California Falling Short in Kids’ Dental Care, Studies Say

A couple of recent studies contend California is not doing well with dental coverage or oral health care for underprivileged children.

One study, released last week by the Pew Center on the States, gives California a “C” grade for meeting half of the eight policy benchmarks in Pew’s analysis.

The second research project, Children’s Dental Health Study commissioned by First 5 LA, the Annenberg Foundation, The California Endowment and The California Wellness Foundation, says tooth decay among poor, young children in Los Angeles County is widespread and getting worse.

Gayle Mathe, director of policy development for the California Dental Association, said she hopes state officials will pay attention, but she acknowledges that in tight fiscal times, oral health issues are not at the top of policymakers’ lists.

“We appreciate reports like these because they shed light on problems that need to be addressed,” Mathe said. “But unfortunately, the budget situation in our state changes the way policymakers look at anything.”

State officials are wrangling with a $20 billion deficit in the state budget, a process unlikely to improve dental coverage or oral health care programs. 

“A lot of what’s happening around the state is very worrisome,” Mathe said.

California “Moving in Wrong Direction’

According to Pew researchers, California is one of five states “moving in the wrong direction” in the percentage of Medicaid-enrolled children who see a dentist each year.  About 31% of kids enrolled in Medi-Cal got dental care in 2007, down from 32% in 2000.

California fell significantly short in another measure in the Pew study, which used three and four-year-old data: only 27% of the state’s population had access to fluoridated water in 2006.

That number is considerably higher now, “well over 50%,” according to Mathe. Water systems in Los Angeles and San Diego which were not fluoridated in 2006, are now fluoridated.

“California policymakers are doing well but should do more to expand dental care to reach more children,” said Shelly Gehshan, director of the Pew Children’s Dental Campaign in a statement accompanying the study. “By enacting a handful of effective policies, California can help eliminate the long-term health and economic consequences of untreated dental disease among kids.”

Pew gave each state and the District of Columbia a grade in eight specific policies and then issued an overall grade determined by how many policies were in place and how well they were pursued.

The policies, which include fluoridated water systems and sealant programs, fall into four categories:

  • Cost-effective ways to help prevent problems from occurring in the first place;
  • Medicaid improvements that enable and motivate more dentists to treat children;
  • New work force models that expand the number of qualified dental providers; and
  • Gathering data to gauge progress and improve performance.

California is one of 20 states receiving a C grade from Pew.

Six states — Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina — got an A for meeting at least six of the eight policy benchmarks.

Nine states got Bs, six states and the District of Columbia earned a “D” grade and nine states failed by meeting only one or two of the benchmarks.

New Jersey earned the lowest grade in the country, with only one benchmark policy in place.

No state achieved a perfect score in all eight benchmarks.

Suggestions for Policy Improvements

The Pew project, “The Cost of Delay: State Dental Policies Fail One in Five Children,” indicates two-thirds of the 50 states do not have effective policies in place to ensure proper access to dental care. The study, supported by the W.K. Kellogg Foundation and the DentaQuest Foundation, suggests states make several improvements, including:

School-based sealant programs in which provide kids with a protective coating on their teeth. Sealants can prevent decay and cost about one-third as much as filling a cavity, researchers said.

Water system fluoridation, deemed one of the 10 most important public health achievements of the 20th century, according to CDC.

Adjustments in federal Medicaid policy that would encourage more dentists to treat low-income children.

3 of 4 Poor L.A. Kids Have Untreated Cavities

Urban researchers in Los Angeles found many of the same problems Pew researchers described.

“Many of the findings in the Pew study reinforce what First 5 LA has identified here in Los Angeles County,” said Conrado Bárzaga, senior program officer with First 5 LA.

“Although these statistics are disheartening, it is great to see these issues examined through a national lens. Dental cavities are largely preventable and appropriate health care policies are urgently needed to improve the health and wellbeing of our children,” Bárzaga said.

The Los Angeles area study indicates about 72% percent of children under age 5 in underserved communities have untreated cavities. That’s more than double the national average among youngsters in comparable age and income groups, according to First 5 LA officials.

“We knew there was a need, but we didn’t know the depth of the problem until now,” said Evelyn Martinez, executive director of First 5.

For the First 5 LA study, 2,313 children from low-income families were examined at 59 Los Angeles County sites. Among the findings:

  • About 1 of 5 children (21%) had no dental insurance and of those who did, almost 60% were covered by public programs in which access to care is often a problem. About 43% were covered by “Denti-Cal,” California’s Medicaid dental program, and another 14% were covered through Healthy Families;
  • About half of the 5,790 dental offices and clinics in Los Angeles County do not serve children covered by Denti-Cal. Fewer than half (44 %) treat children two years of age or younger.
  • Most parents (86%) do not follow the American Association of Pediatric Dentistry recommendation that children should see a dentist before their first birthday.

Adult Dental Care Also Waning in California

Although these two studies examined only problems with children’s oral health, adult dental care for low-income residents is also waning in California. Last summer, about 3 million poor and disabled adults lost their dental coverage when the state’s Denti-Cal program was cut in the budget process.

Under federal law, dental coverage is considered an optional benefit. States do not need to provide dental coverage to be eligible for Medicaid funding.

Related Topics

Insight Medi-Cal Public Health