Carolyn L. Higgins – Contributing Writer
One parenting expert suggested that the Tooth Fairy should leave receipts under the pillows of children to make the “teeth-for-treats transaction feel even more legit.” At Blue Ridge Free Dental Clinic, children and adults alike receive the benefit of real life Tooth Fairies, dedicated doctors and staff. While the service is free and the transaction often produces smiles that are priceless to patients, it would take a lot of receipts for the 1,316 extractions performed in 2017 by staff dentist, Dr. Michelle McDonald, part-time staff and a team of 12 volunteer dentists. Additional services performed at the clinic that year included 1,163 fillings, and 451 cleanings, according to Melanie Jones, director of Blue Ridge Mountains Health Project, Inc. Although pain is the common denominator that leads most patients to call the clinic, beyond their first visit, patients may receive cleaning and full restoration, including filling and sometimes crowns, partials or dentures. “Once we have fully restored the patient’s oral health, they receive a final cleaning and ‘graduate’ from our program,” said Jones. “Most patients are on a treatment plan that lasts from three months to a year. After they graduate, we provide resources for maintaining their oral health through prevention.” The Tooth Fairies are the clinic’s best outreach to the community – they are the face of the clinic. They bring awareness to oral health and prevention in schools and community events. So many give generously because they were introduced to the clinic’s good work by a Tooth Fairy. The fairies participate in local parades, health fairs and assist with the clinic’s in-school prevention programs. Founding Board Member Ron Keller established the Fraternal Order of the Tooth Fairies in 2005. Kids and adults alike love the fairies. Jones walks with the fairies in the local parades and enjoys seeing the smiles they bring to faces of people – both young and old. Supporters of the clinic recently gathered in Highlands to celebrate the positive impact on its mountain communities. As the only nonprofit provider of free, comprehensive dental care in Western North Carolina, the clinic fills a much-needed role. It is sometimes the “unsung hero,” often unnoticed by the community. Area residents may have seen the clinic’s public relations Tooth Fairies, but are unaware of the breadth of the clinic’s work. Board president Ron Freeman commented, “Right in our back yard exists an organization reaching hundreds of people in need each year . . . We really have something special here.” Community impact It has been proven that limited financial resources are a barrier to dental care. The Blue Ridge Mountains Health Project was formed in 2004 for the sole purpose of establishing the Free Dental Clinic. Their main focus is prevention and hygiene according to Jones as she shared information showing the great need for dental care. Dental insurance provider Delta Dental, estimates that lifetime costs for the treatment of tooth decay can range from $1,788 to $4,187, and Medicare does not provide any dental services. Medicaid provides limited dental assistance, but large portions of the needy population, particularly the working poor and elderly, do not qualify for that program. As a result of this barrier, many patients forgo dental care for years, leading to critical infections and life-changing situations. For this population, basic nutrition, employment, and family life take a back seat to constant, and often debilitating pain and embarrassment. A Duke University study concluded that dental emergency room (ER) visits throughout North Carolina are more common among the uninsured, seldom result in definitive care or hospital admission, and often result in prescription of an opioid or antibiotic. At 81% of 69,000 visits reported in 2011, the patient received an opioid prescription on discharge. The clinic’s prevention focus aims to significantly reduce preventable dental ER visits, delayed care for treatable conditions and opiate prescriptions for dental pain in western North Carolina. Clinic staff and volunteers After 23 years in private practice, McDonald was hired as staff dentist in 2016 and also serves as dental director. She had supported the clinic as a volunteer dentist from its inception in 2005. Her vision is to create a system of care within the clinic that not only eliminates pain and infection for patients, but also fosters a strategy of preventive care and supports the patient’s greater well-being. McDonald treats patients three days a week, and hygiene is offered three days a week. Two registered dental hygienists and two dental assistants are on staff. “Twelve volunteer dentists have a deep compassion for our neighbors in the most need and make this their mission work,” said Jones. “Some live in the area part-time, but many are here year-round. They are the heart of the clinic.” The clinic is grateful for its dedicated, volunteer dentists. It is notable that some travel from outside the area. Dr. David Jones, who specializes in dentures, drives from Atlanta twice a month. Dr. John Berg and his wife Debbie drive from Chattanooga once a month. Dr. Mike Hamrick travels at least twice a month from Bryson City, and Dr. Paul DeCarlo drives weekly from Whittier. Dr. Kathy Smith drives weekly from nearby Highlands. The successful model of the clinic was built on the expertise of the volunteer dentists and part-time staff members. There are limitations because many are seasonal residents of the region and are unavailable during the off-season from October through April. Dental health, however, is not seasonal and remains a critical need all year. Patient responsibility Patients are encouraged to be responsible with their appointments, as a courtesy in general and because many doctors travel quite a distance to volunteer their time, and a missed appointment is also a loss for another patient. “We have a very strict broken appointment policy, but we explain to our patients that our dentists are volunteers and that there are many in need and in pain,” said Jones. “We believe most of our patients understand the efforts of the volunteers and staff to provide free care is for their benefit. We believe they are worth the very best care available – we only ask that they commit to making their appointments on-time and following treatment plans so that they may receive the full benefits of their care. “We do make sure that our patients understand the value of the services being provided by volunteers. We are more than an extraction clinic and our services are free . . . We do ask for a donation to cover the lab fees for crowns and dentures.” Partners make a difference With an aim to treat the whole patient, the clinic partners with a variety of human services agencies, including Eastern Carolina University’s School of Dental Medicine’s fourth-year dental students; Community Care Clinic of Macon County, Mission Hospital of Highlands-Cashiers, Macon County Public Health and Blue Ridge Health of Sylva – 21 percent of clinic patients are referred from these sources. The clinic also partners with Vecinos, an organization dedicated to helping farm workers, as well as Life Challenge, a ministry for young women with life-controlling problems. “We love working with the young women at Life Challenge and watching them regain control over their lives,” said Jones. “We believe that hope begins with a smile – all of our patients need a little hope in their lives.” Serving low-income patients in Jackson, Macon, Swain and Transylvania counties, the clinic’s accomplishments have been recognized by health leaders in North Carolina. In 2017, the N.C. Department of Rural Health awarded the clinic a grant to support their Hygiene Program, and the Duke Endowment recently awarded a prestigious three-year grant to help increase access to dental care in western North Carolina. The N.C. Association of Free and Charitable Clinics and Blue Cross Blue Shield N.C. Foundation recognized the clinic as one of the top performers in the state. Foundation support has enabled the clinic to upgrade its radiology and charting systems to digital technology. McDonald says, “I am proud that we are able to impact real health gains. We empower patients by partnering with primary care providers and social service agencies.” “I absolutely love seeing our patients smile,” said Jones. “I love that I have a team of staff and volunteers who go way beyond that smile to treat the whole person. We can help patients on the right path to total wellness – whether that means making a referral to a medical provider or assisting the patient with resources for another quality of life need. We give hope to many who have lost it.” Patient Bonnie, a retired pediatric nurse, came to the clinic in late 2017 in need of a complete restoration of her smile. Bonnie, who spent a portion of her career in pediatric hospice, arrived at the clinic having “lost her smile.” After extractions, fillings and partial denture, they gave Bonnie her smile back. She had an emphatic response: “I thought I lost my smile, but you gave it back to me! And I have so much to smile about! You changed my life.” The qualification screening process New patients must be able to show proof of residence in Jackson, Macon, Transylvania or Swain counties. The income level is verified to be at or below 200% of the poverty level through tax returns or pay stubs. The clinic also collects information on medical history and current dental concerns. Friends or family members refer most patients and the clinic performs outreach, including to the most remote parts of their service area. The clinic provides education and screenings in some Jackson County schools and has an online presence through Facebook and their website www.brfdc.org. Activities through year-end • Dental care five days a week, for those in need. • November, partnering with ECU School of Dental Medicine to provide a special Saturday clinic. • December, hosting ninth grade students from Summit Charter School, providing screenings, education and a volunteer project for student participation. • December, Tooth Fairies in Cashiers Parade, Highlands Parade and in Sylva. Former Board President Ron Keller shared his experience. “In 2006, I became the clinic’s first Tooth Fairy. I was slightly embarrassed dressed in a pink tutu, gossamer wings and a golden tiara. Twelve years later, I am proud of the clinic’s continued growth and the fact that I have 17 additional men willing to dress in colorful costumes and share my passion in support of the clinic’s mission.” Since its humble beginnings in 2005, the clinic has performed 52,262 emergency, restorative and preventative dental procedures with a value exceeding $7,800,000 – all at no charge to patients. “Our efforts to reach more patients have increased operating costs by 39 percent over two years,” said treasurer Bill Blank. “That is a significant increase for a small, local nonprofit organization. Our past growth would not have been possible without the financial support of our many loyal donors; similar support will be critical for the clinic to cover the increasing costs associated with the level of growing services envisioned by the clinic board and staff.” Jones added, “The mission of our clinic, to restore lives one tooth at a time, continues to be embraced by the small communities the clinic serves. We are honored that so many have invested in our clinic, and we would love to introduce our good work to new supporters and partners.” The clinic has kicked off its Annual Fund Drive, and a lead Tooth Fairy and loyal supporter has offered a $25,000 match to funds raised in the campaign. To make a donation, mail to BRFDC, P.O. Box 451, Cashiers, N.C. 28717. To schedule a tour, call Jones at (828)577-3966.