In 2018, the El Dorado County Public Health Division completed an oral health needs assessment and established a four-year plan to increase access to dental care in its community of roughly 189,000 in the Sierra Nevada foothills.
Cassandra Krupansky, DDS, MS, was a pediatric dentist from a private practice in Roseville, California, when she read the assessment and saw the immense dental needs of her neighbors in Placerville.
Partnering with other dentists, Dr. Krupansky started working with El Dorado Community Health Centers, a Federally Qualified Health Center in El Dorado County. EDCHC was already providing whole-person-centered care in Cameron Park and Placerville, but the need in the area was great and unmet with too many patients lacking access to care.
Krupansky and the EDCHC dental team saw patients who had never seen a dentist or had rampant cavities, cysts, abscesses and dental needs so severe she had to refer them to specialty clinics such as the University of California, San Francisco School of Dentistry.
Still, despite EDCHC’s significant work to begin meeting the dental needs of El Dorado County’s West Slope residents, South Lake Tahoe remained a challenge with a critical shortage of dentists accepting low-income and Medi-Cal patients. Between 2024 and 2025, the Placerville Dental Clinic saw over 500 patients from the Tahoe area who drove up to two hours over 2000 times for appointments during that period.
El Dorado Community Health Centers, in collaboration with El Dorado County’s oral health program and local Medi-Cal plan Mountain Valley Health Plan, recognized the magnitude of the problem and made the decision that South Lake Tahoe needed a dental home. And it got one. In October 2025, all three organizations partnered to open the South Lake Tahoe Dental Clinic of EDCHC — the first of its kind in this area.
Connecting rural communities to oral health care
The clinic had more than 600 patient visits in its first two months and continues to have a full schedule.
“Here we have a community with a clear health need, and local government, health plans and community clinics came together to solve that problem,” says Caleb Sandford, CEO of El Dorado Community Health Centers. “If any one of our groups was not here, this clinic wouldn’t be open today.”
EDCHC’s South Lake Tahoe clinic has five dental chairs and plans to install two more as its staff grows. However, recruitment of dental assistants is difficult in the small rural area, and the clinic faces challenges in finding enough staff to meet the needs of the community.
EDCHC Placerville previously launched an in-house trainee program using CDA’s DA Training Curriculum and was able to hire its first dental assistant using CDA’s dental assistant training resources. They plan to expand the program to train additional dental assistants to help meet the needs of the Tahoe community as well.
“Hiring dental assistants is a challenge, but CDA’s roadmap helped us offer an education pathway for a local community member interested in joining the dental profession,” Krupansky says.
The EDCHC program continues to support local community members and dentists working in rural communities. Two of their clinic dentists in South Lake Tahoe and Placerville are National Health Service Core Scholars. NHSC is a program that forgives the awardees’ dental school loans after they complete four years of service at an FQHC. Programs that support early-career dentists alleviate the burden of educational debt so they can focus on serving rural and other communities with dire dental needs.
Krupansky shares, “I have been here since 2022, and this county’s public health system goes above and beyond to connect community members to care. I am seeing fewer cavities in kids now than when I first started, which is a testament to the work of the oral health program instilling value for oral health from a young age. As a pediatric dentist, I am now seeing more kids come to the clinic before they go to an emergency department.”
Every year in California, there are over 50,000 dental visits to the emergency department for nontraumatic dental conditions. These visits negatively impact the teeth or supporting structures and include tooth decay, abscesses, dental caries and infection that are better treated by a dental professional than in an emergency department.
Implementing children’s oral health assessments
The El Dorado County oral health program, funded largely through Proposition 56 tobacco tax revenue, focuses on preventive care and community building to reduce the high oral health needs of the population it serves.
The program in 2024 began implementing California’s Kindergarten Oral Health Assessment for capturing the dental needs of children entering public school across the state. Since then, the number of schools completing the required oral health assessments has increased from six to 19 schools. Some schools require active consent, which requires clear approval by the parents/guardians to complete the assessment, while other schools use passive consent, which allows students to complete assessments unless they opt-out. These efforts also revealed that schools using passive consent for school-based KOHA screenings have a 70%-95% completion rate, while schools with active consent have approximately 10%-15% completion.
The local health department staff hope this data encourages more school districts to implement passive consent for KOHA. The clinic’s approach is a team effort with the RDHAP conducting screenings, and the program assistant and health program specialist educating kids about oral hygiene and integrating oral health into the school’s curriculum. The El Dorado County local oral health program also works with Alpine County to reach 54-60 students across all grade levels.
Reducing patients’ travel time from two hours to 20 minutes
With the South Lake Tahoe clinic now open, students in the city and adjacent cities are now about a 20-minute drive from dental care rather than two hours.
“We have a lot of oral health champions in our county,” says Andrea K. Lindner Jones, health education coordinator/project director at El Dorado County. “Not one Head Start/Early Head Start teacher said no to our program coming into schools to educate students about oral health. Not one school said no to having dental staff from the El Dorado Community Health Center conduct oral health screenings during annual Pumpkin Patch social. They worked with us to get the system set up with the same goal of removing barriers to oral health care in our community.”
