By Ed Martinez – August 2, 2001
In March 2001, the San Diego County Children and Families Commission announced its intention to award San Diego’s Council of Community Clinics $1.5 million to develop a countywide dental safety net.
The net would be capable of servicing the oral health needs of 4,000 children under 5 years old in 15 participating clinics. The San Diego County Children and Families Commission is the legal entity charged with allocating Proposition 10/tobacco tax funds to local agencies serving these children.
Ten of the participating 15 community clinics will offer comprehensive disease prevent and treatment services (both primary and complex treatment) while five clinics will focus on disease prevention and community education services.
The Proposition 10 funding of the children’s dental safety net represents a unique opportunity to develop one of the nation’s first community-based initiatives to effectively deal with the epidemic of children’s dental disease. The epidemic so far has defied eradication by mainstream dentistry and the dental public health profession.
With the breakthrough funding and partnerships with other community organizations serving children, the community clinics have taken the lead in developing a dental safety net.
The net adds a critical component to the comprehensive health care services provided by the Council of Community Clinics to San Diego’s uninsured and underserved. Dental decay (caries) is the single most common chronic disease among children, five times more common than pediatric asthma. In San Diego County, dental disease is the most common health problem found in Child Health and Disability Prevention Program exams, and dental surgery is the second more frequent surgery performed at Children’s Hospital and Medical Center.
Like many chronic and acute health conditions, dental disease impacts high-risk communities disproportionately through poorer oral health outcomes and less access to care. Children from families with incomes below 200 percent of the federal poverty level are three times as likely to have unmet dental needs. In fact, nationally more than 75 percent of dental caries are found in just 25 percent of children.
A recent survey conducted by San Ysidro Health Center found that of 2,000 kids screened under age five, 69 percent were found to have untreated dental disease; 9 percent (176 children) had 12 or more caries.
San Diego’s communities suffer from both a lack of resources for prevention and treatment, despite remarkable consensus among experts about best practices to meet the oral health needs of our youngest children. The sad fact is that more than 19 communities in San Diego County have been designated as dental health professional “shortage areas” for their dentist-to-population ratios.
Causes for these resource shortages are numerous, including lack of providers willing to see the youngest children, lack of culturally competent providers in low-income areas, and poor reimbursement for dental public health services. For example, the Child Health Disability Prevention program in San Diego County reimburses dental providers approximately $150 per child for restorative dental care, while the average costs are double that figure.
To effectively address the area epidemic, the community clinics’ dental safety net project will emphasize early integration of prevention strategies into primary care settings throughout San Diego clinics. The program’s early intervention plan includes coordination of screening and referral systems to link children with a dental home, including the supplementation of early intervention screening programs at clinics, preschools and other community-based service programs.
Most important, the dental safety net will expand the capacity of existing clinic programs by recruiting three pediatric dentists and 15 oral health educators, as well as developing nine new dental suites in five participating community clinics.
The County of Community Clinics anticipates the project will make substantial improvements of the county’s highest-risk children during its first year. Goals established by the council include:
- A minimum of 4,000 children ages five and under will be linked with a community clinic;
- At least 2,000 children ages five and under will be provided their first dental exam;
- A minimum of 4,000 children and families will be assisted with health insurance applications.
Developing and maintaining the dental care infrastructure needed to bring about long-term improvements in oral health status is a major challenge for our community. Collectively, we must move forward with a sense of urgency to safeguard our children’s right to happy and bright smiles.
Ed Martinez is a resident of El Cajon and former CEO/President of San Ysidro Health Center