Health Care Quarterly:

A reason to smile again

Jeffrey Engle

Jeffrey Engle

Diagnosis: Periodontal disease

Patient of: Lydia Wyatt, DDS, Volunteers in Medicine of Southern Nevada

For years, 51-year-old Jeffrey Engle’s mouth was a constant source of emotional and physical agony.

In 2009, shortly after being diagnosed with Type 2 diabetes, his teeth began falling out, one after the other. Eventually, his mouth consisted of five teeth and a few broken ones that were scraping his gum line.

Engle brushed twice a day and had only a few cavities, but decades of smoking cigarettes, drinking sugary sodas and diabetes’ side effects ravaged his teeth and promoted periodontal disease and subsequent bone loss. Type 2 diabetes can complicate health conditions and thus create myriad issues, including advanced kidney disease, nerve damage and heart problems.

Diabetes damages the blood vessels that carry oxygen to the tissues and organs, as well as extremities, decreasing the body’s ability to heal and repair. As you get older, severely damaged small blood vessels are often precursors for loss of extremities like toes, fingers, teeth and even eyesight.

As Engle’s condition worsened, he grew out his mustache and placed his hands in front of his mouth when he spoke. At the convenience store where he worked, Engle heard whispers from customers who assumed his condition was due to drug abuse. He quit the convenience store job and began working overnights as a security guard. It paid only $9 an hour, but the solitude of the graveyard shift was a welcome relief from the stares and whispers.

“I’m a strong person, but it does get to you from time to time,” Engle said.

At $9 an hour, Engle fell into a medical gray area. He made too much to qualify for government assistance, but could not afford his employer’s health insurance that would have cost nearly a quarter of his paycheck. Nearly three years ago, Engle’s niece suggested he apply for medical assistance at Volunteers in Medicine of Southern Nevada (VMSN), a free and charitable clinic that provides health care to our community’s uninsured population.

At VMSN, Engle received comprehensive diabetes management care, including regular consultations and free test strips and insulin. Meanwhile, his oral care continued to suffer. There were very few foods he could eat without extreme pain. His quality of life was suffering. Something needed to be done.

In April, after more than three years of planning and fundraising, VMSN unveiled its dental program at the Ruffin Family Clinic with four operative chairs.

“Somehow, my story got to the right person, and VMSN called me up and said they had a surprise for me,” Engle said.

The surprise was that VMSN would perform a full restoration of his mouth, including a set of customized dentures.

Following an initial consultation, we extracted Engle’s remaining teeth and allowed the tissues to heal. He recovered for six weeks, and during his next office visit, we took impressions of his ridges and then selected the shade and size of his new teeth. His new dentures were set in wax and placed in his mouth to ensure they were the correct size and shape. About two weeks later, Engle returned to have his dentures set, and after years of discomfort, he finally had a full, healthy set of teeth.

“I’m grateful for anything I do get,” Engle said. “I’m embarrassed when I get some help because I’ve always done everything on my own. I’m so grateful. I know that I can’t repay everything VMSN has done for me.

“For me, life is so much better now.”

And whenever he has a spare dollar or two, he insists on donating it to VMSN.

“Maybe,” Engle said, “it can help somebody else.”

Teeth, and what we can do with them, are integral to our health and happiness. Imagine being able to eat anything you can want after years of restrictions. Engle can now eat most foods, including his personal favorite — pork chops — with no issues. He no longer waits until the middle of the night to shop at WalMart. He smiles without hesitation and sleeps through the night without waking up in searing pain.

His new teeth have given him the gift of dreaming big once again; Engle would like to eventually leave the graveyard shift behind and work a 9-to-5 job.

In the coming months and years, VMSN hopes to expand the dental program — more volunteers and funds are needed — so that more individuals like Engle can get the comprehensive dental care they so desperately need.

Dr. Lydia Wyatt is the volunteer dental director of Volunteers in Medicine of Southern Nevada.