The young man could not have been more than 25, tall and thin, even a little gaunt. When he smiled, he was all cheekbones and chin, with only two or three crooked teeth left in his mouth. It was startling to see a fellow so young and so deprived.

We met on a day in June, along a branch of the Potomac River. He was a pleasant guy, eager as a farm boy to go fishing, but his near toothlessness made him seem much older than his years.

Cue Sen. Bernie Sanders, independent of Vermont:

“Far too many Americans, especially in rural areas, do not have access to a dentist, which forces them to either travel long distances or go without the care they need. Very few dentists accept Medicaid (for low-income patients), preventing the most vulnerable people in America from getting the dental procedures they need.”

That’s what Sanders had to say in May when he filed legislation to expand government-funded dental coverage for seniors, veterans and low-income families. The Comprehensive Dental Reform Act of 2024 would also increase the number of dentists and dental hygienists, filling a particularly big need in rural areas.

More than anyone in the Senate, Sanders points out inconvenient truths. Like the late Rep. Elijah Cummings of Baltimore, a champion of oral health who pushed Maryland to expand dental coverage for the disadvantaged, Sanders wants the federal government to do more through Medicaid, Medicare, the Affordable Care Act and the Department of Veterans Affairs.

The nation has a dental crisis, he says, and brings data to the claim:

“Nearly 70 million adults and nearly eight million children have no dental insurance and many of those who do have dental insurance find that coverage to be totally inadequate. …One out of five seniors in our country are missing all of their natural teeth. Over 40% of children in America have tooth decay by the time they reach kindergarten.”

Research and surveys by Kaiser Family Foundation show that half of U.S. adults have difficulty paying for health care and, in recent years, 60% of Americans said they put off getting the services they need. Dental care, Kaiser reported, is the service most likely to be delayed due to costs.

Sanders again: “The situation has become so absurd, that each and every year hundreds of thousands of Americans travel to countries like Mexico, Costa Rica, India, Thailand and Hungary where it is much less expensive to get the dental care they need even after paying for round-trip airfare and hotel stays.”

In Maryland, some people wait until they hear about a free dental clinic.

There’s a big one scheduled for Friday, Sept. 13, and Saturday, Sept. 14, at the Wicomico Youth & Civic Center in Salisbury. It’s called the Eastern Shore Mission of Mercy, and when it was last held, in 2019, more than 1,100 men and women showed up for help with their teeth.

This year’s event will be the first large one since the pandemic — smaller missions are held around the state at different times — and organizers expect more than 100 dentists, hygienists and dental assistants to volunteer.

“It’s very rewarding, but it’s also very exhausting because there is so much need,” says Dr. Celeste Ziara, the president-elect of the Maryland State Dental Association who has been volunteering for the missions for several years. “About four or five hours into it, you’re exhausted, but you keep going because the line never stops.”

The doors open each day at 7 a.m. for hundreds of adults who either have no insurance or have no provider willing to take patients on Medicaid.

Each patient goes through a medical assessment and dental triage, including an X-ray, before being escorted to one of the rented dental chairs on the floor of the civic center. Some people just need a cavity filled or a tooth extracted. Others have a whole mouthful of problems, but can only have one issue, the most urgent, treated at the mission. Usually that’s all there is time for.

“Sometimes patients will come in and say, ‘This front tooth is broken, it really bothers me, I don’t like the way it looks,’” says Judy Forse, a hygienist based in Salisbury. “But they might have a bombed-out tooth with an active infection. They’re worried about that front tooth when in actuality we should be concerned about the tooth that’s infected.”

Forse expects each day of the clinic to run nonstop for 10 to 12 hours. She says she could use more volunteers to work in shifts so that fewer patients are turned away.

“Many of them will get there very early in the morning, and they are waiting all day long to get a tooth extracted,” says Forse. “The goal is to make sure they don’t have any type of infection in their mouth, anything that could send them to the hospital. That’s the priority.”

It’s humbling, Forse says, to see so many people in need, but hugely rewarding to see so many grateful for dental care they thought was out of reach.

I’m of two minds about this — appreciative that dental professionals in our state are willing to stage a free clinic for those in need, but also bothered that dental care must come to some like this. To quote Sanders one more time: “Dental care is health care and health care must be considered a human right, not a privilege.”