BARBOURSVILLE — Todd Joseph steered off Interstate 64, stomped the accelerator up Mall Road and walked into a blue vinyl-sided building with a wraparound porch where 14 people waited for a reason to smile. It was 7:15 a.m., 15 degrees outside, the first morning in days that it hadn’t snowed. “Do you need a full upper and lower denture today?” asked the receptionist. Joseph, 21, had driven 40 miles from his home in Raceland, Ky., last February to Affordable Dentures, one of 126 denture practices that is part of a nationwide chain based in Kinston, N.C. Joseph settled into his seat and waited for his name to be called. A company video was running on a television in the waiting room. A narrator was explaining Affordable Dentures’ services. Dentists do extractions and take X-rays. There’s an on-site laboratory. Supplies are purchased in large volume to save costs. Savings are passed on to the customer. “We’ll do our best to make your visit comfortable,” the narrator said. “Todd Joseph,” someone called. And just like that, Joseph was ushered into a back room where he hopped up into a dental chair and was greeted by Dr. Kenneth Lyons, one of two dentists at Affordable Dentures. Joseph told him his upper denture was broken. The pink plastic had cracked down the middle. The denture didn’t fit right. “Let me see how you bite,” Lyons said. “The bite is so good there. This is a real pretty set up. I don’t think there’s room for me to improve the bite.” Joseph would only need a new pink plastic base. Teeth from the old denture could be taken out and placed in the new one. “You don’t have any wear on those teeth,” Lyons said. “They have years of service left.” Lyons promised a new base, thicker and stronger. The price: $140. Joseph purchased his denture about a year ago. His four front teeth got knocked out after a robber struck him with a baseball bat in 2005, he said. Weeks later, Joseph’s teeth started falling out, he said. He swallowed two of them one night. He waited eight months before having the rest of his top teeth extracted. “I didn’t feel like messing with a partial, so I got the whole thing done,” Joseph said. Lyons needed to get a copy of Joseph’s mouth for the new upper denture. Joseph bit down into a gooey blue substance held in a contraption that looked like an oversized mouth guard. “It may feel gaggy,” Lyons warned. The room was busy. There were four assistants, two dentists. Patients were coming and going. The denture practice’s owner, Steve Nicholas, was asking people to bite down into slabs of beeswax. His assistants were using a special machine called an Alginator to spin a white powdery substance used to take impressions of teeth. Air hoses were blasting. “What color of teeth would you like, sweetie?” a dental assistant asked a patient, who chose the whitest color. Ninety percent of patients choose the whitest color. Minutes later, Lyons pulled out the mouth trays and told Joseph to take a clipboard to the cashier up front where they accepted cash or credit card only. “Will I get my teeth today?” Joseph asked. Lyons nodded. He told Joseph to return by 2:30 that afternoon. Four hours to a new set of dentures Denise Kirby and Mary Ann Milum hadn’t seen a denture this bad in months. It was stained with tobacco, burned right through the plastic base. A front tooth was chipped. “Nasty,” Milum said. Kirby tapped the teeth with her drill bit. They were porcelain. Nobody had made denture teeth out of porcelain in years. Everyone uses acrylic now. The tag on the green plastic tray identified the denture owner: Larry Coleman, 66. Kirby and Milum, part of a team of lab technicians at Affordable Dentures, would be making Coleman a new set of dentures today. They had four hours. The clock was ticking. “He’s going to look nice when he gets his teeth in. He’s going to be smiling,” said Kirby, who insists you shouldn’t judge someone by the condition of their dentures, because you don’t know their economic status. They were making 19 plates that day. On their busiest days — usually in the spring after people receive their tax refunds — they’ll make 40 pieces. Every denture is handmade. Teeth are set — one at a time — in wax first. Each denture has 28 teeth. The wax is melted with irons heated by a Bunsen burner. A deep-fryer is used to boil off the wax. The teeth are set in plaster. Plastic resin then is poured into a mold to make the denture base. They’re expected to finish all dentures by 2 p.m. It takes weeks — and at least three visits — for someone to get a set of dentures from a regular dentist. “Here, it’s just one done, another done, done, done, done,” Milum said. “It’s an assembly line.” Milum and Kirby get to see people’s old dentures, so they have a good idea how to make new ones. They’ve seen just about everything. There’s the denture that had a fake acrylic “press-on” fingernail in place of a tooth. Another denture wearer used “Bondo” — an auto body repair putty — to reset a tooth. Other people want the fake teeth taken out of a dead family member’s denture. The teeth are reset in a new plastic base, which they wear. Another popular request is to remove a gold crown from a dead person’s denture and reset it in a relative’s plate. Milum and Kirby make dentures for all ages. “We have lots of people in their 30s, 40s and 50s,” Milum said. “It seems like you’d see a lot of more older people, but you don’t.” The youngest was a 15-year-old girl from an Amish community in Ohio. About once a year, a group of Amish boys and girls comes to the denture practice in Barboursville. All their teeth have been extracted. “It’s just a maintenance thing,” Kirby said. “They know they can come back and get a new denture after so many years.” Kirby learned her craft from her grandfather. She started making dentures in 1978. She hasn’t stopped. Each denture is different, each mouth is different. “It’s fun,” Kirby said. “Everyday, something different comes through the door.” In West Virginia, there are only a handful of denture practices with in-house labs that provide same-day service. So Affordable Dentures stays busy. People drive from Ohio, Kentucky and Tennessee. Truckers will exit the interstate and stop at the denture store on their way through West Virginia. A trucker from Alaska recently had a denture made there. The only threat to Affordable Dentures’ booming business: illegal denture makers. Usually, people who operate the clandestine denture stores have worked in a lab or learned the trade from a father or grandfather. They order denture supplies through the mail. Some get caught, threatened with prosecution, but they just move elsewhere. “There’s bootleggers everywhere,” Kirby said. “People make good money until they’re caught. It’s not worth going to jail.” The hardest to please: first-time denture wearers. They’re picky, Kirby said. They want dentures to feel like their real teeth. “It’s a challenge every day,” she said. “You never know how many are going to walk through that door.” By 1:30 p.m., the lab room smelled of burned plastic. Kirby was trimming and polishing Larry Coleman’s denture. Bright pink. Shiny white teeth. Coleman’s first initial and last name were imbedded in the plastic. Kirby held up the old tobacco-stained denture for comparison. “See how much better he’s going to look,” Kirby said proudly. “He’ll look like a million dollars.” Denture demand expected to boom At first, Steven Nicholas was apprehensive about pulling teeth. Dentists are taught to save teeth, to remove them only as a last resort. But not long after he opened Affordable Dentures in 1992, extractions became second nature. There’s just so many to do. Nicholas pulls teeth between 10 a.m. and noon every day. “After you get in there, and you’ve done several hundred, you realize it’s not that bad,” Nicholas said. Nicholas once pulled 30 teeth from a patient’s mouth in one visit. The extractions required nearly a dozen shots of local anesthesia. “A lot of people we see here have waited so long that their teeth have rotted to the bone, and the bone has rotted, too,” Nicholas said. “It’s almost as if the mouth itself breathes a sigh of relief: ‘Oh, get rid of those, they’re so nasty.’” What rankles Nicholas is having to pull rotted teeth from patients in their 20s and 30s. Young men and women who have never brushed, flossed or been to a dentist. They tell him that their parents lost their teeth, so they will too. “People see it as an inevitable consequence of aging,” Nicholas said. “They don’t think there’s anything they can do to save their teeth.” Even young people with perfectly good teeth will ask Nicholas to extract them. Nicholas refuses, but he knows he can’t stop people from finding an unscrupulous dentist out for profit. Thirty pulled teeth equals about $2,000 for an hour’s work. Nicholas has built one of Affordable Dentures’ most successful practices. The Barboursville office usually ranks about 15th in sales each year among the denture chain’s 126 practices, Nicholas said. The company has offices in 33 states. Nicholas wanted to pursue a dentistry career ever since he got braces as a teenager growing up in Huntington. He went to Marshall as an undergraduate, then got his dental degree at West Virginia University’s School of Dentistry. He worked as a dentist for seven years, but “wanted to try something totally different.” A newspaper advertisement announced that a national denture company was looking for someone to open a practice in Barboursville. The building, across from the Huntington Mall, was already half finished. Nicholas started as an employee of the chain, then became practice owner and manager after paying off the building’s construction costs. Affordable Dentures still handles the practice’s accounting and payroll, allowing Nicholas to concentrate on making dentures. Dental supplies are bought in bulk and shipped to each office, reducing costs. “It’s a faster pace,” he said. “You see the end result very quickly. In the morning, you do the impression. In the afternoon, you put the denture in, and you’re ready to go.” It’s a formula that has worked. Affordable Dentures, which opened its first store in 1975, keeps expanding. Across the nation, the company’s practices treat about 300,000 patients a year. A full set of dentures costs as little as $375. More than half of Affordable Dentures’ patients drive more than 40 miles to visit an office. The company’s slogan: “A good reason to smile.” “We open the doors and people just keep coming,” said Hugh MacGregor, the company’s vice president of marketing and patient services. “You would think, as oral-health knowledge improves, denture use would go down, but that’s not the case. It’s a sad story, but it allows us to continue to grow as an organization.” Indeed, contrary to conventional thinking, the demand for dentures is expected to grow in the coming years as the Baby Boomer generation gets older. Harvard School of Dental Medicine researcher Chester Douglass estimates that the number of people who need full dentures will increase from about 34 million now to more than 38 million in 2020. And those numbers don’t include partial dentures. Douglass predicts that the 10 percent decline in people with total tooth loss each decade for the past 30 years will be more than offset by an 80 percent increase in adults over 55 during the next 20 years. Douglass’ research also shows that dental laboratories experienced a significant increase in demand for complete and partial removable dentures during the past three years. The demand for other lab services, such as crowns, bridges and implants, was flat. With most of his customers from West Virginia and Kentucky — both states already have large elderly populations — Nicholas has watched his sales steadily increase in recent years. He doesn’t ever worry about going out of business as people become more aware of the importance of oral hygiene. Bad habits persist. People still will chew tobacco. They still will smoke. Nicholas estimates that 95 percent of the people he sees are smokers. “You have the human factor that will always be there,” he said. “There will always be people who brush and floss, and there will always be people who don’t.” Nicholas also knows that many private dentists won’t do dentures. They’re time consuming. Most dentists also don’t like to pull teeth. Too many things can go wrong. Teeth break off. It’s messy. They usually send patients to oral surgeons. “Dentures are not rocket science, but dentists don’t like to do them,” Nicholas said. With his on-site lab, Nicholas can fix an ill-fitting denture quickly. Patients are satisfied. They keep coming back. He provides a service that enables people to eat and chew and feel better about themselves when they smile. Some people report that the dentures work better than their old teeth. “We’ve had people who cry when they look in the mirror, they’re so happy,” Nicholas said. ‘We take teeth off, they take clothes off’ The waiting room was starting to fill again. Some patients returned from a shopping trip at the mall. Others waited in cars, engines idling, heat cranked, listening to southern gospel music. Affordable Dentures sits beside the Southern Xposure Platinum. Nicholas is quick to point out that his practice opened years before the strip club, not the other way around. The club used to be a restaurant. His patients and the club’s workers seldom cross paths. “They work at night, we work during the day,” Nicholas explained, putting the finishing touches on a pair of dentures in the lab as the clock ticked closer to 2 p.m. “We take teeth off. They take clothes off.” One by one, the patients returned to the four operatories, taking seats in dental chairs. New dentures were lined up on a table in the middle of the room. Todd Joseph was handed a “goody box” with denture adhesive, a brush and cleanser tablet. An assistant held up his renovated denture. Joseph inserted it, raised his lip, looked in a mirror. He was pleased. “They put ridges on it. It looks like real gums now,” he said. “I get excited about the littlest of things.” The trays in the middle of the room were emptying quickly. Larry Coleman’s name was called next. He took a seat. His denture was 26 years old, Coleman said. Dentists recommend that you get new dentures every three to five years. Coleman said his denture was just fine most of the time. “They were good ones,” he said. “But my gums would stay sore. I had to put a pad in them.” Lyons inserted the denture. Coleman cringed. His upper gum was still sore. It was painful. “If it’s sore when I take it out, it’s not your denture, it’s your gum,” said Lyons, then retreated to the lab. Coleman blamed his dental problems on chewing tobacco. He had no plans to quit. “I’ve been doing it since I was 12 years old,” he said. “Kinda hard to quit now.” Lyons returned after making adjustments to the new denture. This time, it still hurt a bit, but it fit more snugly. An assistant held up a mirror. Coleman was going home with a new acrylic grin. “Pretty now,” he said, smiling. To contact staff writer Eric Eyre, use e-mail or call 348-4869. State of Decay: The series Sunday Part 3: Nothing to smile about Across the state, children are missing school, eating poorly and not sleeping well because of untreated tooth decay. Next Monday Part 4: The fight for fluoride Dentists and health officials recommend fluoride in the battle to improve dental health. About one in four West Virginians rely on well water, which normally isn’t fluoridated. How we did the series Sunday Gazette-Mail reporter Eric Eyre spent six months researching oral health in West Virginia as part of a Kaiser Media Fellowship in Health. Eyre visited dental clinics throughout the state and interviewed dentists, hygienists, dental assistants, doctors, researchers, dental school students, state health officials, nonprofit group leaders and patients with oral-health problems. Much of the dental data was culled from the Behavioral Risk Factor Surveillance System and federal Centers for Disease Control and Prevention in Atlanta. Eyre, a Gazette-Mail reporter since 1998, now covers health for the newspaper.