UAB Professor, Alumnus Help One County Fill a Pressing Need

By Jo Lynn Orr and Matt Windsor

UAB Dentistry alumnus Timothy Smith (right) and hygienist Jane Crumbley remove a painful tooth during a recent visit to Pine Apple. Thanks to the efforts of UAB epidemiologist John Waterbor, dental students at UAB now join Smith to experience the appeal of rural practice first hand.

This story starts with a movie. A few years ago, UAB epidemiologist John Waterbor, M.D., Dr.P.H., was asked to review a documentary that had been entered in the UAB School of Public Health’s Koronis Film Festival. 

A Certain Kind chronicles the work of three dedicated physicians in Alabama’s Wilcox County, one of the poorest counties in the nation. The film made quite an impression on Waterbor, and he got an idea how he could help.

In 2012, Waterbor submitted his idea to another School of Public Health contest: the annual Back of the Envelope Awards. He proposed a fact-finding mission to Wilcox County, in which he would interview the physicians featured in A Certain Kind and members of the county health department, add his own assessment of the county’s most critical health needs, and suggest ways that UAB could get involved. 

The only trouble was that “I’d never even been to Wilcox County, let alone had any contacts there,” Waterbor says. That is, until he met Elliot Dansby, a UAB medical student in the Rural Medical Scholars Program who was looking for a research project for the summer before his second year. It turned out Dansby was born in a county neighboring Wilcox—and Zyba Anderson, director of the Wilcox County Health Department, was a family friend. So Dansby helped Waterbor determine whom to talk to and what information to collect.

On the Road

On Monday mornings, Timothy
Smith pulls his trailer from his
home on Smith Lake to Eutaw,
Alabama. He sees patients there
through Wednesday, then drives a
few more hours down the road to
treat patients in Pine Apple all day
on Thursday.Waterbor and Dansby traveled to several towns in Wilcox County. They made two visits to Pine Apple, where Roseanne Cook, M.D., one of the physicians featured in A Certain Kind, runs a health center. Waterbor concluded that Wilcox residents had decent access to medical care. Dental care was another story. Cook’s health center had the space and the necessary equipment; “the one thing it didn’t have was a dentist,” Waterbor says.

A grant from the UAB Center for the Study of Community Health offered enough funds to hire a dentist on a temporary basis to begin delivering dental care to Pine Apple residents, many of whom had not seen a dentist in 10 years. “But we wanted something self-sustaining,” Waterbor says. As a baseball fan, he thought of the perfect model: “a baseball-style farm system that would allow us to ‘grow’ our own prospects.” So he got in touch with the School of Dentistry’s Conan Davis, D.M.D., M.P.H., an expert in community outreach and the administration of dental care programs, for assistance. 

“We decided to find a dentist at the School of Dentistry willing to see patients in Pine Apple, and eventually to take our dental students down to Pine Apple for a rotation,” Waterbor says. “You could rotate in 10 to 20 students over the course of six months, and it would only take one or two of them to say, ‘This is someplace I’d like to come back to.’ Growing your own dentists in an in-need community will probably work better than trying to entice a dentist who is already settled to move his or her practice to town.”

Confessions of a Traveling Dentist

Meanwhile, Timothy Smith, D.M.D., a 2012 graduate of the School of Dentistry, had some time on his hands. He was already practicing a few days a week in Eutaw, Alabama, a 45-minute drive southwest of Tuscaloosa, while he established his own dental practice on Smith Lake. “Eutaw is a very rural area, and I do a lot of what I call ‘meat-and-potatoes’ dentistry: fillings, extractions, partials, that kind of thing,” says Smith. “It’s super satisfying.”

(Story continues beneath the video)

Timothy Smith explains how simple lessons can save mouths.

Looking for new ways to help, Smith asked Davis if he knew of any other communities in need of a dentist. He learned about Waterbor’s grant, and quickly signed on, despite the lengthy commute. “I get up early on Monday mornings to drive to Eutaw, stay there through Wednesday night in a travel trailer, then drive down to Pine Apple and see patients all day on Thursday,” Smith says. Usually, the patients are “lined up” on his clinic days in Pine Apple, he adds.

Even with his busy schedule, Smith says he is relishing the experience. “I’ve always wanted to go where I was needed,” he says. “But I didn’t know how much I would enjoy it.”

The needs in Pine Apple are evident. “We’re meeting people at the end of the road for their teeth,” Smith says. Even though his prices are far below normal—he charges $25 for an extraction—many of his patients still can’t afford to get everything done. “I had a patient say, ‘I only have enough for one tooth—can I pay for the rest in pecans?’ Smith recalls. “I said, of course you can. Any time!”

Jane Crumbley, the hygienist at the practice where Smith works in Eutaw, accompanies him on trips to Pine Apple. “He’s been such a blessing to the area,” she says. “There’s not a day that we work when we don’t have a patient who says, ‘Thank you. I love you.’”

The Roots of the Problem

Smith practices—and helps train
UAB dental students—in the Pine
Apple Health Center, a medical
clinic run by physician Roseanne Cook. Since October 2012, Smith has had some additional help in Pine Apple from students at the School of Dentistry. The work is “eye-opening,” Smith says. “What do you do when you need to have all your teeth taken out and you don’t have insurance and you don’t have a job?” he says. Gaining an understanding of these real-life dilemmas is vital training for UAB dental students, Smith adds. “I’m hoping they will think, ‘What can I do to make a difference?’” 

On a recent Thursday, Smith talked with a patient who had been bothered by severe tooth pain for two weeks. Taking a quick look, Smith saw that the offending tooth was worn past the pulp down into the root. Like many of his patients, she had tried to keep the pain in check with Goody’s powders until she couldn’t stand it anymore. She had also taken some antibiotics she had in the house. In a few life-changing moments, Smith had the tooth out. 

While he works, Smith tries to educate. He explained to the patient why antibiotics might be great for abscesses but will do nothing for her type of tooth pain. “One of the things I want to work in is to take patients where they are and make sure they don’t lose what they have left,” Smith says. He shows them how to brush and floss and gives fluoride treatments. “People will come back for a follow-up, and I look at their mouths, and the difference is incredible,” he says. “Often the thing I hear is, ‘Nobody ever showed me how I should brush my teeth.’ 

“But you start teaching people, and they start getting on board,” Smith says. “If they see results, they will change.”