Lost in the chatter about Affordable Care Act, insurance coverage, doctor choice and copays is the issue of dental care, especially for the working poor.

That’s a problem, because poor oral hygiene can be a gateway to many other health problems. That’s something that Dr. Tom Underwood was aware of more than two decades ago, when he and other local dentists laid the groundwork for what is now the Interfaith Dental Clinic.

The clinic, which began in the basement of West End United Methodist Church as a part of the church’s Outreach Commission (and with some help from the Nashville Dental Society), has a simple mission: “Restore, protect and improve the oral health” of uninsured, low-income employed people, their children and the elderly in Middle Tennessee, according to its mission statement.

The clinic was successful from its inception. It moved to its own building in 1998 at 1721 Patterson St., and a Rutherford County extension was opened in 2012. Between the two sites, there are 10 operatories and a full complement of modern equipment. And all because some dental professionals realized that charity could, in fact, begin at home, says Dr. Rhonda Switzer, executive director.

“When people think about changing the world, they often will go outside America’s border to do so,” Switzer says. “They think of people with needs and they want to help. There was a corps of dentists who were members of West End UMC and the Nashville Dental Society, and they were doing that. Eventually they realized that some of the teeth they were seeing overseas were better than those in their neighbors, and so they decided to something right here at home.”

It wasn’t an “either-or” proposition, as the dentists knew they could continue working in other countries. But they also knew that there was, and is, a serious dental health crisis in Tennessee, and so they set out to address it. It took a while to get the church on board, not because its leaders didn’t care, but because there was no model to follow and so everyone was creating the project as it went along.

“When they began in the basement, they had two values: excellence and compassion,” Switzer says. “They were not going to be a ‘pull it or patch it’ clinic, but one where they really improved lives by going deeper. They wanted to find out why this person got dentally sick, and help find ways to get them well.”

Over time that has meant connecting with other nonprofits serving the working poor, so that a more holistic approach can be taken to services provided. And given that the clinic was swamped with patients from the very outset, it’s also meant a lot of restored smiles over the past two decades.

“They had no track record, so had no idea if people would come,” recalls Switzer, who has been with Interfaith since 1995. “People loved the idea. They were desperate for care, and dentists were willing to volunteer. The community jumped in with dollars and it took off. I had worked in public health and had a lot of ideas, so it was a good fit.”

To quality for clinic services, a person must demonstrate that they are below 250 percent of the federal poverty level, and not have any insurance coverage. Patient care coordinators are available to speak with potential patients about their specific needs, and guide them through the application process, Switzer says.

The clinic acts as the charitable arm of the Nashville Dental Society and includes the faith community, with several churches becoming involved with the clinic over the years. That, along with growing corporate support, has allowed for the continued upgrades and expansion to a second location.

At the same time, volunteer dentists like Dr. James Crafton have found ways to integrate their clinic work into their own practices.

“I wanted to give back to the community when I began many years ago,” Crafton says. “In those days I took my own staff and tools down, and we’ve evolved to not having to do that any more. I would also take the afternoon and evening off, and that sometimes was hard, so I now have some clinic patients come to my office.

“This way they can see me from beginning to end for their treatment, which is nice. And when I get done with one, I can work with the clinic and see a new patient who’s gone through the screening process and is ready for treatment.”

As someone embedded in the dental community here, Crafton says he sees firsthand how the clinic is making a widening difference in Middle Tennessee.

“I have patients come to my office, and they can’t afford what needs to be done,” he says. “They are the working poor, and so the clinic is able to help them. There’s just no way they can afford private practice, but this way they have an option for dental care.

“And the clinic has been huge in terms of preventative dentistry, and more. I saw a guy at a breakfast fundraiser last year, and he said they saved his life. It wasn’t just that they dealt with his teeth, but also helped him address his overall health issues. It’s a powerful program.”

The goal, Switzer says, is to turn every patient into a dental-health advocate.

“They talk about the importance of dental health, and then help others make positive changes and it goes out from there,” she says. “In Tennessee we do not rank high in dental health, and that needs to change.

“We can do everything that dentistry can offer at the clinic, so we can help a lot of people get well. Really, our only limits are funding and volunteers.”

Indeed, like any nonprofit, there’s always a wish list that’s far longer than the capital budget will allow. And because the ACA as it stands now doesn’t really do much on the dental front, there aren’t a lot of government funds waiting in the wings, either.

“This model really works, but there’s a lot more that we’d like to do,” Switzer says. “We get everything from people who are just looking for a place to get teeth pulled and get dentures to those who only want a cleaning and assessment so they can get into a dental treatment program. We’re going to be here for a long time.”