It may be the only dentist’s office in the country in which the whirring of the drill is drowned out by the rumbling of the subway. But no matter. At the Hub of HOPE, located in the concourse under Suburban Station, dentist Janine Burkhardt is not only giving her homeless patients a reason to smile, she’s giving them the ability.
Burkhardt, 30, graduated from Temple University Dental School in 2015 and, after a brief stint in private practice, applied to be a dentist at the Stephen Klein Wellness Center in North Philadelphia, run by Project HOME. But the center was looking for a dentist who would not only see patients but oversee all dental operations. Burkhardt, 26 at the time, thought the position might be beyond her skill set, but she was so impressive, she got the big job.
In December 2018, Burkhardt expanded care into the medical suite at the Hub of HOPE, the downtown service center for Philadelphia’s homeless and transient population, an initiative of Project HOME, SEPTA, and the city. While Burkhardt sees patients at the Klein Center Monday through Wednesday, she sees patients at the Hub on Thursdays. For most of these patients — who may have no access to Medicaid — the help is free.
A dental office almost didn’t make it into the 11,000-square-foot space, but Burkhardt fought to get one room with one chair — and an instrument cart that’s like a dental Swiss army knife: It combines a drill, a brush, suction, water and more in an efficient, compact, mobile metal box about the size of a washing machine.
“It’s hard to be that productive with one room because you can’t bounce from chair to chair” treating multiple patients, said Burkhardt, sitting in a small, windowless office beneath the Broad Street Line. “But we thought it was still better to have one chair rather than no chairs because at least we can provide the care right here.”
And the single room has had an unexpected benefit. “I get to engage more with my patients,” she said. “I hear their life stories and work to establish some type of trust so that they want to come back.”
The motorized cart also has had an unforeseen benefit. “It’s very noisy,” she said, “and sometimes drowns out the subway.”
Burkhardt said her small staff works hard to address patients’ chief complaints and make them feel as comfortable as possible with the process.
A patient who had come for help earlier in the day with what he thought was a broken tooth began to get very nervous when Burkhardt started to explain the procedure to remove it. He was afraid he’d choke on the rinse water while tilted backward in the chair. “He was breathing heavily,” she said. So instead of extracting the tooth, Burkhardt, who has a soothing voice and easy laugh, changed plans.
“Today, let’s just try to smooth it out without any water and we can check next week to see if you’re ready to get going,” she told him.
He immediately calmed down.
“OK,” he said, “let’s try that.”
This obvious concern for the patient’s well-being works — and for some patients who experience very little concern on the streets, it does not go unappreciated.
“Sometimes someone will say, ‘This was great!’ ” Burkhardt said. “How often do you get to hear someone say they love the dentist? Most people hate the dentist.”
Dentist hate has no home with the homeless, however. Since Burkhardt began the Project HOME dental practice at Stephen Klein Wellness Center, she’s brought on a second dentist, is in the process of hiring a third dentist, and has hired a trio of assistants to treat over 4,270 patients. The center has also partnered with Temple’s Kornberg School of Dentistry on a senior year outreach program for students and, via a partnership with Einstein, has expanded services to offer dentures, crowns and root canals on a limited basis. (The more advanced procedures are performed only at the center, not the Hub, due to the frequent number of follow-up visits required. To date, more than 4,270 dental patients have received care.
"Janine is awesome,” said Project HOME founder Sister Mary Scullion. “We are so fortunate to have her. Her leadership in growing and developing this important service has been a blessing.”
For many of Burkhardt’s patients, it had been years, even decades, since they’ve had dental care, and it has impacted their lives in multiple ways. Some have become addicted to painkillers due to cavities, abscesses, or nerve damage. Others have been unable to find employment because they’re embarrassed to open their mouths.
“Getting their teeth fixed may be a way to help them get a job,” Burkhardt said. “You’re not going to feel comfortable smiling, and maybe you’re being judged when you present for an interview.”
She added that, on the pain front, “I rarely prescribe any narcotics because a lot of studies show that they’re not needed for tooth pain or post-op pain. Usually, the pain afterward is nothing like the pain that brought them in to see us.”
One such patient was Rudy Jones-Bey, 60, who owes his new set of teeth to Burkhardt and the Hub.
Last year, Jones-Bey was sleeping on a park bench. He is now in a men’s facility and hopes to get housing early next year.
Jones-Bey said the dental and medical staff of the Hub gave him so much information about his high blood pressure and diabetes, he referred to them as the all-knowing Dr. House from the medical TV show.
“The difference,” he said, “is that they’re so caring. That’s what separates them from a hospital. I tell everybody about this service. You’ll never find a better group of people.”
In harder times, Jones-Bey said, when he was hungry the Hub staff would reach into their own pockets to give him food money. Now, he said, “Sometimes I buy them lunch, when I get my food stamps. It’s about giving back.”
The stories at the Hub aren’t all akin to the Homeless Hallmark Channel, of course.
Lydia Watson-Lewis, 26, works two days a week at the Hub doing general needs assessments for would-be Hub patients as she works toward a master’s degree in social work at Penn.
While she calls the Hub “the coolest thing,” she said it can also be depressing. “You’re seeing some people on their worst days. It’s like the interesting, dark, underbelly of Philadelphia.