Uncover the unique challenges and rewards faced by correctional dentists as they provide essential care amid a backdrop of limitations and risks.

By Michal Christine Escobar

While many aspiring dentists may not immediately think about working at a correctional institution upon graduation, correctional dentistry can provide a very fulfilling and stable career path. Like any dental field, it has pros and cons, but many correctional dentists find deep satisfaction in their work. This type of dentistry provides a unique opportunity to serve a population in need, with the added benefits of a reliable work-life balance and strong job security, as well as the chance to make a meaningful impact on patients who are often extremely grateful for the care they receive.

Reliable, Not Glamorous: Correctional Dentistry’s Scope

According to Rhay Street, DDS, dentist with the Cook County, Illinois, Department of Corrections, correctional dentistry can most aptly be described as a “meat-and-potatoes” kind of dental practice. This is due in large part to the limitations that the state or federal government places on the care correctional dentists can provide to incarcerated individuals.

For example, in California, correctional dentists are not allowed to offer implants, crowns, bridges, cosmetic dentistry or orthodontics to incarcerated individuals, explained Eric Wong, DDS, MAGD, supervising dentist with the California Department of Corrections and Rehabilitation. Instead, dentists tend to do a lot of routine extractions, restorations, dentures and treatments for infection because periodontal disease, dental caries, grossly decayed teeth, abscesses and fractured mandibles (from altercations) tend to be the most common dental maladies among prison inmates.

Since patients aren’t receiving complicated treatment, correctional dental clinics rarely, if ever, have access to the newest dental equipment available. Instead, dentists have access to “solid equipment that gets the job done,” Street said.

This doesn’t mean that correctional facilities are using ancient equipment. For example, California will replace dental operatory systems every 10 years, panoramic radiography machines every 15 years, autoclaves every five years, and compressors and vacuums every 5–7 years, said William Kushner III, DDS, FAGD, regional director of AGD Region 13 and director of the California AGD’s Pathway to Fellowship program. Kushner is also a supervising dentist for the California Department of Corrections and Rehabilitation. These replacement lifecycles are deliberately in place to ensure that correctional dentists have access to the equipment needed to provide the legally required care for their patients.

When it comes to ordering materials, correctional dentists must adhere to a budget. In some cases, they may also be given a list of preapproved materials (determined to be high quality and top grade) from which they can order.

This is the case in California, Kushner explained. “When new materials become available to the market, it can take a long time for them to be added to the preapproved supplies list. Thus, dentists in the correctional system are often using tried-and-true products and rarely get to use new, cutting-edge materials.”

Other correctional facilities, such as Cook County Jail in Chicago, do not provide their dentists with a preapproved supply list. Instead, dentists are allowed to order any brand of material as long as they stick to their budget, Street said.

“I always ordered the best materials available at the time,” said Ronald Townsend, DDS, a retired dentist from the Cook County Department of Corrections. “We never cut corners by using cheap materials because we need our work to last as long as possible.”

Treatment Planning in Correctional Dentistry

Before correctional dentists create a treatment plan for their patients, they must first ask: How long will this person be a ward of the state?

“Some individuals who are in jail might only be incarcerated for a year or less,” said Michael W. Lew, DMD, MAGD, chief dentist with the California Department of State Hospitals. “They might refuse our treatment plan because they believe they’ll be able to visit a private practice within a reasonable amount of time and then have access to treatment options that the state doesn’t provide.”

On the other hand, some patients are wards of the state for a very long time, whether they’re currently in jail or in prison. In those instances, these individuals are much more willing to accept the treatment plan suggested by a correctional dentist, Street added.

However, correctional facilities didn’t always offer comprehensive care. For example, in the past, the sole treatment model for incarcerated individuals in California was urgent care.

“Now, we have a much more comprehensive care model where we offer annual checkups to our patients and provide a treatment plan that encourages better oral hygiene,” Wong said.

The Realities of Correctional Dentistry

Working as a correctional dentist isn’t for everyone, but many have found the work to be rewarding and satisfying. However, there are some key differences from private practice.

First, when working in a correctional facility, “you lose the autonomy to practice as you see fit,” Wong said. “It’s a very litigious environment, and we’re governed by strict policies and procedures to ensure that each individual is treated with the same amount of fairness.”

Second, the correctional environment can be depressing, which makes it easy for dentists to bring negativity home, Kushner said. In fact, the suicide rate among staff members within the correctional system is high, and dentists are no exception.(1,2)

Third, while some incarcerated individuals made mistakes but still are good people, many more are hardened criminals or con men looking to take advantage of anyone they interact with, Kushner said. Dentists must be constantly on guard for concerning behaviors to keep themselves and their patients safe.

On the other hand, working for the government comes with many perks. Besides standard benefits — health insurance, vacation time, personal time off — government employees can take advantage of a lucrative pension plan and typically have a better work-life balance than private practitioners, allowing them to spend more time with family compared with owning a private practice, Lew said.

Correctional dentistry is also an option for dentists looking for help with student loans, as they could qualify for loan forgiveness through state and federal programs that encourage dentists to work in underserved areas, Lew said.

But perhaps the biggest advantage is the joy and gratification that comes with working with patients who are truly appreciative of the treatment they receive.

“Private practice patients can be very demanding and thankless,” Wong said. “But incarcerated individuals will almost always treat you with kindness and respect because they recognize that you’re doing your best to help them out, and they’re grateful for it.”

Maintaining Safety in High-Stakes Environments

The safety of correctional dentists is of paramount importance. Typical safety measures include having a custody officer within sight of patients during their appointments and cameras within the clinic, Wong said.

In some cases, patients will be handcuffed during their appointments, Street said. These individuals typically come from the highest-security divisions of a prison or jail, whereas inmates from lower security divisions will not be handcuffed.

Patients are usually civil and grateful for the treatment they receive, Townsend said. But there are times when inmates can become belligerent.

“One time, I had a patient who was in a lot of pain,” Townsend recounted. “At the time, we were seeing patients on a firstcome, first-served basis. He tried to cut the line, and when I told him he had to wait his turn, he began yelling, swearing and even spat on me. But the security guards stepped in and removed him from the clinic. The next day, I asked the guards to bring him to me when I had a break in patients so that I could examine him, and he was very grateful that I was willing to see him after his outburst.”

In the event of a severe security breach, correctional dentists in California are told that, while the state will do everything it can to ensure their safety, it will not negotiate with a prisoner over a hostage, Kushner says.

“We’re trying to remove any value a hostage might have, which ensures an employee’s safety. While it’s very rare that a hostage situation occurs, we need our employees to know how it will be handled,” Kushner added.

With that said, Wong, Lew and Street all agreed that they’ve always felt safe in their roles as correctional dentists.

“Private practice isn’t immune to rude, poorly behaved or even dangerous patients,” Lew said. “At least in prison, I have a custody officer with me if things get out of hand.”

Street echoed that sentiment, noting he’s had “more problems working in private practice than at the jail.”

Michal Christine Escobar is a freelance writer based in Chicago. To comment on this article, email impact@agd.org.

Veterans of Correctional Dentistry: Meet the Experts

William Kushner III, DDS, FAGD, supervising dentist for the California Department of Corrections and Rehabilitation, director of AGD Region 13, and director of the California AGD Pathway to Fellowship program

• Opened a private practice in 1994.

• Joined the police academy and became a reserve deputy in 1999.

• Sold his private practice and became a correctional dentist in 2005.

• Promoted to supervising dentist in 2007.

Michael W. Lew, DMD, MAGD, chief dentist, California Department of State Hospitals

• Operated a private practice for 25 years before becoming a correctional dentist in 2007.

Rhay Street, DDS, Cook County Department of Corrections

• Opened a private practice.

• Began working part time for the Cook County Department of Corrections, eventually transitioned to full time.

• Left in 1999 to work for a community health center that served underserved populations in Chicago.

• Returned to the Cook County Department of Corrections in 2017.

Ronald Townsend, DDS, private practitioner

• Began his own private practice in 1988.

• Began working for the Cook County Department of Corrections in 1991.

• Promoted to chief of dental services in 2010.

• Retired from the Cook County Department of Corrections in 2017.

• Continues to operate his private practice.

Eric Wong, DDS, MAGD, supervising dentist, California Department of Corrections and Rehabilitation

• Operated a private practice for 20 years before becoming a correctional dentist in 2007.

References

1. Frost, Natasha A. “Understanding the Impacts of Corrections Officer Suicide.” National Institute of Justice, 30 April 2020, nij.ojp.gov/ topics/articles/understanding-impacts-corrections-officer-suicide#1-0.

2. Weichselbaum, Simone. “For Corrections Officers and Cops, a New Emphasis on Mental Health.” The Marshall Project, 14 June 2017, themarshallproject.org/2017/06/14/for-corrections-officers-and-cops-a-new-emphasis-on-mental-health.