With a silvery Airstream trailer as a dental office and a picnic shelter as a waiting area, Jeff Bailey goes about his work, brightening the sometimes gapped smiles of Appalachian residents.
It is no small task in impoverished mountain communities where many people see dental care as a luxury they simply cannot afford.
That is not the case this day, as dozens of people wait their turn for free services in one of the mobile dental offices that travel the hills and hollows of eastern Kentucky.
Bailey belongs to a group of volunteer dentists working with area Southern Baptist churches to reach out to uninsured families that do not make enough money to pay for dental care but make too much to qualify for Medicaid assistance.
By some estimates, about a third of the dental patients in the mountain region fall into that category, and Bailey believes it is the primary reason that central Appalachian states lead the nation in toothlessness.
More than 32 percent of Tennessee residents surveyed last year had lost six or more teeth because of decay or gum disease, according to the Centers for Disease Control and Prevention. That number was 38.1 percent in Kentucky and 42.9 percent in West Virginia, which holds the distinction of the most toothless state.
Those numbers show a tremendous need, and clinics on wheels can be a big help, said Gerald Ferretti, a dental professor at the University of Kentucky, which has four dental vans to help fight tooth decay.
Ferretti said Kentucky, which was ranked No. 1 in toothlessness in 2003, has a tremendous need. He said he would like to see more faith-based organizations operating dental vans.
"The problem is almost epidemic in the state," Ferretti said. "We need to get everyone involved. Dental care is a very, very critical need."
David Aker, mountain missions director for the Kentucky Baptist Convention, said churches in the Red River region of the state joined forces to equip and operate the dental trailer.
In a similar program, Aker said the Elgin Foundation of Oneida, Tenn., has equipped a dental van that makes rounds through the hills of Tennessee and Kentucky.
In addition, some Christian groups have opened free clinics in church buildings, which are staffed by volunteer dentists who come to the region from other parts of the state for weeklong mission trips. And yet others hold dental care events in Wal-Mart parking lots across the region, handing out free toothpaste, dental floss and toothbrushes to everyone who wants them.
Dozens of people made their way into the Airstream parked outside Stanton Baptist Church, 45 miles southeast of Lexington, while clowns entertained the waiting crowds in what could have easily been mistaken for a carnival.
Had it not been for the free service, Tina Davis of Stanton said she would have had to put off her visit to the dentist because she would have had to pay for the cleaning she received and for the checkup given to her 1-year-old daughter. The total would have been about $140.
Bailey said about $3,000 worth of free dental care is provided each day the Airstream is in use.
Often, Bailey comes across adults who postpone dental visits until pain leaves them no other choice. In those cases, he said, he finds that cavities have so eroded the teeth that the option usually chosen is having the offending teeth pulled.
That is because many of the uninsured people Bailey sees either cannot afford or are unwilling to pay for procedures such as root canals that could save the tooth.
And, for people older than 21 who receive Medicaid assistance, the government pays only for extractions. Root canals and bridges are not covered.
Aker said too many people in mountain communities have the mistaken idea that losing teeth is a normal part of growing old. Some do not seem to realize that teeth are intended to last a lifetime.
"People feel like they can do without teeth, or that they can always buy false ones," he said.
Bailey said he hopes the number of mobile dental offices can help change that mind-set.
"It definitely is going to reach a lot of people," he said.
Ferretti praised the church groups for reaching out to the adult population while the University of Kentucky dental vans reach out to children. About 500,000 children in Kentucky are covered by government dental care programs, but he said only about one in four see a dentist every year.
"What we're trying to do with the mobile programs is to provide a cultural change, to let people know the importance of taking care of their mouths," Ferretti said.
Ferretti said he hopes the university can help bring that change with its fleet of dental vans, helping to teach children the benefits of good oral hygiene and at the same time applying fluoride treatments and dental sealant to ward off decay.
"We're hoping to make an impact," he said. "We're trying to get to the children as early as we can."