"I saw a lot of patients who hadn't seen a dentist before," said Smith, a Kentucky native.
Appalachia has one of the worst dental health problems in the nation. And Kentucky has the third highest rate of tooth loss.
Smith treated patients who had tried to pull out their teeth with pliers; others had superglued their teeth back onto their gums. And he saw people who were sick from chronic infection.
But the most heartbreaking stories came from his youngest patients.
"I would see a lot of kids who had a mouth full of rotting teeth," Smith said. "They were in pain, and they'd be hurting at school."
So in 2005, Smith created a mobile clinic to bring free dental care to children in need.
Since then, his nonprofit, Kids First Dental Services, has treated more than 43,000 children throughout Kentucky.
"(I hope) none of these kids ever have poor oral health and bad teeth as a barrier to keep them from moving up in life and bettering themselves," he said.
CNN's Laura Klairmont spoke with Smith about his work. Below is an edited version of their conversation.
CNN: You were born and raised in Appalachia. What makes this region special to you?
Smith: What you see right away is the beauty. I think it's the most beautiful place I've ever been. We have the mountains and trees and lakes. We have lots of talented, resourceful people who live here—real craftsmen and just good, solid people.
The only disadvantage is there's not a lot of economic opportunity with jobs. Poverty is a serious issue. Unfortunately, when we make the news, most of the time it's talking about the poverty and the negative. People from Appalachia feel like they're stereotyped as toothless, barefoot and uneducated.
CNN: Appalachia does have some of the worst dental health problems in the country. Why do you think that is?
Smith: The number one issue is education. When I first started practicing, I would see babies being fed bottles filled with sugary drinks. Also, many people can't afford to get treatment done, and many of these families don't have the transportation that they need to access it.
It's also the history here. People have been poor here in the past, and they didn't have means for taking care of their teeth. People have that fatalistic notion that, "If my parents lost their teeth early, I'm going to lose mine anyway. So what's the point in getting them fixed?"
People let their teeth go. That's why it is so important to educate the kids. If you teach them early on, they'll take better care of their teeth and won't have these problems later on in life.
CNN: How did your nonprofit work evolve?
Smith: We wanted to help kids access preventative dental care, so we turned a trailer into a mobile dental clinic. At first we went to a couple schools. Then other schools around the county started asking us if we could come to see them. In a couple years, we had school districts all around Kentucky asking us to come and see their students.
We saw so much need that hadn't been met. Now, there are schools we go back to each year, and with every year we see more improvement in the oral health of these kids.
CNN: What services does your mobile dental clinic offer?
Smith: We provide free checkups for kids. We give them dental exams, clean their teeth, do x-rays when needed, apply fluoride, do sealants on any permanent molars that don't have decay in them. And we make a treatment plan of any other needs that they have—the restorative work or extractions they need done—because we don't have the ability to do invasive procedures in the mobile clinic.
That treatment plan is sent home to the parents. I do that follow-up treatment for any of the kids who are able to come to my private practice. But in some cases it's too far away, so we also provide a directory of local dentists in different areas who've agreed to provide follow-up care.
CNN: What does this work mean to you?
Smith: I felt like I had a calling to do this. It was just something that was laid out in front of me that needed to be done, and no one else was doing it. Just seeing that we're still making a difference keeps me going.
When I see kids at schools we've been providing treatment to for 10 years and how much the incidence of tooth decay in the kids there has been reduced, that's motivation enough.
I've had people get up out of their chair, look in the mirror, and cry. People who, before, wouldn't even let you see their teeth, and now they've got these big, wide smiles. That's one of the most rewarding things.
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