When money gets tight, people ignore their dental care. It's a huge part of the health care crisis in America.
That's exactly what a group of doctors and nurses from Rhode Island and Massachusetts discovered on their first volunteer medical mission in the United States.
Northeast VOSH has spent 25 years serving the poor in Central America. This year, for the first time, they traveled to Tennessee. What they saw rivaled the need in third world countries.
The lines are dishearteningly long. The wait is nearly as painful as the aches that brought the uninsured and underinsured to this free medical clinic, which is set up inside the Bristol Motor Speedway. 500 people from Tennessee and beyond would get in on day one. Hundreds would be turned away, like Gary Hughes, the front desk clerk at our hotel.
"Everything alright with your stay last night?" he asked us.
Gary has a full-time job, but no health insurance. He hasn't seen a dentist in 14 years. His whole life, he's hidden his smile, too embarrassed to open his mouth.
He and his wife, Tara, slept in their car in the parking lot, only to learn, by morning, the clinic was full.
"I'm a little disheartened, but what can you do?" Gary told us.
Gary missed his chance. There were two days left of the clinic, but he has to work.
Tara, Gary's wife, is five months pregnant. A badly infected wisdom tooth jeopardizes the baby's health. "It's probably the fifth or sixth time my bottom back one has abscessed," Tara said about her tooth. "I've been on antibiotics eight or nine times. I can't afford to have it pulled."
Of all the doctors here, dentists see the most patients. "We haven't seen decay in Central America like this. We're not sure what's doing it, but its bad," said Dr. Frank Casarella.
Dr. Casarella, a dentist from Seekonk, and one of the Northeast VOSH volunteers, thought he'd be doing more cleanings and fillings. But unlike Honduras and El Salvador, it's almost all extractions.
Preventative care is a luxury here people just can't afford. So after years of neglect, their teeth can't be fixed. They have to be yanked. Dentists at the clinic keep small collection of the teeth they've extracted in just a couple of hours in a jar.
Jeff Smith is losing all his teeth. "I waited in the parking lot for a couple of days and now they're going to be gone. So it's worth it," said Smith. The pain so debilitating, it's hard to eat or even talk.
"They were decayed so badly we couldn't get a grip with our forceps to remove the tooth," said Dr. Casarella about Smith's teeth.
But Dr. Casarella gets the job done and sends Jeff home, gripping gauze between his gums.
"So you're thinking this is going to change your life?" I asked Jeff.
"Oh yeah, I can eat," he said happily.
Remember Tara, five months pregnant? She made it in to the clinic the second day.
Dr. Geoff Burns, a family physician from Massachusetts, says it's critical for Tara to remove that abscessed tooth.
Dr. Burns explained the dangers of not removing the tooth to Tara: "The child being born much earlier than it should have and/or it being infected. So you can have still birth because of this."
Finally, the tooth comes out, but not easily.
Tara starts to moan, grip her shirt in pain, and nearly calls it quits. All it takes is one last tug from Dr. Casarella.
"It's out. You're done. You're done. Good job," Dr. Casarella congratulated Tara. Like most patients here, Tara will go back to a hard life, but now she's healthy and pain-free.
"Now, I think I can just focus on keeping myself healthy and prepare for the baby to come," Tara said with a smile on her face.
Her husband, Gary, will have to wait for some other clinic, some other year. And though he hides his painful teeth behind a shy grin, with his first child on the way, there's reason to smile.
Unless the health care crisis is solved, Northeast VOSH volunteers know their kindness will be needed again.
If you'd like to donate, volunteer, or get more information on Northeast VOSH, go to NEVOSH.com