Probing the roots of neglect

Dental hygiene among the ultra-Orthodox is often disastrous, a consequence of lack of both money and awareness. The new reform in dental care may help the situation, but some are dubious

By Tamar Rotem

Considering the high cost of the As the 12-year-old girl steps out of the treatment room at the Chabad dental clinic in Jerusalem's Mea She'arim neighborhood, she asks: "How long will it take?" The answer she receives from the female dentist, concerning how long the thin metal wires encircling her teeth will have to stay on is apparently satisfactory; the girl gives a little smile.

Tuesdays is orthodontics day, for girls only, at this clinic for disadvantaged residents, in the heart of the ultra-Orthodox neighborhood. Girls aged 10 or 11 flock there: How their teeth look is a very important aesthetic issue for them. Indeed, within just a few years they will begin getting offers for potential husbands.treatment and the large number of children in these religious families, orthodontics cannot be taken for granted. Today - as Chabad dental clinic director Rachel Donat relates, and as emerges from conversations with mothers - the accepted practice for ultra-Orthodox preteens who want to have their teeth straightened is to save up money from babysitting jobs.

At the clinic, where dental care is subsidized, they charge about NIS 6,000 for the whole process, which may sound astronomical to a girl who slowly accumulates her shekels, but is lower by several thousand shekels than orthodontic care offered by health maintenance organizations and certainly by private clinics.

In some cases, says Donat, there is a medical justification for orthodontic treatment as a result of teeth being neglected from an early age. Thus, for example, the extraction of baby teeth because of decay is very common at the subsidized clinics run by nonprofit organizations, of which there are a number in Jerusalem. Instead of preserving teeth, parents - to the child's detriment - often prefer to extract and save money.

The Chabad clinic serves "families that barely make it to the end of the month, in which the fathers study at a kollel" (a yeshiva for married men ), according to Donat, a resident of the Betar Ilit community outside Jerusalem.

"This is a population that opts for minimal dental care. Whatever hurts is taken care of; they come to the clinic only when a child isn't sleeping at night and there is an emergency. It's shocking to see a 5-year-old child with only one whole tooth in his mouth. It isn't that they don't care, but parents say to me: 'I'd like to [give my child dental treatment], but don't have the money.'"

Donat adds that many families cannot afford even the lower prices at the clinic, which charges about NIS 100 for a child's filling. "The cheapest is to extract baby teeth. To rehabilitate a tooth, or put a crown on it - that's hundreds of shekels. In very many cases we extract, because there is no alternative."

Supposedly, all this will change in the wake of the reform spearheaded by Deputy Health Minister Yaakov Litzman, involving free dental care for children under the age of 8. While the reform, which went into effect earlier this month, does not include orthodontics, it does include such services as tooth reconstruction, fillings, extractions, root-canal work, temporary crowns, anesthesia with nitrous oxide, and x-rays, with a deductible of up to NIS 40 per visit.

Although Litzman's scheme is intended for the entire public, members of the ultra-Orthodox sector are among those that need it most. Donat believes the reform "will solve a great deal of problems," but adds that it is inadequate, as "there are children up to the age of 12 or 13 who also need treatment."

A dentist who works at a Meuhedet HMO clinic in an ultra-Orthodox neighborhood doubts the reform as planned will help much. According to him, his clinic's management recently instructed dentists to limit the number of procedures per visit and thereby save on certain treatments: "A child comes in and might need three fillings on each side. But according to the instructions, and because up to NIS 40 is charged per visit, I can do only two."

Asked about the policy, a spokesperson for Meuhedet says these instructions come from the Health Ministry, not the HMO itself.

Another dentist who works at Meuhedet and at a subsidized clinic says the HMO is worried about being inundated with patients, with the advent of the reform scheme. According to her, ever since the HMOs started offering free dental treatment as part of their complementary insurance plans (Maccabi up to the age of 6; Clalit until the age of 18, or 6 under a cheaper plan; and Meuhedet until the age of 12 ) about a year and a half ago, there has been an influx of ultra-Orthodox seeking treatment for their children. She says the HMOs have not prepared themselves for the reform yet, but in any event nowadays, "by law, you have to treat everyone. If you're treating one child for an hour, though, how are you going to take care of the others?" She fears the HMOs will not be able to keep up and people will have to wait a very long time for appointments, which will consequently affect the level of treatment. She also fears dentists' salaries will decrease, good dentists will leave HMOs and the quality of service will decline even more.

From conversations with ultra-Orthodox parents it emerges that most are not yet aware that they are entitled to free treatment. In general, they are skeptical. Nor has Litzman become the "hero du jour" in the Haredi press, though the reform has been depicted as positive there.

"It's a pity the reform has come along only now, when I have only one child under the age of 8," says Rivka, a mother of nine in Jerusalem (who preferred, like others, that her real name not be published ). "Today I am paying thousands of shekels for my son because I didn't give him dental care when he was little. I have taken out a loan. The dentist told me this was the result of neglect. I once thought I didn't need to worry, that it was only baby teeth and why invest? When you have nine or 10 children, you say: 'Never mind.' Do you know how much laughing gas costs? Or a filling? Where can I find the money to pay for this?"

A matter of poverty

Various perceptions have taken root among the poorer ultra-Orthodox populations: for example, that small cavities and baby teeth need not be treated. Plus - as a woman from the Toldot Aharon Hasidic sect related - among women there is usually great attention to oral hygiene, but among men brushing their teeth is not considered essential. Some parents interviewed noted that at the heders and Talmud Torah schools, sweets are handed out as rewards and there is no awareness of the damage they cause.

According to Dr. Yaron Avda, who in the past worked at the Chabad clinic and is currently employed at another clinic in Jerusalem, people belonging to the religious community will only pay for dental treatment if they are in pain. "When I see other teeth that are neglected while I work," he says, "they usually insist that I not deal with them. I try to persuade them they should get treatment but it doesn't always work."

Another issue involves dealing with many children, notes Avda: "Our view is that until the age of 8, children can't brush their teeth alone. The model we aspire to is for the big ones to help the little ones. In this [ultra-Orthodox] population, it is common for an older child to accompany a small child to the appointment; therefore, we are trying, for instance, to make the big sister responsible since the mother cannot see to all of them ... Extraction is often a lot less painful for children, but cases come in with teeth entirely destroyed and only the roots left in the gums."

Today, Avda says, he is seeing a change. "A child comes in with his mouth completely destroyed, we perform very complex treatment and six months later fewer procedures are necessary - in families that care, we really see an improvement. This is a population that wasn't exposed to a dentist before the supplementary insurance plans, and today parents are coming in for preventive treatments as well."

According to Prof. Harold Sgan-Cohen, head of the community dentistry department of the dental school at Hadassah University Hospital, Ein Karem, the upsetting situation in the ultra-Orthodox sector has nothing to do with religion, but rather with poverty.

"Research has shown," says Sgan-Cohen, "that poor people tend to be sicker and there is a lot of illness that isn't treated because people have no money, and this is the case with dentistry." He notes that poor families are also usually less strict about brushing teeth and often consume a lot of sweet foods. "The cheapest way to quiet a child," he says, "is with chocolate spread or raspberry juice made from syrup."

Noahides establish website for interested followers

by Toby Tabachnick
Staff Writer

07.22.10 - 11:06 am

Amy Boiles lives in Denver City, Texas, a town of some 4,000 residents, situated near the New Mexico state line. Boiles, like the others in Denver City, was a practicing Christian — until about a year ago, when, as she puts it, she could no longer “pretend that the New Testament is true.”

Through a high school friend, Boiles began learning about an alternate way for gentiles to serve G-d. And with the help of Michael Schulman, a Lubavitch physicist in Pittsburgh, she found spiritual guidance, as well as a community.

Boiles is a Noahide, a gentile who follows the seven commandments that G-d gave to Noah and his children after the flood to ensure order in the world. The laws prohibit (1) idolatry, (2) blasphemy, (3) homicide, (4) forbidden sexual relations, (5) robbery, and (6) eating meat taken from a live animal (cruelty to animals) and require (7) establishment of courts of justice.

“There are two paths to serve G-d and to have a reward in the world to come,” Schulman said, “that of the Jew, and that of the non-Jew. The Noahide has seven commandments given as part of the Torah. If a gentile accepts these seven commandments, the person recognizes that these are coming from G-d, so that’s his path.”

Schulman has been running a Noahide outreach organization, Ask Noah International (ANI), since 1999. Although he was employed as a senior research engineer from 1988 through 2006, he no longer works as a physicist, and is devoted full time to Ask Noah.

The organization, founded by Chaim Reisner, also of Pittsburgh, boasts an extensive website (asknoah.org), with educational and outreach materials and essays, and fields the questions of those interested in the Noahide laws. Schulman and Reisner also work to connect Noahides with each other, helping them find community.

Boiles was attracted to the Noahide commandments after being inspired from a verse in Genesis where G-d tells Cain he will be forgiven if he improves himself.

“This was contrary to Christianity,” Boiles said, “In Christianity, you can only be forgiven through a blood sacrifice — through Jesus Christ. I didn’t know there was another option. I didn’t know that under the umbrella of Judaism there is a place for non-Jews.”

“G-d doesn’t require man to go through Jesus. You can go straight to G-d. That’s liberating for me,” she said.

At age 61, Larry Telencio, of Naples, Fla., having rejected his Christian background, was searching for meaning. He found ANI on the Internet and now studies the universal laws, as well as Torah, although “not too deeply. Deep delving into the Torah is forbidden to a gentile,” he said.

“The Noahide path was basically all the things I believed in,” Telencio said. “I believe in one G-d, and Hashem is the only G-d.”

While the Lubavitch are known for their efforts of outreach to other Jews, the Lubavitcher Rebbe, Rabbi Menachem M. Schneerson, saw a mandate to reach out to gentiles as well, Schulman said.

Although the sages of the Talmud understood the importance of spreading the word of G-d to gentiles, that duty was suppressed for centuries in favor of “self-preservation,” Schulman said, after the Jews’ exile following the destruction of the temples. About 30 years ago, Jews began to resume the mission of educating non-Jews.

“In the 1980s, the Rebbe said the time has come, and societies are open enough. Jewish people have success in the world. There is a new obligation to pick it up again,” Schulman said.

The Lubavitch decided to take up the cause to ensure the Noahide laws were conveyed to non-Jews in accordance with the Torah.

“There were others outside Lubavitch that took this up more quickly than Lubavitch groups,” Schulman said. “They were spreading the seven commandments, but in some cases, they were not properly educated. In some other cases, they had their own agendas. There needed to be a dedicated Torah-based organization that has oversight to take up this message.”

Schulman became involved with spreading the word of the Noahide laws when Reisner sought some help with his fledgling website.

“I became the webmaster,” Schulman said, “and from there, I started seeing how much this was needed. I saw the [Noahide] movement was going offtrack, and saw that it needed to go on the path of a Torah teacher.”

The movement is growing, according to Schulman, and is becoming more widely accepted, although there is a notable lack of Noahide communities in the United States, and Noahides here must go to the Internet to find other Noahides with whom to connect.

Noahides in other countries, such as the Philippines, the United Kingdom and Kenya, have had more success in building Noahide communities, Schulman said. While these communities do not have rabbis, they have community leaders who aid with learning Chumash and Tanach.

Schulman has developed a set of courses on Noahide principles of the commandments and faith, and, more recently, has been putting together appropriate prayer services to help these communities.

He is also helping to edit a comprehensive codification of the commandments.

“The Rebbe wanted a codification of the Noahide commandments, like the Code of Jewish Law,” Schulman said. “The Rebbe said there should be one for the Noahide communities.”

Codification of the Noahide laws has become one of Schulman and Reisner’s “major goals,” Schulman said, and they recruited Torah scholar Rabbi Moshe Weiner to take on the project. While Weiner thought he would be able to complete the project in a year, it has taken four years to cover just the first six of the seven commandments. In 2007, ANI published volume one, covering the first three commandments, and the principles of faith, and in 2008, the second volume, covering the second three commandments, was published.

While some Noahides do aspire to convert, most are content living as non-Jews, following the Noahide laws.

“It is not a goal at all to encourage conversion,” Schulman said, “although some do decide to go down that road. Most people just want to connect with the truth.”

Both Telencio and Boiles appreciate Schulman’s help in connecting them with a virtual Noahide community.

“There are no other Noahides in Naples,” Telencio said. “Most of my contacts are through the Internet.”

And community, wherever one finds it, is important, especially after leaving behind the religion in which one is raised.

“When you leave Christianity and the church, you lose community,” Boiles said. “And my family has been a problem. But I had to do it. Now I see that my job is to align myself with Jews, and that we have a collective mission.

“I’m very magnetically drawn to Judaism. Part of me yearns for conversion, but I take this very seriously. Right now my path is as a righteous gentile, and to serve Hashem.”

(Toby Tabachnick can be reached at tobyt@thejewishchronicle.net.)