Texas ended its prison dentures program, plans new inmate dental care

The Chronicle’s year-long investigation in 2018 that led to the creation of the 3D-denture program highlighted stories of more than two dozen inmates who couldn’t chew their food. Some said they’d had all their teeth removed with the false promise they’d get dentures soon. Others came in with dentures that broke, only to learn that the prison system wouldn’t agree to replace them – and that they’d have to survive on a “blended diet” instead.

The 3D-denture program’s demise only came to light after prisoners reached back out to a reporter last summer after again noticing a dearth of dentures, and in August officials confirmed it had been shut down. But a few months later, the Texas Department of Criminal Justice tweeted a video about long-term goals. Among those was expanding access to dentures.

“As the age of our population continues to increase, TDCJ is dedicated to finding innovative health and wellness solutions prioritizing healthcare and public safety,” Dewayne Springer, a prison nurse, said in the video. He went on to list a few improvements, including a plan to offer better food, the creation of a tattoo removal service and “expansion of the denture program.”

For months, both the corrections agency and its main healthcare provider – the University of Texas Medical Branch – declined to give any additional details as to what that might entail. Finally, this year, prison spokesman Robert Hurst confirmed that prison health providers are now purchasing traditional dentures from a supplier in Florida – and ultimately the goal is to make them available to anyone nearing release.

“The details of the denture plan are still being worked out,” he said, “as our dental units get back up to speed and we wait on this year’s legislative sessions.”

Abrupt change 20 years ago

Until about two decades ago, Texas prisoners routinely got dentures. Then in 2003 – a year after the state’s prisons came out from under federal oversight – the corrections agency abruptly halted its in-house denture-making program, for reasons that are now unclear.

The following year, the state doled out roughly 1,300 dentures to toothless prisoners. But that figure fell quickly, and by 2006 prison medical providers issued fewer than 300 dentures statewide. A decade later, that number dropped to 71 and by 2018, it dropped again – to just 34.

In part, that downturn was driven by a policy that only allowed for dentures when they were considered a “medical necessity” — and chewing didn’t count. That meant only a few dozen of the state’s more than 115,000 prisoners qualified for teeth.

“There’s this misunderstanding that dentures are the only way to be able to process food,” Dr. Owen Murray, the University of Texas-Medical Branch’s vice president of offender services, told the Chronicle in 2018. “And our ability to provide that mechanically blended diet is actually a better solution than the mastication and chewing process.”

But following the Chronicle’s coverage in 2018, prison officials promised change, vowing to update policies, hire a denture specialist, start a denture clinic and review all denture-related grievances from the past year to re-evaluate any prisoners who filed complaints. “We want to see more dentures prescribed,” prison medical director Dr. Lanette Linthicum told the Chronicle at the time.

Two months later, the agency announced plans to become the first prison system to 3D-print dentures on-site. After spending around $56,000 for the initial equipment purchase, the program kicked off in June 2019.

Initially, officials estimated that their new printer would enable them to make anywhere between 4 and 10 sets of dentures per day, for around $50 each. But according to data obtained through records requests, the actual output proved to be far more modest.

From fall 2018 through fall 2019 – the fiscal year during which the state launched its 3D-printing program – Texas prison medical providers doled out 150 sets of dentures, most of which were issued in the three months after the 3D-denture program began. Though that year-end total represented a nearly five-fold increase from the year before, it was still a far cry from 10 a day.

In part, that was because prison and medical officials never expanded the system’s denture policy, so teeth were still only available when deemed “medically necessary.” Though prison dental staff often interpreted that phrase more broadly than they had in the past, they weren’t required to – and many toothless prisoners wrote to the Chronicle complaining that they were still unable to get teeth.

The following year, the corrections agency seemed poised to issue even more sets of dentures – but then the pandemic hit, halting prisoner transfers and the denture program with them. In the end, the prison system gave out around 190 sets of teeth during the 2020 fiscal year, and just over 90 the year after that. The program seemed destined to putter along slowly, offering far more dental prosthetics than in years past – but still far fewer than officials had promised.

But then in summer 2022, prisoners began writing worried letters, saying they’d heard rumors that the 3D-denture program had been shut down completely. In August, a prison spokeswoman confirmed their suspicions.

“The 3D-denture program has been discontinued due to issues such as breaking,” Amanda Hernandez wrote in an email. She said both of the prison system’s medical providers – University of Texas-Medical Branch and Texas Tech University Health Services – had begun issuing traditional dentures instead.

Despite the setback, according to a UTMB spokesman, the ultimate goal is still to provide more dentures.

“There is a new program that will be rolled out in about 3 to 4 months,” Chris Smith-Gonzalez wrote. “Dentures will be provided for both medical necessity and there will also be a program to provide dentures to patients with 12 months or less remaining on their sentence.”

‘So many inmates without teeth’

That could represent a significant expansion in the number of prisoners eligible for teeth, but three months came and went with no new program in place. Eventually, UTMB refused to offer any details and instead referred all questions to TDCJ. But the TDCJ spokeswoman explained that UTMB would actually be running the program, and referred all questions back to the university. For several months, each agency directed a reporter to ask the other, both maintaining that the other was responsible for releasing the information.

In the meantime Texas Tech – which provides medical care for about one-third of the state’s prisons – launched a denture-making lab. Though officials discussed the new lab at a healthcare committee meeting in September, Texas Tech spokespeople did not respond to a request for further comment, and did not answer questions about the new program’s location or planned capacity.

And so, five years on, progress has been halting, and it’s a source of deep frustration for incarcerated people who prefer to chew their food instead of drinking it.

David Pedder, who’s been in prison for over a decade, said earlier this year that he started his quest to get teeth back in 2017. The 60-year-old saw several medical providers, some of which told him that nobody could get dentures. Others simply told him that he could not.

“I sit here today with only three teeth in my mouth,” he wrote in a letter late last year. Though at one point he tried the prison’s “blended diet,” eventually he decided to try gumming his meals instead.

“I am not going back to them putting all my food in a blender, grinding it up, and throwing [it] on my tray,” he continued. “There are so many inmates without teeth in here, it’s going to take a lawsuit to get us teeth.”

But last month, prison officials finally gave some sign of hope for the toothless. In a March 3 email, Hurst said the agency will keep providing dentures when they’re deemed “medically necessary” – but also to anyone within a year of release. “Priority will be given to inmates nearing discharge to assist them with self-esteem and appearance as they seek employment and other opportunities in the re-entry process,” he added.

Now, the prison system is getting traditional dentures from a supplier in Florida. But the more expansive program to provide them will require more dental staff – and prison officials have requested a 15 percent pay increase for healthcare positions, in the hope of coming closer to a wage high enough to attract and retain medical staff.

Whether the prison system actually gets that funding is up to state lawmakers, who are expected to approve a 2024 and 2025 state budget during the current legislative session.