After serving Hawaii’s low-income population for over 20 years, the state’s only free dental clinic might be forced to close its doors this summer.

The Aloha Medical Mission dental clinic provides basic dental services, such as exams, cleanings, fillings and extractions, to patients who lack dental insurance coverage. But the clinic, which is funded solely through grants and donations, is running out of funding to keep its operations going.

“We’ve always had a hard time balancing the books and getting enough grants and donations to be able to continue to serve, but post-COVID it has been a very big challenge,” said Dr. Kerry Ishihara, a volunteer dentist and board member at the clinic. “Now we’re to the point where the funds have dried up and we are on the verge of having to close.”

Established in 2002, the Aloha Medical Mission dental clinic provides free basic dental procedures to qualifying patients — approximately 2,400 visits each year by around 650 patients, The clinic has completed approximately $4 million worth of services, according to office manager Hayden Skura.

“With us being here offering these services for no cost, it saves (people) a lot of stress from having to worry about how they would pay for it otherwise if we weren’t here, and it saves them from pain on their end because they would have to save up money before they can be seen to get their toothaches treated,” Skura said.

The clinic is staffed by a paid dental director and a paid part-time dentist, with the rest of the services being provided by seven volunteer dentists — most of whom are retired dentists. The clinic’s approximately $750,000 budget goes toward just the necessities: rent, salaries for paid employees and dental supplies.

“We spend as little as we can,” Skura said. “We’re not paying for anything other than just the bare minimum to keep the clinic going.”

But the recent decrease in grants and donations has hit the clinic hard. Ishihara said that in the past the clinic has received funding from both private donors and organizations like the Hawaii Dental Service Foundation and the Hawaii Medical Serv­ice Association, as well as the state and city’s grants-in-aid funds.

“There’s just been kind of a perfect storm of not being able to get the money that we had been able to get in the past,” Ishihara said.

Skura said the clinic always was spread pretty thin, so the loss of grants and donations has posed new challenges for the clinic’s operations.

“The past couple of years, we haven’t gotten some of the grants that we normally had,” Skura said. “Everybody already had a lot of responsibilities, but now we’ve actually lost a couple positions and we haven’t been able to fill them again due to a lack of funding. It makes it a little more difficult.”

The clinic is nonprofit Aloha Medical Mission’s main health care focus in the state. Originally started as an overseas medical mission trip, the nonprofit works to provide free health care services to low-income communities in Hawaii, Asia and throughout the Pacific.

The clinic also operates a restorative dentistry program in partnership with transition homes called Welcome Smile that provides incarcerated women and victims of domestic violence who are trying to reenter the workforce with prosthetic teeth. Another program, First Smile, does outreach with local schools, teaching preschool and kindergarten students about oral hygiene.

The dental clinic was initially located at the Institute for Human Services facility, before it moved to Palama Settlement and then to its current location at the Aloha United Way building.

Patients must show proof of low-income status to be treated at the clinic, such as pay stubs, a determination letter from the Department of Human Services, unemployment benefits or a homeless certification.

“Dental services aren’t typically covered by insurance, so for the procedures, people usually end up paying out of pocket,” Skura said. “When you’re talking about people who are living at or below poverty income levels, it’s basically impossible for them to do.”

Adult dental services weren’t covered by the state’s Med-QUEST program until January 2023, when the state Legislature passed a bill to provide greater access to preventive dental care.

But for people who don’t qualify for Med-QUEST and can’t afford regular insurance, the dental clinic is an invaluable resource.

“I think, in general, dental care is probably not looked upon as essential, although I think most people would agree it’s important,” Ishihara said. “Some of these people have not been to the dentist for 10, 15, 20 years, and they’re not in very good shape, but there are other people who have been trying to keep up with their dental care and just because of the cost or because they’ve lost insurance or lost employment, they’ve had this gap where they couldn’t go to the dentist.”

Ishihara said the clinic is still operating as it always has but that without “an influx of money,” it probably will have to close in July or August.

“I think this is the sort of niche that we fill in where people can continue to be able to get at least some dental work done, even if they don’t have the money or the insurance to do it,” Ishihara said. “It’s kind of a tragedy that we’re not better known in the community.”