Kara Burns left federal prison in 2013 with little more than a bus ticket and a few hundred dollars she had managed to save. She had to start looking for work, but like many former inmates, she had a problem that made rebuilding her life even more stressful: Bad teeth.
Burns’ dental problems began long before her incarceration. For years, he used methamphetamine, which is known to cause devastating tooth damage and gum disease. While in prison for two and a half years for drugs, he saw a dentist twice, he said. By the time she was released, she was missing several teeth and had several decaying ones covered by silver crowns.
“I have all these obstacles – obstacle after obstacle – a criminal record, my home address is a halfway house, and I don’t have the money to buy clothes to be able to present myself professionally. And then my teeth also rot,” said Burns, 40, who lives in Denver.
It’s not uncommon in America—whether you’ve been incarcerated or not—to not have access to a dentist. In 2016, 74 million Americans lacked dental coverage, according to the National Association of Dental Plans. But poor oral health is a particularly vexing problem for many ex-prisoners, experts say. For recently released prisoners who already carry the societal burden of a criminal record, dental problems can compound the daunting challenges of returning home, such as finding work and housing.
Severe teeth and gum problems can cause debilitating pain and are associated with a number of other diseases, including Cancer and cardiovascular disease. They also carry a heavy stigma. Lisa Simon, a Harvard Dental School fellow who treats inmates at Nashua Street Jail in Boston, says this is especially true for missing front teeth. “People judge you if you don’t have them,” she said. “It can be very difficult or even embarrassing to try to look for a job or just function in the world.”
Even before their incarceration, prisoners are likely to have unmet dental needs, research shows. While in prison, they have a constitutional right to dental care, but courts have offered little guidance on what services institutions must provide. If a tooth or gum problem causes more than minimal pain, facilities are needed to treat it, said David Fathi, director of the ACLU National Prison Project. “Even a few days of untreated dental pain is not allowed.”
Beyond that, guidelines vary by company. In many facilities, few clinicians serve the entire inmate population, often resulting in long waits for regular cleanings. In March 2017, an inspector general report revealed that one in four inmates at a federal prison in California were on a waiting list for dental care. some waited as long as eight years.
Even when inmates receive care, many complain that prison dentists choose to pull their damaged teeth instead of repairing them with restorative procedures such as crowns and bridges. The Florida Department of Corrections’ dental policy, for example, says crowns, bridges and implants are provided only in exceptional cases. considers these procedures to be elective dental care, a spokeswoman for the agency said.
Cost is likely a factor: Pulling a tooth can cost less than $200, while more complex restorative procedures can cost thousands, recent figures from the American Dental Association show.
Some ex-prisoners say the dental care they received in prison had effects that lingered after their release.
When the cap on Henri Siron’s front tooth broke off in a Colorado prison, the dentist there said her only option was to pull it, she said. Chiron refused, believing that a new cap would fix the problem. “I was very self-conscious, I wouldn’t smile,” she said. “I always had my hand over my mouth.”
Once Chiron was released from prison, her still-cracked tooth made job interviews particularly stressful. “I would find my super glue and try to stick [the old cap] in, hoping it would stick around long enough while I was talking to someone,” he said. It took more than a year to raise the money for a new cap, even with Medicaid, the state insurance program. He eventually managed to secure a steady job babysitting in the evenings.
Kristy Pomeroy, who until recently ran a program for ex-prisoners with The Next Door, a Nashville-based Christian nonprofit, said her clients also faced dental anxiety during job interviews. Damaged or missing teeth undermined their self-confidence, she said. It didn’t help that many employers didn’t want to hire them in positions that required working with the public. “It was like, ‘I need you to work here, but I can’t put you in front,'” he said.
Kristi Hornick, who until recently ran the Reentry Initiative, a program that provides housing and support to formerly incarcerated women in Colorado, tells a similar story about her clients. “If they don’t have confidence in their teeth, it’s very hard for them to have the confidence, ‘I deserve this job,'” she said. After their dental issues are addressed, “it’s like they’re a new person. They discovered a new hope,” he said.
This was the case of Jenny Chestnut, a former drug user who spent two years in prison in Colorado for theft. He lost several teeth in prison because “they didn’t want to fix them,” he said. (In an emailed statement, a spokesman for the Colorado Department of Corrections said that while restorative procedures are the treatment of choice for the agency’s dentists, if a tooth is badly worn or broken, extraction is the only option.)
Chestnut’s father mentioned her predicament to his dentist, who was so moved that he offered to do the necessary work for free. With the dentist’s help, Chestnut got dentures. “It’s hard, it’s lonely, and man, you cry a lot, but it’s possible,” he said of recovery after returning home from prison. “If people had good dental care, then it would be a little easier.”
But for many ex-prisoners, getting expensive dental work can seem out of reach. “When people come out, their physical and dental needs aren’t necessarily their first priority,” Pomeroy said. “They’re worried to death about keeping a shelter over their heads if they comply with probation and parole and work.”
Some may be lucky enough to secure dental coverage through a job with health benefits. But even for the insured, dealing with complex dental problems can be prohibitively expensive.
Other former inmates turn to low-cost clinics, such as those associated with local dental schools. That was the case for Albert Pugh, who was missing several teeth and wearing a poorly fitted partial denture by the time he left Alabama’s prison system after three decades. After Pugh began working for Foundry Ministries, a Christian social service organization based in Bessemer, Alabama, he was able to have several implants and a new partial denture made. He was referred to a low-cost clinic affiliated with his employer. The whole process took just over a year, with Pugh paying a few each month until the bill was paid.
“When you get your teeth back, you can smile with confidence,” she said. Pugh, who now works as director of a Foundry program for ex-prisoners, said at least a third of his clients have significant dental needs, and he refers them to the same clinic that helped him.
For Cara Burns, restoring her missing and damaged teeth took the generosity of a good Samaritan. In the first week after her release, Burns connected with the Denver chapter of Dress for Success, a nonprofit that provides office clothing and other support to low-income women. At an event organized by the group, which provided help with her resume and clothing for interviews, Burns met a dentist who offered to perform the extensive dental work she needed for free. This required root canals and crowns for almost every tooth in her mouth.
“Once my teeth were fixed, my whole world opened up,” said Burns, who currently works as an instructor and catering manager for a nonprofit that provides culinary training. “It has changed everything for me.”
