Free Clinic’s Sole Dentist Impacted With Record Number of Patients

When Nora Lopez had problems with her teeth early last year, she sought refuge in the dentist’s chair at the South Bay Free Clinic.

She returned last week for her 16th filling in 20 months. The drill-and-spit routine has grown all too familiar to the 20-year-old clerk and part-time student, who barely flinched as clinic dentist Dr. Barbara Saltzman carved away at a molar.

“There,” Saltzman said as she finished. “Another tooth saved from the clutches of decay.”

For hundreds of South Bay residents, Saltzman is the dentist of last resort, helping patients fend off tooth decay and gum disease. As hard economic times continue their grip on Southern California, a record number of people with ailing teeth and limited funds--far too many for one dentist to handle--are appealing to her for aid.

Switchboard operators at the clinic report an upsurge of callers who say that they cannot afford a private dentist, they have no dental insurance and their teeth hurt. So they turn to the free clinic, which provides low-cost--sometimes free--dental services to those in need.

“It’s just getting worse. They’re out of work, they don’t have any money,” said clinic receptionist Irma Arellano, who last week was telling people seeking first-time dental appointments to call back in January.

Callers with emergencies are referred to low-cost clinics, although Saltzman will take some of those cases if time allows. Other Los Angeles-area clinics and local dental societies are also receiving more requests for free or inexpensive dental care.

“People seem to put the small amount of money they have toward other things--food, shelter, clothing. The only time dentistry gets priority is when it’s painful,” said Dr. Ed Maggiore, clinic director at the UCLA Venice Dental Center. And with county officials contemplating a severe paring of adult dental care at public clinics and hospitals because of state funding cuts, there may be even more people seeking dental treatment at free clinics that have no room for them.

Saltzman, 50, finds herself on the front lines as the only full-time staff dentist at a free clinic in Los Angeles County.

Her one-room office is tucked in the rear of the Manhattan Beach central office of the South Bay Free Clinic, a nonprofit health center that offers general medical services and testing free to thousands of area residents.

Sometimes Saltzman gets help from volunteer dentists and assistants. But she usually works without a dental assistant, fetching her own tools and developing her own X-rays, briskly moving around the small office in a white smock, pants and sandals.

Rather than preparing a bill, she asks her patients for a donation as they leave the chair. Some can contribute; some cannot. The six patients she saw one day last week donated a total of $28--less than the cost of a single filling from a private dentist.

Last month, 102 patients visited Saltzman’s office, most of them from Redondo Beach, Lawndale, Inglewood, Torrance and Manhattan Beach.

Each patient visit costs the clinic $60. The dental program will cost $110,000 this year to operate, with $40,000 coming from a federal grant funneled through the city of Manhattan Beach and the rest from other contributions and general clinic funds. Some elderly beach cities residents receive free dental care at the clinic through a program targeting low-income senior citizens funded by the South Bay Hospital District.

About 25% of Saltzman’s patients, no matter what their age, have never before seen a dentist. Some recently arrived from countries that have rudimentary dental care.

“In a lot of places, their experience with dentists has not been pleasant--if they had any,” she said. “These people are thanking you for giving them a shot--because they’re used to feeling it.”

Saltzman performs basic and preventive dental care. She does cleanings, fillings and extractions but usually not more elaborate techniques such as crowns and root canals.

The children who make up 15% to 20% of her patients are frequently her entree into family treatment. A teacher might refer a child for care; then Saltzman might examine a sibling or parent.

“I’ve got plenty of patients who have cavities in every single tooth. And diet has a lot to do with that . . . sugar, sugar, sugar,” she said.

Saltzman, a UC Berkeley graduate, majored in English and spent two years in the Peace Corps in Sierra Leone, West Africa, before receiving her dental degree at age 39. She went overseas again to provide volunteer dental care to Moroccan immigrants in Israel.

She was drawn to the South Bay Free Clinic as a volunteer, and nine years ago became its first director of dental services, a part-time post that eventually became full time.

Now, as the recession lingers, her program’s popularity has soared.

Although dental disease has been reduced nationwide, experts say, lower-income groups continue to have problems. Studies have shown that in California, 25% of the children have 80% of the tooth decay. Most of them are from poor or minority-group families, said Dr. James R. Freed, clinical professor of public health dentistry at the UCLA School of Dentistry.

Demand also is up at the Los Angeles Free Clinic, which is staffed by volunteer dentists and hygienists.

Likewise, two Los Angeles dental societies report an increase in requests for low-cost care.

“People are saying they’re laid off, they ran out of their dental insurance and they’re in pain. They need dental work,” said Jan Pye, executive director of the Western Los Angeles Dental Society in Westchester.

In response, area dental societies are launching a program in which member dentists can “adopt” needy children and provide them a year’s worth of care, said the society’s president, Dr. Sherwyn Rosen of Palos Verdes Estates.

Still, clinic officials say they see no easy solutions.

“We’re limited in how many patients we can see,” said Suzanne Rivera, the South Bay Free Clinic’s executive director, who explained that expanding the dental program is hampered by a lack of finances and space.

What the clinic hopes to do, Rivera added, is to attract more volunteer dental workers to “fill in the gaps.”

Meanwhile, Saltzman moves from patient to patient, saving a tooth, teaching a youngster how to brush, attempting to keep dental disease at bay.

“You want to take care of everyone, and you want to do everything for everyone,” she said. “And you can’t.”