Twice-a-year trips to the dentist are rarely fun for anyone, not to mention those trouble-shooting appointments for root canals, fillings and extractions.

What is periodontal disease?

While brushing, flossing and regular cleanings are important for everyone, particularly children, they're even more crucial for adults with existing gum and tooth disease, or periodontal disease.

"Periodontal disease is a chronic inflammation of the gums and bone, basically, where you'll have inflammation and you'll have bone loss," said Dr. Mark Barry, a dentist and an associate dean at the Medical University of South Carolina's College of Dental Medicine.

"It's caused by bacteria that create toxins that eat away the bone and the bacteria accumulates in the plaque, this gooey substance in your mouth, and they mix with calcium and phosphate and they create what's called tartar. Tartar sticks to your teeth."

It essentially eats away the bone, he said.

"The ligament in the bone is what holds the tooth in, and when that is destroyed, the foundation for the tooth is destroyed and that's when you get loose teeth and potential abscesses."

How do you prevent it?

"Keep your teeth clean, floss and brush. It's really a pretty easy concept ... and don't forget to spit," he said, ending with a little dental humor.

Footing even a fraction of the bill for these services makes them all the more painful.

But many South Carolinians without dental insurance simply can't afford to take care of their teeth. Despite study after study that shows how important regular cleanings are, oral hygiene is just too expensive for many of the uninsured.

That could soon change for an estimated 270,000 low-income adult Medicaid patients in South Carolina. By mid-summer, they may have limited access to preventive and emergency dental services if the General Assembly signs off on Gov. Nikki Haley's health care wish list.

"This state, 10 years ago, maybe 12 years ago, was the model for Medicaid ... for dentistry," said Dr. Mark Barry, a dentist and an associate dean at the Medical University of South Carolina's College of Dental Medicine.

"Then it just started to erode and the fees didn't keep up with inflation and all that," he said. "What was once a model for the whole country, now isn't so much. I think that's probably why these efforts are being made. People are realizing that we do need to do something different."

In 2011, South Carolina cut emergency dental services for adult Medicaid patients to save money, while maintaining preventive and emergency services for children. Haley's proposal, unveiled in mid-January, would restore emergency dental services for adults and, for the first time, cover preventive services such as cleanings.

All this would cost an extra $35 million, the state Medicaid agency estimates. And while the plan may not necessarily save South Carolina money, Haley's health care adviser says it's good public policy, akin to paying for vaccinations that the health department administers.

"We need to look at dental services differently than we have in the past," said S.C. Medicaid Director Tony Keck, a member of Haley's cabinet. "Dental health is increasingly tied to broader physical health beyond just the mouth: heart disease, healthy pregnancies."

Even employability, Keck said. Bad teeth make bad first impressions. Tooth aches mean missed days at work.

"It's like the eyes are the windows to your soul, the oral cavity is everything else," Barry said, including "function, aesthetics, nutrition, infection, chronic inflammation."

Andrew Schweiger, who owns three dental offices in the Midlands, said his practice fields calls every week from adult Medicaid patients who don't realize their emergency dental benefits were cut to begin with.

Most of them can't afford to pay out-of-pocket for tooth extractions because the procedure runs anywhere from $125 to $450, depending on the case's complexity, he said.

"We've seen some horrific stuff and the whole reason they can't get treatment is because of money," Schweiger said. Most of them are referred to the emergency room.

"We can't afford to give tons of treatment away for free," he said. "It breaks your heart for lack of a better way to put it."

The executive director of the South Carolina Dental Association said there is no good estimate for the number of residents in this state with no dental insurance.

Details about the governor's proposal to restore these services for adult Medicaid patients are still in development. For example, Barry said MUSC leaders believe the Medicaid agency should target preventive services on vulnerable adult patients, including those with existing tooth and gum disease, diabetes or special needs.

Barry participated in a workshop last week at the South Carolina Dental Association in Columbia to discuss these ideas.

"The studies show that not having a cleaning ... every six months - while that's ideal and optimal - it's not going to, in a healthy adult, it's not going to create problems," he said. "Whereas a patient with periodontal disease and diabetes, that's something that should be more targeted."

It's still unknown if the General Assembly will support the proposal, but Schweiger said he's optimistic.

"You have to think that, at least, this is an easy case to make from a money standpoint," he said. "We can keep these people out of our emergency rooms. That's the big thing these days. We want people to be covered so we don't have to spend all that money on the back end when they go to the hospital."

Reach Lauren Sausser at 937-5598.