On a busy Friday in February, children across America received much-needed dental care courtesy of the "Give Kids a Smile" access-to-care campaign. By any standards, the event was a success: as many as 1 million children were seen by the many dentists, hygienists and assistants who volunteered their time at about 5,000 locations nationwide. Industry donated home-care and professional products valued in the millions of dollars. Health departments, dental schools and private practices contributed space and supplies. The ADA provided leadership, organization and publicity.

Was all this time, effort and expense worth it? Absolutely. Because of what we did back in February, thousands of young people today stand a better chance of making it into adulthood with healthy teeth and gums. It was a prime example of what can be accomplished when the efforts of willing volunteers are focused on a pressing need.

So a certain amount of self-congratulation is justified. In the grand old tradition of the frontier barn raising, our profession pitched in to get something done. At the end of the day, we can step back, take a deep breath and relish the satisfaction that comes from having made a tangible contribution to the community. It’s a fine barn we built, and it felt great abuilding.

But what happens the next day? There sits the barn, but the neighbors have dispersed to their own farms and preoccupations. The immediate task is complete, but the real work has just begun. Long-term needs won’t be satisfied by bursts of volunteer energy, but rather by planning, commitment and sustained steady effort. And, inevitably, by funding.

While neglect is not confined to any one group, it is clear that the children of low-income families are especially prone to oral health problems. They rely disproportionately on publicly subsidized programs (primarily Medicaid) for health care. At a time when multi-billion-dollar state budget deficits are the norm, the pressure for program cutbacks is irresistible. The states face a stark choice—higher taxes or leaner programs or both—and dental services are vulnerable.

Vulnerable, and hurting. Last year 11 states reduced or eliminated Medicaid dental services not specifically required by federal statute. This year the outlook is even bleaker, as 25 states consider cutting their dental coverage. Under Medicaid, the cost of dental care is shared between federal and state governments, and the state’s share is not inconsiderable. While federal law mandates services to children, each state decides for itself whether to cover adults. It is this adult coverage, therefore, that is most at risk. The effect on children will be indirect but no less real: I fear that these families will come to see oral health as optional, marginal, a luxury.

If you are distressed by this prospect, please contact your state representatives and let them know why. Call them or, better, visit their offices. Speak from your own experience; share examples (we all have them) of patients for whom dental treatment meant the difference between poverty and gainful employment. You don’t need to be politically sophisticated to convey some idea of the costs—in pain and self-esteem and lost productivity—that result when common oral conditions are left untreated. Be persuasive, but be reasonable. There simply aren’t any easy options left.

Access to care is a complicated issue on which reasonable people disagree. What is clear from the present economic crunch is that, whatever approaches are taken, the problem is a chronic one requiring steady attention from many quarters. A barn raising is gratifying and worthwhile when the need is acute, and I’m proud that dentistry has risen to the occasion. But we can’t do it every day, and we can’t do it alone.