CLEARWATER — As Dr. John Bindeman paused with his dental tools over James Caruana's mouth, he encountered the telltale signs of neglect.
There were loose and missing teeth. A few were brown with decay. Caruana, a Homeless Emergency Project resident whose last dental exam was in 1988, described how he constantly swallowed pain medication and swished peroxide to calm pain from an abscess.
Deliverance finally came last week in the form of Bindeman, a volunteer dentist at the Homeless Emergency Project's free dental clinic.
"I would've gone on treating it with Tylenol and hoping it would fall out on its own," Caruana, 50, said minutes before he was sedated to undergo a four-tooth extraction. He'll receive more work, including fillings and a partial, in coming weeks.
"God is putting things back together," he said, beaming.
HEP's dental clinic has produced lots of smiles over the past decade and a half. The clinic was the brainchild of Dr. William Johnston, a retired dentist who volunteered at HEP answering the phone. The facility opened in 1994 using $2,500 from HEP and a $5,000 X-ray machine donated by Johnston.
Seventeen years later, the program has expanded to include about 20 volunteer dentists, who donated 800 hours and provided 2,249 procedures valued at $313,000 last year alone. Johnston still volunteers his time, too.
Officials tout the dental clinic as just one portion of HEP's holistic approach to help its residents rise out of homelessness and into stable housing and employment. The nonprofit — which provides each client a caseworker, treatment plan and a bicycle to get around — also offers an after-school center for the children of residents and mental health counseling opportunities, as well as requiring that everyone work, either at a job or as a volunteer.
With the economy pushing more people into homelessness, HEP's 350 beds are near capacity and that means residents may have to wait weeks for an appointment at the dental clinic. That also delays the patient education each dentist strives to provide to help break bad oral hygiene habits, which can lead to more dental problems, or even health issues, down the road.
For example, studies have shown that the bacteria that causes periodontal disease can contribute to heart problems, said HEP board of directors member Dr. Susan Hudak.
While some of the problems the clinic sees result from neglect of oral care, some patients have never set foot in a dentist's office simply because they couldn't afford it.
"Our philosophy from dentistry is (that the mouth) is the opening to your whole body, so if you have access to dental care, you have better mental health, self-esteem and proper nutrition," Hudak said. "And for a lot of people, it's a matter of being able to get back on your feet, and get a job. Being able to smile for an employer."
Dr. Marshall Spoto, 70, who joined HEP's volunteer corps nearly 17 years ago, stops in for a few hours once a month to perform fillings and extractions. An orthodontist by trade and semiretired, Spoto said he enjoys having an outlet to put his general dentistry skills to use. But even more so, he enjoys knowing he's made a difference.
"We go down there because we want to help other people," he said, "but it's a humbling experience and I think we get more out of it than they do."
However, the dentists stress that they couldn't do it alone.
Their work is supplemented by local hygienists and St. Petersburg College dentistry students gaining experience and school credit.
And then there are the dentists who can't offer time, but donate equipment. The dental labs that provide dentures, crowns and bridges. The oral surgeons and other specialists who handle complicated procedures best performed using equipment available in a regular office setting. The laypeople, who help answer phones and schedule appointments.
Caruana's 44-year-old wife, Sharon, who also had work done, said HEP's dental clinic staff "obviously cares about the people they work on."
During the procedure, they made sure she wasn't in pain, she said, and went out of their way to check up on her after her procedure.
Sharon Caruana teared up while describing how HEP dentists put an end to the pain she'd felt for 20 years. In a few weeks, her missing molars will be replaced with a partial, which she never thought she'd be able to get. "I know it sounds silly to be so thrilled over dentures," she said, "but I want my smile back — my whole smile. The pain went on in my teeth for years. They (HEP dentists) fixed me."
Keyonna Summers can be reached at firstname.lastname@example.org or (727) 445-4153.