RIFLE, Colorado - The Mountain Family Health Centers Dental Clinic in Rifle, from the grand, stucco-colored waiting hall to the hushed dental operatories in the back, is sparkling. Each of the clinic's five general dentistry operatories, where patients sit to have their teeth worked on, is accompanied by a large window.
The clinic opened just over a year ago, and has two dentists, three assistants, two part-time hygienists and support staff.
Dr. Patricio Gonzalez, one of the dentists, likes having all the windows instead of a TV on the ceiling. The surrounding grounds may not be the most beautiful, he said, but the trees, sky, distant mountains, and the neighbor's peacock strutting by provide a gentle atmosphere.
"Some of our patients are in distress and in pain," he explains. "The view can be more soothing than watching a movie."
Gonzalez studied biology and Spanish literature before attending dental school at the University of Missouri in Kansas City. He graduated in 2001 and was an Army dentist in Germany for six years. Now, he shares an office with the clinic's dental director, Dr. Garry Millard. And Gonzalez has a commanding, framed print of Picasso's "Don Quixote" above his desk.
The dentistry staff is slowly adding more art to the walls of this portion of the 9,000-square-foot dental and medical clinic, which serves the area's uninsured and low-income population.
"You usually think about a dental clinic for the underserved as a trailer," said Dr. Millard, "But we have a beautiful facility."
Mountain Family Health Centers has had a family practice clinic in Glenwood Springs since 1999, but its Rifle clinic is new and offers medical and dental services. Over 600 patients visited the dental clinic in the first six months of 2012, more than the total amount of dental patients for 2011.
Millard, who specializes in periodontics, had a private practice in Chico, Calif., for 15 years before coming to Rifle. He believes the clinic plays a large role in area dental health.
"For some people," he said, "we're the only dentist they'll ever see."
A clinic outreach program provides basic dental screenings and other information at elementary schools from Parachute to Carbondale. Priority schools are those that have the highest percentage of students enrolled in free and reduced-cost lunch programs.
Millard said he's shocked by the amount of tooth decay he sees in Garfield County. He attributes some of it to the lack of fluoride in municipal water supplies.
"This part of Colorado is unflouridated," he explained. "Decay is far greater than in Glenwood Springs and Aspen."
He said the recommended level of fluoride in drinking water to prevent tooth decay is 0.7 parts per million (ppm).
"Aspen is close to .7 ppm," he explained. "Glenwood Springs is slightly above that." The schools he visited so far have been in New Castle, Silt, Rifle, Parachute and Carbondale.
None of these communities adds fluoride to its municipal drinking water, according to sources at each of the town governments.
But Millard said tooth decay is also a result of parental values, early childhood dental care, and family finances.
The average visit to a dentist costs $150 for a basic adult visit and $115 for children, according to the Aspen to Parachute Dental Health Alliance.
Not everyone can afford that, which is what drives the need for Mountain Family's community dental clinic - the only one along the I-70 corridor between Denver and Grand Junction.
The Mountain Family dental clinic does not offer services for free, but several payment options are available, including Medicaid. Luann Varela, in charge of financial services in Rifle, said Medicaid-qualified children and teens can receive full medical and dental coverage. Adult Medicaid patients are covered in full for medical visits, but must pay for routine dental care. Medicaid does cover emergency dental work.
But not enough dentists in the area accept Medicaid patients, said Millard.
The Mountain Family dental clinic is involved in a statewide program called Cavity Free at 3. One of its goals is to encourage more dentists to become Medicaid providers.
"It's a big problem that requires teamwork," Millard explained. "If every dentist saw one or two Medicaid patients per month, we would see a decline in the rate of tooth decay."
At the federal level, the proposed Comprehensive Dental Reform Act would broaden the dental services covered by Medicaid. Dr. Gonzalez calls the proposed legislation a step in the right direction. Meanwhile, a lot of needs are going unmet.
"We're doing the best we can and it's not enough," he said.