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There is nothing quite as heartwarming as a child's smile. But the tight-lipped, shy kid who struggles to stay on task could actually be hiding a mouthful of distress.

According to a Utah Department of Health (UDOH) survey conducted in the fall of 2010, more than 2,600 first-, second- and third-graders needed urgent dental care due to extensive tooth decay, infection and/or pain — in large part due to a lack of insurance and income to pay for the costly services.

In response to that need, Salt Lake Donated Dental Services — a nonprofit clinic that has provided dental care to the underserved of all ages since 1990 — launched its pediatric sedation program in March. It currently operates one day per month.

While using anesthesia significantly adds to the cost of the dental work, the practice makes sense for young children who are in chronic pain and can't sit still for extended periods of time. Even X-rays are taken during sedation."The dentist needs them immobile so he can open their mouths and see what the problems are," said Julie Dobell, an anesthesiologist who totes portable equipment to Salt Lake Donated Dental's offices to perform her job.

Dobell described another benefit to children getting multiple tooth repairs done in one quick session: "They don't spend the rest of their lives fearing the dentist."

So far, 18 children have received $32,930 worth of sedation and dental treatment, including 44 fillings, 82 crowns, 31 extractions, 18 cleanings, 13 sealants and 12 fluoride varnishes.

Grateful patients • "I thank God for these services," Iraqi refugee Raad Alsaedi said last week via Nora Abjulmajeed, the clinic receptionist who interpreted his soft-spoken Arabic. "I appreciate everything they are doing."

Alsaedi's youngest son, 6-year-old Hussien, was under anesthesia at the time and within the hour, dentist Dale Hibbert had filled nine cavities, installed one stainless steel crown and extracted two teeth. Soon Alsaedi, a musician who is currently unemployed, was helping to wake his son and take him home.

Hibbert's regular dental office is in Layton, but for a decade he has volunteered his time and talents to Salt Lake Donated Dental.

"I think what I enjoy most is the gratitude from the patients," Hibbert said.

Many of the children have been referred to the sedation program by SLCAP Head Start, which serves children up to 5 years old who live in families with incomes at or below the federal poverty level — about $23,000 a year for a family of four. The early childhood development program can accept children with family incomes up to 125 percent of that threshold.

"Their new sedation program has allowed us to cover the cost for more of our children and families," said Jennifer Godfrey, health manager for SLCAP Head Start, "and its been a huge asset to our children and our agency."

Godfrey has witnessed the transformation in kids before and after they've had their dental needs addressed.

"We see everything from children being happier, eating more, and being more able and willing to learn because they're no longer in pain," Godfrey said. "The change is often incredible."

Jacobi Vargas was next in line following Hussien Alsaedi's session last week and Dobell initially put the 4-year-old to sleep using anesthetic gas, then quickly installed an intravenous drip to maintain the slumber. The intravenous method wears off more quickly than the gas and has fewer side effects, Dobell noted.

"They'll be able to go home and have a better day afterward," Dobell said, "instead of spending the whole day recovering."

Young Vargas, who received one filling and 17 crowns along with a cleaning and fluoride varnish, is apt to have a better life as well.

"If you're in pain, you can't be eating nutritiously. And that affects the whole body," said Bobbi Lord, development director for Salt Lake Donated Dental.

Pain and shame • However, the damage extends beyond physical well-being to social development and mental health.

"You get a lot of patients who try not to smile," Lord said. "They don't talk a lot, because they're embarrassed by the look of their teeth — even young children."

And then there's the pain, increased infection and premature loss of baby teeth, which serve as placeholders for their permanent ones.

Stephanie Jensen, Salt Lake Donated Dental's executive director for the past nine years, said the new sedation program could ramp up to add an extra day per month as needed. September's session is already booked, she added.

Monday through Friday, the nonprofit is busy providing free dental services to clients of all ages at or below the federal poverty level and discounted services to those at 101 to 200 percent of that threshold.

"They just don't have the same choices that someone with private insurance might have," Jensen said, noting that costly crowns, root canals and bridges are simply out of reach.

Salt Lake Donated Dental also provides dentures at a cost of $220 per arch rather than the $1,000 to $1,200 clients could expect to pay elsewhere.

The pediatric sedation program is currently funded by Larry H. Miller Charities, the Church of Jesus Christ of Latter-Day Saints Foundation, and the George and Dolores Dore Eccles Foundation.

According to the UDOH survey, even though dental decay can be prevented, it continues to be the most common, chronic childhood disease in the nation, impacting the low-income population in particular.

"Donated Dental has been around for quite awhile and provides vital help for the community," said UDOH Dental Director Steven Steed. "This additional ability they've made available just adds one more level of value to their already important clinic." twitter: @catmck —

Where • 1383 S. 900 West, Suite 128, Salt Lake City.

Free care • Provided on a daily lottery basis to individuals at or below the federal poverty level. To learn more, call 801-983-0345.

Discount care • Clients at 101 to 200 percent of the federal poverty level pay for services at significantly reduced rates. To learn more, call 801-972-2747.

Pediatric sedation • Now available one day per month for low-income children with extensive dental needs.