He needed what was left of the front nubs pulled a long time ago, and I'm sure at least a dozen cavities filled, but he kept putting it off until eventually he "lost Medicaid". The dentists would've required deep cleanings before doing any work too which adds to the process because they can only deep clean one section of the mouth per visit (4 sections). Josh would've had to schedule at multiple different offices over a period of probably 4-6 or so months to get everything done.
Huge Reminder: Please brush your teeth preferably twice a day and floss too, because poor dental health can lead to horrific health complications throughout your body.