When island artist Shelly Hurd stopped by the dental van last week to inquire if the dentist might pull a troublesome tooth, she received mixed news: He will, but for further dental care, she may have to seek another solution, as the van might not return to Vashon after July.

The dental van, operated by Medical Teams International, is staffed almost entirely by volunteers and has served Vashon several times a year since 2009. Recently, dentist Cliff Eckman, who has volunteered his services since the van’s first visit, and Hilary Emmer, who schedules patients and provides program support, announced they will leave their unpaid posts in July. So far, no one has stepped forward to fill either of their roles, though Vashon HouseHold Executive Director Chris Szala, who heads the Vashon Social Services Network, said that group is slated to discuss the issue this week.

“It is something we would like to continue,” he said.

Scores of patients have sought care at the van since its earliest days on Vashon, thanks to former islander Heather Robinson, who first brought the van to the island. As a dental assistant, she worked for a local dentist and saw there were many people who could not afford to pay for their services and had nowhere else to turn. She learned about Medical Teams International and approached island dentists to see if any might volunteer if the nonprofit organization would send a van to Vashon. Eckman, who was working part-time and preparing to retire, stepped forward.

“I have always thought one should give back,” he said last week. “I thought let’s give it a try.”

Since then, he has cared for hundreds of islanders and frequently has seen severe dental problems in patients, he said, including teeth decayed down to the gum line and severe periodontal disease. In recent years, the van has come for two days at a time, with the volunteer staff seeing between 15 and 18 patients a day in the fully equipped coach in downtown Vashon.

It is well known that dental problems frequently cause pain, but neglecting teeth can also have serious effects on overall health, Eckman noted, as infection and inflammation can contribute to heart disease and weaken the immune system.

Islander Rebekah Kuzma, an island musician and mother of six, sought help at the dental van when she had a toothache that would not go away. She had only praise for the services she received over the course of four or five months.

“They are clean and efficient and thorough,” she said. “They were really helpful. It felt like a normal dental appointment anywhere.”

With six children, Kuzma noted her family lives on a tight budget.

“I appreciated being able to take care of issues that I needed to without taking away funds for the kids,” she said.

Kuzma can count many islanders as fellow patients at the van. According to the most recent records, since September 2012, the van has provided more than 560 dental appointments for low-income adults and 83 for children. Eckman completed more than 600 fillings and nearly 250 extractions, along with nearly 20 root canals and more than 60 fluoride treatments. These services — provided at no cost to the patients — are valued at nearly $330,000. With Medical Teams International, however, which charges $800 per day for use of the van, the total amounted to just under $40,000.

Considerable financial support from the community has made the dental van’s services possible over the years, Emmer noted. Granny’s Attic has supplied $15,000 two years in a row; the Eagles donate $1,000 annually, and the Beardsley Family Foundation provides $2,000 a year. In 2011 and 2012, Emmer brought the van to the island to see schoolchildren six times a year and funded those visits through recycling events that brought in about $5,000 each. And when Emmer ran for unofficial major in 2012 and won, a portion of the money went to the dental van. Some Vashon residents donate as well, she noted.

“The community should be given a lot of credit for the support,” Eckman added.

Currently, most adults and children on the state’s Apple Health plan, or Medicaid, are eligible for free dental services at several Puget Sound-area clinics, but Eckman and Ellen Broyles, who manages the dental van, both say that because the state’s reimbursement rate is so low, it can be difficult to find a dentist who will take new patients, especially adults. On Vashon, no dentists accept patients with Apple Health, and according to Broyles, about 80 percent of dentists statewide will not accept it.

Among those who often have difficulty affording care are seniors, as Medicare does not include any dental coverage, Eckman said.

“The support system is just not out there overall,” he added.

Hurd, who requested the tooth extraction last week, has Medicare but no dental insurance.  She first sought help from the dental van when she was having tooth pain nearly a year ago. At the van, she received an exam and X-rays, as all patients do, but the care she needed exceeded what could be done there, so they referred her out for a root canal. That dentist did not believe she could save the tooth and referred Hurd to a specialist, who said the work needed in her mouth would run about $20,000 — or, as Hurd said, “the downpayment on a house.”

With that information in hand, she returned to the dental van last week, seeking to remove the tooth, but both she and Eckman acknowledge extracting it is not the best solution.

“I don’t know what I’m going to do. I will have no teeth in one side of my mouth,” she said. “I will ask them for suggestions.”

Now, with the van’s volunteer staff in transition, Eckman says he has concerns about leaving, but will turn 79 this year and is ready to retire from the volunteer position. He noted that one person cannot solve all the problems, anyway.

“What we need is Medicare that covers dental work for all,” he said.

Eckman credits Emmer with being “the backbone of the operation,” and noted that replacing her is also essential for the van to continue. A tax preparer and community activist, Emmer spends about 20 to 30 hours a month on the work, she said, scheduling patients, creating and storing charts and writing grants. Additionally, she said, some of the patients are very poor, and that means they have no cell phone or landline, and so she has resorted to other forms of communication to reach them. Szala, the head of the social services network, said he believes the network will pick up her position in some way.

Also essential to the van’s work are dental assistants, Emmer said. When she started, the pool to draw from was larger than it is now, and more volunteers are needed to ensure that two will be available to serve when the van visits.

With the van’s future unclear, Emmer said her goal is to have everyone who started dental work at the van completed by July. Soon there will come a time she will not schedule any new patients, she said, but for now people can call her if they want to be seen. Typically, she said, there was a five-month waiting list, but currently there is none.

Looking ahead, she said she has some money left over to help people with the cost of care in case of a dental emergency if the van stops serving Vashon, but she hopes it will not come to that.

“I think it has served the community well. We have seen people that have not seen a dentist in 10 years,” she said. “I hope someone will come forward and say we can’t lose this. That would be great.”