Before Jessica Creel celebrated her 21st birthday Monday, she went to the dentist Friday.

“I have to go or I won’t be seen at all,” the mother of two said before the appointment.

Virginia adults on Medicaid do not qualify for dental services, but before a 21st birthday they can still use Medicaid at the dentist.

Despite several community efforts to bring dental services to low-income, uninsured adults, living with dental pain has become commonplace for many in Southwest Virginia.

Creel said she felt lucky to squeeze in a dental appointment before the cutoff, but she was worried what would happen if the dentist found too many things wrong to fix in one sitting.

Her fears came true.

She had two wisdom teeth pulled and a root canal. Four cavities were also discovered, but there wasn’t time to fix them. Without a place to go, Creel said she won’t have the cavities filled.

“There are plenty of people who go untreated, there is no question about that,” said Dr. Richard Joachim, an area dentist and the dental director for Bradley Free Clinic. “I know of heart wrenching stories of suffering moms who in some cases have gone years with chronic infections. There is plenty of need out there. And how to help out with that is challenging.”

Bradley is one of the better-known places where adults can receive dental care. But getting into the program is not easy.

Between 75 percent and 80 percent of people who call Bradley for dental care are turned away, Joachim said. Many of those people are placed on a waiting list, but are never seen because Bradley cannot meet the demand.

Bradley isn’t the only program with an extensive waiting list.

The Virginia Dental Association runs a donated dental services program for the elderly or those with a disability. That program has a waiting list of more than 700 people, and most patients have to wait a year and half for services, said Barbara Rollins, who helps coordinate the program.

With this year’s cancellation of a two-day free dental clinic that has served about 1,000 people annually, people such as Creel are expected to have even fewer options for dental care. For two years the Roanoke Mission of Mercy dental clinic has been a spring event at the Roanoke Civic Center, but scheduling conflicts forced organizers to push it back to March 2010.

For many adults, Mission of Mercy is the only opportunity they have for dental care. Last year 5,038 dental procedures were performed on 991 people, including the pulling of 2,023 teeth.

Still, Mission of Mercy can’t even meet the need, as each year hundreds of people are turned away.

“Many, many adults in the Roanoke area and all of Southwest Virginia have learned to live with the pain, and you can do that up to a certain point,” said Tom Adams, the dental grants coordinator for Carilion Clinic. “I’ve talked to people whose mouths look so terrible you just cannot believe the amount of disease they’ve been walking around with.”

Worried that postponing the Mission of Mercy for a year would exasperate any already serious problems, Joachim said he is working with others to put together an adult clinic within the next few months.

“I can’t afford to create unrealistic expectations,” Joachim said of the early plans. “It will be a very modified project.”

The substitute clinic will likely not be open to the public. Instead patients will be identified from Bradley’s waiting list and through programs such as Project Access of the Roanoke Valley and Child Health Investment Partnership.

The patients will likely be screened at the free clinic and then sent to various volunteer dentist offices for treatment.

Details are still being worked out, and Joachim said the number of people helped will depend on how many area dentists can be recruited for the cause.

While the need for adult services is clear, the state of dental care access for children is slightly different.

“As for the children’s [access] problem, we haven’t solved it, but it’s not as big of a problem any more,” Adams said.

Adams was among those who helped to open Carilion’s Pediatric Dental Clinic in 2001.

That said, pediatric dental services are not always the easiest to access. The Pediatric Dental Clinic currently has just one dentist, causing some patients to have to wait for services, Adams said. Typically, the clinic has three dentists, and Adams said they are recruiting for two more.

Additionally, the Roanoke City Health Department is also looking to recruit two dentists for its program that sees patients under 21 years of age. Both of the dentists who had worked for the health department recently left, leaving the program without a dentist, said spokesman Robert Parker.

“We fully intend to restore that program,” Parker said. “We recognize the need for access is becoming more and more important in an economic environment like this.”

The recent departures of pediatric dentists has been noticed, said Robin Haldiman, executive director of the Child Health Investment Partnership in Roanoke. Additionally some parents with children enrolled in Medicaid have struggled to find dentists who are accepting new patients, she said.

Creel, the 21-year-old Roanoke mother in need of dental care, said she spent several days trying to identify a dentist who would see her as an adult.

“I’ve called every dentist and every service I can think of but couldn’t find any place to go,” Creel said.

Haldiman’s program, CHIP, works with low-income children in Roanoke, Salem, and Roanoke, Botetourt and Craig counties.

Last week Creel was one of about 80 parents to bring her child to CHIP’s dental fair.

“This was easy,” Creel said of the fair, which provided educational information, a quick dental checkup and a fluoride treatment.

Creel’s 1-year-old son, Joshua McDaniel, had a positive screening with no reports of problems.

“I just don’t want him to have problems,” she said.

Haldiman said she hears frequently from mothers who say they worry that their children will end up with dental problems like their own.

Haldiman also chairs the executive committee that is organizing the Mission of Mercy project for 2010.

“The truth is many of the mothers we see here are the very ones who end up in line at the Mission of Mercy project,” Haldiman said. “They know what can happen.”