Volunteers of America Michigan opens a dental clinic for the homeless

The pain was so intense, it awakened Nelsene Davenport. When she got to a dentist, the only option was extraction.

“He finally got it out. He was twisting — you could hear it all up in my head. He took this one first and he got it out and after all that pain it bled just a little bit,” Davenport said. “He removed two teeth.”

The process was long and painful, but without it, Davenport might have had more serious consequences.

“He told me I was a miracle. He said I’m surprised it didn’t go to your brain or to your heart and you didn’t get pyrea,” Davenport said, referring to a severe gum disease. “He said, ‘You’re just real lucky.’” That was 32 years ago. Davenport has never had consistent access to quality dental care. And her tooth pain flared up again this year. But this time things are different. She was one of the first patients at the Volunteers of America Michigan’s brand new dental clinic.

“We decided to get dental because the research is very clear that the average homeless person hasn’t seen a dentist in nine years,” said Patrick Patterson, executive vice president of VOA Michigan.

Made possible by a $300,000 donation from the Delta Dental Foundation, it also took help from institutions and private donors to get the clinic built and furnished.

The clinic’s unique setup means that customers aren’t charged directly, but it also means that billing is complicated — most homeless people don’t have insurance. In order to create a self-sustaining system, additional funds were needed. The Blue Cross Blue Shield of Michigan Foundation donated $100,000 and the Ingham Health Plan donated $50,000, along with other donors.

“This clinic is set up by Volunteers of America primarily to treat homeless people and their dental concerns. We’ve been doing that since Feb. 14 — Valentine’s Day,” Said Peter Chiaravalli, a dentist and the clinic director. “We’ve seen quite a few people ,and we’ve done quite a few treatments and mainly with the homeless.”

Chiaravalli, who retired two and a half years ago, was in practice for over 40 years. He was approached to help with the clinic in 2014. Since then he has been a dedicated volunteer to get the new facility up to snuff.

“I said I’d do this for six months, three days a week, but I’ve been doing this longer than that for five days a week,” Chiaravalli said.

Since then Chiaravalli has cut back to two days a week but still stands in as a dentist until a full-time dentist can be found and a self-sustaining model can be organized. Chiaravalli also hires staff and set up an agreement with the Michigan State University College of Osteopathic Medicine that allows the clinic to have specialized Medicaid billing.

Yet even with all its progress, it’s still not where it could be. Comparing the new clinic to his old practice where Chiaravalli could see over 300 patients monthly, he said it’s fully operational, but far from fully “optimized.”

“Since April we have probably seen 200 people, so we’re underutilized at this point,” Chiaravalli said. “We’re quite sure that if the word gets out that we’re seeing Medicaid patients we’ll get more.

“Our primary focus is on this population that either lives here or either uses this facility for support in one way or another.”

Patterson said that the dental program’s newness could be another reason behind the clinic’s low turnout.

“In our world, there is no familiarity with preventative or regular care because in the past the only thing available was the emergency room, which never gets you to outpatient care,” Patterson said.

That’s exactly what Chiaravalli hopes to change.

“It would be nice if we could go beyond just taking care of what I like to call pain, swelling, bleeding emergencies — in other word,s those are the true dental emergencies, but that’s kind of a low level of care.

The hope with this clinic was for not just to be an emergency clinic,” Chiaravalli said.

To achieve this, hiring a full-time dentist is priority, but barriers to entry can be broken down in other ways. Chiaravalli said that introducing patients to the importance of preventative care is important to combat fear and “felt need.”

“Nothing’s hurting, nothing’s bleeding.

They may have advanced periodontal or gum disease, they may have a situation that’s deteriorating slowly, but they have no felt need,” Chiaravalli said.

And for people like Davenport, it’s understandable why her teeth aren’t at the top of her list.

“It hasn’t been bothering me. I have so many things going at one time. I have so many friends I’m worried about right now, my grandson and then the job and getting all my paperwork done and then the apartment,” Davenport said. “It’s a whole bunch of stuff. I know as soon as I get everything solved then I can go to this before it starts flaring up again, because I know it’ll start flaring up again.”

Yet strides are being made. The importance of her dental and overall health is not lost on Davenport. When asked if she would continue going to the clinic even after she fixed her dental issues, she said yes. “I want to make sure everything else is working,” Davenport said. “I went a whole lot of years without medical care.