Health & Medicine

Mini-clinics may offer solution to California’s dental woes

Hygienist Jennifer Fitzpatrick does a dental exam on student Leo Preciado during a press conference at Harmon Johnson Elementary School on Aug. 2, 2016.
Hygienist Jennifer Fitzpatrick does a dental exam on student Leo Preciado during a press conference at Harmon Johnson Elementary School on Aug. 2, 2016. Courtesy of University of the Pacific

Lying in a dentist chair in a tiny room next to the cafeteria at Harmon Johnson Elementary School, 11-year-old Leonardo Preciado sat remarkably still.

Just a few months ago, getting him to go to the dentist was like pulling teeth, said his mother, Alma Negrete, a grounds worker at the school near Arden Arcade. Making an appointment for him was also a challenge because dentist offices were always overbooked, she said.

So she sought help at the small dental clinic on the school campus, where the walls are plastered with information about healthy eating and brushing habits. That room is part of the school’s “virtual dental home” program, a grant-funded service that connects Harmon Johnson students to an in-person hygienist and an off-site dentist.

“He doesn’t like to brush his teeth,” Negrete said as she watched Leonardo get a cleaning during a recent visit. “It was hard to convince him. He used to hide candy, and I’d find all the wrappers. ... But it’s less now. He’s learned how to eat healthy foods.”

About 200 Harmon Johnson students have enrolled in the virtual dental home program, which has been in place there and at 50 other schools, senior centers and long-term residential care facilities statewide since 2010. A University of the Pacific report released earlier this month backs the clinics’ model, which proponents say is an affordable way to offer much-needed dental care to low-income Californians who wouldn’t otherwise have a place to go.

With current grant funding running out for the programs, the model’s proponents are holding out for state Assembly Bill 648, which would expand virtual dental homes in areas of greatest need.

The dentists behind the University of the Pacific report have spent the past six years building dental homes – small clinical spaces where hygienists can take X-rays, clean teeth and perform minor procedures such as applying sealants and filling cavities. An off-site dentist looks later at the child’s records and decides whether the child should be taken to a full-service dental office for treatment.

The hope is that the virtual model, part of the growing field of telemedicine, will help fill a gap in dental services for people on Medi-Cal, especially children. Two-thirds of Sacramento County children didn’t receive any preventive dental care services in 2014, according to a report released earlier this year by the Medi-Cal Dental Advisory Committee.

Throughout the state, people on Medi-Cal are struggling to find dentists who will accept them. A 2014 review by the Bureau of State Audits found that five counties in California had no active dentists, while 11 counties had no dentists willing to accept new Medi-Cal patients. The problem has grown as more children have enrolled in Medi-Cal dental services, said Mayra Alvarez, president of The Children’s Partnership, a California-based child health advocacy organization.

“We have an imperative to make sure the Medi-Cal program meets the diverse needs of our California students,” she said. “The reality is, it’s not.”

Virtual dental homes such as the one at Harmon Johnson was set up with $5.5 million from the California Health Care Foundation, the California Dental Association Foundation, the California Endowment and about two dozen other groups. The money was used to purchase equipment for each site, pay dental hygienists to come a few times a week and compensate dentists and private practices who have agreed to diagnose children from afar.

The grant money also funded the University of the Pacific report, which tracked progress at sites over the past six years. It found that about two-thirds of children and half of seniors and disabled people in long-term care facilities could have their dental needs met by hygienists and dental assistants without needing to see a dentist in person.

The report also showed that 82 percent of fillings done by dental hygienists, rather than dentists, at the virtual dental homes remained intact after three months. A new California law enacted in 2015 authorized dental hygienists to treat small cavities without a dentist on site.

The study also estimated that providing care through a virtual dental home costs $41 per child in elementary schools and $31 per child in preschools.

“Dentistry has not been as active in using telehealth as some of the other aspects of general health care, but it’s a system where clearly we have the technology to make this work,” said Dr. Paul Glassman, a dental program director at the University of the Pacific and an expert in teledentistry. “This demonstration shows that it can actually work. It can connect dentists in their offices with units on site, and it makes all the difference in keeping mostly kids healthy here.”

Sammy Caiola: 916-321-1636, @SammyCaiola

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