Introduction

California’s colorful quilt of care is stitched with compassion

Debra Belt

Copyright 2002 Journal of the California Dental Association.

Like a quilt stitched together by the compassion, talent, and creativity of those who care about the millions in California without dental insurance, a patchwork of reduced-fee, sliding-scale, and volunteer community clinics covers the state. Helping to reinforce the blanket of care provided by the clinics are mobile dental vans, local dental society foundations, community action groups, and individual dentists who volunteer to treat the underserved in their own offices and in school-based programs.

Often referred to as a "safety net" for those who have no other options for dental care, the quilt is well-pieced-together in some areas and thread-bare in others. Heavily populated areas, especially those with dental or hygiene schools in the vicinity, have the most resources. Alameda County, for instance, benefits from the University of the Pacific Dental Clinic in Union City, and can also refer patients to the University of California School of Dentistry in San Francisco, in addition to a dozen other clinics offering a range of services. However, even in an area such as Alameda County, there are reports of long waiting lists for routine dental services, especially in the Oakland area. Likewise, Orange County and Sacramento report that some clinics are heavily backlogged and at times unable to accept patients.

Other, less-populated regions such as those served by Butte-Sierra District Dental Society and the Northern California Dental Society cover large geographical areas where resources are sparse and community clinics can be counted on one hand. These two local dental societies cover 15 counties, including rural areas such as Plumas County, where there is one community clinic, and Modoc County, where there are two.

Almost every one of CDA’s 32 local dental societies reports receiving calls on a daily basis from people without dental insurance who are seeking dental care. San Francisco Dental Society has a referral hotline that receives approximately 200 calls a month, and the society itself receives about the same number of calls a month. Several local societies noted that it’s often most difficult to find services for adults, as children’s services are more available.

From Solana Beach to Eureka, Red Bluff to La Puente, and everywhere in between, dentists step up to help meet this need.

Community Clinics

The network of care threading through the state is varied. Clinic payment arrangements range from Medi-Cal, to sliding-scale fees based on income, to reduced fees, to $10 fees, to free. This issue of the Journal of the California Dental Association includes a list of community and low-cost clinics, many of which are staffed or supported by CDA dentists. To list every volunteer and every effort would take several issues of the Journal. For years, the CDA Update member newsletter has profiled the individual efforts of volunteers, and there are still hundreds of untold stories. Although each story is unique, familiar themes are evident in volunteer profiles: They begin working with whatever resources are available – a donated room in a church or school, a local fairground, or their own office space. Volunteers also work tirelessly to recruit others to help in their effort, and they inevitably succeed. And without fail, the volunteers say they are compelled to do what they do as a way of "giving back" what has graciously been bestowed upon them.

St. Leo’s Dental Clinic in Solana Beach is only one such story, but it illustrates the ongoing efforts around the state.

St. Leo’s began the way many community clinics begin – with one or two determined volunteers working in whatever donated space is available.

In the case of St. Leo’s, one dentist began providing dental care to uninsured children in a spare room at St. James Parish Hall. The year was 1995, and founder Robert Bobbitt, DDS, set up the three-chair clinic using donated equipment and took on "more patients than he knew what to do with." He had no grant funding and managed with the resources at hand: a few nondental volunteers and a lot of willpower.

Bobbitt worked for more than a year in the makeshift clinic, upgrading equipment and recruiting other volunteer dentists, hygienists, and assistants as he went along.

When St. James Church decided to refurbish Parish Hall, Bobbitt had to store the equipment and contemplate the fate of the clinic.

He began searching for a new location, and St. Leo’s Mission offered a small patch of land where a dental facility could be built adjacent to the medical clinic. Roger Kingston, DDS, a local oral surgeon and on-call volunteer from the defunct clinic, joined the effort and contacted fellow Rotary Club members about helping with the project. Soon an architect was designing a new facility and contractors, roofers, plumbers, and other skilled tradesmen joined with Rotarians, church volunteers, local dental society members, and others from the community to build a new clinic.

What they built was a handsome, tile-roof facility with space for four dental chairs and a compact lab. In 2000, Bobbitt and his small brigade of volunteers moved in and once again began providing care to uninsured children younger than 12.

Bobbitt said the clinic helps provide service to children of working-poor families who are not eligible for Denti-Cal or Healthy Families. Those who utilize the clinic are mostly Hispanic families who have numerous access hurdles including finances, lack of transportation, and communication challenges.

The clinic is staffed on Wednesday nights and Saturdays, and the volunteer force has expanded to about 10 dentists. Bobbitt is retired from private practice and serves as the clinic director.

After moving into the new facility, the clinic expanded its role and began providing dental care to adults participating in the "Welcome Home Ministry," a program assisting women and men as they are released from prison. The clinic provides basic hygiene, restorative, and removable prosthetic services as part of an overall program providing shelter, clothing, counseling, and job interview skill development.

The clinic asks for a $10 donation from those utilizing the clinic, and 95 percent of the clinic’s patients make the donation. Bobbitt noted that the fee adds a perceived value to the care provided and gives patients a sense of pride to be able to contribute to the clinic.

The clinic continues to survive on support from individuals and service clubs and recently received a $10,000 grant from the Foundation of the Pierre Fauchard Academy, an international dental honor society. The grant money will be used to replace an X-ray machine that is beyond repair and for supplies and laboratory services not donated.

The listing of clinics in this issue includes the names of many clinics with similar, noble stories: St. Raphael Sister Ann, Sonrisas, Su Salud, Dientes!, and Tzu Chi to name only a few.

Local Dental Society Foundations and Mobile Clinics

Helping to add another layer of coverage are local dental society foundations made up of dentists who volunteer their time and often their office space to help care for those in need. Local foundations range from the long-established such as the Marin County Dental Care Foundation and the Mid-Peninsula Dental Society Dental Health Foundation to the newly formed Alameda County Dental Society Dental Health Foundation. Other local dental society foundations include the Erwin N. Lebow Children’s Dental Health Foundation in Contra Costa County, Harbor Dental Health Community Services, Inc., and the Santa Barbara-Ventura Dental Care Foundation.

One of the oldest component foundations is the Mid Peninsula Dental Health Foundation, which began in 1969, founded by Alvin Janklow, DDS. The society hosts annual fundraisers and member dentists contribute money to the support the 40 or so dentists who help care for patients.

Further extending the reach of dental care are mobile dental vans that travel to underserved areas and schools. Mobile vans are operated by and in conjunction with number of different agencies including county health departments, clinics such as the Tzu Chi in Alhambra, charities such as Ronald McDonald House, and organizations such as the Health Trust in Santa Clara County.

Additional Efforts

Additionally, individual dentists throughout California step up on a daily basis to provide care and support in a number of other ways. From finding ways to secure funding for programs to teaming up for children’s dental health days and sealant clinics, dentists do more than volunteer in clinics.

A group of dentists in Tulare-Kings Dental Society this year teamed up with Tulare County Health Department’s "Adopt-a-Child" program and provided cleanings, sealants, fillings, and extractions to as many underserved children as possible on Feb. 22 for "Dentists of a Heart Day."

Six dentists in Tulare-Kings -- Amy Coeler, DDS; David Humerickhouse, DDS; Fred Buettner, DDS; Steven Kindy, DDS; Gerald Schneider, DDS; and Richard Barnes, DDS -- volunteered their time, staff and office space to provide essential dental care to children.

"The group planned to try to cover as much geographic area as possible in the two counties and is also developing treatment plans before the actual event to help make the day as productive as possible," Humerickhouse said.

In striving to make the day even more successful, Loann Van Gronigen at the Tulare County Health Department is working to provide volunteers to drive children and their guardians to the dental offices.

"This kind of teamwork helps break down the transportation barrier that is often an issue in access to care," Humerickhouse said.

In Carpinteria, volunteer dentists have been conducting screenings in schools during Children’s Dental Health Month for more than 15 years.

This year, a group of six dentists conducted screenings in the area’s elementary schools in February. Volunteering for the effort was Robert J. Berkenmeier, DDS; John E. Conti, DDS; Loren K. Churchman, DDS; John W, Marsh, DDS; Janice M. Sugiyama, DDS; and Gerald A. Malovos, DDS.

"Carpinteria is a small, contained area, so we don’t have a difficult time determining which schools to screen," Sugiyama said. "We simply go to all of the elementary schools, which is four."

The dentists spread the screening dates throughout the month and last year screened several hundred children during February.

"This is a small town, and all of us want to do what we can to help our community," Sugiyama said.

That sentiment is common throughout the state and motivates many CDA dentists to use their professional skill and compassion to help reinforce the patchwork of care in California.

Author

Debra Belt is CDA’s managing editor, which involves editing and writing for the CDA Update and editing CDA Scientific Session publications. She can be reached at debrab@cda.org.