic dental care and limited oral surgery to adults and children on Medicaid from the following counties: Calhoun, Christian, Fayette, Greene, Jersey, Macoupin, Madison, Montgomery and Sangamon.
However, the clinic stopped accepting new adult dental patients unless they live in Macoupin County in January 2009, said Kent Tarro, Macoupin County health department administrator.
*Capital Township, 901 S. 11th St., Springfield, 525-1736. Limited emergency dental care vouchers, accepted by most dentists, are available to Capital Township residents who have no dental insurance and are at or below 150 percent of the federal poverty level. A township resident can receive one $100 voucher a year. Medicaid recipients are ineligible.
*Catholic Charities, St. Clare's Health Clinic, 700 N. Seventh St., Suite A, Springfield. 523-1474. Services for ages 3 to 18 include cleaning, fluoride rinse and dental sealants. Further dental work by appointment. Uninsured adults can receive free and reduced-price services from local dentists, but it can take months to be seen.
*Sangamon County Community Resources, 200 N. Ninth St., Room 311, 535-3120. Provides dental vouchers of up to $500 to Sangamon County residents at or below 200 percent of the federal poverty level.
About 230 people, most of them adults, received dental vouchers last year and early this year.
*Southern Illinois University School of Dental Medicine, Alton. (618) 474-7000. The school's clinic offers a range of preventive and restorative services for children and adults, performed by dental students supervised by licensed dentists. The clinic accepts Medicaid and charges below-market fees to other patients, but there is a yearlong wait for most new patients to get in for their first appointment.
Emergency patients can get in quicker, said Debra Schwenk, a dentist who is an assistant dean of the dental school.
*Healthy Communities Partnership/Hopemobile, Lincoln, 735-2317. This mobile dental program serves only pregnant women and children who are on Medicaid or uninsured. The partnership involves several organizations, including the Logan County Department of Public Health, the Lincoln-Logan County Chamber of Commerce and Abraham Lincoln Memorial Hospital.
Patients receive cleanings, sealants and exams. Early cavities can be filled, but more extensive treatment isn't provided.
*DentaQuest of Illinois, formerly known as Doral Dental Services, (888) 286-2447. Oversees dental services for Illinois Medicaid, Medicare and All Kids programs. Provides listing of area dentists who accept reimbursement through these programs.
Dental health at risk
*Poor dental and oral health can contribute to heart disease, stroke, pre-term childbirth and oral cancer.
*Medicaid patients in more than 60 percent of Illinois counties lack good access to dental care.
*Budget cuts have caused some public dental clinics to close, leaving a ratio of one clinic for every 8,400 children who rely on public aid.
*For Medicaid patients who need specialty care, the drive could be more than five hours to find a dentist who specializes in their condition.
*In 2006, more than 100 million Americans were uninsured for dental care for the full year - nearly three times the number who lacked health insurance.
*Untreated tooth decay affects more than one-quarter of adults ages 35 to 44, and 18 percent of those 65 and older.
*One in four senior citizens has lost all of his or her teeth.
Sources: Illinois State Dental Society and The Kaiser Commission on Medicaid and the Uninsured.
Photo above: David Spencer/The State Journal-Register -- Medicaid dental patient Nancy Suddoth, 52, speaks with dentist Lisa Baines about her dental history before Baines does an examination of Suddoth's teeth at Capitol Community Health Center.