Cristi Carroll remembers the discussion she had with the first of three orthodontists about braces for her daughter, Alex, now 14.
“I was shocked at the cost,” she says. “I can’t remember the total dollars, but I remember them saying it would be $250 a month for two years. That’s a car payment. I’m a single mom.”
The braces, though, were definitely needed. Alex’s adult teeth were crowding into her mouth, with some coming in behind others or twisting sideways to fit.
Two consultations with no better outcomes left her discouraged. “That was the first time I thought to myself, I’m not going to be able to let my kids have braces, even though they needed it. I can’t afford it. How do people do this?”
As a single parent with two kids, Carroll, who works in a hospital billing department, doubted she’d qualify for any kind of assistance. “I’m going to be one of those that falls right in that gap,” she remembers thinking.
But qualify she did – for a growing but little recognized program called Smiles Change Lives that helps families who might otherwise skip needed orthodontics because of the cost.
The Kansas City-based non-profit is devoted to the idea that fixing misaligned teeth and cross bites is not just an aesthetic frill for the self-involved, but a necessity for proper digestion and speaking, says co-founder Tom Brown. And, just as important, the newfound confidence of kids who had been teased about their teeth helps them succeed in a competitive world.
Unlike other non-profits that target the lowest income groups, Smiles Change Lives sets its sights on people who fit under the umbrella of “working families” – the police officers, teachers, single parents and foster caregivers for whom braces, especially for more than one child, are often out of reach.
Since its inception in 1997, it’s grown into a national organization with 750 participating orthodontists that has served 12,000 kids.
Even so, many people have never heard of it. The only reason Carroll heard of it, she says, was because she ran into an old friend who works in the Smiles office. When she dropped off some materials on the program at her daughter’s school, the workers there said they were unaware of its existence.
The program works like this: Families fill out an application (the first questions are about whether the child has generally good oral hygiene). Income guidelines vary according to the cost of living in different parts of the country and are based on taxable income.
But income is far from the only factor, Brown says. Because the success of orthodontics depends so much on a patient’s willingness to brush and follow instructions between visits, there’s an element of the application that attempts to find out how committed the family will be to taking care of their teeth. Applicants all have to complete a short essay about why they want the work done. Then, to make sure the families have financial skin in the game, they must pay a $30 application fee and a $650 fee to participate, once selected.
That amount comes to one-tenth of the average $6,500 braces would cost normally. It’s a substantial deal, considering that even families with dental insurance can end up paying thousands for a child’s orthodontics.
Having more than one kid with major tooth misalignment was the situation Carol Webster found herself in a couple of years ago when her son Travis, now 13, needed them. The family had already paid for braces for their eldest child, with some help from dental insurance. But orthodontics loomed on the horizon for son Travis and possibly two more of five children in a family already stressed by a bankruptcy filing in the wake of the Great Recession.
Carol Webster, who home schools and teaches yoga, and her husband Eric, a theater technician independent contractor, were trying to recover from a botched home improvement that resulted in rain coming through a roof left open, as well as the loss of real estate investment money in the market crash, she says.
“Everything just fell apart financially for us,” she says. “We just couldn’t catch up after 10 years. So we’re very grateful. It was really hard, and for braces…I don’t know what we would have done.”
Orthodontists have the final say about who they accept. Often that’s based as much on the patient’s attitude as family income. Any sense of entitlement, for example, can be a deal killer, Brown says.
Perhaps that’s because the orthodontists are donating their skill and want to make sure the result is a healthy, straight smile. Orthodontists don’t get paid by the non-profit. They volunteer their empty timeslots. Hardware and materials are donated from participating companies.
And while it’s true participating orthodontists might get a satisfied and grateful patient who will recommend them to others, for most of them, it’s about more than that.
Dr. Kelly Toombs, founding orthodontist of Smiles, donates from 20 to 40 cases a year. “To be able to do this and provide such a visible, tangible, life-changing benefit to these kids is so amazing,” he says. “It is so rewarding to me to be able to do it that I think I get more out of it than my patients.”
“They are some of the most rewarding patients to treat. They are motivated, they are grateful, they are thrilled to have this opportunity,” he says. The program gives them access to what can be a life-changing procedure, he adds.
That may be the end result that Smiles Change Lives founder Virginia Brown, Tom Brown’s mother, had in mind when the first seeds of the non-profit germinated in 1983. That was the year the Browns started a private foundation with money from the sale of the family oil business.
Virginia Brown, who died last year at age 92, had always had a soft spot for kids with crooked teeth. She’d had them herself and knew what it meant to hide a smile, Brown says.
Originally, the foundation started helping people with facial deformities, particularly cleft palates. “She felt that if a person did not feel normal or comfortable with their face then they weren’t going to go anywhere in this world. To her it was very, very important,” Brown says.
The path took some twists and turns, but by 1996, the organization began its focus on orthodontics. At the time, there were no free orthodontic treatment or support programs for the less fortunate, Brown says.
So the foundation made a deal to fund braces for 16 kids over three years. At first, the program served the lowest income rungs. But results were often mixed because patients didn’t follow the care instructions.
By the early 2000s, the non-profit began to take a different approach. Brown says he became convinced the program would do better to help kids of working families who struggled to make ends meet but who made too much money to be served by other programs.
Now “our program is not aimed at the lowest economic class,” Brown says. “We were looking to help people who were trying to help themselves, that is, the working poor or, now, the middle class. The people for whom there are no programs at all. The ones falling through the cracks,” he says.
In other words, “We give a hand-up, not a handout.”
By the end of 2009, the program really started to take off. Today it has doctors in every state plus a program in Canada.
The recession may have had something to do with that. Brown says before 2008, people pooh-poohed orthodontics as a cosmetic procedure. “After that, all of a sudden people realized there’s a limited job market and if people want to get ahead in life they’re going to have to project themselves in a way that makes people comfortable,” he says.
Not to mention that misaligned teeth can result in other health problems or speech impediments.
The Smiles Change Lives office is decorated with thank-you notes and drawings from the program’s young patients. Brown also keeps a book of essays from kids, many of whom say they need braces to stop the bullying they get for having crooked teeth.
It’s a subject the Webster and Carroll kids shrug off with teen bravado. “I kind of wore it like a badge of honor,” says Travis of the times when kids would be amazed at his crooked teeth. “I’m homeschooled and I have bad teeth. That’s me,” he says, laughing.
But he says that will change after he gets his braces off in a few months. He’ll be better known at that point as a cross-country and track runner who entertains his friends, as he did at his orthodontist’s office, with yoyo and magic tricks.
“I think it’s cute when kids have bad teeth, but when adults have bad teeth it’s just not as good,” he says.
The Smiles program will also help Travis’ brother, Garrett, 17, and Alex Carroll’s sister Lily, 11, both of whom also have serious bite problems. After seeing her sister’s teeth, Lily, who was born with a cleft palate, wanted braces so much that she pulled out six of her baby teeth so her mouth would be ready faster, her mother says.
Cristi Carroll has already started to see what the braces have done for her kids. Alex, who was always a bit self-conscious, ran for student council and has managed the volleyball and wrestling teams. When she saw a boy sitting by himself every day in the lunchroom, she made it a point to get out of her comfort zone and go sit with him. She identified with him, she says, “because I wasn’t as social and I felt like I didn’t really relate too well to people.” Though she wasn’t an enthusiastic public speaker, she gave a speech about suicide awareness and prevention, calling on her own experience with bullying.
Lily, who’s had her braces since August, has started a school club that encourages acceptance no matter what differences exist among people.
“If you were to read the thank-you notes and the essays, Smiles Changes Lives is not a dental program,” says Brown. “What Smiles Changes lives is is an antidote to bullying.”
Kids are being made fun of and their confidence is eroding because of those crooked teeth, he says. “Which is exactly what happened to my mother when she was a child.”
“You know when the bullying stops? The day they get their acceptance letter they have a different attitude,” Brown says. “When all is said and done, Smiles Change Lives presents itself as an antidote and cure, if you will, for bullying based upon how a kid looks.”
