Fishburn comforts her granddaughter, Amber, while Dr. Gerald Awadzi
examines the first graders teeth in the tiny Miles for Smiles
mobile dental clinic. Dental assistant Gail Scott waits by. The
clinic provides free medical care to school children in seven southwest
When 10-year-old Lynn Smith
broke a front tooth her mother tried, unsuccessfully, to find a dentist
near the familys home in Macks Creek who would see her.
I had to drive clear
to Jefferson City to a dentist who would take her Medicaid and they
wouldnt do anything, Denice Smith says. All they did
was take an X-ray and write notes.
Smith was told it would cost
$500 to fix the tooth. She couldnt afford the work and her daughter
would have gone untreated if it werent for an unusual program
which provides free dental care to school children in seven southwest
Missouri counties. Now Lynn can flash a toothy smile, her broken tooth
repaired in a tiny 8-foot by 18-foot dental clinic that pulled up to
her school recently.
Each week the Miles for Smiles
mobile dental clinic sets up shop at one of 28 schools located within
a band of small towns that stretches from Lamar and Nevada, to the west,
to Buffalo to the east. From Monday through Thursday a parade of school
kids pass through the trailers two dental chairs, receiving all
manner of treatment everything from cleanings and sealants to
fillings, extractions and even root canal therapy.
The program is a response
to a severe lack of dental care in rural areas. The situation is particularly
serious for those who rely on Medicaid, the federal program that funds
health care for low-income families.
of the patients Miles for Smiles treats have never been to a dentist
prior to the clinic's visit to their school. Each child wears sunglasses
to reduce the glare of the dentists light and to protect their
In our seven county
area theres 29 dentists and none of them are taking new Medicaid
patients, says Tina Munroe, project coordinator for Miles for
Smiles. Quite a few of them arent taking new patients at
all, even if they have insurance.
The shortage is not limited
to southwest Missouri. Only about 15 percent of private dentists
accept Medicaid, says Chris Stewart, director of the Oral Health
Initiative of the Missouri Primary Care Association. Stewarts
organization represents 15 Federally Qualified Community Health Centers
in the state, 11 of which offer free dental care to anyone who walks
through their doors.
Citing low Medicaid reimbursement
rates about 55 percent of normal fees according to the Missouri
Dental Association dentists say they simply cant afford
to treat low-income patients. It costs them money every time they
see anyone (on Medicaid), says Dr. Jake Lippert, executive director
of the association.
The effect is that many children
never see a dentist.
When the moneys
tight, if the kids coughing or throwing up (parents) know theyve
got to go to the doctor. If their tooth aches, well, Eat on the
other side. Its something you can put off, Munroe
says, explaining the thinking of some parents who cant afford
Dorado Springs R-II School nurse Loree Schweizer greets a young
patient at the door of the Miles for Smiles trailer following his
appointment. School nurses screen patients for financial need and
bring students to and from their appointments.
The Miles for Smiles program
began when Barceda Families, a child abuse and neglect prevention program,
set out to address the poor dental health it found in children. Working
with Citizens Memorial Hospital of Bolivar, Barceda Families (named
for Barton, Cedar and Dade counties) applied for a grant from the U.S.
Department of Health and Human Services Office of Rural Health
The $200,000 annual grant,
awarded in May 2000, allowed the organization to purchase and repair
a 1960s-era travel trailer that had previously been used as a
dental clinic but was sitting unused on flat tires with its interior
in dire need of attention. Over the next few months the programs
first dental assistant was hired, the trailer was restored and new dental
Miles for Smiles started
treating children in February 2001. It relied on volunteer dentists
until Dr. Gerald Awadzi, the clinics first full-time dentist,
began work in July.
Today, the clinic treats
low-income and uninsured students in kindergarten through 8th grade
at schools in Barton, Cedar, Dade, Dallas, Hickory, Polk and Vernon
counties. In addition, it keeps a full summer schedule, visiting health
department offices and summer schools.
Working with school nurses
who screen the children for financial need, the Miles for Smiles clinic
has no shortage of takers. During a recent visit to El Dorado Springs
R-II School parents requested service for more than 160 students. With
two dental chairs and two dental assistants, the clinic only saw about
15 patients a day leaving nearly 100 children to wait for the
clinics next visit.
Gerald Awadzi talks with Jonathon Michlich, a student at Eldorado
Springs R-II School who received dental care during a recent visit
of the Miles for Smiles clinic.
We only have so many
hours in a day. We try to get in all we can but we cant see them
all in four days, explains Gail Scott, a dental assistant who
has worked for Miles for Smiles almost since its inception.
As great as the demand is,
the condition of the patients teeth is an even more dramatic indication
of the need.
People dont realize
that right here in Missouri there are kids with just bombed out mouths
and serious decay and problems, says Munroe, a social worker who
occasionally fills in as a dental assistant. We had a child one
time with 16 cavities and you only have 20 baby teeth.
For Awadzi, who practiced
dentistry in his native Ghana before attending the University of Pennsylvania,
the condition of childrens teeth in southwest Missouri was hard
If I didnt come
here I wouldnt have believed it, he says. This is
Awadzi says childrens
teeth are no better here than they are in rural Africa where people
brush their teeth with twigs. A sugar-rich diet is responsible for much
of U.S. childrens tooth decay but lack of even basic dental care
is also to blame.
You see 12, 13-year
olds who tell you theyve never brushed their teeth or they dont
have a toothbrush, he says of his American patients.
While every Miles for Smiles
patient leaves the clinic with a toothbrush, Munroe says the problem
is not that families cant afford basic necessities. Many children
arent being taught to care for their teeth, she says.
You can just see a
lot of the parents that come (with their children). You can tell that
they were not taught to brush their teeth, Munroe says.
To counter the generational
spread of poor dental hygiene the program also tries to teach children
the importance of brushing and flossing.
Scott, Miles for Smiles first dental assistant, shows David Green
the results of her efforts cleaning his teeth. Often the Miles for
Smiles staff must educate children about the importance of brushing.
Maybe its the
first time anyone has ever explained to them why they need to brush
their teeth, Munroe says. If we can get the kids to realize
how important it is then well be able to make a big impact.
But no matter how well a
child brushes they still need to see the dentist on a regular basis.
The Miles for Smiles project barely begins to address the staggering
need for dental care, especially for low-income families.
When youve got
850,000 people, or one in seven bodies, in the state of Missouri on
Medicaid, theres a lot of patients out there that want to be seen,
Despite criticisms to the
contrary, Lippert says Missouris dentists are doing their part
to serve low-income families. Besides dental clinics funded by hospitals,
federal programs and county governments, dentists themselves often volunteer
their time, he says.
Still, in seven Missouri
counties at least, there remains more than enough work to keep Dr. Awadzi
and his staff hopping. How long that will continue remains to be seen.
The clinics grant expires in 2003 and, like regular dentists,
its unlikely Miles for Smiles can survive on Medicaid reimbursements
One things for sure.
The steady stream of kids with poor dental health that passes through
the Miles for Smiles trailer doors is not likely to subside any time
I have school nurses
who call me all the time saying, Ive got a kid in pain here.
Weve called 15 dentists and nobody will take them. Is there anything
you can do? Munroe says. If we werent here they
wouldnt be going to a dentist anywhere else.
For more information about
Miles for Smiles call (417) 328-6334. To find a Federally Qualified
Community Health Center offering dental care near you, call (573) 636-4222.