The California Dental Association is calling for increased efforts to combat tooth decay among children and resume the important progress the state was making prior to the COVID-19 pandemic.
As highlighted in a recent Los Angeles Times report, pediatric dental disease rates in California remain higher than most states, a problem worsened by the pandemic when many people delayed or skipped dental care. The report serves as a jarring reminder of the need for improvements and a recommitment to the work that was underway just prior to the pandemic’s onset.
California has made significant transformations to oral health policy in recent years to increase access to dental care. There are opportunities to continue this progress through comprehensive actions.
CDA President John Blake, DDS, issued the following statement:
This problem was decades in the making, due in large part to substantial underfunding of Medi-Cal and dental public health. In 2017, for the first time California was in the midst of several critical changes to finally reverse course:
• California voters approved Proposition 56 in November 2016, a measure CDA co-sponsored to enact a new tobacco tax that provided over $1 billion for Medi-Cal reimbursement rates, which had been among the lowest in the nation. Proposition 56 also secured student loan repayment funding for dentists in underserved areas and permanent funding for the state Office of Oral Health (OOH), which had just been established in 2015.
• In 2018, OOH adopted a 10-year State Oral Health Plan to address oral health disparities. This followed in the footsteps of an Access to Care Plan developed by CDA in 2012.
• California also obtained a Medicaid waiver from the federal government in 2016 to fund the Dental Transformation Initiative, which tested innovative models to increase preventive dental services for children (these pilot programs were successful – with a 19% increase in the number of preventive visits – and made permanent in 2022).
• The California Department of Health Care Services (DHCS) made a variety of programmatic changes making it easier for providers to participate in Medi-Cal, including streamlining provider enrollment. DHCS also launched the Smile California campaign to provide new resources and increase awareness of Medi-Cal’s improvements. CDA has been an active partner in this, continuously informing and encouraging our members to consider becoming Medi-Cal providers.
• Four California cities had recently passed taxes on sugar-sweetened beverages (SSB), providing new funding for public health and education programs (this momentum was unfortunately halted after a state law passed in 2018 prohibiting local SSB taxes for the next 12 years).
These significant steps were just underway when the pandemic began in 2020. Nevertheless, there is progress. Since 2017, the number of dentists participating in Medi-Cal has increased 30%. Untreated tooth decay in children has declined 7%, and the number of dental visits has more than doubled since 2007. OOH has implemented some key parts of the State Oral Health Plan, expanding dental sealant services and strengthening the state’s Kindergarten Oral Health Assessment program to improve data collection and link vulnerable students to dental care in their community.
This is a complex problem that will require a long-term commitment to a wide variety of solutions. This includes full funding from the state for the Office of Oral Health, in accordance with Proposition 56, and streamlining the allocations so the funds can be spent as soon as possible to continue implementation of the State Oral Health Plan. OOH’s ongoing work includes:
• Building a statewide referral system so medical providers can more easily refer patients to dentists.
• Expanding water fluoridation (just under 60% of the state’s population has fluoridated water, but this is an increase from 17% in 1995).
• Expanding children’s access to fluoride varnish application services to help prevent decay.
• Training community health workers in oral health care navigation and case management.
The state must also provide full, stable funding for Medi-Cal that protects benefits and adequate reimbursement rates. Inflation and cost increases have already eroded the value of the Proposition 56 rate increases and tobacco tax revenue is declining as expected, so long-term funding solutions are essential. As one step, CDA and a coalition of health organizations are now sponsoring a new ballot measure for the November 2024 election that would help stabilize Medi-Cal and student loan repayment funding.
It is also incumbent upon the provider community, health agencies and all stakeholders to do all we can to raise awareness of good oral health practices and the resources available to those in need. CDA will continue to be a committed partner in this work so we can get all Californians’ oral health on the right track from the earliest ages.