The pain is pretty much ongoing, Tammey Nicklas said.

Eating, smiling, talking, all have become inconveniences.

But the Hayden woman soldiers through it, she said, now that nearly all her dental insurance has been cut.

"It's hard. I can't even eat regular food," said Nicklas, adding that her Medicaid benefits have been increasingly rolled back. "My teeth are rotting out of my mouth because I can't get proper care."

A broken tooth was all she sought treatment for at Dirne Community Health Center on Tuesday.

"My insurance covers emergencies," she said, sitting in the waiting room. "Fortunately that's what I need today."

A growing chunk of Kootenai County residents are losing their quality of smiles - and general comfort - local dental offices agree, which mirrors a statewide and national trend.

Dentists across the state report that financial difficulties are barring residents from seeking dental care, the Idaho State Dental Association announced on Tuesday.

The ISDA also pointed to an American Dental Association study, "Breaking Down Barriers to Oral Health for All Americans," revealing that the number of Americans regularly visiting a dentist has been dropping since 2007.

Coeur d'Alene Dental Center is definitely seeing more holes in its patient schedules, said dentist K.C. McVey.

"More people have flown off the radar who normally come in and see us on a regular basis," McVey said. "Some of it's due to the economy, due to the fact they've either lost their job or their job cut their insurance."

His office has also stepped up its pro-bono practice, McVey said, estimating that he provides about $1,000 to $2,000 in free dental care a month.

"It's definitely been a trend toward increase in that," he said.

It's tough to ballpark the number of patients lost, McVey said, but "it's noticeable."

He worries for those who are ignoring pains or aches, he added, noting that skipping check-ups increases the risk of developing new cavities, gum disease and infection from untreated problems.

"Not only that, but there's a systematic link between your mouth and the rest of your body," McVey said. "It increases the chance that other parts of your body will be affected."

His recommendation to the cash strapped is pursuing payment plans or pro bono work.

He also advised looking into community health centers.

Many are doing so, said Alan Brockway, development director at Dirne.

Dental visits at Dirne, which offers a sliding fee scale for the uninsured, shot up from 3,140 in 2008 to more than 8,000 in 2011.

"For many, it's one of the few opportunities or options they have," Brockway said, adding that self-pay starts at $50 for dental visits.

There is no income requisite to receive treatment at Dirne.

Many dental patients at Dirne have been prolonging treatment to save money, Brockway said.

"From the word filling, the cost begins to rise," he noted. "What many people are doing is holding out and waiting, seeing if it will go away."

Some have ignored pain to the point that they end up at the emergency room, he said, which refers them straight over to Dirne.

"Last year, our director of dental services reported he had as many as eight clients referred over from the emergency room in one day," Brockway said. "That's significant."

Mike O'Brien had ignored a lost filling for three weeks before visiting Dirne on Tuesday.

With six children and his company not providing insurance for years, O'Brien said, he has grown accustomed to accepting discomfort in his mouth.

"You can imagine," the Post Falls man said of how it feels. "I wouldn't be here now, except the filling came out and the nerve is exposed."

O'Brien does plan to rely on Dirne more often, he said, after discovering the options it offers.

And maybe smiling won't be so hard, either because of finances or pain.

"This is our option," he said of Dirne. "And we're grateful for it."