Just before 5 a.m. Friday, Pearl Schulte sat with more than 100 other people in a Duluth arena that had been converted into a huge dental office waiting room.
After driving about 40 miles from Cromwell, Minn., Schulte had barely slept.
"I napped a tiny, tiny bit," she said with a tired laugh. "This floor's really hard."
Overnight on Thursday, dozens of people slept on the cold, concrete floor, or in their cars, eager for a dental appointment in a free clinic. Many were desperate to have aching teeth pulled, or cavities filled.
Today and Saturday, about 1,500 people are expected to receive dental care there. Organizers say they're among the millions who are slipping through the cracks of the nation's dental health care system, either because they're not accessing care, or are unable to pay.
Schulte, who owns a small gift shop where she sells jewelry she makes, cannot afford dental insurance.
"We just don't have the money for it," she said. "[I'm] too busy getting groceries and other things."
Health care experts say dental care is often a lower priority than other medical needs. About a quarter of children and adults under 65 have untreated tooth decay, according to the Kaiser Family Foundation. Last year only 35 percent of adults saw a dentist.
Duluth resident Steven Mattson, who arrived at the free clinic at 6 p.m. Thursday, slept in the waiting room. He hasn't seen a dentist in 20 years.
"I was a heavy smoker. I drank a lot of coffee and really messed up my teeth," he said. "[They] just deteriorated, started falling apart.
Mattson has never been able to afford dental repairs. Over the years, he said he has repeatedly been treated in the hospital emergency room for mouth pain.
"My face is just really messed up," he said. "At times I'll swell up so much I can't even talk."
At 5:30 a.m., patients were shuttled to a triage area, where retired dentist Matt Anzelc of Hibbing, Minn., took a look at Mattson's teeth.
"Let's make number 30 a priority for extraction," Anzelc told a U of M dental student who was assisting him. "Definitely he's going to want to get his teeth cleaned."
This is the fourth year the Minnesota Dental Foundation and Minnesota Dental Association have put on the free clinic. Similar "Missions of Mercy" clinics are held in 30 other states.
Anzelc also volunteered at earlier clinics in Mankato and Bemidji to help people. Many who come for treatment are among the working poor.
"They don't have insurance," Anzelc said. "Maybe they don't have enough money to afford dental costs. So we're very happy and pleased to be able to help them."
In Duluth, volunteers transformed a curling arena into a massive, 100-chair dental clinic, staffed by 1,200 volunteers who scurry about in bright, color-coded shirts. By the time they finish Saturday, they hope to have seen a total of 2,000 patients.
"If these were 2,000 patients with diabetes standing out there, or with asthma, the nation would be in an uproar," said Dr. Leon Assael, an oral surgeon and Dean of the University of Minnesota Dental School.
"I think the average person, especially those who enjoy good dental health, don't understand how bad it is when your mouth is getting destroyed by the typical dental diseases," he said.
Assael notes that dental care is not covered by Medicare, and adult dental coverage is optional under state Medicaid programs.
But awareness of the problem is growing.
"What that says is that even at the federal level, state level, dental is second to overall health care," said Carmelo Cinqueonce, executive director of the Minnesota Dental Association. "It's not a priority."
The Affordable Care Act does require oral health coverage for children. And it expanded Medicaid coverage in 30 states, including Minnesota. But Minnesota ranks last in the country in Medicaid reimbursement rates for pediatric dental services, and is fourth from the bottom in funding rates for adult care. The Legislature approved a 5 percent increase last session, but Cinqueonce said that's not enough.
"We're putting band aids on the problem," he said. "If we really want to tackle this, we need to commit to addressing it and solving the problem."
Dentists volunteering at the Duluth event say the work they're providing is a drop in the bucket of what's needed.
But that care can be incredibly important to patients like Steven Mattson.
"I was really nervous at first because I was the first guy in there to get his tooth pulled," he said. "I feel on top of the world. I actually got goose bumps."
His mouth still swollen, he said he feels better than ever.
"I haven't really been able to eat food, solid food, in like 10 years," said Mattson, who plans to enjoy his first hamburger in that time. "It's really an emotional time for me."