MONROE For someone about to see the dentist, 5-year-old Guianella Saavedera-Diaz is all smiles.

So is her mom, Lily Diaz. The Indian Trail woman praises the care her three kids receive at the Union County dental clinic and encourages friends to go there, too. The county Health Department runs the clinic for people on Medicaid or who don't have insurance.

But now the center is fighting for survival. Confronting a $13.2 million deficit in its 2011-12 budget, Union County is making a range of cuts that take effect in July, including eliminating all $188,000 it provides to the clinic.

Health Department Director Phillip Tarte said this week he remains optimistic he can continue the program, despite losing county funds.

Medicaid and patient fees also provide income for the program, whose budget will drop by 21 percent in the new fiscal year to $260,000.

The county board of health approved moves to trim costs and help make up difference from the loss of county funds, Tarte said, including the difficult decisions to lay off one of five clinic staffers and eliminate sliding-scale fees.

Even as he works to keep the clinic afloat, Tarte worries about the overall access to dental care during the recession, especially for low-income people.

"During this economy, it seems like dental services, and health care in general, are the last things people spend money on," he said.

Dr. Rebecca King shares that concern. She is section chief of the N.C. Oral Health Section in the Department of Health and Human Services.

King and Tarte worry that many people struggling to pay rent or buy food see dental care as one of the first things to drop, even though ignoring that care can lead to long-term health problems.

Union is the first county King is aware of to end dental-clinic funding. She said another county facing a budget shortfall, Orange County, is closing one of its two clinic sites to save money.

Not all N.C. counties fund dental clinics, although King said residents all have access to nonprofit or local government dental care serving low-income residents.

In Cabarrus County, for instance, the health agency is separate from county government and county funding is not an issue for its dental services, said Public Health Director Dr. Phred Pilkington. The clinic mainly sees children.

Mecklenburg County runs a pediatric dental clinic for children younger than 15, and also is not anticipating any cuts in funding for the new fiscal year.

Union County's dental clinic began in 2004 for children only. But as the no-show rate increased, the county opened the clinic to adults as a way of encouraging parents to bring their children.

Until now, if a patient did not have Medicaid coverage, fees were based on income and billed at a sliding scale of between 40 to 100 percent of service costs. Because of the downturn in the economy, the county had seen an increase in sliding-scale needs. County funds had subsidized the difference between what people paid on that scale and the cost of services.

Under the changes that start next month, the sliding scale is eliminated. In general, Tarte said, the clinic fees are less than what people would pay at a private practice.

The clinic is part of the cramped Health Department offices in Union Village in Monroe. In 2009-10, the clinic helped more than 1,000 people, including about 700 children, a number that has decreased over the past couple years.

Some patients in their 30s or 40s have told dentist Dr. Anjali Seth they were visiting a dentist for the first time. She said she did not know where they would go if the clinic was no longer there.

For Diaz, the mother of the 5-year-old calmly sitting in the dentist chair, she is relieved the clinic is still around.

"I can't afford anywhere else," Diaz said. "It's a good deal here."