It is virtually impossible to drive in any big city or even smaller town without seeing the homeless, their grocery buggies carrying their tools of survival, their tarps that serve as housing. They navigate sidewalks with their rolling luggage that carries any overflow.
They are everywhere and, for whatever reason—and there are many—it is a population that continues to grow.
While it may be easier to look past these men, women and, today, entire families, Denver dentist Dr. Carol Niforatos, doesn’t. In fact, she invites them into the practice she has run at the Colorado Coalition for the Homeless for more than a dozen years.
“We do not deny access to anyone who comes through our doors,” said the affable tooth doctor in a recent interview. By ‘anyone’, Niforatos includes both low income and no income patients. Her job, she intimates, is not to judge, but to treat, provide dental care that for too long has been neglected.
While most of the dental care Niforatos provides is most often basic, some patients require more than just a quick in-and-out visit. It’s not like an ‘air in the tires’ visit for many. But a good look under the hood.
She tells the story of a forest service worker whose camper caught fire. He escaped the blaze. His dentures didn’t. Niforatos worked with him and replace his partial dentures. “That was very satisfying,” she remembered.
Creating an entire set of dentures, which is done on site, is just one service available to homeless, uninsured or Medicaid patients. The clinic also provides fillings, crowns and no surprise, extractions.
It may seem hard to believe, but Niforatos is immovable about oral health being public health. Neglecting your teeth, she said, can be a precursor to far greater health problems and the data bear it out. Poor dental health has been linked to cardiovascular disease, complicated pregnancies, diabetes, even Alzheimer’s. Poor dental care can be a gateway to more serious health issues. “When we do not address oral health, our (health) problems increase,” Niforatos said. Even something as seemingly as simple as inflamed gums can be a sign of a bigger issue. “Gum disease can affect tissues around the teeth, teeth can be lost, and inflammation can go on…travel through the body.”
And while these connective oral health issues can lead to far more serious problems, Niforatos tamps things down to a more practical level, laying out reasons why it’s important to help as many people as possible. “There is a certain segment who come in with a tooth ache,” she said. Some have insurance, others are afforded a sliding payment schedule. Others are simply unable to pay. They’ve lost a job or can’t afford dental insurance, Niforatos explains. There are plenty of reasons. At the clinic, they get treatment, not judgment.
Homelessness comes with a multitude of challenges, said Niforatos. Some people, she said, just don’t have the money. But there are other things, too, not the least of which is basic survival. Staying alive when you’re homeless is job one.
Being homeless for many or even most of the clinic’s patients was not the plan. Sometimes life, which often comes with bad breaks, just happens. A ‘central casting’ smile is often a casualty on this journey. “When you have as many challenges as our people struggle with,” Niforatos said, your focus changes, simple survival suddenly becomes the most important consideration. “Dental health is no longer a ‘top five’ priority.”
Additionally, a number of the men and women she sees at her 2111 Champa Street clinic, are not single-issue patients. More than a few are dealing with mental health issues or substance abuse challenges. But a toothache, as most can attest, can be quite a motivator. “They just end up on our doorstep,” Niforatos explains.
Other patients visiting Niforatos’ Champa Street clinic, the Coalition’s 2130 Stout or a shelter operated by the Denver Rescue Mission at 4600 E. 48th Ave., are fixed-income seniors or “children who are unhoused.”
Today, it’s not just a patient load dropping in at Champa Street and that Niforatos and her team treat. The Colorado Coalition for the Homeless has a mobile van that makes site visits where transient encampments have dropped anchor across the city. And while the mobile clinic may seem like a luxury, the Illinois native says, that’s both too easy and baseless to conclude.
Niforatos says she understands that perspective, but it’s not accurate. “We can’t pigeonhole and put them (patients) in any category we want.” Each person is unique, she said. “We need to understand the forces that put them into homelessness,” and isolating on personal responsibility as a reason may be convenient, but far from accurate. “It lacks an understanding of a 360-degree view…it’s a short-sighted argument.”
While the clinic does get some state and federal funding, along with gifts from “various entities throughout Colorado,” every penny is scrutinized. “Our budget is our top priority, and our philosophy of service is simple: ‘Judicious use of resources.’
The Colorado Coalition for the Homeless has been a city resource since 1984. In that period, it estimates that it has treated more than 19,000 patients, including a growing immigrant population. “We have Spanish language interpreters on staff,” said Niforatos. “It’s a huge priority for us.”
The clinic has also adapted new technology for dealing with new arriving immigrants for whom it has no interpreters. It is now employing “devices that can translate,” said Niforatos. “No one is the same and we can’t dismiss them in any way.”
