Bill Would Explore New Tier of Dental Provider for California

This week, the California Senate will consider a previously non-controversial bill aimed at improving dental care for underserved children. After clearing its first hurdles with strong bipartisan support, the bill is now generating some pushback.

SB 694, by San Fernando Valley Democrat Alex Padilla, passed its first three committee votes with unanimous approval. The Senate Health Committee and the Senate Business, Professions and Economic Development Committee sent it along the legislative path with 7-0 votes. The Senate Appropriations Committee last week approved the bill with an 8-0 vote.

Now it’s on the Senate floor with a Jan. 31 deadline.

The bill’s two main components would:

  • Create a statewide office of oral health, led by a dentist, that would help California get federal money for subsidized dental programs; and
  • Authorize a project to explore new workforce training and delivery models with the goal of providing oral care for underserved children.

So far, more than a dozen organizations — including the California Dental Association — have lined up in support. Two organizations have recently come out against it, saying they weren’t previously aware of the bill’s provisions. The bill’s author and supporters said the opposition was unexpected.

There appears to be no opposition to the bill’s first component. Representatives from the two opposing groups said they like the idea of increasing oral health’s statewide clout. But they’re worried about scope of practice issues raised in the workforce training study.

The bill would launch a project to train a new level of oral health professional in California — people less educated than dentists, but with enough training to perform some dental procedures. The bill would establish the framework for a study — probably about three years long — but it does not spell out the details of how the new tier of providers would be trained or what levels of procedures they’d be able to deliver.

“We’re asking for a scientifically based study to explore the possibilities of delivering care in different ways,” Padilla said. “There are already well-documented access issues in many areas, and they’re only going to be exacerbated as we move toward 2014. We have to think creatively about how to make sure coverage equals access,” Padilla said.

Other states, including Alaska and Minnesota, have launched programs training new tiers of dental professionals who can provide care to underserved populations.

Professional Opposition

The California Academy of General Dentistry and the California Association of Oral and Maxillofacial Surgeons oppose SB 694.

“We’re pleased that California is looking at the issue, but we feel this bill is going at this in the wrong direction,” said Myron “Mike” Bromberg, chair of the Legislative & Governmental Affairs Council of the Academy of General Dentistry.

“This bill creates a new dental workforce position. A dental therapist is basically a kid out of high school you send to school for two years and then let them perform surgeries and irreversible procedures.

“It’s shocking to me that it would be OK to experiment on poor children, and that’s really what this is,” Bromberg said.

W. Frederick Stephens, president of the California Association of Oral and Maxillofacial Surgeons, agreed.

“We don’t support the bill as written,” Stephens said. “We don’t feel that someone with minimal education should be doing surgery on anyone, especially kids.”

Padilla said the groups are overreacting.

“We don’t know yet what the specifics of this research are going to be,” Padilla said. “We’ll have to determine the necessary education and training, and we’ll have to determine the specific procedures and types of care that can be provided with that level of training.”

Padilla said critics were “calling out extreme examples of extreme scenarios” prematurely. “We don’t know yet what the substance and content specifics will be of this research.”

Professional Support

In addition to the California Dental Association, these organizations support the bill:

  • California Head Start Association;
  • California School Health Centers Association;
  • California Association of Rural Health Clinics;
  • California Coverage and Health Initiatives;
  • California Dental Assistants Association;
  • Community health clinics; and
  • Other children’s health advocates.

The endorsement carrying the most clout by far is that of the CDA, the largest statewide dental association in the country with almost 25,000 members — about 72% of the dentists in the state.

“CDA supports moving forward with policy that’s evidence-based, and currently there is a lack of needed information concerning potential new dental workforce providers providing care for underserved children,” said Alicia Malaby, director of communications for CDA.

“A rigorous scientific study on the safety, quality and cost-effectiveness of allowing certain procedures, such as fillings, to be performed by non-dentists is needed. It is not appropriate for California to create any kind of provider without this assurance, and therefore CDA is opposed to any changes in scopes of practice until such compelling data exists.”

No Shortage of Dentists, but They’re Not Evenly Spread

California is not deficient in dentists. In fact, according to the California Academy of General Dentistry, California has more dentists per capita than any other state — one dentist for every 1,250 residents, compared with the national average of one dentist for every 1,639 residents.

“California does have a good supply of dentists, but they’re not where we need them and they’re not necessarily treating people who need dental work the most,” said Jenny Kattlove, director of strategic health initiatives for The Children’s Partnership, the bill’s sponsor.

“There is a huge disparity in how much oral health care low-income and minority kids receive in California,” Kattlove said.

California has 333 federally designated dental health professional shortage areas, Kattlove said. All but five of California’s 58 counties have dental professional shortage areas, according to The Children’s Partnership.

“And nearly one million kids live in those areas,” Kattlove said. “That’s the statistic that we’re most concerned with.”

Dental Programs Whittled

Over the past several years, subsidized dental programs in California have been whittled and eliminated to save money. But the savings have come at a price, according to CDA’s Malaby.

“Cuts to virtually all adult Denti-Cal benefits ‘saved’ the state $109 million and caused the loss of $134 million in federal matching funds — leaving three million poor, disabled and elderly Californians without dental coverage,” Malaby said. Denti-Cal is the dental benefit under Medi-Cal, California’s Medicaid program.

“In addition,” Malaby said, “the state eliminated funding for the California Children’s Dental Disease Prevention Program, which provided preventive oral health care and vital resources to low-income children. Establishing an oral health infrastructure, as called for in SB 694, would be a good place for the state to start.”

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