"Other people could see," he explained. "I lost three teeth, two up here and one on the bottom. ... The place I worked at, it was $14 per plate, and no one wanted a waiter with no teeth."

By the time Courtais arrived at the dental clinic on the Highland campus of Alameda County Medical Center, his gum infection had gotten so bad that all his teeth had to be pulled.

He is now being fitted for dentures; and when they're finished later this month, his former employer has promised to take him back, Courtais said.

It's a vicious cycle: Left unfilled, even a small cavity can spawn a catastrophe, turning a few-hundred-dollar filling into several thousand dollars worth of oral surgery.

"It's always hard to pinpoint what caused a job interview to not result in a job offer," said Alissa Friedman, executive director of OPTIC, a nonprofit job training program in Antioch. "But I've had experience with some very talented people who had problems getting a job longer than you would think, and they had some very obvious problems with their teeth."

Absent social science research, the importance of a smile is difficult to measure, Friedman admits. Most likely, she says, its appearance affects potential employers on a subconscious level.

"It's sort of a class issue," she said. "There's a way you peg someone as being part of a particular social class based on what their teeth look like, and that either matches or doesn't match your idea of what you want in that position."

California funds dental care for the Medicaid-eligible under a program called Denti-Cal, but patients struggle to find dentists willing to accept the low reimbursement.

Services are limited to extractions, fillings and cleanings but remain in such demand that assistants hold lotteries several nights a week to choose among potential patients.

The section sees six to 10 patients per night. It survives on volunteer time and donated equipment -- including a bin of slightly torn smocks, an old beauty-salon chair and a manual X-ray developer.

"We have a lot of immigrants who don't speak English, who have a really hard time telling us what's going on," said Dr. Anna Dong, a volunteer dentist. "We try our best here. We point a lot."

"I think it's probably money," he said. "When the economy turns bad, dental is one of the things that people let go. If you're kind of afraid, and then you add money on top of it, that becomes, 'OK I don't want to do it.'"

"Most people don't come in until something hurts them, and by that point, there's not much we can do," she said. "You don't want to do that, but you have to just pull the tooth."

"It was just way too much for me to even deal with, so I just let it kind of stay there exposed, and then it became worse and worse," he said. "Maybe psychologically it was just too much for me to be able get my brain around, when your teeth are breaking off. People have dreams of teeth falling out; it's so Freudian."

Morris eventually paid a private dentist $300 to fill the molar. Unable to afford the rest of his fillings, he was pleasantly surprised to find the free clinic.

"Now I have a chance to be able to take care of these little cavities before I have to go through the serious stress that I had with the last one," he said.

"I think in many ways, it's a social justice issue, as well as a health issue," said Wynne Grossman, executive director of the Oakland-based Dental Health Foundation.

"To have people in this country that make the assumption that they don't have the right to their teeth is shocking and really sad," said Grossman.

Lack of access to care, she says, is a systemic problem in California, fueled by Denti-Cal reimbursement rates that remain a third of what private insurance will pay. To fill a tooth, for instance, Denti-Cal offers dentists $37.05.

Many dentists don't accept Denti-Cal, saying the payments don't even cover basic operating costs. Others do so in the spirit of pro-bono work, as a way of helping people in need, said Dr. Kerry Hanson, chief of Highland's dentistry division.

Only a few public dental clinics serve East Bay residents who are uninsured and can't afford care. Funding uniformly lags behind the demand for service.

Highland's dental clinic uses a sort of triage system to manage the overflow, giving priority to patients with abscesses, severe gum disease or painful damage to the soft-tissue inside a tooth.

On any given day, the waiting room is packed with walk-in clients, a few holding their mouths and grimacing as they wait for their turn in the chair.

"There's a bacteria that causes cavities, and that bacteria is transmissible," said Grossman. "If you have parents who have untreated disease ... you're more likely to have it."

Untreated tooth decay is twice as common among poor children as their peers. And painful dental conditions can mimic the affects of attention deficit disorder, making it difficult for the children to succeed in school.

The good news, Grossman said, is that dental disease is easy to prevent. Pilot programs around the state are showing how small interventions, such as sealants and fluoride varnish, can help children break the cycle of tooth decay and gum disease.

Perez is keenly aware of the contrast between the care offered at his office and the need suffered by low-income residents of neighboring communities.

Throughout his career, he's volunteered to treat patients at emergency clinics. Earlier this year, he awarded free "smile makeovers" to two graduates of OPTIC.

One, Pittsburg resident Donald Buchanan, began visiting Perez regularly last spring, getting his teeth fixed and whitened, in preparation to have them covered with porcelain veneers.

"This chipped tooth, it kind of probably put in someone's mind, 'This guy's been in a few fights,'" he said. "I have sometimes in the past kind of hid my smile, because it was weighing on me."

Although Buchanan's dental transformation is not yet complete, he was hired this fall as an instructional aide for the Pittsburg Unified School District.

"I think it will make a difference, I can't say how much," Buchanan said. "More people can probably stand to be in my face a little bit longer."

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