In California today, there are 317 officially designated areas that suffer from a lack of dentists and dental care. Nearly one million children live in these areas. Too often, families seeking a dentist cannot find one who will see children or who will take their Medicaid insurance card. In Santa Clara County, 13.6 percent of children ages 3 to 11 have never been to a dentist, compared with 11.6 percent in the entire state, according to a 2009 UCLA study.
So where do many of these patients go to treat a dental problem? Local hospital emergency rooms (ERs). A new report by the Pew Center on the States cites data from California as evidence of a national phenomenon. In our state, the report notes, California’s ERs received more than 83,000 visits in 2007 resulting from preventable dental problems. The Pew report estimates that dental ER visits increased 16 percent from 2006 to 2009. Many of these problems and costly emergency room visits could have been prevented if these patients had been able to get routine dental care months or years earlier.
This lack of access to dental care is an issue a number of states have been trying to combat. California, Ohio, Washington, Kansas and Vermont, for instance, are working on legislative solutions that could create more alternatives to meet the dental care needs of under served populations and help stem the tide of costly ER visits.
The California Senate recently passed legislation (SB 694) that would establish a State Dental Director and authorize a study to test expanded dental workforce models. The Dental Director will provide state oral health leadership, bring in federal dollars and implement critical public preventive oral health programs. The study would allow for carefully trained practitioners to provide an expanded set of procedures in schools and other settings where children who have no other access to care are located. These would be carried out under the supervision of a dentist.
Similar types of dental professionals are already working in Minnesota and Alaska, and they have offered effective care for decades in more than 50 countries, such as Canada and Great Britain.
While the type of practitioner has varied in different countries, one common theme is training practitioners who come from and return to practice in communities that have difficulty attracting and retaining dentists. What is unique about this approach is that these providers cater to the communities’ needs.
They go to where children are and can work with parents and the community to identify the best way to meet the children’s dental care needs.
The Pew study signals that emergency room visits for dental problems are on the rise because for many low-income children, finding a dentist to treat them is becoming increasingly more difficult. Unless we act soon, this problem is likely to worsen. Under the federal health reform law, approximately 1.2 million more children in California will gain dental coverage by 2014, leading to an even greater mismatch between the number of children seeking care and the availability of providers.
California has an opportunity to address this problem.
By studying ways to expand the dental workforce, our state can improve access and lessen the need for people to seek care for toothaches or other dental problems at hospitals. This will not only improve the public’s health, it will ease the burden on our state’s taxpayers.
