WAIMANALO — Even as Ryan Kalama was filling out paperwork at Waimanalo Smiles Dental Clinic, he was nervous.

"I was having an anxiety attack," he said. "And then as they were checking my mouth, even that hurt. They weren't even doing anything yet."

Kalama is among hundreds of thousands of Hawai'i residents without dental insurance, and one of the first patients to visit the new clinic, which is co-located with the Waimanalo Health Center.

Waimanalo Smiles charges patients based on ability to pay. Executive director May Akamine said it's the only dental clinic of its kind in Windward O'ahu.

The clinic opened in April and in two and a half weeks had booked patients for the next four weeks.

"I see some of the worst cases here than I've seen in my whole career," said Dr. Anthony Kim, the clinic's sole dentist, who previously practiced in Oregon. "We have patients coming in that haven't been to a dentist in 20 years."

Kalama had been in pain for 13 years. After a few weeks and two appointments, he said, "I was pain-free."

The Oral Health Task Force found in 2001 that 28 percent of Hawai'i residents lack dental coverage, and only 30 percent of Hawai'i dentists serve indigent residents covered by the Medicaid program.

"I went through every clinic," Kalama said. "It's really hard to find a dentist that can take that tab. It's hard for them to help everybody."

Out of the 150 patients the clinic has seen since April, 110 qualify for Hawai'i QUEST, a state Medicaid program for individuals with a family income below the federal poverty level.

Since Gov. Linda Lingle announced this week that she would scale back state healthcare benefits for low-income adults, Akamine has been worried that the center, which relies mainly on federal and state funding, will suffer.

"But we're here to serve the community, and we're going to find a way to do that," she said. "I haven't been sleeping much, filling out requests for grants."

The sliding-scale fees are part of the clinic's appeal.

"The scale can slide down to zero sometimes," Akamine said.

The center calculated the actual cost for a routine visit, and it came out to $250. But, if they're able, uninsured patients are only asked to pay $49. Grants from foundations and the government cover the rest.

"The need is great, and the resources are terribly scarce," Kim said. "If they cut funding, you've got to wonder what's going to happen to all these people."

Most of the patients who come are uninsured, but Kim hopes that more people from the community will utilize the clinic.

"People who have regular insurance, that really helps us cover our costs," Kim said.

Kalama and Fredlyn Amina, both Waimanalo residents, said they've recommended Kim to people in their community.

"For meeting a doctor for the first time, he's shown me a lot of love," Amina said.