MADISON, Wis. (AP) — Sarah Thames, 24, had not been to a dentist for a decade when an abscessed tooth a year ago sent her to a Madison hospital emergency room.
That's where she first heard about the Madison Dental Initiative. Thames was afraid to go to the dentist, she recalls, but was in an awful lot of pain with what turned out to be a mouth full of diseased teeth.
Fourteen tooth extractions later, Thames was at the Madison Dental Initiative clinic inside the Salvation Army one recent afternoon, smiling while she waited for another session in the dental chair.
"I'm scared of dentists and when I first came, I was panicky because I didn't know how it was going to be. But the dentists here are good," Thames told The Capital Times (http://bit.ly/1eoTxnW). "They let you know what they are going to do, and if you are in pain they give you more numbing medication."
She credits removal of discolored teeth with helping her get a job at a fast food restaurant and said she is looking forward to getting dentures from the clinic. Like all of the services she has received, there will be no charge for the dentures.
Thames is one of about 1,100 children and adults who are homeless or at risk of homelessness who received some $265,000 worth of dental care through MDI in 2013, according to Lisa Bell, a founder and executive director of the program.
An outgrowth of a graduate project by Bell, a registered dental hygienist who holds a master's degree in public health, the program has grown from a once-weekly session in a staff break room in 2009 to a several days a week, three-chair clinic with 50 volunteer professional dental care providers and 50 student volunteers.
The Salvation Army has donated space, heat and electricity to the clinic because of the vital services it provides for its homeless clients, says social services director Leigha Weber.
"The value is immeasurable. It's offering people we serve a level of care they can't easily access," Weber says. "A lot of people neglect their mouths because there are so many other pressing things to take care of. It's nice to be able to refer them down the hall."
Bell says studies show a high incidence of serious dental disease among homeless people. That became obvious in the early days of the clinic.
"We were hoping we would be fixing teeth and cleaning teeth, but for a year, all we did was take teeth out," Weber says. "We were seeing patients with enormous levels of disease. There was no way to restore those teeth."
The disorder and demands of homelessness make dental care a low day-to-day priority, says Russell Gilman, who heard about the clinic on the street and had one tooth pulled and a root canal procedure on another in his first month as a patient there.
"Trying to survive every day, it's hard to think about dental care. Or I'd lose my toothbrush," says Gilman, 51, who says he's been living in his truck for about a year. "You hear a lot of complaining about toothaches."
Gilman says the work done at the clinic "makes me feel more confident in myself, being able to smile. I really appreciate the work they do here, and the kindness."
The dental health care providers who volunteer are dedicated to serving the clinic's population, Bell says.
One of them, oral surgeon Troy Alton, comes monthly to MDI with his staff to perform extractions.
"Everybody has some kind of talent that they can use to give back to the community," Alton says. "We have unique skills we can use to get people out of pain when they have bad teeth."
Alton says tooth pain can directly affect quality of life and everything that follows, from motivation to mindset.
"There is almost nothing worse than having a toothache. People say it's worse than having a baby," he says. "And it doesn't really go away until the tooth is taken care of. If people don't have a place to get into, it makes their quality of life pretty awful."
It is difficult for low-income, uninsured people to access dental care. Dentists in private practice have advocated for years for increased reimbursement through the state Medicaid system, saying the low level of payment limits the number of indigent patients they can accept. Clinics at Access Community Health Center and Meriter Hospital generally require some payment, Bell says.
MDI cost about $110,000 to operate in 2013 and is able to provide free care because of its volunteer provider base and grant and donation funding, she says.
The clinic also provides an interdisciplinary, holistic environment for students, according to Bell. Dental hygiene students from Madison College treat patients in a rotation at the clinic; medical, nursing and pharmacy students from the UW School of Medicine and Public Health work with dentists taking patient histories and performing triage. Students at the School of Dentistry at Marquette University in Milwaukee next year will begin externships doing dental work at Madison Dental Initiative.
"We're looking at a large cadre of students who don't have regular exposure to a public health environment," Bell says. "This is giving them that exposure and providing culturally competent providers long term. "
To help grow the clinic's capacity, Bell is launching a campaign to encourage area businesses to "donate a day" by donating $600 a month or a quarter, the approximate cost of one of the four-hour clinic shifts.
"If we can get businesses to donate a day, the whole community will have a vested interest in ensuring this project is successful," Bell says.
Homelessness is a complex issue, as are the causes of dental disease among the homeless. Bell says the clinic focuses on education about the impact of smoking and poor nutrition on dental health, as well as poor daily hygiene. Dental disease and the subsequent infections that develop can be socially isolating and debilitating, she says.
"People point fingers (at the homeless) and say 'if they'd just get up off their rears and get a job,' but you're not going to get a job with a mouth full of dental decay. And even if you are hired, you'll be taking time off because you're sick," she says.
Bell believes dental care can be the first positive step homeless people can take to getting their lives back in shape.
"We see that when we make small changes, our patients make huge personal changes," Bell says.
Information from: The Capital Times, http://www.madison.com/tct