In rural Missouri, dental care for the uninsured is so hard to come by that the waitlist for one clinic stretches to six months.
The clinic, a Catholic ministry of the Archdiocese of St. Louis, has no permanent home and never sends out bills. The 16-ton truck rolls into town and sets up in parking lots to see patients, some of whom haven’t had their teeth checked in decades.
“We could go day and night,” said volunteer hygienist Diann Bomkamp of Creve Coeur. “There’s so many people in need.”
The Rural Parish Clinic first hit the road in 2019 to offer free medical treatment to adults who lack insurance and earn less than 200% of the poverty level, or about $60,000 for a family of four. It is open two days a week, rotating through six destinations.
By early 2021, the clinic had furnished another truck, this one home to a pair of dental exam rooms. It started with appointments four days a month in two locations. Now, it operates 12 days each month, and a fifth stop, in Ste. Genevieve County, was added to the route in the fall. Through October of this year, the dental clinic had treated 533 patients, 50 more than in all of 2022.
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Bomkamp, who has worked in the field for more than a half-century, has seen some of the worst cases of her career at the clinic: adults who haven’t been to a dentist since they were children; longtime smokers or chewing-tobacco users; people who have recovered from meth or alcohol addictions, but are stuck with gnarled smiles.
“They’re coming in with some really bombed-out teeth,” said Bomkamp. “They have nowhere else to go.”
About two-thirds of Americans have unmet dental needs, according to KFF, an independent health care researcher. The situation is worse in Missouri, where more than three-quarters of the population can’t access dental care — either because they can’t afford it or there are no nearby practitioners.
For acute medical conditions, emergency rooms or urgent cares are an option.
But there’s no equivalent for dentistry. And when people ignore small problems, they snowball.
For months, Aaron Lawson had braced for a shock every time he took a swig of water. But without insurance, the tree trimmer couldn’t afford to get his cracked filling fixed.
He heard about the Rural Parish Clinic from his mom. He checked in this month while the truck was parked outside St. Joachim Catholic Church in Cadet, not far from where Lawson lives in Lincoln County.
An hour or so later, he was as good as new, if a little numb.
“I probably would have lost the tooth otherwise,” Lawson said.
The Rural Parish Clinic’s model is built around continuity of care, said director Sister Mary Rachel Nerbun, a physician and nun. There aren’t many one-and-done visitors.
“The goal is to improve health outcomes over time,” said Nerbun.
Many dental patients are referred from the medical clinic, local service agencies or food pantries. Initial appointments last an hour and include screenings for diseases such as hypertension and diabetes.
Poor dental health has consequences that extend outside the mouth. Conditions including heart disease, stroke and bacterial pneumonia have been linked to substandard dental hygiene. Chronic pain reduces quality of life. And beyond the physical discomfort, missing or damaged teeth can restrict job opportunities and erode self-esteem.
Bobbie Harris of Bloomsdale makes pies at her daughter’s restaurant in Ste. Genevieve County. Harris often felt exhausted even before she had pulled out the rolling pin.
“To stay up all night with a toothache is unbearable,” she said.
In June, a customer pointed her to the mobile dental clinic. Over the course of three visits to Bonne Terre, she had 10 teeth extracted and was fitted for dentures, work that would have cost a few thousand dollars.
“I’m 100% more confident,” Harris said. “It’s your looks. It’s your appearance.”
The dental truck is the only free clinic in Missouri that offers dentures, said Nerbun. Its target group, she said, is the working poor: people who earn too much to receive government assistance but too little to pay for procedures out of pocket.
It takes about a million dollars a year — including five paid staff members — to run both clinics, which are funded through private donations and small grants. About 80 volunteers contribute to the dental side. Eventually, if it can get more help and raise more money, the Rural Parish Clinic would like to add dates to its calendar, and possibly another truck.
“We want to reach everybody in need,” Nerbun said. “We’re transforming people.”
Kathi Brandle of Bonne Terre has had dental problems for 45 years, since several of her teeth were knocked out during a horseback-riding accident when she was a teenager. Her tongue would catch on the jagged edges.
Time only made things worse, but Brandle, who is raising two grandchildren on a fixed income, never had the money to keep up with the treatment.
“My mouth just hurt all the time,” she said. “I didn’t smile. I didn’t like talking.”
After several months on the Rural Parish Clinic waitlist, Brandle had her first appointment in May. By August, she had new dentures, top and bottom. When her grandkids came home from school that afternoon, she greeted them with a big grin.
“It’s life-changing at 61 years old to be able to smile again,” said Brandle. “I feel so blessed.”