Schools Struggle to Provide Dental Health Safety Net

Dental disease at the intersection of school performance and health for thousands of California children

By Jane Meredith Adams, EdSource Today

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

As California educators grapple with boosting student achievement across economic lines, the teeth of poor children are holding them back.

Hundreds of thousands of children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem.

Increasingly, dental health advocates are looking to school districts to help solve the crisis. Innovative oral health care projects have been launched in school districts around the state that provide students with no-cost dental screening or treatment. Insurance companies are billed whenever possible.

Dental disease is at “epidemic” levels among California children, according to the U.S. Surgeon General, and low-income children are disproportionately affected. They are 12 times more likely to miss school because of dental problems than children from higher-income families.

“The issue is huge,” said Gordon Jackson, director of the state Department of Education’s division which oversees health, counseling and other support programs provided at schools. “Tooth decay remains one of the most chronic diseases for children and adolescents. As we’re having the conversation about California’s future and student academic achievement, we have to have a conversation about oral health as well.”

But many districts lack the resources, or balk at being asked to provide dental care on top of a rigorous curriculum.

“It’s a great idea to bring universal prevention programs of all types, including dental, to schools,” said Kimberly Uyeda, director of student medical services for the Los Angeles Unified School District. “Whether there’s enough time in the day is another question.”

Lost revenue

Still, schools have a vested interest in helping solve the problem.

Dental problems keep California students out of school an estimated 874,000 days a year, costing schools about $29.7 million in lost attendance based-funding, according to the 2007 California Health Interview Survey, conducted by researchers at UCLA.

Dental health also affects student performance. Students with toothaches were almost four times as likely to have a lower grade point average than students with healthy teeth, according to a 2012 study by the USC School of Dentistry.

Advocates say the dental health crisis is exacerbated by the failure of Medi-Cal’s dental program, called Denti-Cal, to adequately serve low-income children, lack of funding for a state school-based dental disease prevention program for low-income children, and the lack of money to enforce existing state laws requiring oral screenings and preventive care for school children.

School-based dental clinics can play a large part in the solution, given the holes in the state’s safety net. One model is to house dental care inside a school-based medical clinic. Some 61 school-based health clinics, out of about 200 in California, offer dental screening or treatment.

Outside of a school setting, finding a dentist who accepts Denti-Cal is a significant obstacle for low-income children. California’s reimbursement rates to Denti-Cal dentists are among the lowest in the nation, according to a recent report by The Children’s Partnership.

The numbers of low-income children who need care are expected to increase when the Affordable Care Act -- including its Medi-Cal expansion -- is fully implemented. Come January 1, nearly half of California’s children will be Denti-Cal patients, according to The Children’s Partnership report.

The implications are clear, advocates say. “You’ve got to bring the services to the children,” said Roseann Mulligan, with the USC School of Dentistry and one of the authors of the study regarding oral health and student achievement.

Reaching students

A number of districts are doing just that. Some of the dental services are financially self-sustaining through billing to insurers, while others rely on grants and partnerships. The goal is for all clinics to become self-sustaining.

Two days a week, inside the sleek new student health center housed at James Madison Middle School in Oakland, students spend about 50 minutes during physical education class period or the “sixth period” extra time in a baby-blue dental chair. A hygienist screens students for tooth decay, cleans teeth, and applies fluoride varnish and sealants. The clinic, which doesn’t provide fillings or other restorative dentistry, accepts dental insurance and Denti-Cal, and provides free service to the uninsured. Services are funded by the Alameda County Public Health Department and The Atlantic Philanthropies.

Another model is a mobile dental clinic. In the San Diego Unified School District, the La Maestra Mobile Health Clinic, which includes dental services, began operating in fall 2012 to provide fillings and restorative dentistry to students at the Hoover Cluster of schools: 10 elementary schools, two middle schools, and one high school in the City Heights neighborhood, an area of high need.

“What we are trying to do is make it a positive experience,” said Dorothy Zirkle, a consultant for Price Charities, a nonprofit dedicated to improving the quality of life for children in City Heights. “Our kids have a high need for multiple fillings. We need to build trust.”

All services are no-cost, with providers seeking reimbursement from insurers when possible. Among the organizations funding the facilities and services at the mobile dental clinic are La Maestra Community Health Centers, private foundations including the City Heights Partnership for Children, and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

A third model is a partnership with a nearby dental college to offer expanded services for students. In the El Monte City School District, students receive comprehensive dental care at two dental clinics housed in elementary schools, as well as from a mobile dental unit.

Advocates say these programs and others like them are key to helping solve the dental health crisis facing California students.

Data that show the connection between oral health and student achievement will help persuade districts to support school-based dental care, said Maryjane Puffer, executive director of the Los Angeles Trust for Children’s Health, a nonprofit founded to serve students in LA Unified.

“School districts are eager to find a way to help kids stay in school and achieve,” she said.

Learn more: