Roger Roth's dental practice has changed somewhat since he relocated from Hayden Lake to Pesega, Samoa.

Many days the retired dentist and his wife Julie, a dental hygienist, stroll the half mile from their cinder block home to the free clinic they operate.

People are usually lined up before the doors open, some waiting for hours.

The couple tends to them first-come, first-serve. Appointments are hard to book on the poverty-beleaguered island.

Their supplies are limited. Their assistants are volunteers.

Yet after 10 months living and working in the humid, Pacific island country - generally lacking in dentistry and oral hygiene - the Roths have treated 4,000 people free of charge.

"Even if the procedure is more technical than we can do, they say 'thank you for your time.' They say, 'We're so glad you're here,'" said Roger, speaking over an Internet connection from Samoa this week.

The couple always refuses money from those who try to offer it. Yet patients still make other payments, in bananas, hugs, teary exclamations of thanks.

That's more than enough, Roger said.

"I can't do this forever. I'm old," admitted Roger, 66, with a chuckle. "But this year, there's no price to pay us to compensate for what we're doing."

Giving back

The couple faced a decision, Roger said, when he wrapped up his Coeur d'Alene dental practice after 40 years. Julie had worked part-time for much of it.

"What it really boils down to is dentistry has been good to us for 40 years," Roger said. "But we wanted to give something back, while we still had some of our skill and our health."

The couple, who met while pursuing dental degrees at the University of Oregon, are members of the Church of Jesus Christ of Latter-day Saints.

When they stumbled across the chance to run a church-supported dental clinic in Samoa, they figured it was now or never.

"This was an opportunity, while we still had each other," said Roger, adding that Julie is 64.

They were the ideal professionals for the gig, said Jeannine Chisholm, who helps assign service projects for the Academy of LDS Dentists.

"(Roger) wanted to go," Jeannine said. "His wife is a hygienist. That's just perfect."

The Roths are providing a service that's desperately needed, she added.

"Samoa has about 200,000 people, and only has about eight dentists," Chisholm estimated. "They don't have enough dentists to take care of it."

Adapting

With a 23-month visa, the Roths have had to make some adjustments.

While no one is starving in Samoa's agricultural villages, Roger said, it is unheard of for a citizen to own a car.

"It is poor, from our standpoint, as far as jobs and those kinds of economic indicators," he acknowledged. "But it's rich in culture. They have large families. They are very religious, very moral people."

Most haven't been schooled about dental care, he added, so the Roths see a lot of mouths in pain.

In the small Samoan clinic, the couple has no budget. All dental supplies are donated by U.S. manufacturers and Kootenai County practices.

Opening four days a week, the clinic sees about 20 or so a day, he said.

"(Dental services) are drastically needed," Roger said. "The only dentists they have are at the hospital here. They're pretty well trained, but they're very under supplied."

The couple treats patients from 3 years old to the elderly, he stated, spanning all religions and classes.

"Even seen the head of state and the prime minister and their wives," Roger stated in a follow-up e-mail.

They have visited schools, too, and neighboring islands with portable equipment.

Chisholm said the Roths have also coordinated with the local government and the church to distribute information about proper dental hygiene.

"They will soon be traveling to several other countries, to see what they can do there," she added.

The couple does what they can, Roger said, though that isn't always much.

"We do very basic dentistry. Exams, cleanings, fillings and extractions," Roger said, noting their limited equipment. "Basically relieving pain and suffering. Promoting good health and education."

Hard work, he said, but worth it.

"It's such a thrill to see teenagers whose front teeth are decayed, and to make a smile out of their face," he said.

Worthwhile

Roger has never witnessed such gratitude for care, he said.

Or for life in general.

People are glowing with thanks after having teeth pulled, he said.

"Little children, maybe with abscess teeth, I can't tell you how many have come to me after I took their tooth out. They're really tough. They give me a hug and say, 'Thank you,'" Roger said. "I've never had that happen to me in 40 years in the U.S."

The country's tight-knit culture was tested in December, when Cyclone Evan ravaged the island.

Roger and Julie were in the midst of a disaster that obliterated 1,500 homes.

"It was one of the worst (cyclones) they've had since 1992," Roger said.

Everyone relied on each other for help, he said. The Roths pitched in where they could.

"The clinic was closed for a week. We had no power or water," Roger said. "My wife was going 24 hours doing laundry for people, doing cooking, baking. I was cutting trees off people's houses."

One of the couple's sons, Travis, said their generosity has been an inspiration.

The Rathdrum resident plans to bring his own children to visit Samoa to help out.

"My son, he's trying to put together a toothbrush drive (for the trip)," Travis said. "I've certainly seen how it's impacting my two kids, to help grandma and grandpa with what they're doing."

Roger said he and Julie wouldn't mind settling in Samoa for good.

But with four grown children and 16 grandchildren back in the U.S., that doesn't seem a realistic option, he conceded.

For now, they continue on at the clinic. Providing fillings, extractions, advice on oral care.

Helping people smile.

"Just these people," Roger said of what makes it all worthwhile. "We've fallen in love with these people."