Sometimes it seems as if the rest of the world knows more about America’s dental health care crisis than we Americans do.

This coming weekend, I will be going to Smyth County, Virginia, which is about an hour’s drive north of where I grew up in East Tennessee, at the request of a film crew from France that is working on a documentary about the U.S. health care system. Smyth County, in the mountains of southwest Virginia, is the site of the next Remote Area Medical “expedition,” a free three-day clinic where most of the patients will be seeking—first and foremost—dental care.

The producer of the documentary reached out to me after reading my books and articles about the barriers to medical and dental care that millions of people in this country still encounter, nine years after the passage of the Affordable Care Act.


This will not be the first foreign film crew to report on the Smyth County RAM event. Last year, the BBC produced a documentary, which aired in England and around the world, called “Toothless and Uninsured in Virginia.” It was filmed at the Smyth County clinic, held annually in the hangars of a small airport.

“There are millions of people in this country who can’t afford to go to the dentist. Millions,” Stan Brock, the founder of RAM is quoted as saying at the beginning of the BBC documentary. (Brock died a few months after that interview.) We’re later told that 74 million Americans don’t have access to dental care. That’s actually was a significant understatement. As many as one of every three U.S. residents foregoes an annual visit to the dentist because the expense.

For many who don’t have access to dental care, Remote Area Medical, a charity that was created in 1985 to fly American doctors and dentists to poor cities and villages in South America and Africa, has become the only place where they can get the care they need. And it is because the need is so great here that the vast majority of RAM’s clinics are now held in the United States.

This past February, RAM held it’s 1,000th free clinic, not in another country but in Knoxville, Tennessee, where I went to college.  And just like almost every one of RAM’s previous 999 free clinics, most of the people who showed up for care in Knoxville were there primarily for dental care.

Photos from a previous RAM expedition

One of those patients was a woman who asked to be identified only by her first name, Nikki. Nikki traveled more than 60 miles from Spring City, Tennessee, to get four diseased teeth pulled at the Knoxville clinic.  She said she didn’t have the money to pay for dental care.

Like hundreds of others, Nikki drove the night before the official start of the clinic and slept in her car. She wanted to be among the first in line the next morning, well before dawn, to get a ticket to enter the clinic that day. She got one, but many others did not. Most of those not so fortunate spent yet another night in the parking lot.

“I got here at 8 or 9 p.m. last night,” said Nikki, who had been suffering from abscessed teeth and gum disease for six months. She said she had gone to the emergency room of a nearby hospital a number of times but only got pain medicine and a suggestion to see a dentist.

I went to my first RAM clinic, at the Wise County (Virginia) Fairgrounds, in 2007.  I was so stunned by what I saw—thousands of people standing in long lines to get care in barns and animal stalls—that I left my job in the health insurance industry and became an advocate for reform. I supported the Affordable Care Act because I thought it might make RAM’s work in the United States unnecessary. I should have known better.

Even though the ACA has reduced the number of uninsured people in this country, a rapidly growing number of Americans are enrolled in policies with such high deductibles they can’t get the care they need. And the ACA did little to alleviate our dental health care crisis. If anything, the lines of patients waiting for dental care at RAM’s clinics are as long as ever. A RAM board member told me last month that the organization plans to hold a record 100 or so clinics this year, almost one every three days. Once again, most of them will be in this country.

My next column will be a report from the Smyth County clinic. After that, I’ll write more about the causes of our dental health care crisis and what we can do about it.