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Last January, one of my back teeth broke. A big chunk -- part filling, part tooth -- dislodged when I was chewing something bready. I couldn't get it fixed because I didn't have the money or dental insurance.

So I lived with it. For months. And more months, until the open gaping hole hurt so much I couldn't stand it. I knew I had two choices: find a clinic with a sliding scale or have it pulled. Even though I don't make much money, I had put off the clinic idea because I had a feeling I'd still be charged more than I could afford since I'm not dirt poor.

However, in a desperate attempt to salvage the tooth, I took a stab at a clinic, against my instincts.

The dental clinic at Yale-New Haven Hospital isn't taking new patients for about a year, I was told. I could only come in as an emergency patient to get my tooth yanked. Same story at the Hill Health Center.

I called Mark Masselli, president of Community Health Center (CHC) in Middletown. (I know through my work as a journalist.) He told me about Meri-Care in Meriden, a dental clinic his operation bought in 1997. The city used to run it, but it went broke and was shut down.

I made an appointment, asked roughly how much it will cost, and was told that's unknown until I come in, and not to forget my proof of income.

After getting lost for about 20 minutes (a combination of my really lousy sense of direction and a street I was told to make a left on being closed off), I arrived at the clinic on Miller Street. It was in an old municipal building. There was a social service office in there and the WIC program. I spotted a sign. It said to take the elevator to the second floor for the dental clinic.

The elevator was broken. Not a problem for me, but I wondered how people who are physically disabled would make it up there. Doesn't seem right.

"You're late," a woman said from behind the counter. She was friendly enough, but the clinic was hopping with little children and older folks.

I explained to her that I got lost. "Well, have a seat and we'll see if you can be seen. Someone else was taken since you didn't show up," she told me. I asked her for a rough idea of what it'll cost before I wait â€" possibly for nothing.

She checked the sliding fee scale and said it would cost me $93 for an exam.

I was floored.

"$93 just for an exam? Not to even fix my tooth?"

I left. Aching tooth and all. I can get an exam by a private dentist for less than that, close to my Hamden home.

I wound up going to a local dentist, who gave me two options (again with the options): pull the tooth or spend $2,200 on a root canal and crown. I pleaded with him to just fill it. He told me there's no guarantee the filling would stay in place more than two days. I told him I'd take my chances.

He didn't charge me for the x-ray or exam. But I got hit with a $240 bill for a huge, white filling. As I left, the dentist said to me, "I'll be happily surprised if you still have it in a year."

I called Masselli again. We talked about how much harder it is for the uninsured and money-challenged to get dental care than medical treatment. How dentists have now surpassed the family physician in raking in the bucks, because they don't take Medicare, and HMOs only cover a small portion of dental treatment, usually $1,000 a year.

Masselli explained dental treatment is still looked upon as almost a luxury item. Hence the lack of public funding and over-the-top fees.

"Dentists are not part of managed care. They're still the private office of 20 years ago," he said.

Since most of the dental biz is funded by out of out-of-pocket payments, the fees are huge. HMOs virtually always make deals with health-care providers for lower reimbursements, so we â€" the out-of-pocket payers â€" have to dish out a lot more for medical and dental care and prescriptions. In other words, we subsidize the multi-billion-dollar managed health-care industry. Nice, heh?

"The oral health needs of Americans are at an epidemic level, particularly the elderly and children, as well as disproportionately for minority populations," Masselli continued. "In the schools we're finding bombed-out mouths, a lot of dental decay."

Of the nine CHCs in Connecticut, seven offer dental services: Stamford, Norwalk, Old Saybrook, New London, Middletown, Meriden and New Britain. "We could triple our size and still have the same crisis we have," Masselli says.

In addition, CHC runs mobile dental units staffed with hygienists that go to schools in New London, New Britain and Norwalk.

There are no statistics on how many people in the state go without dental care because of lack of ability to pay. And since HMO dental coverage is typically quite measly, the insured, like the uninsured, often go without sufficient care.

CHC's clinics are funded by federal and state grants, but nothing's guaranteed, says Masselli. The grants are not based on the number of patients served. "If we doubled the number of patients we took in, we wouldn't get double the reimbursement," he says. In fact, he tells me that the state has cut funding to CHCs by 40 percent over the last five years, while health costs are rising 12 percent a year.

"We operate in a crisis mode. Every morning our offices probably have over 100 people trying to get services," he says. "The real tragedy is many come in in bad shape. Broken teeth, periodontal disease."

But Masselli is not a believer in pulling teeth right and left. "That's one of the things we're not doing. We're focused on restorative care (like root canals). Unlike medical care, it's us or bombed-out mouths."