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."

Orthodox Jews asked to consider Jacksonville

JACKSONVILLE, Fla. — Jacksonville is known for its beaches, military installations and the slogan hailing it as "the bold new city of the South."

But it isn't known as a major center for Judaism, with the local Jewish community estimated at 13,000, compared to about 2 million in New York and about 550,000 in South Florida.

So Rabbi Yoseph Kahanov said he was puzzled to learn the Orthodox Union listed Jacksonville among 22 "emerging communities" Orthodox Jews should consider if seeking to leave Jewish mega-centers such as New York City.

"Jacksonville really lacks, at this point, the basic necessities for Orthodox Jewry," said Kahanov, spiritual leader of Chabad of Northeast Florida.

The city has no kosher restaurants or grocery stores, so meats and other supplies have to be shipped in from Atlanta, Miami and other cities. The educational system — two day schools, one of them Orthodox, and no high school — for Orthodox youths "is still in its infant stages," he said.

"To be put on a list like this, to me, is surprising."

So how did northeast Florida make the list?

The answer is partly to be found in the nation's ongoing economic slump, but also in decades of Jewish migration from large urban centers in the Northeast, especially the greater New York City area, denominational leaders and scholars said. Others active in the city's Jewish community say its location, climate and welcoming reputation overcome difficulties in obtaining the foods, religious education and other services plentiful in major Jewish centers along the Eastern Seaboard.

Amy Lipper concedes northeast Florida presents a "challenge" to those adhering to the strictest dietary and religious standards in Judaism.

But Lipper said she and her husband, Jay, enthusiastically represented her city and Orthodox synagogue in New York at the Orthodox Union's "Emerging Communities Fair" featuring 21 other communities touted on the list.

Lipper was an ideal delegate for the task: Born and raised in New Jersey, her family moved to Jacksonville in 2004 after her husband lost his job earlier in the decade.

Her family struggled at first without those amenities, but has since thrived with the food co-ops, lower tuition costs and the Jewish community's friendly, welcoming nature. Area grocery chains also are adding a growing number of kosher products.

"You just gotta think out of the box," said Lipper, a member and staffer at Etz Chaim Synagogue in Mandarin.

The Orthodox Union began its list of emerging communities last year, partly as a response to the economic downturn that hit the New York-area economy especially hard, organization President Stephen Savitsky said.

Cities on the list are selected in part based on their "Jewish infrastructure" — a combination of availability of kosher food and religious and educational institutions.

But cost of living, housing prices and the availability of jobs also are considered, Savitsky said.

Jacksonville was added to the list this year because it has an Orthodox Union synagogue, hosts the Torah Academy school and has a ceremonial bath known as a mikvah. The city's diverse economy, lower home prices and a Jewish community known for its social service network and outreach were other reasons, he said.

"It's an atmosphere in which you can raise an Orthodox family," he said.

According to the National Realtors Association, the median sales price of single-family homes in the greater Jacksonville area was running about $154,000 during the first quarter of 2009. Single-family homes were selling from $321,000 to $430,000 in various New York-area markets.

Jobs are another story.

The Bureau of Labor Statistics reports the region's unemployment rate at 9.2 percent, compared to 7.8 percent in and around New York City.

But job seekers from larger metropolitan areas such as New York City "may have a leg up" in experience and reputation when competing for jobs as they start becoming available in Jacksonville, said Candace Moody, vice president of communications for WorkSource, a nonprofit that promotes employment in Northeast Florida.

The Orthodox Union effort comes at a time when some Jewish communities are competing for members.

The Jewish community in Dothan is offering $50,000 to households that relocate to the Alabama city. The community in Tulsa, Okla., is touting its city's job market and lifestyle at JewishTulsa.org, on Twitter and Facebook.

Jacksonville's Jewish population has remained steady around 13,000 since it was last counted in 2002, suggesting that new members are born or move to the city near the same rate they leave, said Joanne Cohen, assistant executive director of the Jacksonville Jewish Federation.

"As opposed to other communities, which are losing members, this is a thriving community where lots of things are possible," she said.

Kahanov said he would be cautious touting Jacksonville as a place for the Orthodox, but added the city has much to offer those "with a pioneering spirit."

But Lipper noted that many Orthodox and other Jews may be willing to overlook their concerns if they are facing economic hardship.

"Up there when you have no job, you have high mortgages and high (Jewish school) tuitions, you really have to go elsewhere," Lipper said. And it might as well be Jacksonville, "where you stand a chance to get back on your feet."

From the Archives: NYPD CHOSEN GUNS

Didja hear the one about the cop who walked into a doughnut shop and asked for a bagel and a shmear?

You will soon. The NYPD is adding 10 Orthodox Jews, including one woman, to their ranks. That's the largest Orthodox contingent ever in the department's latest cadet class.

When Ari Husarsky told his parents he wanted to be a cop, they were all verklempt.

"My mom flipped," the 24-year-old recalled as he stood outside the Police Academy on East 20th Street near Gramercy Park.

When the shock wore off and he had promised he would still keep kosher on meal breaks and, yes, in doughnut shops, his parents gave him their blessing.

"My mother was also against it for the obvious reasons," added Brighton Beach resident Max Silva, 28, a former caterer at Meisner's in Brooklyn. He said they thought it was just too dangerous.

"It was just one of those childhood dreams I never grew out of. Everybody was against it because nobody thinks of Jewish people as police officers," he said.

"I always wanted to be a cop, but my wife, Sharona, was against it," Silva added. "But I convinced her. It took her two years. She thinks it's a dangerous job. I was sick of my other job because there was no room to grow. I wanted a future."

The Police Department has welcomed the new recruits, who are excused from working after dusk on Fridays and on Saturdays and Jewish holidays.

"This class is going to be the ice breaker," cadet Shmuel Tenenbaum said proudly. "The next class is going to have 30 or 40."

He said he'd prefer not to work in an Orthodox area, especially his own Brooklyn neighborhood of Crown Heights, where his dad owns a matzo factory.

"If you give a Jewish guy a ticket, it's very hard," he said, noting that he might be pressured to give preferential treatment. "And then people talk. They could make your life miserable."

Tenenbaum is fulfilling his childhood dream of becoming one of New York's Finest. He finally took the plunge after serving as an auxiliary cop for the Highway 2 unit.

And he doesn't think that wearing a yarmulke under his police cap will mean he's different from the others. "I just feel like a regular person. I don't stop and think my yarmulke is on."

Luckily, he's now got plenty of support from the Jewish community, especially his rabbi.

Single and 25, David Attali is hoping that being a cop will make him a babe magnet, or at least help him find a wife. "I think girls actually like it. Because how many Jewish cops are there?" he said.

But he worries that the low starting salary will make it tough keeping kosher.

"A burger at McDonald's costs two or three bucks, but at a kosher place it's $8," he lamented.

The Orthodox recruits graduate from the Police Academy in December along with 1,218 classmates.

Police recruit Jesse Cohen, 34, said his parents were convinced he was meshugana, but eventually they relented. "It's what's in your heart," he said.

Born in Uzbekistan, Amnum Pirov, 32, was a barber in Queens. He believes he's the first Bukharian Jewish officer. He's married, has three kids, attends yeshiva, and despite the dangers intrinsic to being a cop, wife Elana is proud of his new career.

While working as a manager at a kosher grocery store on Long Island, Chaim Goldgrab, 25, would often daydream about a new career. Since he couldn't decide whether he wanted to be a mortician or a cop, he decided to do both, and is also training as a funeral director.

His preference is saving lives rather than dealing with the dead. "I never fit the mold," he said.

Eleena Zazon, 23, who lives in suburban Monsey, is one of a handful of female Orthodox Jews on the force. She's looking forward to making her mark on the shooting range: "I've always been very adventurous and looking for excitement."

She said her friends "are a bit surprised" by her chutzpah and she's bucking strict tradition by wearing pants instead of long dresses, an Orthodox symbol of modesty. But her gear is manufactured specifically for women - so it's not in violation of Orthodox law.

The kosher cops have had to deal with a few wardrobe issues during training.

"Even today in the gym my yarmulke fell off when I was doing push-ups," said Eliezer Zinstein, 24, who signed up after working as a Talmud teacher for five years in Canarsie, Brooklyn.


The by-the-book cadet said that only once he had to seek a rabbinical resolution.

"I used to wear wool tzizit," he said, referring to the tassels worn by observant Jews at the corners of an undershirt-like garment.

His wise rabbi told him that he could wear lighter cotton during strenuous workouts. The tassels also are tucked into his pants.


Kalman Witriol, 23, was destined for the job. He's following in the footsteps of his brother, Joel Witriol, who was featured on The Post's front page in 2006 when he became the NYPD's first Hasidic cop.

"The NYPD is the most diverse city agency and the most diverse police department in America," said Police Commissioner Ray Kelly. "It's one of our great strengths."


rblau@nypost.com