Douglas Lott sees it in the faces of many young people sitting in his Sacramento dentist’s chair.

“I have more people unable to pay for treatment,” Lott said. “The hardest hit are the younger kids, who … don’t have a steady job, or insurance, or are in college. When you tell them they need a root canal or crown for $2,500, they have a look on their face like it’s not real.”

But Sacramento’s double-digit jobless rate and bleak economic conditions are all too real, and they’re affecting dentists along with their patients. Like many small businesses, Sacramento area dental practices are getting drilled by the economy, state budget cuts and insurance plan changes.

Dentists in the Sacramento region are reporting that business dropped by as much as 25 to 30 percent in the last three years, said Cathy Levering, executive director of Sacramento District Dental Society. That number is about even with the statewide figures for decreased dental business, she said.

Dentists are also struggling with lost retirement funds in the stock market, which is delaying retirement and making it tough for younger dentists to move into practices. Meanwhile, cuts to Denti-Cal, the lack of free dental clinics and decreasing insurance coverage over the last decade are chipping away at dentists’ profits.

Because of state budget shortfalls, the state’s Denti-Cal program eliminated adults from its program in 2009, making only children and pregnant women eligible for subsidized dental care and further reducing patient loads.

Eight of 10 dentists in California are sole practitioners, according to the California Dental Association, which means they bear the brunt of financial downturns.

The poor economy means patients are forgoing routine and elective care, coming in only for more complicated and expensive emergency treatments. Many dental offices are finding it necessary to get more creative with financing.

Carmichael dentist Gabrielle Rasi said her business is off by about 10 to 15 percent since the recession hit, mostly in elective and cosmetic procedures. Five to six years ago, her patients would take out home equity loans or charge their credit cards to have elective procedures, but these days, patients are more conservative, she said.

Many dentists in the Sacramento region have patients who are state employees, and furloughs and cuts mean fewer trips to the dentist for them, Rasi said.

In some cases, patients ask to postpone treatment for several months so they can save up the money.

“Now they just do what they absolutely need to,” Rasi said. “Sometimes, the first thing out of their mouths is, ‘Do I really need it?’ ”

Rasi knows of patients who are going through big changes in their lives, including job losses or insurance coverage reductions. Her office works with patients to spread payments over time, defer payments or sometimes she “adopts” a longtime patient, meaning she does the work for free.

While the majority of her patients have dental insurance, Rasi sees newer patients coming into her office without insurance. She worries that patients are postponing or eliminating routine cleanings and checkups, which can lead to more complicated treatment.

“I try to educate my patients to at least come in once a year,” Rasi said. “If it’s a cavity now, in two to three years, it will be a root canal or crown.”

Timothy Mickiewicz said he understands why he sees some patients less.

“If you have to make a choice between feeding your kids and going to the dentist, you’re going to feed your kids,” Mickiewicz said.

Mickiewicz said he’s seeing growth in his facial pain treatment business, and he wonders if that’s because more people are under stress and grinding their teeth.

Mickiewicz is responding to the economic crunch by being more flexible on payments. He sees many patients on an emergency basis only.

“Some of my new patients say, ‘get me out of pain,’ and once the treatment is over, I never see them again,” he said.

Ryan Wilgus, an associate in Mickiewicz’s office, feels lucky to have a job. After graduating from University of the Pacific’s dental school in San Francisco in 2010, he found positions were rare and competition was high.

“Some of my classmates are taking a year or more to find jobs,” he said, adding that dental school debt can hover at $150,000 for a public school, and more like $300,000 for a private school. “Not a lot of dentists are hiring, and not a lot of dentists are retiring in these times.”

While job hunting, he interviewed at offices in the East Bay and Sacramento that offered him a position, then rescinded the offers six months later.

“Older dentists usually slow down and take on younger associates,” Wilgus said. “Now, they’re kind of hanging on for dear life, clinging to patients and trying to make up for what they lost in the markets.”

Levering said the average age of a retiring dentist among the 1,600-member Sacramento dental society is between 55 and 60. But because many lost their retirement nest eggs and 401(k)s in the recent recession, they are delaying retirement.

“A lot of dentists who planned to retire three to four years ago are not retiring, partly because of the economy,” Levering said.

New dentists could also see reduced fees, as Delta Dental is requiring new dentists to join its preferred provider organization (PPO) network, which gives less in reimbursed fees. While most dental practices have overhead of 55 to 70 percent, this move could raise overhead for a new dentist to as much as 80 percent, Mickiewicz said.

Recent closures and consolidation of dental clinics in the Sacramento area mean many adults have no dental safety net, Levering said.

“We have no clinics in Sacramento County offering free care now,” she said. “In fact, we are one of the few counties in the nation without access to free care.”