David Ford has teeth. They’re not real, and they’re prison issued.
But the 58-year old wants you to see them, flashing a full smile at every opportunity. “I feel like I’m back,” he said.
The Harris County man waited four years before finally getting his dentures in November after a Houston Chronicle investigation revealed that toothless inmates in Texas prisons were routinely denied dental prosthetics and instead forced to gum their food or drink it, pureed in cups. But Ford’s new pearly whites could mark the end of an era for the state’s prison system. Starting in the spring, the Texas Department of Criminal Justice will no longer have traditionally molded dentures made for its inmates. Instead, they’ll become what’s believed to be the first corrections agency in the country to 3D-print them on site.
“It sounds like a miracle,” said Michele Deitch, an attorney and criminal justice consultant who teaches at the University of Texas at Austin’s LBJ School of Public Affairs. “I’ve never heard of anything like it.” A speedier alternative to traditional denture-making, technicians at prisons across the state will use wands to scan the mouths of toothless inmates, then send off the image to a central location for 3D-printing, cutting down the process from months to weeks. The system will avoid the need to transport prisoners across the state and, though the initial purchase of the equipment is pricey, officials said the individual sets of dentures could be as little as €50 apiece.
“I just want it done right,” said Sen. John Whitmire, D-Houston, who pushed officials for change after reading the Chronicle’s coverage. “It’s a shame that it got into this shape but I’ll be the first to say they’re doing a good job when they’re doing a good job.”
The Texas prison system has historically struggled to deliver adequate medical care to its inmates. In 1974, an inmate injured by a 600-pound bale of hay launched a lawsuit that forced the prisons to reform. For years, the system provided dentures produced in-house through a vocational program for inmates. But that ended for unknown reasons in 2003 — around the time the prison system came out from under decades of federal oversight. Afterward, the availability of dentures fell sharply. In 2004, prison medical providers ordered 1,295 dentures. The following year, that number fell to 518 and then 258.
By 2016, prison medical providers only approved giving out 71 dentures to a population of more than 149,000 inmates. By contrast, California — the next-largest prison system — gave inmates a total of 4,818 complete and partial dentures in 2016, according to state data there. Over the course of a year-long investigation, more than two dozen inmates wrote letters or spoke to the Chronicle to detail the problem. Some said they’d had all their teeth removed with the false promise of dentures to come. Others lost them over time, or came in with dentures that broke, only to learn that the prison system wouldn’t agree to replace them. Some filed grievances and request forms but were repeatedly denied, sometimes by staffers citing policies no longer in place, other times by dentists claiming they couldn’t get teeth unless they became underweight.
The long-standing policy only allowed for dentures in situations of “medical necessity” — and chewing didn’t count. “Generally speaking, someone with no teeth should be offered dentures,” Dr. Jay Shulman, a Texas A&M University adjunct dentistry professor, said in September. “The community standard for dental care has not been applied to prisons.” But in October, prison officials announced plans to change policies, hire a denture specialist, start a denture clinic, train unit dentists to better identify when dentures are necessary, and review all denture-related grievances from the past year to re-evaluate any prisoners who filed complaints. Then, last week, officials confirmed plans to pursue 3D-printing dentures at one of the prison units, though it’s not yet clear which one. “TDCJ along with our correctional health care partners will be utilizing new technology to provide dentures to those who need them,” said prison spokesman Jeremy Desel. “The number of elderly offenders within our system continues to climb, and we believe that this will be the most efficient and cost-effective solution.”
“A lot of people”
When he was sent to state prison five years ago, Ford still had just enough molars to hold in place his partial dentures. But less than a year into his 20-year bid, he got his “tiger” tooth pulled. Afterward, he had nothing to keep his partials in place — and soon discovered he couldn’t get new ones made. That same year, his bottom dentures broke. In 2017, he lost another tooth in a prison fight and, afterward, a prison dentist pulled the rest — promising the Houston man he’d get some dentures. But when he got back to the unit after surgery, Ford found out he had two choices: lose weight until he qualified or drink blended mess hall food.
He dropped more than 25 pounds, but still couldn’t get new teeth. After the Chronicle put in a request to interview him earlier this year, top brass called him in for some questions about what sparked the media interest. Ford told them. A few days, later, he got approved for dentures. First, he was taken to the prison hospital in Galveston, so surgeons could shave down the bone so dentures would fit. Then, he waited three weeks for his mouth to heal and went in to take impressions. He tried a plastic version and had more measurements taken, and finally — on Nov. 26 — he got his new teeth.
Two weeks later, he’s still in awe, and fielding questions from other prisoners who want to know how they, too, can get teeth. “Now I’m feeling everybody else’s pain,” he said. “There’s a lot of people.”
Ahead of the curve
Exactly how many people fall into that category isn’t clear yet. Though the prison system has the ability to track how many toothless inmates come into the system, so far they haven’t done it. In the future, they plan to - but for now they’re focusing on setting up the new denture-making system, a joint effort between the department and its medical providers: University of Texas Medical Branch and Texas Tech University Health Sciences Center.
To make that happen, the prison system has to purchase the equipment - which officials estimated would cost between €50,000 and €100,000 - and hire another dentist and two dental assistants. Ideally, they’ll be able to handle 8 to 10 patients per day, according to Dr. Owen Murray, UTMB’s vice president of offender services. “It will speed up the entire process and over time we won’t have to relocate patients,” he said. And it could all be up and running by March, he added.
Still, some experts were skeptical.
“It’s unusual for any state entity to be that far ahead of the curve in technology - that’s what really makes me scratch my head,” Shulman said. “If this were an academic institution, I could see it. But a prison?” Since it’s still a relatively new technology, there have been no clinical trials done for full sets of 3D-printed dentures, according to Faleh Tamimi, a professor who’s studied the technology at McGill University in Canada. “Nevertheless, most reports in the scientific literature show that although they might have some limitations, they are mostly as good as the older dentures, and in some cases they are even better,” he said. “They are less prone to human error, and they are more accurate.”
The U.S. military has already began using them, he said, and they’re coming into use in private clinics. “Like any new technology, there are always new challenges that arrive,” he said, “but overall it is expected that within the next 5 to 10 years, 3D-printed dentures will replace the manually produced ones.” As with old-fashioned dentures, they still require adjustments afterward, Shulman pointed out. “We’re basically going to have to step back and see what happens,” he said. “I can’t think of any time government does well in dealing with a new technology.”
A Killer Burger
For years, Ford has been dreaming of a good hamburger. From inside the Huntsville Unit, he can see the burger joint across the street - just close enough for fantasies. It’s a greasy spoon with menu items like the “Killer Burger,” “Warden Burger” and one regrettably named “Old Sparky.” As the eatery closest to the heart of the Texas prison system, it’s a hotspot for freshly released inmates. Ford won’t be able to go inside until at least 2023. But in the meantime, he stares out the window, waits for the days burgers are on the mess hall menu, and dreams of a calmer life after prison.