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  October 8, 2017

How Does Dental Care Fit Into the Healthcare Debate?

'We need to not just cover an infection or a big-time emergency, but also comprehensive care and preventative care,' says activist and dentist Javad Aghaloo of the Sage Initiative
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AARON MATÉ: It's The Real News. I'm Aaron Maté. I'm here with Dr. Javad Aghaloo. He is the founder of the S.A.G.E Initiative, which is a non-profit serving low income communities with dental care in California and Arizona. Dr. J, hello.

JAVAD AGHALOO: Good to be with you, Aaron.

AARON MATÉ: Thank you for being here. Tell us about your group, Sage.

JAVAD AGHALOO: S.A.G.E is a non-profit organization that, as you said, provides dental care free, no cost to the patient at all, in underprivileged, underserved areas. My area right now is southeastern California, kind of on the border of Mexico, but in that community of low income and underserved population are veterans, believe it or not. Veterans don't get any dental care from the VA unless they're 100% disabled. We're changing that. I'm providing dental care to the veterans as well.

AARON MATÉ: So, you're a veteran who's say 50% disabled or 60% disabled. You don't get your dental care covered?

JAVAD AGHALOO: Right. If you're up to 90% disabled, as a veteran, as a war hero, all these things. There's many different ways to be disabled, PTSD would be mental. Something physical, an arm, a leg. They don't get any dental coverage from the VA unless they're 100%, and so I'm changing that. I took it upon myself. I'm a veteran myself, US Air Force lieutenant colonel, and I just couldn't stand for that anymore.

AARON MATÉ: What kinds of problems do people come in with, especially those who can't afford to pay for their dental care themselves?

JAVAD AGHALOO: Usually these are long range problems. They come in usually with a toothache, that would bring them in, or some kind of infection or a loose tooth or a broken tooth. That's the first thing we address is the problem, but we obviously find many other things, gum disease, which is a huge problem also other cavities that aren't hurting them right now but they will. What we like to focus on is not just the emergency care but also comprehensive care and preventative care to prevent problems in the future.

AARON MATÉ: As a dentist, what's your take on the ongoing and very dramatic healthcare debate in the US? It's interesting. When we talk about healthcare here, we don't often hear about dental coverage. It's not even really part of the mainstream conversation. This is at a time when Republicans have been trying to strip even what's considered essential health benefits from health care plans as part of their measures that they keep trying. As someone who provides this service of dental hygiene, dental care, what do you make of the role that this factors or does not factor into the conversation?

JAVAD AGHALOO: I'm glad you bring that up Aaron, because it factors directly into it, and that's what we don't understand a lot of times. The mouth is obviously part of the rest of the body. If you have infection and disease in your mouth, then you have infection and disease in the rest of your body. Things like diabetes go up if you have gum disease, heart disease. Actually, we talked about it before. The same plaque that's in your mouth, the same bacteria is the same plaque that clogs your arteries and causes a heart attack or a stroke. If the vessel goes to your heart, it'll cause a heart attack. If it goes to your brain, it'll cause a stroke. It's directly involved, dental and medical. We haven't realized that yet, so this debate going on is very, very instrumental in dental care and dental prevention. We need to make sure that's covered. Right now, Medicaid covers some dental, but only pretty much emergency stuff. It's not to the level that we need it.

AARON MATÉ: You, I'm sure, treat some Medicaid recipients?


AARON MATÉ: How's their coverage?

JAVAD AGHALOO: Their coverage is terrible. Like I said, in my area, 85% plus a lot of times are Medicaid recipients. In California, they call it Medi-Cal, but it's Medicaid. They cover emergencies, like we said, if somebody comes in with a toothache, they'll cover the emergency, but a lot of times, they only cover extracting the tooth. They won't cover a root canal or a crown necessarily, which is another way to treat a tooth that's infected. They cover the extraction, which is much less expensive, quicker, and things like that. They will cover a regular cleaning, but they won't cover what's called a deep cleaning. If you have gum disease, you need what's called a deep cleaning. They won't cover that, so either the patient doesn't get it or the patient has to pay for it. That's a big problem.

AARON MATÉ: Right. I suspect that, as is the norm with this ration-based healthcare system, that not dealing with some of these issues now leads to much bigger problems down the line that then impact other parts of the healthcare system too.

JAVAD AGHALOO: Definitely it impacts, like I said, diabetes is one of the biggest problems and diseases we have, and there's a direct relation between gum disease and diabetes. If you have gum disease, you're two to three times more likely to have diabetes. If you have diabetes, two to three times plus more likely to have gum disease. Just by somebody having diabetes, I give them antibiotics before dental treatment so they don't get gum infections. We do extra cleanings on them just because they have diabetes.

AARON MATÉ: Bernie Sanders recently unveiled his Medicare for all plan. What does he say there about dental care?

JAVAD AGHALOO: He does. He's one of the only politicians I've ever seen to even talk about dental, so I'm so happy about that. In the plan that I've seen, it's not that specific. He says we're going to cover dental but I haven't seen exactly what's covered. I haven't seen if the root canals are covered, the deep cleanings are covered, or routine fillings are covered or preventative care things which is what we really need.

AARON MATÉ: Your community that you serve through S.A.G.E is near the Mexico border.


AARON MATÉ: Do you see a lot of undocumented immigrants?

JAVAD AGHALOO: We do. In that area, there's a lot of undocumented immigrants, migrant farm workers, things like that. It's not just them, they have families a lot of times. They have husbands, wives and they have children, so what about those people? These are all people that we treat for free, no questions asked. A lot of people don't even believe it. A lot of times they think it's too good to be true, but that's what I'm trying to get out there and educate people and let people know that we're doing this service.

AARON MATÉ: In treating this undocumented community, what do you learn about the struggles that they face in their lives?

JAVAD AGHALOO: It's amazing. A lot of them are scared. They might have a toothache, their child might be in pain but they're scared to come out sometimes and go to a dentist or go to a healthcare provider because they think they might be deported just by seeing a healthcare professional or by making themselves known. They're in a lot of fear, very scared.

AARON MATÉ: You started off in private practice.


AARON MATÉ: What led you to make the jump to expand into serving a population that often gets ignored?

JAVAD AGHALOO: Yes, my background is military. I'm a lieutenant colonel in the Air Force and I remain in the Air Force Reserves. I developed my altruism and my giving back to the community and my public service in the United States Air Force. I still own two private practices. In the area that I chose to have my private practices, we have this underserved medically and dentally depressed population. I just couldn't take it. These people weren't getting covered. I decided to start the non-profit organization treating these people without having any coverage and not having to pay anything.

AARON MATÉ: Because medical school and because expenses are just what they are, do you think that the US healthcare system sets up this binary for doctors where they have to choose between the mission of their profession and their own personal financial goals and well-being?

JAVAD AGHALOO: That's a great point because I have a lot of doctors that work with me and they might be able to volunteer one day, but they can't volunteer on a consistent basis. They can't do this community service all the time because they still have to feed their families. I run into the same thing myself but I am 100% committed. I've put everything I have into this non-profit organization. To me, success isn't how much money you make, it's how many people you help. I still have my private offices that are able to fund what I'm doing, but my passion is the public service, the non-profit. A lot of dentists, a lot of healthcare professionals in general, they care about people but they have to feed their families. I think a binary system is created.

AARON MATÉ: How many people do you serve through S.A.G.E?

JAVAD AGHALOO: We've already seen over 3,000 patients. Right now, I'm seeing these patients after hours and on the weekends of my private offices because S.A.G.E does not have its own building yet. I own two private offices and I'm seeing these patients out of those offices on the weekends, after hours, things like that because funding is scarce. It's difficult to get grants. It's difficult to fundraise, so I've been funding this. I'm very lucky to have many volunteers and many staff that helps out, but in general I've been funding it myself.

AARON MATÉ: People who couldn't afford to come in during normal business hours, you open up your practice to them on weekends, on your downtime basically?

JAVAD AGHALOO: Yes. On Sundays we're seeing patients. Yes, all the time.

AARON MATÉ: As you look at the healthcare debate right now, we're talking today as the Republican, their latest attempt to repeal Obamacare has collapsed, but say they had been successful. Their effort was aimed at targeting billions of dollars from Medicaid. How would that have impacted your patients?

JAVAD AGHALOO: That would have directly impacted my patients in the dental field because a lot of people, a lot of professionals, a lot of politicians think that dental care is just elective and it's not. As we're saying, it relates to the rest of the body and it's a preventative thing and it's necessary, so I think one of the things first to be cut would be the dental. If their cutting all this Medicaid funding and 90% of my patients are Medicaid, dental already is very scarcely covered. I think that it would be cut back a lot and have very severe consequences to my patients.

AARON MATÉ: Is there a lobby that can effectively organize and represent the needs of your patients, who can say, "No. These people need this protection. They need this care. They need this service. We should give it to them." Right now, of course, the insurance industry has a lobby, medical associations have lobbies, but patients don't really have that same kind of representation.

JAVAD AGHALOO: They definitely should. I don't think patients have accurate and appropriate representation because we do have insurance companies which they end up taking a lot of extra money that they don't need to, and then they have the American Dental Association, which is a lobby pretty much for the professionals, for the dentists. If we have a lot of dentists out there that they do care about the patients, but like we said, they have to feed their families, so it's about being able to make money and make a profit in their business as well. I don't think the patients are as well represented as they should be.

AARON MATÉ: Do you have young dentists in training coming through your office trying to learn the practice through volunteering?

JAVAD AGHALOO: I'm glad you brought that up because right now, again, we're in southern California, and we just started a program with UCLA, University of California Los Angeles, a very big and historic university. Their dental school is going to start sending senior dental students to our non-profit organization to get this real world experience of the patients that are low income, in need, veterans, things like that and to show that it's very important to give back to the community. We're really happy about that. We're actually starting very soon.

AARON MATÉ: Finally, Dr. J, where do you want to see the conversation that we talked about around dental care go as this country continues to evolve on the issue of healthcare? Bernie Sanders has gotten unprecedented support for his Medicare for all bill, something we've never seen before from Democrats. Many lining up now to support him. If you could inject your own perspective into the conversation around dental care, where would you want it to go? How should we see it differently than we have so far?

JAVAD AGHALOO: We should see it that medical and dental are connected. They're pretty much one and the same. In medicine, we have different specialties for bones, for arms, for legs, for heart. Dental should really just be another specialty of medical, in my opinion, because it really is. I'm glad that Bernie Sanders has brought it up and started the conversation in the Senate and in Congress, but we need to go further. We need to not just cover an infection or a big time emergency, but comprehensive care and preventative care. It's going to really impact the health of our children and our citizens.

AARON MATÉ: Why do you think it hasn't gotten to that level yet?

JAVAD AGHALOO: I'm not sure. If you study other models, European models, Canadian models, they at least take care of their children. I believe that the kids from 0 to 18 are covered dentally fully. I believe that pregnant mothers, while they're pregnant and up to like 12 months after they give birth are covered. However, it doesn't go the next step of covering everybody, which I believe it should.

That's a great first step, but one of the things I see, Aaron, and it's interesting because it doesn't just impact somebody's health but their self-esteem, their ability to get a job. I work with a lot of homeless rescue missions, a lot of homeless patients that are getting back on their feet. These people are ready to go. They feel good, but they don't have the smile. A lot of them have an ugly smile or missing teeth and they're just embarrassed to go to a job interview. I just did some work on a patient the other day and he sent me some flowers and all these things. He was so happy because he got a job. He felt confident in going to an interview because his smile was better now. Your smile is such a big asset, not just for your health but for everything.

AARON MATÉ: We'll leave it there. Dr. Javad Aghaloo, dentist and founder of the S.A.G.E Initiative, thanks very much.

JAVAD AGHALOO: Yes. Thank you.

AARON MATÉ: Thank you for joining us on The Real News.


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