The kid is screaming all night. Her father, who works two jobs, beats the girl’s mother because she can’t stop the child from crying. It’s only when the girl’s face starts to swell that her parents take her to the hospital – where doctors discover an infected tooth.

The child stops crying.

Dr. Lester Machado sees it all too often. “Dental neglect of a child can lead to all kinds of social problems,” he says.

Machado, whom the San Diego County Dental Society (SDCDS) will induct as its president on Nov. 10, says he treats at least one child a month with a life-threatening infection caused by a dental problem. “At least 4 percent of kids in San Diego schools that have a dental abscess are in pain and can’t concentrate on school because of a tooth problem,” says Machado, the first openly gay man inducted as president of the society.

Machado’s peers say his concern for disadvantaged kids has been the driving force behind his 17-year career as both a dentist and physician.

“He’s tirelessly trying to find ways to treat [children of low-income parents and the working poor],” says David Baron, executive director of SDCDS, describing why SDCDS’ some 2,000 members elected Machado to be their president, a role he will officially assume this January. “His peers respect his leadership, vision and tradition of giving back to the community,” Baron says.

Machado, who specializes in oral/maxillofacial surgery at Rady Children’s Hospital San Diego, says he “always wanted to work with children. I knew that I was gay. I wasn’t going to have children of my own. And I just had an affinity for helping kids. Maybe a rough childhood makes you have some kind of desire to help other kids.”

For the last 17 years, Machado has been doing just that – not solely through his work with Children’s Hospital or through his clinics in Hillcrest and Chula Vista, but also by advocating for San Diego’s water to be treated with fluoride.

In San Diego, Machado says, there are two tiers of dental care: “There’s the tier that probably you and I had, where we had fluoride in the water, or if we didn’t, … we had fluoride pills when we went to the dentist every six months, and now as adults we don’t have any cavities, ’cause everything’s been prevented. Then there’s the other tier, the new immigrants, the illegal immigrants, the working poor, the disadvantaged children, whose parents are working. They’re struggling. Mom and Dad might not even have enough money for toothpaste; there’s no fluoride in the water. And, these kids don’t come to the dentist unless it’s an emergency.”

Such children, Machado says, face life and death situations because of lack of dental care. “They’re on the brink of dying because of a dental abscess. You know, in America,” he says incredulously.

Fluoridation, he says, would help. “Fluoridation reduces tooth decay by 50 percent, and fluoride’s naturally occurring anyway. You just need to adjust it to an optimal level.”

Not everyone agrees that the benefits of fluoridation outweigh health risks, however. According to a Sept. 16 article in The San Diego Union-Tribune, although 67 percent of Americans receive fluoridated water, San Diego County has resisted fluoridation for 50 years – ever since 1945, when Grand Rapids, Mich. was the first city to treat its water with fluoride.

That began changing in 2001, when the City of Escondido became the county’s first water provider to fluoridate. Today, fluoridation is inconsistent throughout the county, with some areas only partially fluoridated, while others have varying levels of fluoridation or no fluoridation.

Although he’s quick to credit others, such as Supervisor Ron Roberts, Machado has, for the last five years, been instrumental in a push to extend fluoridation into other areas of the county. The effort has met with increasing success. The Metropolitan Water District of Southern California, which provides 80 percent of the water used in San Diego County, according to the Tribune, began fluoridating the treated water it sends here this fall. And this week, “We got a promise from the chairman of the supervisor of the board, Ron Roberts, … for $5.7 million for water fluoridation. … The other thing that’s happening is the Metropolitan Water District is bringing fluoride to San Diego’s water. ... So that will treat all the water that goes to Ramona, San Marcos, Poway, and Rancho Bernardo. It’s going to start in December of this year.

“Half the cavities all of a sudden disappear once you start putting fluoride in the water,” Machado concludes gleefully.

Fewer cavities will be bad for business, and that’s doubtless just what Machado wants, because it means he’ll have more time for the numerous community projects he volunteers with.

The San Diego LGBT Community Center’s youth housing project is one of them. Homeless GLBT kids are “one of the things that I am passionate about,” he says. “I’ve been working with Dr. Delores Jacobs [The Center’s chief executive officer] to establish a mentorship program with the residents of the youth housing project. There are 23 residents there, and for those who would like it, we will be establishing a mentorship program where they will be connected with a company in San Diego, and a person in that company, and they will have an internship for a job there. And in that job they would have a group of two or three mentors that would work with them, that would be their contact into society and help them with any issues or any concerns that they might have in the workforce – how to dress, how to do an interview, how to advance, how to get the job done – all the things a homeless person wouldn’t otherwise know.”

“I think Dr. Machado really understands the need for providing opportunities for residents of the youth housing project. He’s been working since the spring on this with us,” says Patrick Loose, The Center’s director of programs and operations. The Center’s youth housing project is just over a year old.

“He’s just incredibly generous,” Loose adds, referring to a donation of several hundred toothbrushes and toothpastes that Machado donated to the Center.

Dr. Machado notes that he made the donation in the society’s name. “If anyone has any special needs, the society is available to help the residents,” he says.

The society will honor Dr. Machado this Saturday with a Recognition Dinner at the Omni Hotel in Downtown San Diego.