It wasn’t that long ago that a line of people stood at the corner of a neighborhood in North Philadelphia around Temple University. The sun had not yet risen and the traffic was light. The few drivers who passed watched the crowd curiously. Those who waited hoped to be admitted to a free dental clinic for the poor and uninsured, hosted by Mission of Mercy in Pennsylvania, or MOM-n-PA, a non-profit organization. Some people were there for routine care; others needed essential procedures.
MOM-n-PA has been holding “dental shows” all over Pennsylvania since 2013. They have held a show every year, except for 2020, when the pandemic forced them to cancel. Typically, during a two-day clinic, the organization treats around two thousand people at a fun fair or arena. Corn COVID meant that the 2021 fair had to be smaller. Temple’s Kornberg School of Dentistry had agreed to host the event, and eight hundred patients was the likely ceiling.
Even before the doors opened it was clear that MOM-n-PA would reach that ceiling quickly. Sixty-four-year-old Bobby Jones arrived at 6:20 a.m. A M, elegantly assembled in a black outfit with a bolero. He told me he wanted to have his teeth cleaned. Seeing the queue, he regretted having arrived at 4.30am. Yet he said, “I am too blessed to be stressed.” Miguel Villar, a young man with a cropped mustache and soul patch, lined up, sharing a bag of fluffy pretzels. He too was awaiting treatment. He thought it had been ten years since he had been checked. The pretzels were hot – a good thing, considering it was still dark and freezing cold.
Medicare does not cover dental treatment except in certain specific circumstances, for example, if a procedure is required during hospitalization. Medicaid coverage for adults varies from state to state. A person can have medical insurance but not dental insurance. Even those with dental coverage may have difficulty getting care. According to the Center for Health Care Strategies, less than half of dentists in the United States accept Medicaid or the Children’s Health Insurance Program, and getting an appointment with whoever does can be a challenge; some counties in Pennsylvania do not have a single dental provider who accepts Medicaid. “Eligibility doesn’t necessarily mean access,” Amid Ismail, the dean of the Kornberg School of Dentistry, told me as he showed me around the fair. Temple operates a clinic that provides care to those who struggle to afford the typical costs of dental services. But even his care, Ismail said, is out of reach for many low-income patients. The pandemic has worsened the situation, as many clinics and dental offices have closed.
As the morning wore on, the line outside continued to grow. Every now and then someone in the line spotted my press badge and, mistaking me for a volunteer, approached me pulling on a mask and asking for a dental consultation.
I didn’t have any dental training, but felt close to people online. Having grown up in poverty and without dental care myself, I am missing many teeth. Many of those that remain are broken or damaged; last year one of my lower front teeth broke, leaving a jagged chip that slices my tongue and inner lip several times a day. I have known the shame and embarrassment of asking for free treatment. In particular, I used to dread the critical comments and lectures I received from dentists. One of the fundamental principles of MOM-n-PA is that every patient is treated with dignity and respect.
As in most American cities, there is glaring evidence of poverty all over Philadelphia. This seems especially true in areas where the poor can afford rent. The day before the fair began, a driver was shot dead near the dental school. A casual observer might have assumed that some of the ramshackle houses nearby were abandoned and vacant, but, having spent periods of my childhood in places like them, I knew better.
Finally, the sun rose. The day has warmed up. Then, after lunch, a sign was put up on the door of the dental school. Four hundred and fifty people had already registered; those who were still in line should return the next day. People moaned in frustration and despair, and the line of potential patients dispersed.
In the absence of a government effort to provide essential dental care to all Americans, organizations like MOM-n-PA try to fill the need. Over the past nine years, the group has provided approximately $ 6 million in care to tens of thousands of patients. No one involved – dentists, oral surgeons, lab and x-ray technicians – gets paid, and many incur considerable expense while participating.
MOM-n-PA is part of a patchwork of organizations. Terry Dickinson, the former executive director of the Virginia Dental Association, created the Missions of Mercy program in 2000; there are now independents MOM organizations in dozens of states, with names like Iowa MOM and mid-south MOM. There is also Mission of Mercy, Inc. — not affiliated with MOM—Which was founded in 1994 and operates mobile clinics in Maryland, Pennsylvania, Arizona and Texas, through a fully equipped mobile dental clinic. Another organization, America’s Dentists Care Foundation, provides dental equipment and staff for many of these events. In 2019 alone, ADCF provided equipment and operational support to more than two dozen state partners, with the combined value of the services reaching nearly $ 25 million.
Of course, these organizations can only help a small fraction of those in need. The second day of the dental salon was a critical time. For a number of people, this was their only chance to get urgent dental care in the next year or so. A line started to form around 4 A M, some setting up camping chairs and others sitting in wheelchairs.
Adela Morales was among the first in line, arriving in an Uber at age three. Her graying hair was gathered in a ponytail under an Eagles cap and she wore a floral print mask. She was hoping to get root canal treatment. Maddie Milnes arrived after Morales, reaching the line at 4:15 am, accompanied by two friends who were there to keep her company. She told me that she also wanted to have a root canal; she had had a dental consultation in May, but couldn’t afford the thousand dollar cost of the procedure. A Grateful Dead fan, she was almost entirely dressed in tie-dye. His friends carried backpacks adorned with small stuffed animals and figurines.
Anita Legette was only a few places ahead. She had come the day before with her son for treatment; now she was back to herself. She needed extractions but had resisted, due to a combination of fear and finances. “Yesterday in the line I heard a guy say he called somewhere in West Philly, and it was two hundred and fifty just to have a tooth pulled out!” she said. By 9 A M, Morales had done it inside; along with about 20 others, Milnes was in the root canal holding area, located near the school dental museum, which featured a ‘bucket of teeth’, filled with specimens drawn by Edgar RR (Painless) Parker , an early 20th century street dentist and showman. Legette, meanwhile, had her teeth pulled out. She left school, then came back in line, this time escorting a group of young children in need of care. A little girl was wearing a denim jacket with a photo of Snoopy on the back. A boy was carrying around a folding metal chair, almost as big as himself, which he set up for Legette when she needed to sit down. Legette and the children arrived inside shortly before organizers put another sign on the door, stating that the fair had once again reached capacity.
Around lunchtime, Milnes and his friends emerged. “I could really take a nap!” Milnes said, yawning. His friends nodded.
The queue had largely cleared and people were walking away. Some contained gift bags containing a toothbrush, toothpaste and other supplies; many were smiling or doing their best if their faces were numb. Others had been turned away and appeared deflated. As I left, I saw an anxious man approaching a security guard. He asked when the free clinic would reopen.
This story was supported by the nonprofit journalism Economic Hardship Reporting Project.