PORTLAND (AP) - Teeth and gums make one of health care's best cases for the value of prevention. Most dental pain - physical and financial - is preventable by daily brushing and flossing, and regular checkups in a dentist chair.

But in an economy full of cavities, that preventive advantage bites both ways.

"Dental care takes a back seat to medical care," said Peter Morita, associate dean for patient services at the Oregon Health & Science University School of Dentistry. "It's one of the first things that, in bad times, people cut back on or go without."

Good times or bad, "taking care of your mouth and teeth goes a long way to saving yourself pain and problems and money, too," said Rickland Asai, a Portland dentist and president-elect of the Oregon Dental Association.

Some insured patients, fearful of losing job benefits, rush to get expensive dental work done while they still have coverage. But Asai worries that "we're on a bubble" of dental demand that soon could burst as more Oregonians lose dental coverage along with their jobs.

Companies are eliminating or reducing employee dental benefits, said Mike Shirtcliff, a Redmond dentist and president of The Advantage Community, whose dental plan covers about 100,000 people in rural Oregon.

Reductions in benefits often come in lower dollar caps on coverage or higher deductibles. Some plans also are tightening coverage limits from one dental crown every five years to one every 10 years, or increasing the copay on a root canal from 20 percent to 50 percent.

"The result is more people without dental insurance, so they go to the dentist less," Shirtcliff said.

And putting off routine dental care leads to an increase in emergencies. A cavity becomes an abscessed tooth, and if patients lack insurance, they can end up in an emergency room.

"Dental problems don't go away, they just pile up," Shirtcliff said.

Among dentists, it's known as a "busyness problem." More than half of 1,749 Oregon dentists surveyed during the last three months of 2008 reported falling incomes and an increase in open appointment times.

"Unfortunately, this means that patients may be deferring even the preventive care that could save them from experiencing severe oral health problems and additional expenditures in the future," said Brett Hamilton, spokesman for the Oregon Dental Association.

Nationally and in Oregon, the percentage of adults who get their teeth cleaned rises sharply with income. In households making less than $15,000 a year, 41 percent of Oregonians report getting a teeth cleaning within the past year. That doubles to 80 percent in households with incomes of at least $50,000.

Total dental enrollment in Oregon is essentially flat for ODS Cos., which covers about 730,000 Oregonians. But ODS is seeing a slight rise in claims, probably because insured patients stopped putting off needed dental work, Vice President Jonathan Nicholas said.

For a decade, retiring dentists have outnumbered new graduates from dental school. But that trend may be in for something of a reversal as older dentists decide that their shriveling 401(k) plans won't allow them to retire.

At a recent statewide dental meeting, Shirtcliff said, he spoke to 15 dentists who were delaying their retirement because of the economic downturn and six retired dentists who inquired about resuming work because of their depleted investments.

He also said he knows of 25 Oregon dentists who have filed for bankruptcy or are thinking of doing so. Five years ago, that number would have been zero.

Although some patients are choosing to reduce their out-of-pocket dental costs by delaying needed treatment or leaving an extracted tooth unreplaced, Asai said those phenomena are not unique to a dismal economy.

"Some people are more willing to give up that part of their anatomy," he said. "Others are almost devastated."

Gov. Ted Kulongoski's proposed budget for the next two years would cut all adult dental coverage under the Oregon Health Plan's "Plus" benefit package, which serves about 383,000 low-income Oregonians on Medicaid. The much smaller "Standard" package, which relies on provider taxes and federal matching money rather than state general funds to cover about 25,000 low-income adults, covers emergency dental care only.

Asai said his group will fight the cutback in adult dental care when it comes before the Legislature because it would "create a bigger backlash - in people going to the emergency room for dental problems."

Some dentists report seeing more patients with cracked teeth, from grinding teeth possibly due to economic stress. Dentists have long debated the cause of grinding teeth and clenching the jaw. Some blame it on a misaligned bite, others on psychological problems.

"For the majority of us," Asai said, "it comes down to stress."

Studies of college students show that complaints of jaw pain from grinding teeth tend to go up during exam periods, he said. "And then, guess what - spring break comes along, and it's all gone."

The OHSU School of Dentistry runs two clinics staffed by dental students working under supervision of professors. Care is not free, but prices are about one-third lower than those typically charged at private offices.

The adult clinic had nearly 83,000 visits last year, and the pediatric clinic more than 10,000. Demand is holding steady, despite - or perhaps because of - the rough economy.

Jane McLaughlin, 66, of Battle Ground, Wash., has been going to the OHSU clinic for more than two years and is completing her second of three planned dental implants.

"My smile is my vanity," she said.

The implant will cost McLaughlin, who has no dental insurance, about $2,200, compared with more than $3,500 in a private practice. She likes the savings as well as the care. The only drawback is the extra time it takes, since any patient can become a teachable moment for dental students.

The sour economy is a stress test for dentists and patients.

"If you're strapped for cash, you do the things that benefit you right away," said Neal Wallace, a health economist at Portland State University.

Prevention, by contrast, is an investment in the future. "You spend now and get the benefits later," Wallace said.

In economic hard times, he said, "You're gonna go in if you're sick, but not until you're really hurting. Otherwise, you blow it off and don't get your teeth cleaned this year."

Which is exactly the attitude dentistry must fend off, Morita said, with the message that preventive care works.

"I don't know many people who like going to the dentist," Morita said. "Unless they are in pain and we get them out of pain. Then they like us."

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On the Net:

Oregon Dental Association: http://www.oregondental.org/i4a/pages/index.cfm?pageid=1

Oregon Health & Science University School of Dentistry: http://www.ohsu.edu/sod/