Josh Meltzer | The Roanoke Times

David and Debra Shelton have been able to receive dental care since reaching adulthood, when most low-income adults who do not have health insurance cannot afford it. The two have suffered severe pain and tooth loss in the past few decades. "It's like they think people quit having toothaches after they turn 21," David Shelton said.

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• Small Smiles defies traditional system

Expansion of low-cost dental care

A significant expansion of free and low-cost dental services for the poor is under way in the Roanoke region. New dentists and programs represent a long-needed boost in access to care.

For children:

Small Smiles dental clinic opened July 31 at Crossroads Mall in Roanoke. The practice treats children and young adults who get their health insurance through Medicaid. Phone 362-5347.

Carilion Health System’s filled-to-capacity pediatric dental clinic in Roanoke expects to add a third dentist this month. The dentist will expand what’s offered to teenagers and young adults through age 20. Phone 224-4380.

The Virginia Department of Health, which sees only children, hired a dentist assigned to the Alleghany Highlands, where there wasn’t one. The Roanoke, Salem and Bedford health departments have dentists. Phone 857-7600.

On Sept. 1, the Child Health Investment Partnership in Roanoke plans to begin applying a preventive dental varnish to the teeth of all enrolled children 6 months to 36 months old, about 400 people. Parents will receive an hour-long instruction in dental health of use to them and their children. Phone 857-6993.

For adults:

Bradley Free Clinic in Roanoke offers a variety of dental services, including emergency and restorative care, to its clients on a weekly schedule. The program expanded last year. Phone 344-5156.

The Presbyterian Community Center in Roanoke has collected $2,000 to be doled out in small increments to help low-income clients without insurance purchase dental care. Phone 982-2911.

Future plans:

Project Access of the Roanoke Valley, which arranges free medical care for low-income people who work, are in school or are caregivers, is endeavoring to add dental services. Phone 344-4200.

A group is raising money to stage a weekend-long free dental clinic open to anyone. According to current plans, dozens of dentists and dental hygienists will clean teeth, fill cavities and provide other needed care. May is the target date for the Roanoke event, which could assist 400 to 600 people.

Conceptual plans are being made to consistently screen area schoolchildren for unmet dental health needs.

Kuumba Community Health and Wellness Center in Roanoke is exploring the possibility of offering dental services.

The Edward Via Virginia College of Osteopathic Medicine in Blacksburg plans to open a dental school in 2008 or 2009.

Joann Thomas of Roanoke was relieved last week to finally get a dental appointment for her daughters after trying for a year.

Now patients of Small Smiles, a new Roanoke dental clinic for children from low-income families, both girls needed their teeth cleaned and cavities filled -- one for Jessica and two for Maci.

"I wish they did this for adults," said Thomas, 39, whose teeth need cleaning and repair. "It's a paradise in the desert."

The mark of low income in Southwest Virginia is bad teeth. Thousands suffer because they can't afford dental care. But this year, a major expansion of free and low-cost dental services is occurring in the region.

Still, the programs don't cover all low-income people, and, yet, everyone needs dental care.

Such are the vagaries of a health care safety net that's been cobbled together by charitable organizations, dentists and government agencies. It aids some; others fall through. Just keeping up with what's available is a challenge, but at least some progress is evident.

Children and young adults through age 20 can get care more readily than ever before. But no program, old or new, routinely treats unemployed, low-income adults, such as disabled people, senior citizens and single, stay-at-home moms.

Generally speaking, if people in those circumstances can't produce a bundle of cash, either on their own, or from another person, or with help from a charity, they go without dental care.

Even if they brush regularly, they face the prospect of poor dental health with its potential to cause other physical ailments and lower self-esteem.

Many in the Roanoke region are in this predicament. They grit decaying teeth and bear it.

"I haven't seen a dentist in forever, probably since I was 16," said Jessica Routt, 20, of Salem, a stay-at-home mom with two kids.

Her wisdom teeth ache daily. Over-the-counter painkillers and Orajel, a tooth desensitizer, help, but sometimes, "it hurts so bad you can't eat," she said.

Like her children, she is on Medicaid, the state's health insurance program for low-income children, pregnant women, mothers of newborns, the disabled and others. But Medicaid does not provide dental benefits beyond age 20. Routt turns 21 this month. This restriction is the reason Thomas can get dental care for her daughters but not herself.

Medicaid would have paid for Routt to see a dentist earlier and would pay for one before her birthday on the 26th, but she can't find a dentist willing to see a new Medicaid patient. Dentist participation in the Medicaid dental program has been low because the rate of reimbursement was unsatisfactory.

Health officials were overjoyed when on July 31, Small Smiles opened a clinic at Crossroads Mall in Roanoke -- the spot where Thomas found care for her girls. Its four doctors accept children on Medicaid, and the wait for an appointment is only about a month.

At almost the same time, Carilion Health System this month is expanding its dental care for low-income children on Medicaid, adding a third dentist. Meanwhile, Bradley Free Clinic, designed to assist the working poor, offers its clients a wide variety of dental services provided by volunteer and student dentists.

Still more is needed. In spite of dedicated volunteers and imaginative program design, Bradley Free Clinic turns away 50 to 70 people a week who are seeking emergency dental care, said Ashley Hanson, dental coordinator. "It's just a bad situation for these people. There are so many that still fall through the cracks," Hanson said.

Consider the predicament of Debra Sue Shelton of Roanoke, who doesn't qualify for any program.

Socked by toothache after toothache in recent years, the 48-year-old disabled woman returns each time to the hospital emergency room and goes on prescription antibiotics. In a week or so, the tooth recovers, breaks or falls out. She vividly recalls once pulling her own bad tooth, root and all.

Shelton has tried to avoid burdening already busy emergency services by calling around to see if she can get into a dentist's chair. The last time, she was told she would need $120 upfront. No way, she said. She, her husband, David, and two children live on $1,800 in government support monthly, which places them about at the poverty line along with 13 percent of Roanoke families. They have a phone but no car. Her husband also struggles with the lack of dental care.

Donna McCormick of Roanoke, who has struggled with health issues and unemployment, can relate. Last week, she couldn't finish a slice of her 39th birthday cake at a restaurant because sugar makes her teeth hurt. It was a bittersweet celebration.

"Your smile is everything. But I don't smile; for one thing, my bottom teeth are so bad I'm too embarrassed to. I wear dentures on the top, and they're broken."