California Dental Association Makes Recommendations for Improving Access to Care

The California Dental Association meeting in Anaheim a few years ago

The recommendations were issued at the recent San Francisco California Dental Association meeting.

The California Dental Association (CDA) is recommending a number of ways the state can improve access to oral healthcare services for underserved populations, including new study of workforce models, appointing a state dental director, increasing fluoridation, and expanding the use of federally funded clinics.

The CDA also advocates re-establishing adult dental benefits in Medi-Cal, noting that some 8 million Californians will be older than age 65 by 2030.

During a session at the recent CDA fall conference in San Francisco, dental practitioners were encouraged to take a more active role to help shape national and local oral healthcare policies.

"The future of dentistry should be shaped by those who practice it," said CDA Vice President Lindsey Robinson, DDS, during a presentation outlining the CDA's recommendations. "Proposals coming from outside the profession do not value the same things that dentists value."

As a critical first step, the CDA is emphasizing the importance of getting a state dental director who could help secure funding for programs that would increase access to care.

The association would also like to see the state appoint a task force for "an immediate investigation" into various workforce models to determine the safety, quality, cost-effectiveness, and patient satisfaction of irreversible dental procedures performed by nontraditional providers.

That recommendation is based on CDA-commissioned research on midlevel providers conducted by the New York University College of Dentistry. That study will be published in January, according to the CDA.

Prior studies of midlevel providers were "inadequate to analyze the issue," said Dr. Robinson, a pediatric dentist from Grass Valley , CA.

"The researchers reported that, while there is ample evidence to conclude that nondentists with appropriate training are capable of providing safe and high-quality reversible services (such as sealants), there are no studies -- and I'll repeat that, no studies -- with a sufficient level of evidence to demonstrate the safety, quality, and patient satisfaction of irreversible procedures performed by nondentists," she said.

Existing studies are deficient because of their methodology or sample size, she added.

Future research should consider defined public health settings, multiple models of dentist supervision, various pathways of education and training, and different provider models, including dentists and nondentists, Dr. Robinson said.

Legislation has already been introduced in California with the intent of expanding the dental workforce, she noted. The state senate is considering a bill (SB 694) to investigate the dental care needs of Californians.

"We need to be able to deliver the solid, research-based facts to introduce our workforce proposals and to creditably react to those proposed by others," Dr. Robinson said.

Expanding the capacity of federally qualified health centers is also needed, according to the CDA. Dentists could be paid for a predetermined amount of time or a set number of patients, according to the proposal. Such an arrangement would allow dentists to provide care for the underserved without the paperwork burdens of Medi-Cal.

The California Dental Association leaders do not live in the real world.

The State of California is bankrupt and paying for another bureaucrat in Sacramento is not going to solve the dental disease crisis.

California's access to care problem is driven by the business recession and the lack of dental insurance paid by employers. No jobs, no dental care. Plus, California businesses are waiting for ObamaCare and its mandates to either be constitutional or not. These costs will drive whether companies can afford dental insurance for their adult employees.

There is also a problem with the large illegal immigrant population in the state. While they are not eligible for state supported care, they remain here and their children are. Their children are eligible for state Denti-Cal.

I don't see any support mentioned for the regular private practice dentist and his or her role in this access to care crisis. It seems to me the CDA is failing the very professionals who pay the dues that support the organization.

Not a good move, if the California Dental Association wants to maintain any sense of credibility.

I would suggest the CDA House of Delegates in November send this series of recommendations back to a committee and start talking to its members.