With mouth opened wide, Miguel Alvarez reclines in a medical chair in the small exam room at the Hampshire County Jail and House of Correction in Northampton. His wrinkled orange jumpsuit contrasts with the sterile blue gown and crisp white dress shirt worn by Dr. Thomas M. Cleary, Jr., an Easthampton dentist, who leans in to examine his teeth.

“Are any of these areas sensitive?” Cleary asks as he reaches into Alvarez’s gaping mouth with a slim steel pick and carefully prods a few teeth. Alvarez affirms the sensitivity and jokes about his teeth, “I’ll trade my real ones for some gold ones.”

Alvaraz is one of about 10 patients Cleary, 41, will see today. Contracted by the jail to provide dental care for inmates, Cleary works here every Tuesday from 8 a.m. to noon. The patients he treats bring a wide range of problems to him from cavities to severe mouth sores.

The jail, which is run by the state, is required by state and federal laws to provide its prisoners basic healthcare. Cleary takes a lower rate to treat patients here than he does in the private practice he owns with his father, Thomas M. Cleary Sr. The jail pays him a set fee regardless of how many patients he sees on any given day.

”I enjoy going to the jail each week,” Cleary says. “I receive a great deal of satisfaction from the feedback I get from the residents. It’s very rewarding to me when someone comes to see me because they heard from one of their friends that I would give them great care.”

Broadened experience

After graduating from the University of Maryland School of Dentistry in 2008, Cleary, who grew up in Westhampton, joined his father’s practice the same year. He began working at the jail one year later, taking over from the jail’s former dentist, Dr. Edward J. Welch.

"I was definitely tentative going there, but once I went and saw what he was doing I thought it was pretty neat," he says.

Nearly one decade later, Cleary walks into the jail each Tuesday not knowing what medical problems he’ll face. He triages patients as they come in based on the severity of their symptoms. Unlike the patients he sees in private practice, many of whom consistently maintain their dental health, the inmates give Cleary a chance to attend to a variety dental emergencies he might not see otherwise, sometimes the result of neglect.

“The extremes of oral health needs are much greater at the jail than for many people I see in private practice,” he says. “As a result, I often have an opportunity to see a great deal of improvement over a relatively short period of time.”

And, he says, it is satisfying to him to see the inmates take his health advice to heart.

The medical team

At the jail Tuesday, Cleary steps outside the exam room, which formerly served as an office, and turns a switch that triggers an X-ray machine’s camera arm positioned over Alvarez’s jaw. Cleary’s dental assistant, Megan Valentine, exposes the images with another machine. The pictures will help Cleary find the cause of Alvarez’s tooth pain.

The steady hiss of a sanitation machine, which sterilizes the dental equipment as fast as Cleary can use it, is interrupted every so often by bed check announcements booming over the jail’s loudspeakers, and scratchy chatter emitting from handheld radios carried by prison guards passing by in a nearby hallway.

There are, on average, 240 inmates living at the Hampshire County House of Corrections and every one is given a medical exam, and a dental exam by Cleary, if it’s needed, within a week of the prisoner’s arrival. Last year, the jail had 2,896 admissions. Followup care is provided as needed, said Sheriff Patrick Cahillane, who oversees the facility. According to Cahillane, the state holds jails to certain medical standards, but individual jails can meet those standards in different ways. 

At the Hampshire County House of Correction, there is an on-site medical unit, which consists of exam rooms and has a part-time doctor on staff. It is managed by Kim Myers, a nurse practitioner who is also the jail’s the assistant deputy superintendent. She brings in Cleary and other medical professionals, including a psychologist, to provide regular treatment for the inmates. 

For more specialized care and procedures than these doctors can provide, prisoners are transported by guards to civilian facilities.

All healthcare is paid for through the jail’s annual budget, which is provided through state taxes. Year-to-year, Cahillane said, the medical allocation fluctuates based on the needs of inmates. This fiscal year, of the jail’s $14,165,164 budget, $798,635 has been used so far for the medical operation, including costs for medication and state fees.

Educational opportunity

“The majority of people have some sort of substance abuse, and along with that goes a lot of other health ailments,” including tooth decay, Cleary says later. He’s sitting in front of a computer at his office on Main Street, Easthampton, next to a wall filled with his framed degrees and certificates. It’s a stark contrast to the small exam room at the jail. Orchestral music plays softly instead of bed-check announcements. There’s an orchid on a windowsill in the waiting room outside, and the walls throughout have been painted calming and earthy tones.

"The needs, the treatment, here, is focused on comprehensive care, where someone comes in and we're expecting they'll be with us for 10 or 20 years," he says. "At the jail, it's triaging emergencies, and it's people who may never have seen a dentist before, or the last time they saw one was 15 years ago."

Working with inmates has expanded Cleary’s medical knowledge, he says, and, through hands-on experience, has made him a better dentist. For example, when he began treating inmates with a history of drug abuse, to avoid relapse, Cleary prescribed non-narcotic medication like ibuprofen instead of narcotic painkillers such as Vicodin or Percocet. That was contrary to the approach of pain management he learned in dental school, he says, But the feedback he received from those patients about their pain, and lack thereof, caused him to extend that approach to all of his patients.

"What I've learned, and by reading scientific journals as well, is that the opioids actually don't control pain as well as non-narcotic drugs," he says.

Over the years, Cleary has shared his findings with other dentists a the conferences he attends. Now, given the nationwide opioid crisis, treating pain without narcotics is an officially recommended method. Recently, based on studies, the American Dental Association, a Chicago-based organization that represents more than 160,000 dentists nationwide, announced a policy calling on its members to eliminate opioid painkillers as much as possible in favor of non-narcotic medication.

Cleary says that he treats all of his patients the same, whether he sees them in his office, or behind the jail’s barbed wire fence.

"With the (jail’s) residents, I like to be friendly, and we have a good camaraderie,” he says. “But I purposely don't want to know why they're there, or too much about that, because there's no potential benefit to me. I'm there to help them, and I don't want there to be anything that clouds my judgment.”

Alvarez, for one, appreciates the treatment he’s getting from Cleary.

“He’s one of the best dentists. And he’s fast. I put the (appointment) slip in last week,” Alvarez says, now back in the jail’s exam room waiting area. Cleary has prescribed a teeth guard to prevent him from grinding his teeth at night as a possible solution for his pain.

Alvarez, who is from Worcester County, says in or out of jail, he’s never received the level of dental care that Cleary provides.

Just then, a correctional officer enters the waiting area to take him to the jail’s medical unit to pick up the teeth guard.

"No gold teeth for me,” Alvarez quips as he leaves.

Andy Castillo can be reached at acastillo@gazettenet.com.

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