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This fall 2023 special series dives into how Richmond's neighborhoods promote — or hinder — residents' well-being.

How much a healthy smile costs Richmond’s Latino residents

A dental student explains the dental procedure to a man sitting in a chair
John Wallace
VCU School of Dentistry
Natalia Chavez Choque explains to a patient what is going to happen during his dental procedure. Most of the attendees at the Mission of Mercy event spoke only Spanish.

People without access to insurance can’t afford out-of-pocket costs for dental health. What do they do?

How easy is it for people living in Richmond to find and get what they need? How equitable is it? How “healthy” is any Richmonder’s access to what’s needed to survive and thrive in 2023?

Natalia Chavez Choque was once in the same predicament her Latino patients often find themselves in — needing dental care but not having insurance to cover the cost or money to pay for a procedure.

Chavez Choque, a fourth-year student at Virginia Commonwealth University’s School of Dentistry, said most of the patients she works with at the school’s student clinic are Latino.

“The beauty about seeing the Hispanic/Latinx community is for one, I am never free. I always like to keep myself busy because I know I have so many patients to see,” Chavez Choque said.

According to 2020 Census data, about 104,488 Latinos (7.9% of the population) live in the Richmond region. Approximately 1 in 8 Virginia residents is an immigrant, said the American Immigration Council. Overall, Latinos are the second fastest growing group in the United States, and several reports have found they face barriers to accessing oral health care.

Briseda Rodriguez, a 28-year-old immigrant who lives in the Richmond area, crossed paths with Chavez Choque at a free dental care clinic in Richmond over the summer. The mezzanine at the University of Richmond’s Robins Center was converted into a makeshift dental clinic — with dental chairs lining the hallway, X-ray machines and patients waiting to be seen.

The free dental care clinic was a partnership between Mission of Mercy, the 2023 Special Olympics and Virginia Commonwealth University’s School of Dentistry. The goal was to provide dental care to participants and individuals with intellectual disabilities in the Richmond area. But organizers opened the event to the general public, and soon a flyer with event details in Spanish circulated on Facebook.

Rodriguez and four of her children dedicated an entire Saturday to getting their teeth cleaned and mouths treated. It was the first time her children had seen a dentist since they arrived from Guatemala two years ago.

“Because my children don’t have a Social Security number, it’s really hard for me to get them dental insurance. It’s very costly for me,” Rodriguez said in Spanish. “Dental assistance is very important for me and the children. Since we don’t speak English, it makes it easier when there are Latino providers, so that we can have a sense of tranquility and we can say what we are dealing with or what we need.”

Being the only dental school in the state comes with the cost of responsibility, said Dr. Carlos Smith, who was recently named associate dean for inclusive excellence, ethics and community engagement at VCU’s School of Dentistry.

“What I tell my students here all the time is 'When your patient sits in that chair, you're not just simply treating a tooth.' And in sometimes that's the focus, right, because they do have to learn the technical skills and the art form of dentistry,” Smith said. “But that tooth is attached to an entire person that has a story and a narrative and a journey and how they got here, or what's bothering them, or what has led to their situation.”

The Hispanic Student Dental Association at VCU is already implementing what Smith would like to see by improving oral health care for Latinos. Last fall, Chavez Choque, who was president of the association, taught a series of dental workshops in Spanish for students and staff on how to interpret dental treatment to patients.

“I think it is really important — impactful for me to be able to communicate a treatment to a patient, a lot of times, patients always have questions, [like] why is it so expensive,” Chavez Choque said. “But if you explain them the necessity of the treatment, they really go above and beyond to be able to afford that and improve their general health.”

The need for affordable health care was apparent at the MOM event. The Virginia Dental Association Foundation that runs Missions of Mercy said it treated 175 patients. A total of 527 procedures from cleanings to restorations to extractions and X-rays were performed — work that would have cost patients nearly $50,000. Not one person paid a dime.

The foundation told VPM News that 53% of the people it saw who turned in their intake forms identified as Latino. A small number of patients did not state their race.

"When your patient sits in that chair, you're not just simply treating a tooth. ... That tooth is attached to an entire person that has a story and a narrative and a journey and how they got here."
Dr. Carlos Smith

Armando Coronado brought his wife and daughter to the free dental event. Coronado — who lacks permanent legal immigration status and doesn’t have dental or health insurance — said the MOM event provided an opportunity for many Latinos to be treated for the care they need.

“We don’t have these possibilities. I’ve been here for 10 years and because of the political situation, I haven’t had access to health care to address my needs,” Coronado said.

Aside from costs, there are a number of factors that can impede dental care access, like limited clinic hours, language, promotion of services and lack of transportation.

Virginia is also dealing with a shortage of dental providers that accept Medicaid-enrolled or uninsured patients — despite the state expanding its Medicaid dental coverage and increasing reimbursement rates.

“The percentage of dentists who actually take that as a form of payment has not quite moved the needle yet. And so, that's one of the reasons that [the] dental school has a really large influx of patients, because we're really the largest provider of care where a patient that's enrolled in Medicaid can be seen,” Smith said.

Coronado said many people like himself who lack a Social Security number aren’t able to apply to programs like Medicaid, although they know they would qualify for assistance. All they can do, he said, is endure the pain.

“It’s something so basic but so important. Because [when you have] dental care, you can do things like smile happily with joy and the most principal thing — eat,” Coronado said.

This year, the Virginia Dental Association Foundation has reached a significant milestone. Through its Mission of Mercy events, the organization has contributed $50 million in donated care since 2000 to Virginians.

Spanish–English translation provided by Keyris Manzanares.

Read more from the Healthy City series