Treating an elderly dental patient
A patient is treated at the Gary and Mary West Senior Dental Center. Courtesy of the center

By Karen Becerra

Despite sometimes crippling pain, “Tom,” a Denti-Cal recipient in downtown San Diego, had not seen a dentist in many years. Tom is a low-income senior who has diabetes, chronic obstructive pulmonary disease, asthma, hypertension, depression, anxiety and chronic back pain from lumbar stenosis.

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Lack of accessibility to dentists who accept Denti-Cal and high costs associated with Tom’s needs as a special care dental patient resulted in numerous decayed and unrestorable teeth. He required eight extractions, several fillings, a lower partial denture and a full upper denture to replace his missing teeth.

I treated Tom even though it wasn’t easy. The process involved several medical consultations and considerable time helping him understand and consent to the proposed treatment plan. Once treatment began, it was challenging to get Tom properly seated due to his chronic back pain. He frequently coughed, struggled to breathe and required many breaks during treatment.

Karen Becerra
Dr. Karen Becerra

Ultimately, it took nine lengthy appointments to complete all of his dental work. Many appointments had to be canceled due to issues with high blood pressure and anxiety.

Tom has now completed his treatment, he can eat a healthy diet, is free of oral pain for the first time in many years, and more importantly his physical and mental health and well-being have vastly improved.

As CEO and dental director of the nonprofit Gary and Mary West Senior Dental Center downtown and also as a Denti-Cal provider, I repeatedly see our dental system fail low-income individuals, particularly those with special care needs like Tom. Issues with accessibility and affordability are key reasons why only 44 percent of children enrolled in the Denti-Cal program saw a dentist in 2013, and why only 26 percent of eligible adults with Denti-Cal coverage saw a dentist in 2014.

According to the Department of Health Care Services, seven of the state’s 58 counties have just one Denti-Cal participating dentist—and in 13 counties, there are no participating dentists at all.

So why do so few dentists accept Denti-Cal? Many of my colleagues state the reason they are not Denti-Cal providers is due to low reimbursement rates and the exhaustive process required for reimbursement. Basically, the “hassle factor” is the answer.

Legislation is pending in Sacramento that takes an important first step toward fixing Denti-Cal by addressing its most urgent problem: care for patients with special needs. Introduced by State Senator Scott Wiener, Senate Bill 1464 will develop a mechanism for the Department of Health Care Services to provide additional funding to reimburse providers for their extra time and resources necessary to provide the appropriate level of care for patients with special needs.

I urge you to call your state senator and assembly member in Sacramento and encourage them to take immediate action. Tell them it is critical that we fix and strengthen Denti-Cal to protect vulnerable seniors and improve their lives.

California faces an epidemic of dental disease in which thousands of Denti-Cal recipients have mouthfuls of cavities, are plagued with tooth pain and are at high risk of permanent tooth loss. Entire counties have no Denti-Cal providers and many families don’t understand basic preventative dental care. Poor dental health affects overall health, causing people to get sick, which drives up health costs.

I can afford to treat complex cases like Tom’s because the Gary and Mary West Senior Dental Center is a nonprofit community clinic that receives philanthropic support, allowing us to absorb the financial losses incurred when treating Denti-Cal patients. Other dental providers are not so fortunate.

It’s time for bureaucracy to stop handicapping dental professionals. It’s time for patients like Tom to be able to count on access to affordable, high-quality dental care. SB 1464 will bring Denti-Cal closer to fulfilling its promise to all Californians. Please call your state senator today.

Dr. Karen Becerra is the CEO and dental director of the nonprofit Gary and Mary West Senior Dental Center in downtown San Diego.