Does California need a state dental director?

In our ongoing coverage of Sacramento County’s dental plan for poor kids, we’ve reported on proposals to fix its performance, including a measure in the Legislature that would fundamentally change the way the Medi-Cal program works there.

But there’s another, earlier bill that advocates say would have statewide impact, especially for Californians who live in places where dental treatment is difficult to access.

The measure, SB 694 by Sen. Alex Padilla, D-Los Angeles, would

-- create a statewide Office of Oral Health under the Department of Public Health,

-- create a state dental director, the position to be filled by a licensed dentist and

-- authorize a study that, well, this part is up in the air. The study, interestingly enough, is the most controversial aspect of the bill.

First, what would a state oral health office and dental director do?

“The dental director would bring programs to California’s communities that would increase access to preventive dental programs for kids, such as school sealant programs and educational programs,” said Jenny Kattlove, director of strategic health initiatives for The Children’s Partnership, which sponsored the bill.

Kattlove said California is not taking advantage of all the federal and private money available for dental programs, and a state dental director could identify and apply for those grants.

The new office and dental director wouldn’t be paid for with state general fund dollars, but “other public and private funds” such as grants from foundations, Kattlove said.

The measure, which sailed through the Senate on a 34-2 vote in January, is pending in the Assembly.

Calls for a dental director have come up frequently in the debate over Sacramento’s mandatory managed dental care program for kids. The list of those who believe the state needs one includes Sen. Bill Emmerson, R-Hemet, who practiced as an orthodontist for more than 25 years.

“It’s been difficult for me as a health care provider to watch oral health programs for children being decimated year after year in the state,” he said at a recent legislative hearing.

Now, a quick note about that study. Before recent amendments, the bill would have called for a study that examined whether expanding the dental workforce to providers other than dentists – such as “dental therapists” – could increase access to care. Dental therapists have less training than dentists, but enough to perform some dental procedures such as fillings.

Take a look at this earlier coverage to see some of the objections to that idea.   

Recent amendments have struck out some references to “nontraditional providers” and “nondentists,” but Kattlove said the language is a work in progress.

She hopes the study ultimately will look at “how providers such as dental assistants and dental hygienists with additional training can go into communities and provide dental care to children who would otherwise go without,” she said.

John Mann, Padilla’s spokesman, didn’t discuss the direction of the study except to say that the bill “would authorize a scientifically rigorous study to assess how best to meet the state’s unmet oral health need for the state’s children.”

The California Dental Association, which supported the measure through the Senate, is taking a wait-and-see approach. “CDA expects Senator Padilla to be making decisions on how to move the bill forward. Until the bill moves forward in the state Assembly, CDA does not have an active position on the bill,” said CDA spokeswoman Alicia Malaby.

But Kattlove is convinced it’s essential legislation.

“Lots of other states have dental directors,” she said. “That means that we’ve had no leadership.”



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