On Friday afternoon, Keven Mares Sanches, 4, sat playing with his SpongeBob SquarePants slippers and reading a book in the “jungle room” – a pre-operating room painted to look like a jungle – at St. John’s Medical Center. Sanches’ demeanor was not that of a boy who was going to see a dentist for the first time he could remember and have surgery the same day.

After several hours, the boy was starting to fidget. He hadn’t been able to eat all day. And he was waiting for the magic moment when his teeth would no longer hurt him.

Sanches had been to the dentist only once in his life, his mom, Eugenia Sanches Perez, said with the aid of a translator. A few months shy of his fifth birthday, Sanches already had seven cavities and an infected molar. His teeth hurt him almost constantly. Staff at the Learning Center, where Sanches goes to Head Start, noticed how uncomfortable he was and told his mom about a way he could be helped.

Even just months ago, Sanches more than likely would have continued to suffer unless his family was able to make a trip to Idaho Falls.

Instead, Sanches met a dentist for the second time in his life on Friday at St. John’s.

Jay Cole, a pediatric dentist in Cheyenne, and his partner Michael Clark, will come to Jackson every month to host a pediatric dentistry clinic.

St. John’s hosted its first clinic in November, but the program has been in the works for more than a year, said Virgil Boss, assistant administrator of support services.

Pediatric dentistry for preschool-aged kids is covered by the state under Medicaid. The hospital doesn’t lose or donate any money to the program.

“This is not charity work,” Boss said.

Communities must have a qualified oral surgeon, equipment and an operating room to host clinics. The St. John’s Medical Center Foundation spent $15,000 on the needed oral surgery equipment and gave it to the hospital in October.

Cole and Clark agreed to commit to commuting to Jackson for clinics every month. Kids are screened through the Learning Center. The clinics have the capacity to treat 10 kids a month, Boss said. In the first clinic, six kids were seen. In the second clinic in January, five kids were wheeled into the operating room.

The number of kids should increase as people learn about the program, Boss said. Basic dental care also is covered by Medicaid, but many parents aren’t aware teeth should be a health priority.

“People don’t realize a little problem becomes a big problem,” he said.

Last year, about 650 kids statewide were hospitalized needing acute dental care last year, said Grant Christensen, staff dentist with the Wyoming Department of Health.

In kids up to 4 years old, tooth decay and cavities can occur. Not only does it cause pain for the child, it also is potentially deadly. Cavities left to fester breed bacteria that, if left untreated, can enter the bloodstream and become septic. Every year, kids die from this, Christensen said.

A survey done this year shows that at least 40 kids a year in Jackson need the surgical treatment the clinics provide, he said. Part of the problem is people think of children’s teeth as “baby teeth” and don’t treat decay because the tooth will eventually fall out.

Kids have their original teeth until they are about 12 years old, which is a long time to go living in constant pain, Christensen said. Children with serious cavities can’t eat properly, which leads to being sick more often from a lack of proper nutrition. They suffer academically because they can’t focus because of the pain, he said. These kids also endure being socially ostracized since usually they have a mouth full of black teeth.

Cavities are preventable. Kids should see a dentist for the first time when they are 1 year old and then every six months from then on for a cleaning and fluoride treatment, Christensen said. If a cavity does develop, it has to be treated within a year – the sooner the better – before the child is susceptible to serious infection, he said.

Sanches was one of five patients Cole worked on while in town for a one-day clinic Friday. Sanches’ seven cavities made him the easiest case he saw, Cole said. Most of the kids Cole treats in the program are between 2 and 4 years old, but he does sometimes see kids who are younger than 2. Sanches was also the oldest child Cole saw.

It is estimated that more than 800 kids statewide need to be seen in these programs, Christensen said. With the addition of St. John’s, clinics in Wyoming are now being run in Casper, Rock Springs, Kemmerer, Cheyenne and Worland.

The process of ending health issues related to dental problems is a complex one, Cole said. The key is education of parents. Cole’s work is restorative and it decreases the bacteria count in the mouth. But regular teeth hygiene and annual fluoride treatments are needed to make sure the same kids aren’t back every year with similar problems, he said.

Ideally, the clinics across the state will help curb serious illnesses due to problems with teeth, but the magnitude of the impact programs like the one in Jackson will have is unknown. If he helps one kid, it’s enough, Cole said. Ideally, there wouldn’t be any kids to treat, but Cole takes it patient by patient.

“If the need goes away – that’d be terrific,” he said.

In surgery Friday, a sterile blue cloth was draped over Sanches’ head. His mouth was clamped open. A face mask was stretched tautly over his widened mouth with a few discolored teeth peeking through, waiting for a silver crown.

The sound of grinding teeth, whirring drills and beeping of monitors didn’t disturb the boy from his medicated slumber. With major work, including extracting teeth and filling multiple cavities, the best thing for young children like Sanches is to put them to sleep under general anesthesia, Cole said. It makes the procedure go more quickly and more smoothly since the kids aren’t squirming and can’t feel any pain. The seven cavities took less than an hour to deal with, he said.

While Sanches was nonplused before surgery, he, like most of the kids, woke up disoriented and confused after, Cole said. Most of his patients are used to waking every day with chronic pain, some never sleep well because their mouths ache so badly.

So while waking up from surgery is always surreal, no matter the age of the patient, at least most of Cole’s wake with less pain than they had before, he said.