This dentist is pulling for the poor, uninsured

Retired army dental surgeon has been performing extractions for nearly two decades in Western Md.


HANCOCK -- Tammy Spiker has a heart-shaped hole in her tooth. It's badly infected and hurts.

Desperate, unable to afford the root canal and crown she needs, the 25-year-old single mother drives to this Washington County town to see a dentist who can offer a quick, cheap cure. Her fiance holds Spiker's hand as he tells Dr. Robert M. Johnson what she wants: "Yank it out, please."

And in a matter of minutes, Johnson does just that. It's his specialty. In an age of adult braces, porcelain restorations and whitening treatments, the Washington County Health Department dentist provides a more basic service. He pulls decayed teeth.

There are few public dentists in Maryland - and even fewer who take out teeth the way he does.

Johnson, 73, is a retired Army dentist who has worked for nearly two decades in Western Maryland to provide emergency extractions for the poor and uninsured. He's old-fashioned: He makes his patient comfortable with a shot of Septocaine, a local anesthetic, picks up his forceps and gives a tug.

"People come in here crying, they're in such pain," says Johnson. "That's why I do this."

As Washington County's part-time dental director, Johnson sees almost a thousand patients a year with cracked, diseased or rotting teeth. So committed is he to treating impoverished patients that he got in trouble last summer for trying to set up a clinic outside the county.

Chatty and sympathetic, Johnson has heard lots of hard-luck stories in this mountain region: schoolchildren who don't own a toothbrush, mothers of five who can't pay for fillings, elderly men in need of dentures who walk in because their car doesn't work.

Every health department in Maryland used to offer dental services. But over the past 30 years, many programs were phased out, says Kelly Sage, acting chief of oral health at the state Department of Health and Mental Hygiene.

Nowadays, the state provides dental insurance for low-income pregnant women and children up to age 18. Most of the 12 health departments that offer dental services provide routine checkups and education programs for children. But there's no dental assistance available for adults.

Washington County's department is among a few in the state, including Baltimore City and Montgomery County, that provide urgent dental care for uninsured adults, including basic extractions. Johnson's clinics, though, are unique, says Sage: He does nothing but pull teeth.

Dr. Bob, as he's known, spends much of his time screening young children and teaching them proper tooth care. But every week in Hagerstown - and twice a month in Cumberland - he takes out teeth. On the third Thursday of each month, he opens a threadbare satellite clinic in Hancock's Town Hall.

The clinic is clean but has just one dental chair, a 1950s cast-off that Johnson salvaged and refurbished eight years ago. He uses a portable suction machine. There is no X-ray machine or darkroom. In one corner sits an empty oxygen tank.

Washington County Health Officer William G. Christoffel acknowledges that the clinic could use work but says he doesn't have the money to fix it up.

No one seems to want to see that happen. Patients line up in the waiting room each month. Virtually all are like Spiker, people with severe infections that they tried to cure with Advil and antibiotics.

Such patients can't afford the typical $100 to $200 extraction fee charged by private dentists. In Hancock, thanks to the county and state subsidy, they pay reduced fees depending on family income. Often, it's as little as $10.

Modern dentistry emphasizes preserving a tooth at almost any cost. Extractions, says Dr. Harry Goodman, a professor at the University of Maryland Dental School, are the profession's "mortality rate."

Nonetheless, he says, Johnson's service is "desperately needed." It's the poorest 20 percent that have 80 percent of dental disease, says Goodman. But it's precisely those people who can't afford the $1,000 crowns and restorations needed to save a tooth.

"Adults sort of fall between the cracks," says Goodman, who has led outreach efforts to make dental care more accessible in Maryland. "People who can't afford to go to the dentist wait and wait, and then it's too late to save the tooth."

Johnson's advocacy has won him widespread recognition among dental professionals in the state. Lately, though, it's led to a dispute with his bosses in Washington County.

In July, he was reprimanded for trying to travel to the state's westernmost county to pull teeth. He was fined a day's pay.

For several years, Johnson drove 124 miles to Oakland, a tiny town in Garrett County, once a month. But last year, Christoffel ordered Johnson to stop pulling teeth there, saying he could no longer spare him.

"It's my expectation that he tend to the citizens here," Christoffel said.

Within a few months, Johnson says, the Hancock clinic was filling up with folks who had driven two or more hours in dilapidated cars from Garrett County.

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