Marsha Levison, now 70, once experienced a dental visit so terrible that it kept her from seeing a dentist for the next 15 years.

On top of the pain of having a tooth extracted, she felt the dentist ignored what she was trying to tell him about her teeth. That may have hurt as much as the procedure.

“I just dealt with it,” she said. “I have a tolerance for pain.”

As the years went by, the ache in her teeth kept getting worse, until she finally couldn’t bear it anymore. She was relieved to discover the dental students and instructors at The Missouri School of Dentistry and Oral Health (MOTSOH) at A.T. Still University in St. Louis, an institution treating underserved communities.

“In all the years I’ve been going to the dentist, this is the only place I’ve felt comfortable,” Levison said. She added that she feels respected by the providers there: “They are gentle, thorough and explain things to you.”

Getting dental care again could add years to her life.

Dental care in America faces persistent and severe disparities. The biggest barrier is cost, even among those with insurance. But about 74 million Americans lack any dental insurance. That is roughly three times the number without medical insurance.

As with other forms of health care, rural areas and low-income communities are the hardest hit and face the greatest shortages of dental providers. Medicaid’s lower reimbursement rates lead to far fewer dentists willing to treat Medicaid patients.

Missouri residents are worse off than the rest of the country. Nearly 1.7 million Missourians live in federally designated dental health professional shortage areas -- one of the highest unmet needs nationwide. Even beyond the challenges of finding a dentist, a patient has to be able to take time off of work and arrange transportation and childcare.

Fear of the dentist and/or the memory of previous bad experiences also keep some from seeking care until an ache turns into an emergency. In 2022, there were more than 1.6 million dental-related emergency department visits, costing the healthcare system $3.9 billion. And ERs are generally unequipped to properly deal with dental issues. Patients tend to leave with prescriptions for painkillers and antibiotics, but an ER can’t fix a broken or diseased tooth.

Proper dental care means more than being able to eat comfortably, avoid pain and have a nice smile. Research shows that dental health affects overall health. Gum disease can be linked to systemic inflammation, worsening risks for other inflammatory conditions like heart disease, stroke and diabetes. Chronic oral infections can also affect respiratory health, pregnancy outcomes and cognitive decline.

While most of the patients at MOTSOH are on Medicaid, Medicare or live below the poverty line, anyone can walk in for care, according to Dr. Shaista Rashid, assistant dean of clinical affairs at the school. There’s a sliding scale based on income, and prices are lower than general dentists in the community, she said.

They also offer special programs for veterans, those with special needs and disabilities, children and those needing urgent care.

Older adults with poor oral health are at increased risk for aspiration pneumonia, poorly controlled diabetes, endocarditis and inadequate nutrition.

Winiefred Blackman, 68, had had a series of appointments over the past several months to get his remaining teeth extracted in order to be fitted for dentures. Gum disease had left several holes in his mouth. For years, he’s gotten by on soft foods, soups and noodles. He can’t wait until he has a full set of teeth again.

“I’ll be able to eat again,” he said.

Sam Neudecker slid the dollar bills into his daughter’s Barbie-pink cash register. His neighbors looked over dozens of glass vases set on a folding table in their front yard on the tree-lined suburban street.

His wife, Megan, with help from their 6-year-old daughter, had made dozens of mini floral arrangements with zinnias, cosmos and lavender from their yard for this flower stand. A homemade sign propped in front of the stand noted that the proceeds would be going to The Sameer Project, a nonprofit working to feed the starving people in Gaza. A green, white, black and red Palestinian flag displayed the words “Free Gaza.” In smaller print, at the bottom of the white poster board, it said: "Stop the Genocide."

The neighbors selected a glass mug packed with colorful blooms.

Megan Neudecker, 37, doesn’t personally know any Palestinian Americans.

She wasn’t even very aware of the nearly two-year-long war until a few months ago.

“Should I have known?” she asked rhetorically. “Yes, but I didn’t know.”

That changed after she read a post her cousin, Nicholas Heller, wrote on Medium. He titled it “Genocide and Bedtime Stories: A Father’s Reckoning.”

In it, Heller described the unbearable contrast he lives with every night: “The images on my phone -- grieving families weeping over the lifeless bodies of their children. Toddlers pulled from rubble, screaming. Dust-covered, wide-eyed, trembling in hospital beds. Starving people with hollow faces. Bodies wrapped in bloodied cloth.

"None of it resembles my reality.

"Here, in the safety of my home, it’s warm and quiet. My two children sleep soundly in their bunk beds, bathed in the soft glow of a night-light.”

He wrestles with the fact that “my tax dollars -- the same ones cast in the shadow of Never Again -- aren’t just complicit. They’re funding this genocide.” And then he asks: How are the besieged and bombed Palestinian children any different from his own?

When Megan read that, she started crying. For hours.

She began following Palestinian accounts on Instagram to see what was happening on the ground -- stories she rarely saw on mainstream American media. What she saw horrified her and shook her to her core: a man-made famine. A military starving a civilian population of nearly 2 million people.

As of mid-July, Israel’s military had killed more than 17,000 children and injured 33,000 in Gaza during this latest conflict, according to UNICEF. The scale of child fatalities in Gaza mark it as one of the deadliest conflicts for children in modern history.

Megan’s feelings reflect a broader shift in American public opinion about the war.

Only 32% of Americans now approve of Israel’s military action in Gaza, down from a high of around 50% shortly after the war began in 2023. Disapproval stands at 60%, according to a Gallup poll from July.

Megan felt compelled to do something. Anything. She was cutting flowers from her garden in Webster Groves, Missouri, when she wondered if she could sell them and donate the proceeds.

“It came from a feeling of helplessness,” she said.

The first flower stand sale in July featured a dozen small vases, and the family raised $400. Her neighbors told her that if she did it again, they wanted to donate vases and their own flowers. The second sale brought in $1,000 to fill 35 vases. Their third and final sale took place during a scorching heat wave in mid-August. They raised another $1,100.

“I really don’t have a personal connection to the war,” she said. “I just saw the pictures of what’s happening, and it struck me that there’s no difference between me and my kids and the people there and their kids, except where we were born. I had to do something other than cry.”

At first, she wondered how her Jewish neighbors would respond to the sale and her sign. Several of them donated and bought flowers.

A few passersby booed, and someone left a nasty comment on her Facebook post.

She said it was important to her to use the word "genocide" in the yard sign.

“I’m not trying to be divisive,” she said. “But that’s what is happening.”

She hopes to continue raising awareness even though they’ve held their last sale for the season.

The most beautiful flowers are now dying.

Sobia Shahab, of Ballwin, Missouri, lost her husband of nearly 24 years unexpectedly this summer when he suffered organ failure after a sudden illness.

Shahab, in the haze of shock and grief, decided to sell one of the family’s cars to save on expenses. About a week after Omar died, she took their Nissan Armada to the local dealership where the couple had previously purchased four vehicles.

The dealership accepted the car and wrote a bill of sale.

However, the DMV made a clerical error with the vehicle’s VIN, which created confusion at the dealership about whether the taxes had been paid on the car. The salesman, with whom the family had done repeated business and who knew the circumstances around the returned car, sent Shahab an email saying they could not complete the sale.

The email included a line that devastated her.

“I’m sorry that your deceased husband did not handle this when he bought the Armada,” the salesman wrote.

When she read that, Shahab burst into tears.

“Why would he say that?” Shahab said. “I just lost my husband.” The insensitive remark, insinuating that her deceased husband had somehow neglected his responsibilities, added a layer of pain to her grief.

Of course, her husband had handled the taxes. For three years, they had been driving a legally registered car. That’s not possible unless the taxes are paid. She asked a lawyer friend to send the salesman a reply documenting the paid sales tax and noting the clerical error.

The loss of a loved one leaves us vulnerable and disoriented. Careless words can strike a raw wound. This wasn’t about a car sale. It was about basic decency. Shahab is hardly alone among the bereaved who have dealt with rude and hurtful comments.

Rabia Rafiq, of Wildwood, Missouri, recalls the questions her family fielded after the sudden death in 2023 of her brother Ali, 41. Rafiq’s mother had discovered Ali’s lifeless body in their basement. Friends and acquaintances pressed her family for intrusive details, even as the family themselves had no answers. Immediately after his death, some visitors repeatedly asked her mother unbelievable questions: What position was he in when you found him? What were his last words? What did he look like?

These questions forced her to relive the worst moment of her life. Still, some persisted. They treated the family’s tragedy like a mystery they had to solve, Rafiq said.

When we are confronted with death, it can pique individual curiosity, or even worse, spark gossip. But try to imagine the pain these questions can inflict on those reeling from the sudden loss of a loved one.

At gatherings intended for condolences, some visitors treated the Rafiqs’ home as a social space, laughing and gossiping. Rafiq said others disrespected the family’s wishes for a closed casket, going so far as to try to uncover her brother’s body against explicit instructions. This kind of behavior forced her to take on the role of the protector of her brother’s dignity -- and of her parents’ well-being -- when all she wanted was space to grieve.

After Ali’s passing, one woman told Rabia’s mother, “Well, now your line has ended.” Others openly speculated about possible causes of his death.

“We were just trying to survive,” Rafiq said. She wishes some of those who showed up could have been more respectful.

When people don’t know what to say, they fill the silence with harmful words or actions. Those who feel compelled to play detective, to satisfy their curiosity about the circumstances of death, are making a horrific situation even worse.

Others, uncomfortable with grief, try to normalize the moment with casual chatter or cliches. Those who are grieving may just want compassion and presence. Often that means saying less and listening more: Acknowledge a loss without demanding details. Respect a family’s boundaries. Show up when invited or offer specific support. Avoid careless remarks that suggest blame or speculation.

Words have the power to soothe those who are grieving. Or they can leave even worse scars.