SACRAMENTO, Calif. - As a pediatric dentist, Dr. James Musser sees many cautionary tales.

In his 26 years of practice in Sacramento County, Calif., Musser has on occasion placed stainless steel crowns on all of a young patient's rotted baby teeth. Sometimes these tiny teeth are so decayed they are unsalvageable, and he must remove them all.

"Parents think they get a free ride on the first set," Musser said. "But baby teeth can decay and abscess, and the child can go through severe pain."

Musser sees some of the most serious cases in the county because he is one of the few pediatric specialists able to administer the general anesthesia that many of the patients referred to him require during treatment.

Tooth decay is children's worst chronic health problem, a "hidden epidemic," according to the Dental Health Foundation's 2006 "California Smile Survey."

And dental health officials say the problem will only get worse with a 10 percent cut to Medi-Cal that took effect statewide recently as part of the state's effort to deal with the state budget deficit.

In Sacramento, Yolo, Amador, El Dorado and Placer counties, about 65 percent of children living in poverty do not have adequate access to dental care, according to the Sacramento District Dental Foundation. Statewide studies have shown that poor access is the result of lack of insurance and a limited number of dentists providing care for uninsured or underinsured patients is limited.

Across California, children have more dental problems than children in most other states, according to the Smile Survey.

More than half of all California children have experienced tooth decay by kindergarten. Almost one in five have extensive decay, the study shows. As with many other health conditions, poor and minority children have a disproportionately high number of cavities and poor oral health.

Latino children have the highest risk for dental problems, according to the survey. Among Latinos, 72 percent have experienced decay and 26 percent had cavities on seven or more teeth.

"All things are not equal," said Gayle Mathe, manager of policy development for the California Dental Association. "Eighty percent of disease is in 25 percent of children."

Untreated tooth decay can lead to infections in other parts of the body, such as children's ears and sinuses, as pathogens spread from their teeth. Dental problems also cause children to miss many days of school, according to the Dental Health Foundation.

And dental disease is infectious: Cavity-causing bacteria can be passed from person to person, according to experts.

Dental diseases can be greatly reduced through good prevention practice such as regular dental visits, experts say, but those are precisely the practices that are sacrificed first when treatment is beyond the means of low-income parents.

Smiles for Kids provides dental screening and treatment to children in Sacramento, Yolo, Amador, El Dorado and Placer county whose families don't qualify for Medi-Cal or other public assistance, or who are waiting for other coverage to kick in.

A program of the Sacramento District Dental Society, Smiles for Kids relies on grants, donations from the public and health care providers who donate their time.

"With all the Medi-Cal and Denti-Cal cuts, it's entirely possible we'll need to treat more kids," said Erin Jones, Smiles for Kids coordinator. "It'll have an impact on the number of kids that don't have options."

Lack of dental insurance or not being able to afford dental care was the main reason parents gave to the Smile Survey for not taking their children to the dentist. About 23 percent of parents reported having no insurance, 42 percent had some sort of government coverage, leaving about 35 percent with private insurance.

Those who rely on Medi-Cal will face more difficulties in the future getting their children the dental care they need.

Denti-Cal, as the dental portion of Medi-Cal is known, covers 6.6 million adults and children in California. It uses only 2 percent of the entire Medi-Cal budget, according to the Dental Health Foundation. The budget cuts to Medi-Cal mean Denti-Cal providers will also take a 10 percent cut in reimbursements.

Even before the cuts, Denti-Cal reimbursed well under 40 percent of what dentists are generally paid, said Musser. He says he fears that the budget cuts will result in fewer and fewer dentists accepting such patients.

About 4,000 of the state's 34,000 active dentists provide 97percent of all services to Denti-Cal patients, according to the Dental Health Foundation.

"I can see real shock waves going out," said Musser. "How can I say it won't affect the patients I see?"