Dental care decaying for older emigres

Lidiya Leznek, an 80-year-old Mountain View resident, had eight healthy teeth removed in order to get full dentures, on the advice of her dentist, because the government-funded Denti-Cal wouldn't cover partial dentures.

Unfortunately, the extraction of her healthy teeth resulted in an infection.

Because of swollen gums, she couldn't be fitted for dentures for half a year, so she had no teeth at all during that time.

Now, five years later, it is still extremely painful for her to wear dentures. "They are a decoration," Leznek says. "Before I go to a party, I take pain relief tablets so I can be a good guest and eat a little bit."

Leznek is one of many emigres from the former Soviet Union who has found that good dental care may be out of her reach. While she has government-subsidized dental care for the poor, others don't qualify for public assistance and can't afford private insurance.

Particularly for some at retirement age, the problem can be compounded by language difficulties and particularly acute dental conditions.

Exact statistics are hard to come by but, anecdotally, severe cases of gum disease and bad teeth are common among older emigres.

"Everyone who came from the former Soviet Union has problems with their root canals, with their crowns, with their dentures. Everyone," says Anna Borovik, program director of the L'Chaim Wellness Center, a S.F.-based day facility for elderly emigres.

The daughter of a 76-year-old client at L'Chaim recently described facing two unpleasant choices: paying $700 to $800 each for four bridges her mother needs, or having a dentist pull out all her mom's teeth so she can get Medi-Cal-covered dentures.

"Right now, my mom cannot eat. She cannot chew," said the woman, who asked that neither her mother's name nor hers be used. "I don't know what to do."

At Congregation Beth Am in Los Altos Hills, Inna Benjaminson, director of its emigre program, agreed that dental problems are widespread. "When you first come into the country, you have to go see a doctor, and I don't know one [emigre] who didn't have dental problems," she says.

Beth Am, with 180 emigre families, has joined an interfaith effort to improve access to dental care for low-income adults in the region. Working with Peninsula Interfaith Action, a political advocacy group, congregants have talked to the Santa Clara County Board of Supervisors and other public officials. They've asked for improved access to local services, as well as an additional dentist to staff the county's mobile dental van.

More than 400 people recently filled Beth Am's sanctuary for a PIA-sponsored public forum on improving access to dental care, one of several issues PIA is tackling. Emigres spoke out on the problems besetting their community.

"We didn't start out by focusing on this group," says Rabbi Charles Briskin of Beth Am. "We picked dental care as our issue, and we found 80 elderly emigres [at the PIA meeting] who had never participated in the democratic process wanting to become advocates."

An estimated 35,000 ex-Soviets live in the Bay Area. They come from a country notorious for its poor dental care, where regular teeth cleaning is a foreign concept. According to a survey by the Czech Dental Research Institute, people from the former Soviet Union, Poland and the Balkans have the worst teeth in Europe.

And it's not just an emigre issue. Dental problems among people on limited incomes are a nationwide toothache. A 2000 report from the Surgeon General's Office describes a "silent epidemic" of dental and oral diseases affecting the poor and in particular children and the elderly, which often significantly diminishes their quality of life.

In California, where legislators are wrestling with a $38 billion budget deficit, slashes in funding could only make matters worse for the poorest emigres needing dental care.

The state's Denti-Cal program was trimmed back in the latest round of cuts, and its future is uncertain as California struggles to deal with its budget crunch.

"In the next month or so, we'll know how bad it will get," said Anita Friedman, executive director of the S.F.-based Jewish Family and Children's Services.

Twenty years ago, there were gaping dental problems among emigres, according to Friedman. This was eased by the retraining and licensing of Soviet-educated dentists, the offering of payment plans and some pro bono services, and the operation of a now-closed free dental clinic at Mount Zion hospital in San Francisco.

"It's not as bad as it was," Friedman said of the current situation. "My bigger concern is that it's going to get a lot worse."

For those in need, medical treatment is easier to get than dental care, according to Carolyn Scaglione, director of mobile health services for Santa Clara Valley Health and Hospital System. "There are multiple programs for health but very few for dental," she said. "If you have a bleeding ulcer, you will get treated. It's much harder to find a dental provider."

Dr. Mikhail Berdichevsky, trained in both his native Odessa and at the University of the Pacific's San Francisco campus, is one of many dentists from the former Soviet Union whose Bay Area practices include emigres with bad teeth.

Berdichevsky, who has offices in San Francisco and Walnut Creek, traces the problems to poor oral hygiene and outdated standards of care in their homeland. "If they're young, we can correct it," he said, estimating that 20 percent of his patients are emigres. But for older patients, the problems often are extensive and costly.

"A lot of teeth have abscesses in the root area and patients just get used to this suffering, bad smell [and] bad appearance of metal crowns," he observed.

Starting this month, changes in the Denti-Cal program have further reduced coverage for poor patients. The program, for instance, no longer pays for crowns on back teeth.

For those lacking insurance, dental care is expensive. Even a regular checkup with X-rays can cost up to $200 in the Bay Area. Berdichevsky said a crown costs $730.

It's not surprising that some emigres have chosen to forgo preventive dental care — like Marina, who asked for her last name to be withheld.

When Marina talks, you can see the flash of multiple gold fillings. The small woman with short salt-and-pepper hair says quietly that she suspects she has some tooth problems. But Marina, who lives in Mountain View on a limited income, has been waiting for the last three years to see a dentist. She is waiting until she turns 65 in a few months and becomes eligible for Medi-Cal.

Even those who are insured through Denti-Cal, the federally subsidized dental component of Medi-Cal, often have trouble accessing services.

According to Benjaminson, whose job is funded by the S.F.-based JFCS along with Beth Am, many emigres say they can't find a dentist who accepts Denti-Cal. The program's reimbursements are extremely low, according to professionals, discouraging providers from taking patients.

And Denti-Cal only covers a limited number of procedures. In some cases, patients have had healthy teeth pulled because full dentures are covered while partial dentures are typically not, as Leznek discovered.

Beth Am, in conjunction with PIA, is trying to make sure emigres who have Denti-Cal or are in immediate need can get treated. Although Santa Clara County has a few clinics that provide emergency dental care, connecting the Russian emigre community with these services is another matter. There are cultural as well as language barriers, and basic obstacles like lack of transportation.

Non-emergency care is even more problematic. For Galina Kniajer of Palo Alto, specialized dental care is a luxury she can't afford. When she pulls down her bottom lip, you can see where the expression "long in the tooth" comes from. Her teeth look abnormally long and thin because her gums have receded. She has been diagnosed with periodontal disease, and her dentist has recommended gum surgery that will cost $3,800. It is a specialized procedure that wouldn't be covered by Denti-Cal, if she were eligible, and she has been unable to find affordable dental insurance.

A scientist from the former Soviet Union, she came to the Bay Area to work for a Fortune 500 company. But an injury and multiple health problems forced her to retire, making her ineligible for group medical insurance. An IRA "helps me to survive," she says, but the least expensive medical insurance she could get is out of reach at $750 a month.

Kniajer is not looking for a handout, she emphasizes. What she would like is to find a government-aided group plan, to which she could contribute a fair share.

But right now, such plans don't seem to be in the offing, and Kniajer is torn between saving her retirement fund and getting the operation. "If I spent all my money right now, I would have to apply for SSI [Supplemental Security Income] in the future," she says. "I don't want to beg. I prefer to somehow cope myself."