Rolla has many dentists that serve residents, but rural dentists are retiring and dentists just entering the field are choosing metro areas to set up their practices for the lifestyle and patient numbers. That leaves dentist deserts and Missouri is only meeting its dental needs by 10 percent. Here's what Your Community Health Center is doing to close the gap.

The graphic was stark, because it wasn’t hard to locate the state of Missouri.The little hexagons that represented the states to illustrate a map of the U.S. was color-coded in a warm color scheme range of mustard yellow to alarm red. Missouri was a stand-out, colored red. This graphic from the Kaiser Family Foundation claimed Missouri and eight other states were only meeting 10 percent of the state’s dental needs, based on population, income and licensed dentists. Luckily, Phelps County has a vehicle for closing the gap. Many folks in town know it as the Smile Mobile and here’s the reason why it has become so important to not only Phelps County, but also the surrounding communities.

Rolla has many dentists that serve residents, but rural dentists are retiring and dentists just entering the field are choosing metro areas to set up their practices for the lifestyle and patient numbers, according to a 2015 report by the Pew Charitable Trusts. Rural sociology and rural economics have everything to do with the trend, hence Missouri’s large pockets of underserved residents.

Dr. Arch Kalfus, a dentist from Orange County, California, who has since retired from his private practice, greets me at his dentist office on wheels. I also meet his two dental assistants—Ambrea Tripp from Licking and Amy Agan from Richland. This outreach dental service vehicle previously owned by Phelps County Regional Medical Center, was gifted to Your Community Health Center. While many of Rolla’s residents have seen this vehicle, a large retro-fitted recreational vehicle with happy kid’s art graphics gracing the exterior, RDN wanted to visit with the relatively new staff to see how things were going.

This particular day, it was parked at Truman Elementary for the week, where it could serve up to as many as 20 students needing dental attention.
“It depends on the extent of the procedures we are doing, but we’ll typically see 12 to 15 [children], and depending on the extent of the treatment, we might only see a handful,” said Dr. Kalfus. “After the initial diagnosis and treatment planning and screening, we see the extent of their [tooth] decay and what their needs are—how their oral hygiene is. A lot of the kids we see, have never seen a dentist before, so it slows things down in a positive way—because we want them to have good first experience.”

Phelps County sits in the upper Ozark region, where the median household income is about $35,000 compared to the nation-wide $59,039 figure (U.S. Census Bureau 2016). There just isn’t enough money left over for dental care and that’s serious business when the latest medical research from Mayo Clinic show a correlation between cardiovascular disease, endocarditis and premature births to dental health. Also, researchers are currently looking for other possible suspect disease links due to poor oral hygiene.

But proper dental checkups and maintenance cost just like any other service. While some local dentist offices serve Medicaid patients, it is generally not advertised. One local dentist who wished to remain anonymous said he would love to serve everybody, but Medicare doesn’t pay enough to keep a dental practice open—the need is too great. Still, they will treat a certain number of Medicaid patients every year—it’s just not advertised.

The Smile Mobile actually serves adults as well within its 50 mile radius. Outside of their school routes, they receive payment from private dental insurance and self-pay on a sliding scale, along with those enrolled in Medicaid, so the rolling dentist office helps to fill the gap of lower incomes and dentist deserts.

The vehicle itself is tricked out with two separate dentist “offices,”—one in the front of the bus and one in the back. While new technology is great to solve a dental problem, tooth decay prevention is the goal. Dr. Kalfus talks about tooth decay and teeth alignment in the young students they see.

“We look at the propensity of them getting [tooth] decay in the future, based on their oral hygiene,” he explains. He said they do a plaque index that defines different types of bacteria and organisms that form a layer on the tooth and look at tooth anatomy. According to the doctor, plaque eventually breaks down the tooth enamel leading to tooth decay, and a buildup of plaque can lead to gum disease.

“If the teeth have a “flat” anatomy (as opposed to ridges and rough areas), they have a lower probability of getting decay,” he said. “But excluding genetics, decay itself is 100 percent preventable.”

Dr. Kalfus speaks of the importance of a child’s environment going into what may possibly be their first dental experience.

“One of the benefits the Smile Mobile has, is the kids don’t miss school time,” he noted. “They’re with family or their friends and teachers at school, so they’re very comfortable. They just take a couple steps right out and they’re escorted by one of the assistants or the [school] nurse and within a few minutes, they go right back to normalcy—back into class where they see their friends.

The doctor said regardless of the procedure they had just received, they’re already distracted because they’re back in the school environment. He added that this is a sharp contrast to where the child is taken out of school and probably wouldn’t return for the rest of the school day, making it a very different experience.

He also talks about the importance of continuity of care between dentist visits. “That’s important because it gives people a certain comfort and a degree of trust.”
He notes that some dentists will aggressively treat anything that might be a future problem—which is why some people wind up with a mouth full of cavities, perhaps unneeded. Dr. Kalfus is more conservative.

“The longer we can see a patient, the more we can see “incipient decay,” which is small—it’s not yet clinically aggressive enough to treat. “Maybe we can improve their hygiene and that can re-mineralize their teeth.” He illustrates by talking about FDA-approved materials that can arrest and stop decay.

“We don’t have to anesthetize the patient—we just paint the material on and it will completely arrest, harden and stop decay,” he said. “Then we’ll cover it up with a cosmetic—for children, it’s wonderful. I used it in humanitarian missions all over the world.”

He says kids are very open and honest. They know when someone is making the effort to treat them well, which goes double for dentistry, which can be an invasive procedure.
“Its a very personal thing, when a dentist comes in and we’re [working] right in your facial area, touching your face, sometimes with four hands near your mouth,” he explained. “That’s where the benefit of establishing trust comes in and they’ll be an advocate for me [with their friends].

The Smile Mobile helped 685 kids in the 2017 calendar year, which included other Your Community Health Center outreach services last year. “I’m really proud of my staff and what they do—we all work as a really good team,” said Dr. Kalfus. “We want our first visits, and subsequent ones to be positive and for the kids to leave happy. The potential to give a really good experience is boundless—it’s awesome.”