Opinion: Dental Care is Health Care and All Children Deserve Access

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In California, more than 50 percent of kindergartners have experienced tooth decay, and over 25 percent have untreated tooth decay. Dental problems not only affect a child’s ability to eat, smile and play, but also impact their ability to learn—children growing up in low-income communities are 12 times more likely to miss school as a result of a dental issue than their peers.

When it comes to dental care, California is not serving vulnerable kids and families well. As a state, we need to commit to enacting solutions that will provide all children with better access to high-quality dental care.

Katie Andrew

Children’s oral health is suffering partly because the medical and dental care systems are fractured and siloed. Only 48 percent of children and young adults (birth to age 20) insured by Medi-Cal had a dental visit during the 2018 calendar year, as compared to more than 84 percent of children (ages 1 to 19) who had a visit with a physician, according to state data.

The disconnect between the number of children visiting the dentist as compared to the number of children visiting a physician not only highlights how the system fails to recognize the intrinsic and critical connection between oral health and overall health, but it also represents a missed opportunity for the two providers to work in collaboration with one another to screen, educate and refer children to appropriate care.

In the first five years of children’s lives, they will see a physician a minimum of 14 times, according to the American Academy of Pediatrics. Families view physicians as consistent and trusted health messengers.

Physicians are charged with performing a wide array of screenings and preventive services, which includes oral health care. The American Academy of Pediatrics and Bright Futures Recommendations for Preventive Pediatric Health Care states physicians should address oral health with their child patients and families, including referring a child to dental care, and applying fluoride varnish. However, physicians have a lot to tackle during a 15-minute well-child exam, often leaving oral health as a lower priority.

Medical-dental integration is the solution to the fragmentation in our health care system. That is exactly what a pilot in Sacramento County is aiming to do. Through Sacramento County Public Health’s Dental Transformation Initiative program, Every Smile Counts!, the Med-Dental Pilot is giving medical providers the tools they need to make a robust referral to a child’s assigned dentist, and taking the onus off of the physician by integrating a dental hygienist into the medical team. Based on a model in Colorado, the hygienist is placed within the physician’s office to serve as an oral health resource to the children, their families and the rest of the medical team, while also providing oral health education, preventive services and serving as a liaison to the dentist.

The integration of hygienists into physician offices launched this month in Sacramento County and progress is being monitored closely. This innovative systems-change meets children and families where they are: in physicians’ offices.

Based on the success of similar efforts in other states, we are hopeful that the Sacramento program will see results. However, with the pilot set to end this December, it’s crucial that we make this practice sustainable. It should be part of the norm and fully incorporated into our health care system.

Gov. Gavin Newsom’s proposed 2020-21 budget outlines a multi-year plan, Healthier California For All (also referred to as California Advancing and Innovating Medi-Cal, or CalAIM), that aims to restructure Medi-Cal entirely, and includes an emphasis on integration of services. Oral health is critical to a child’s overall health and future health outcomes, so as the state considers how to better integrate care, oral health cannot be ignored. Rather, it must be a key component of the plan.

Oral health is essential to the overall health of our kids. We know this work is hard—systems and the people within them do not always embrace change—but nothing worthwhile is ever easy. The health of our kids is worth fighting for.

Katie Andrew is the senior associate for oral health at Children Now.

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