A small dental clinic in St. Paul continues serving low-income people in pain, despite COVID-19.

Squeezing the grips of an extraction tool, Dr. Geetha Damodaran pulled first from one side, then the other in an effort to loosen a stubborn, infected molar from the mouth of a young man.

While a global pandemic has sidelined much of Damodaran's White Bear Lake dental practice — and most others — she and hundreds of other area dentists, hygienists and dental students continue braving the dangers of COVID-19 to volunteer at St. Paul's Hope Dental Clinic.

Damodaran, born in India, raised in New Jersey and trained at the University of Minnesota, is putting in extra shifts to ease the pain of people without insurance or the ability to pay for dental care.

"There is a need. And where else are these patients going to go?" Damodaran said while donning personal protective equipment at the beginning of a recent four-hour shift. "The goal is to keep people out of the emergency room, to keep those beds available for patients with COVID."

Hope Dental Clinic is the Twin Cities' only free dental clinic working exclusively with uninsured, low-income Minnesotans. In an effort to preserve personal protective equipment for personnel working with COVID-19 patients and to lessen the danger faced by dental staff, officials at the CDC, the American Dental Association (ADA) and the Centers for Medicare and Medicaid Services have recommended dental offices postpone all nonemergency procedures.

At Hope Dental, where dentists, hygienists and students have volunteered since 1965, that also means no drilling or filling — procedures that could send virus particles into the air. Hope dentists are only pulling painful and infected teeth, said Jessica Flotterud, the nonprofit clinic's executive director. Still, she said, it's a critical component of medical care. Potentially deadly untreated infections can spread from the mouth to other parts of the body.

"If we weren't here, they would be going to the emergency room," Flotterud said of Hope's patients. "Now, more than ever, we really want them out of there. There's going to be more infection, more COVID, and those doctors need to be focusing on those patients."

Despite Hope relying on the resolve of hundreds of volunteers, as well as continuing donations of cash and personal protective equipment, Flotterud said there has been no thought of closing during the pandemic.

"It's just not in our DNA," she said.

As Damodaran and fourth-year dental student Morgan Braza worked to pull a couple of teeth in one exam room, two other dentists grabbed pizza in a break room before donning masks and face shields.

Drs. Michael Perpich and Yubin Choi are partners at Richfield Dentistry. Their own practices have come nearly to a halt while COVID spreads. Volunteering at Hope is not only the right thing to do, Perpich said, but it's also necessary to successfully fight COVID-19.

"Every 14 seconds, somebody walks into an emergency room with tooth pain," he said. "Our goal is to keep them out of there, while helping keep their ability to chew."

The virus is not only straining emergency rooms, "it's effectively shut down the dental industry in Minnesota," said Carmelo Cinqueonce, executive director of the Minnesota Dental Association.

"We've seen the news stories about [closed] hair salons and bars and restaurants. But not a word about dental practices," Cinqueonce said.

If clinics must stay shut until August, he said, nearly half the country's dentists said in a survey they'll go out of business. If they stay closed through June, 18% expect to go under.

The MDA is working with the state Board of Dentistry and the governor's office "to see what can be done," Cinqueonce said.

One thing many dentists say needs to happen before they reopen their doors: Increase the availability of testing for COVID.

"That's one thing many of my colleagues are looking for," Damodaran said.

The daughter of a research scientist and sister to a cardiothoracic surgeon, Damodaran wanted a career in a medical field.

But as a young girl, she was terrified of the dentist.

Over time, the art and science of dentistry started appealing to her. When 3M hired her husband, Damodaran enrolled in dental school at the University of Minnesota. She has been a dentist for 25 years.

Her son and daughter are following in their mom's footsteps as U dental students.

They also volunteer at Hope.

"It's about service," Damodaran said. "At the end of the day, it's really about helping a patient who is in pain," she said. "Nobody wants a toothache."