Extracting and Treating Los Angeles’ Dental Crisis at its Root

Contributed by Dr. Maritza Cabezas, Oral Health Program Director at Los Angeles County Department of Public Health

Los Angeles, CA – Each year, thousands of those living in Los Angeles County wait eagerly to see a dentist at Care Harbor, an annual free clinic. Despite major strides in health coverage, why do many Californians continue to depend on free clinics for dental services? On Friday, May 4^th, 2018, Dr. Maritza Cabezas, Dental Director of the Los Angeles County Department of Public Health’s Oral Health Program (whose mission is to plan, implement, and coordinate all public health interventions that will prevent diseases of the oral cavity in LA County residents) addressed this conundrum with findings from a study of Care Harbor dental patients at CCALAC’s Policy Café entitled, Waiting in Pain: Getting to the Root of LA’s Dental Crisis.

The dental patient survey, conducted at last year’s November Care Harbor event, examined how predictors, such as demographics and patients’ personal experience, may influence access to and delivery of dental health care services. The following are key observations and conclusions from the survey results:

• Approximately 2,200 Los Angeles residents attended Care Harbor 2017, and about half of those in attendance received dental exams.
• There were 810 survey respondents: almost two-thirds were male, and respondents were primarily Hispanic.
• Out of the almost 300 patients surveyed who had Medi-Cal, over 60% of these attendees did not know they had dental insurance.
• Almost 70% of the total respondents said they needed dental care in the past year but did not receive it primarily because they could not afford it, and secondary and tertiary reasons were because they did not have dental insurance or that their insurance did not cover dental services.
• Most respondents lived in dental deserts, areas with high population density, low-income, and with no or insufficient dental services.

In addition, an assessment of the role of safety net clinics in LA County after implementation of the ACA, looking at Countywide data and funded by LA Care Health Plan to benefit low-income and uninsured residents of Los Angeles County – found that dental encounters in Los Angeles County had increased from 2012 (308,908) to 2015 (437,514). But, the report states that “nearly two-fifths of adult residents report not seeing a dentist or going to a dental clinic within the past year…For children ages 0-17, roughly 1 in 10 did not access dental care in the last year due to financial reasons.”

Dr. Cabezas and the Oral Health Program team will address the implications of these findings through the first Los Angeles County Oral Health Improvement Plan, which is being established to thoughtfully respond to the dental needs of Angelenos. It is clear from the results of the survey that there is a need to work closely with local agencies to assist vulnerable clients with establishing dental homes (the ongoing relationship between a dentist and a patient to provide comprehensive, continuously accessible, effective care), and to partner with Medi-Cal to diligently educate patients that they also have Denti-Cal.

Along with establishing these partnerships, Dr. Cabezas plans to team up with Care Harbor to emphasize the need for dental follow-ups and referrals, and enrollment into coverage. Her program will conduct further research with a more detailed survey regarding the types of coverage attendees have during the Care Harbor 2018 event later this Fall.

There is a light at the end of the tunnel in eradicating the dental desert dilemma and shortening the dental patient queues at Care Harbor and other similar free clinic events, particularly given the recent restoration of dental coverage through Medi-Cal. With focused and expansively collaborative efforts, Dr. Cabezas intends to extract and treat Los Angeles’ dental crisis at its root.