Patricia Fanning
By age 60, Scott Phenicie had lost most of his teeth. He cut food into morsels that he swallowed whole, limiting his menu. The construction worker could only dream of a steak dinner.
At 62, Phenicie’s dream came true. A friend treated him to a T-bone steak after the University of Maryland School of Dentistry (UMSOD) provided dental care, restoring Phenicie’s bite and his smile.
Phenicie received dentures that he otherwise couldn’t afford by participating in UMSOD’s Delta Dental Patient Care Program for Seniors. “I appreciate this. I’ve had a lot of compliments so far,” he said.
The grant-funded program began in August 2023, building upon a recent state law that expanded Medicaid dental benefits to cover adults. That expansion went only so far; dentures for those 21 and older are excluded by the Maryland Healthy Smiles Dental Program.
To help meet needs, UMSOD obtained a $150,000 grant from Delta Dental Community Care Foundation, the charitable arm of a network of dental insurance providers. The resulting program identifies Medicaid patients 60 and older who need full or partial dentures, bills the state plan for covered procedures, and draws upon the grant for the balance.
Dentures are too costly for many low-income Marylanders. For patients of UMSOD clinics, a full set is about $2,000, which is lower than other places. The cost might be twice that in the private sector.
“You have someone who isn’t making that much in their Social Security payment every month. They just don’t have that kind of money,” said Robert Windsor, DDS, FICD, who oversees the program.
Windsor, director of UMSOD’s Clinical Operations Division of General Dentistry, said he expects to share outcomes with the state and make data available for future research.
At the Maryland Department of Health, the director of the Office of Oral Health said the program is important. “Dentures help restore the ability to chew, speak clearly, and smile, which impacts overall health and self-esteem,” said Debony Hughes, DDS. “This program and the impact it is making on the lives of seniors clearly demonstrates the need to consider broadening the scope of Maryland’s Medicaid Adult Dental Benefit to include these services.”
Dental Students Paired with Patients
Each of the 76 patients undergoing treatment is paired with a third- or fourth-year dental student, who gains geriatric experience while collaborating with oral surgeons and faculty supervisors.
Some patients come with obsolete dentures, often caused when the mouth changes over time as bone is reabsorbed because of loss of teeth. “Or maybe the person was using a partial denture and those teeth have become involved in disease or decay. Take those out, and that old denture no longer fits,” Windsor said.
That describes Bernice McDaniel, 69, a Baltimore retiree who needed several extractions, starting with “a bad tooth that was giving me fits.” Dental student Dimpy Amin, Class of 2025, recommended a full set of dentures.
“I went in not knowing what to expect because I’d had a partial before,” said McDaniel. Now she is halfway through months-long treatment. One step was choosing a proper shade of tooth color, which she called interesting.
Amin welcomes the experience of caring for the elderly, who might have complex medical histories: “You learn how to take that into account when you’re providing dental care,” she says.
She and her patient anticipate that the completion of dentures will allow McDaniel to enjoy a favorite food: corn-on-the-cob.
Windsor said, “Mastication is a very important part of good nutrition,” referring to fiber and other dietary needs. These often go unmet among the elderly; federal data show that 17 percent of those 65 and older have no remaining teeth.
Dental neglect is a factor for some people. “That’s why they’re coming to us with broken-down teeth. They say, ‘I’m done with this. Just take ’em all out. I’m tired of pain,’ ” Windsor said.
Complex Process
Phenicie was in pain in August 2023, when his few remaining teeth had to go. Thus began a doctor-patient relationship with Stephen Brockbank, Class of 2025.
Phenicie has called him “Doc Stephen” over the course of a 13-month process that included two surgeries, time to heal afterward, and multiple casts of the patient’s jaws to capture muscular anatomy.
“It takes time to get it done right,” said Phenicie, who got his new dentures — and his steak — in September. The next month, he sat for planned adjustments as Brockbank tweaked the fit of the lower denture.
Brockbank relishes the challenge of treating someone who has coped for years with few or no teeth. “Trying to reconstruct their bite, and how they function, and getting them used to having a full mouth that they can chew and talk with, that’s been the most rewarding versus patients who are younger.”
