Two briefs released by the University of California, San Francisco’s Healthforce Center in March said in no uncertain terms that oral health care is one of the most unmet health care needs in California.
Although the state has one of the highest dentist-to-population ratios in the United States, it was found that dentists tended to live and work in urban areas with fewer lower-income families. Additionally, there are systemic barriers to hinder equitable access to care, including workforce shortages, insufficient Medi-Cal provider participation and a lack of diversity among dentists.
To improve access to care and increase the number of oral health care providers, the California Oral Health Equity Coalition (COHEC) and Strategic Concepts in Organizing and Policy Education (SCOPE) are advocating for the use of dental therapists in the state.
Dental therapists are licensed oral health professionals who practice as part of a dentist-led team. They’re trained to provide preventive and restorative care, including filling cavities, cleaning teeth, educating patients about oral health and placing temporary crowns on baby teeth.
The main difference between a dental therapist and a dentist is that the former handles more everyday treatment, while the latter leads the diagnosis and complex procedures.
The pathway to becoming a dental therapist is also easier, which typically requires three years of full-time study in a Commission on Dental Accreditation (CODA) program as opposed to eight years of higher education to be a dentist.
However, dental therapy has only been around in the U.S. for about two decades, and little more than a quarter of the states have authorized its use, including Arizona, Oregon, Nevada, New Mexico and Washington.
Sofia Garcia-George, senior health justice associate for SCOPE Los Angeles, said that both the organization and COHEC are making a big advocacy push in California to authorize the use of dental therapy in order to mitigate the oral health care issues highlighted in the two reports.
“Dental therapists do just a small percentage of the procedures that the entire dental team would do, but they’re the ones that are most commonly needed,” Garcia-George said. “Where the equity piece comes in is that they practice in areas with chronic shortages of dental providers … in rural communities, tribal lands and low-income neighborhoods.
“They also provide care in clinics, dental offices and nontraditional settings,” she continued. “These can be schools, nursing homes and community centers, and that really means that they’re able to bring these essential services directly to the people who might otherwise go without.”
Garcia-George added that in all states where dental therapists operate, they end up serving a much higher percentage of patients on Medicaid than dentists do. And because the cost of employing a dental therapist is about a third of employing a dentist, she said, it’s a more affordable way to treat more patients that will also free up dentists to handle more complex cases.
And the easier it is to maintain good oral health, the better your overall health will become, as dental diseases can have an effect on other parts of the body. Garcia-George said there’s plenty of evidence that shows that comorbidities – the presence of two or more chronic diseases in a patient – associated with dental diseases are very common, including diabetes, cardiovascular disease, rheumatoid arthritis and dementia.
As highlighted in the reports, poor oral health has had a large impact across the state. In 2022, approximately 351,000 children had to miss school due to their oral health – totaling more than 869,000 missed school days.
And without that preventive care, emergency rooms (ER) become the only option for relief. The reports estimate there are more than 50,000 ER visits annually for preventable dental conditions, costing the state around $120 million in expenditures.
Other Options for Coverage
Although Californians with Medi-Cal may be covered, the question remains for those who are not insured. Garcia-George said there are different options people can look for, including Covered California, a subsidized private insurance provider, the Health Consumer Alliance, which provides free phone service for residents struggling to get or maintain health coverage, and Federally Qualified Health Centers (FQHC) that provide care at a reduced cost based on a patient’s income and family size.
But there are some upcoming changes to Medi-Cal that residents need to be aware of. Namely, on July 1, Medi-Cal will no longer be covering dental services for adults 19 years old and over, except for emergencies, depending on their immigration status. For the adults who are going to be affected, they may have to turn to the aforementioned options.
“At the core, people are going to be suffering,” Garcia-George said. “Individuals are going to suffer. Clinics are going to suffer, and it is going to be really expensive. It’s more expensive to go to the ER than it is to get preventive care.
“We should all have access to the health care that we need, but that’s not the way that our system works. So I would recommend reaching out to those services to get specific information.”
To reach the Health Consumer Alliance, call (888) 804-3536 or visit https://healthconsumer.org/.
To find an FQHC, go to https://findahealthcenter.hrsa.gov/.