| Article |
March 30, 2007
East Bay Business Times
Screening aims to get more kids dental care
by Marie-Anne Hogarth
Dentists hope that a new law requiring parents of children in their first year of public school to show proof of a dental screening by May 31 will put some teeth in their case for funding more oral health programs.
Under the legislation, AB1433, which was sponsored by the California Dental Association and adopted in September, parents of kindergartners and first graders must present proof of a dental screening each year, or sign a waiver explaining why their child didn't meet the requirement.
Those waivers, detailing whether the family couldn't meet the financial burden, locate a dentist or had some other reason, will provide data about barriers to care.
"One of the things that this bill will provide is accurate numbers on the need, the perceived need and the un-met need," said Dr. Jason Renner, a Walnut Creek dentist on the board of the Contra Costa Dental Society. "Until the government has numbers, it is hard to put money toward programs."
Access to dental screenings, let alone dental care, is limited, especially for those with very low incomes, because many private dentists don't accept patients on Denti-Cal, California's public program.
Chief among the reasons is the program's low reimbursement - 20 percent to 40 percent of a dentist's fee, based on estimates provided by Renner and others. Eligibility requirements for Denti-Cal include living at or below 100 percent of the poverty level, which is $20,650 for a family of four.
The typical fee for a basic visit to a private dentist for the youngest children, who won't even sit still for a cleaning, is $25 to $50, Renner said. Exams that include radiographs typically start at $100.
Contra Costa County, one of few counties to have performed a detailed survey, found in a March 2007 Health Services study that the ratio of dentists accepting Denti-Cal to kids from income levels living below 200 percent of the federal poverty level - $41,300 for a family of four in 2007 - is one to 1,712.
The ratio is 1 to 246 for kids living at/or above that level.
Of the 785 private dentists practicing in Contra Costa, 98 billed Denti-Cal at least once in the past year, and of those, 34 reported seeing kids with Denti-Cal on a regular basis. Of those 34, one dentist reported seeing kids as young as age one, the recommended age to start seeing a dentist according to the American Academy of Pediatric Dentistry.
"Dentists anecdotally say it is not that they don't want to see this population of kids, but they would rather see them for free because the program is so bureaucratic," said Padmini Parthasarathy, senior health education specialist for Contra Costa Health Services.
Parthasarathy said there are similar access problems for kids in families with slightly higher income levels, for instance those eligible for the Healthy Families program, but no hard data.
The new law allows for the screening to be performed by a dental hygienist or other licensed professional, but makes little provision should cavities be found. The hope is that parents, schools and counties will find dentists to follow up.
"To be candid about this legislation, it raises awareness," said Dr. Jared Fine, dental health administrator for the Alameda County Public Health Department. "The bad news is, it is the beginning of the story."
More than two-thirds of California's children suffer from untreated tooth decay, according to the 2005 Dental Health Foundation's California Smile Survey.
Dental decay, the most common chronic disease among children, causes kids to miss school and schools to lose out on funds distributed based on student attendance. Oral health is also correlated with overall health in a variety of ways, for instance there is a link between gum and heart disease.
Renner said the society is hoping to organize an outreach program through the schools, complementing screening provided by Contra Costa Health Services at schools where more than 50 percent of children participate in the free lunch program. These are kids living at or below 185 percent of the poverty level, which amounts to $38,202 for a family of four.
The Public Health Department in Alameda County runs a similar program but only has funds to reach a third of these schools.
Dental clinics serving patients regardless of insurance status include Asian Health Services, La Clinica de La Raza, Native American Health Center Inc., Lifelong Medical Care, Tiburico Vasquez Health Center Inc. and Tri-City Health Center, but Patricia Barrera, policy director for the Alameda Health Consortium, said capacity at these dental clinics is limited.
There are waiting lists for adults and long wait times for kids at these clinics, she said, although nobody is getting turned away.
mhogarth@bizjournals.com | 925-598-1432