Since the economic downturn, patients have had little reason to smile. Some 130 million Americans have no dental insurance, and along with strained finances, there's not much left over for oral care, say advocates. Moreover, with fewer dentists willing to treat Medicaid patients, including only 10 percent of dentists in Illinois, people are increasingly turning to hospital emergency rooms for routine dental problems at nearly 10 times the cost, according to a recent report released by the Pew Center on the States.