A national study released today by the Pew Center on the States, part of the Pew Charitable Trusts, grades every state's level of adherence to a basic preventive dental procedure for children -- the application of dental sealant. California earned a "C."
Dental sealant is vital for children, particularly for youngsters who don't get regular dental care, according to Bill Maas, policy advisor to the Pew Children's Dental Campaign.
"The most cavity-prone area is the molars, and the top surface of the teeth, and that's what sealant helps protect," Maas said. He said providing sealant is a simple way to reach a large number of at-risk children. "In places where we know there's a concentration of [at-risk] children," he said, "we can bring that to them very efficiently."
School-based programs using hygienists to apply sealant would be a way to treat a lot of children with a minimum of effort, particularly in communities with a higher percentage of lunch programs, Maas said.
"California is doing some things right. For instance, the rules about placing hygienists as being able to administer dental sealant, and being capable of operating [dental sealant] programs effectively and efficiently, that's a good step," Maas said.
The step California has failed to take, he said, is that schools with a higher concentration of at-risk kids are not getting care.
"Less than 25% of the schools that should be targeted do not have this kind of program," Maas said.
According to Jenny Kattlove, director of strategic health initiatives for The Children's Partnership, the state used to have a lot more of those programs.
"California eliminated the dental disease program in 2009," Kattlove said, "and that may have played a role in California getting such a low grade."
Kattlove said there's a state leadership vacuum on dental issues, since there is no designated chief of dental health care in California.
"So now there is no state-led assessment of children's dental health needs, or even a plan to take care of the needs of California children," Kattlove said. "You need to first identify the needs, identify the solutions and then work to address those solutions. That's not happening."
Many California children with private health care coverage don't get dental coverage, she said. And among public Medi-Cal coverage recipients, even when children have dental coverage, they don't always utilize it, for a variety of reasons, Kattlove said. For instance, when adult dental care was dropped as a Medi-Cal benefit, families stopped going to the dentist, even though children were still covered.
"So there are two issues," Kattlove said. "A large number of California children do not have coverage at all, about 1.8 million of them, where many have health coverage but not dental," she said. "And then children in public coverage are not getting the dental care they need, and there are a lot of reasons for that, and one is that the reimbursement rate for dentists is very low, close to the lowest in the nation, and in California there are some administrative barriers providers face when they're part of Medi-Cal."
The first and easiest answer, she said, is school-based dental care. "It's kind of like immunizations at this point," Kattlove said. "It's now a public health issue."
Maas said today's Pew report recommends focusing on school-based programs to apply dental sealant, that it would be a good start, he said.
"Kids do have barriers to [dental] care, but one service that we know works is the sealant," Maas said. "Parents don't need to miss work for this. It makes a lot of sense."
Kattlove said The Children's Partnership is about to release a report in two weeks with an action agenda for improving the dental health of children in California.