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Experts Call for Improvements in Prisoner Dental Care

by Christopher Zoukis

Over four decades ago, the U.S. Supreme Court held in Estelle v. Gamble, 429 U.S. 97 (1976) that the Eighth Amendment’s prohibition against cruel and unusual punishment guarantees prisoners the right to be free from “deliberate indifference” to their “serious medical needs” – a right that extends to dental care. But the interpretation of that ruling has led to widespread complaints about the quality of dental treatment that prisoners receive.

As Texas A&M dental professor Dr. Jay Shulman recently said, prison medical care, including dental care, “violates the constitution only when it’s so bad that it is ... reckless, deliberate indifference to a serious medical need.”

“For the most part, prison systems are not worried about inadequate [dental] care,” he added. “Prisons are typically not going to do any more than they have to to comply with the Eighth Amendment, which means the care doesn’t have to be good. It just has to not be so bad as to constitute deliberate indifference and infliction of pain. That’s the correctional standard.”

Dr. Nicholas Makrides, the U.S. Public Health Services’ chief dental officer, who also serves as chief dentist for the federal Bureau of Prisons, partnered with Dr. Shulman to co-author an editorial last year in the American Journal of Public Health. They called for improvements in electronic correctional healthcare systems, the creation of a nationwide network of correctional health executives “who might confer on how to create a better system,” and the training of more dentists and dental hygienists for positions in prisons and jails.

Drs. Makrides and Shulman pointed to research concluding that chronic illnesses are sometimes linked directly to poor oral health. The Bureau of Justice Statistics has reported that around 40 percent of state, federal and local prisoners suffer from chronic medical conditions.

In California, corrections officials have been forced by a federal court to improve the provision of medical care in the state’s prison system – which includes dental care. Dr. Morton Rosenberg, dental director for the California Department of Corrections and Rehabilitation (CDCR), said the court-ordered reforms have resulted in the provision of better dental care. CDCR prisoners can now expect quality basic treatment for their dental problems, including for tooth decay, pain management and dentures.

“We want to stabilize any conditions that will affect their ability to participate in daily activities, being able to sleep and eat, do whatever they would do in a prison classroom or a rehabilitative program such as in a cabinetry shop,” Dr. Rosenberg said, adding that dental pain is also treated because it will “obviously distract them and make them not want to do what they should be doing.”

He also noted that “a tooth infection that becomes septic, having been left untreated, can be life-threatening.”

Texas state prisoner David Ford, 58, recounted his dental travails in an article published by the Houston Chronicle in October 2018. After arriving in prison in 2014 to serve a sentence for aggravated battery, he lost the tooth that anchored his partial set of upper dentures. Then he lost his bottom denture plate in a fight. When doctors removed his remaining teeth, he was told he would get a new set of dentures if he lowered his body mass index. Yet even after losing 25 pounds he remained on a blended food diet.

The Chronicle investigation revealed that most Texas prisoners with missing teeth were given pureed food instead of dentures. As a result of publicity surrounding the news report, the Texas Department of Criminal Justice (TDCJ) announced it would create a new denture clinic and hire a prosthodontics specialist. Prison officials also promised a re-evaluation of denture-related complaints filed by prisoners over the previous year, as well as additional training for unit dentists and the creation of a review board to oversee requests for dentures.

“We want to see more dentures prescribed,” stated TDCJ Medical Director Dr. Lanette Linthicum.

Just a month earlier, though, Dr. Linthicum had defended the TDCJ’s prior dental care policy – which put prisoners on a soft blended diet instead of giving them dentures – as just one of several “hard decisions” the prison system faced due to budgetary constraints.

“Do I treat the diabetics or do I provide dentures?” she hypothesized at the time.

A single set of dentures costs from several hundred to over $1,000. Chewing, the TDCJ had previously held, was not a “medical necessity” when giving prisoners blended food was an alternative.

Texas’ prison system used to make dentures in-house, using prisoners enrolled in a vocational program. That ended in 2003 – one year after the system emerged from a decades-long period of federal court oversight. The next year, in 2004, the state’s two prison healthcare providers – the University of Texas Medical Branch and Texas Tech University Health Sciences Center – reported that a combined total of 1,295 denture sets had been ordered.

By 2016 that number had plummeted to just 71 sets; that same year the TDCJ reported a prisoner population totaling 149,000. By contrast, the CDCR gave dentures to 4,818 prisoners in 2016, when its population totaled 130,000.

Calling the announcement of the TDCJ’s new denture policy “amazing,” Douglas Smith, a senior policy analyst with the Texas Criminal Justice Coalition, added, “It shouldn’t take [the Chronicle report]. I think TDCJ should want independent oversight as much as the community.”

State Senator John Whitmire said he was happy the TDCJ had responded “correctly,” but disappointed that granting prisoner denture requests was a problem in the first place.

“The state has a responsibility for the safety and welfare of the citizens we incarcerate,” he remarked. “I just expect them to provide proper care before I read about it in the Chronicle.”

While the TDCJ has already implemented the new policy, it won’t be formally adopted until the Correctional Managed Health Care Committee holds its next quarterly meeting in December 2018. 

Sources:,,, Houston Chronicle

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