Wilma Holdridge hadn't been to a dentist in about eight years. Her husband had been laid off from his previous two jobs. But when the pain from a decaying tooth became too much to bear, she applied for services at a free clinic.
She's one of many Americans without dental insurance -- for every person 19 and older without health insurance, there are three more without dental, according to the Centers for Disease Control and Prevention. Some estimates put the figure as high as 100 million.
About 1,000 people are on the waiting list for dental services at the Community Health Clinic of Butler County, which started its dental program in November after struggling for funding. Since then, it has treated almost 250 patients as of the end of June, said Cecelia Buechele Foster, the clinic's executive director. June was the last date for which figures were available.
"We truly are a safety net in the health care delivery system in Butler County," Ms. Foster said.
The clinic provides free services for patients who qualify. They must be Butler County residents between 19 and 64 years old who earn incomes of 200 percent below the federal poverty level -- for instance, an annual income of $21,660 for an individual or $44,100 for a family of four.
The clinic relies on grants, donations and the services of nine dentists and two oral surgeon groups who volunteer, plus three full-time and two part-time employees, Ms. Foster said. It gives priority to people with diabetes and the most severe problems.
She said it was not uncommon to see patients who haven't been to a dentist in 10 or 15 years. It treated 10 people with complicated procedures, such as full-mouth extractions.
Mrs. Holdridge, 52, and her husband, Gary, who live in Penn, had their teeth cleaned and filled, and some teeth removed. They have Type 2 diabetes, which made their cases urgent. Mrs. Holdridge said as a real estate agent and a school bus driver, she couldn't afford to have bad teeth.
"When you're in the public eye, people like to see that smile," she said.
Dental clinics are becoming increasingly important to communities, said Amy Hamlin, executive director of Volunteers in Medicine, an organization with which Butler's clinic is affiliated.
"Dental is the most unavailable service to people who are uninsured," Ms. Hamlin said. "If they're sick, they may go to the ER, they may go see a doctor, but almost never will they get dental care."
The health care reform bill passed in March doesn't include provisions for dental insurance for adults, which she said makes Butler's dental clinic more important.
But the bill could still help people get dental care, said Julia Paradise, an associate director of the Kaiser Commission on Medicaid and the Uninsured, a health policy research organization. Ms. Paradise said that by 2019, the bill would increase the number of people eligible for Medicaid.
In some states, but not all, Medicaid can include dental coverage. Though Pennsylvania is one that does, Ms. Paradise said this service was particularly vulnerable to state budget pressures because of the economy.
"The recession is another factor that helps to explain all the folks who have to rely on free clinics for their care," she said. "It's made an already very rough situation more rough for more people."
Lindsay Carroll: firstname.lastname@example.org or 412-263-1985.