When connecting with a dentist doesn’t mean an office visit

Inside a South Los Angeles classroom filled with plastic dinosaurs, building blocks, stuffed animals and Dr. Seuss books, Mireya Rodriguez counts Hendryk Vaquero’s teeth and looks for cavities.

At just 4 years old, he already has nine stainless steel crowns and multiple fillings, and his gums show signs of inflammation and infection. Since a check-up more than three months ago, he’s lost a couple of teeth, including a capped tooth his mom pulled out after it started bleeding.

“Pero no llore,” said the boy, assuring Rodriguez in Spanish he didn’t cry.

This was only the second time the dental hygienist examined his teeth, many of which have rotted, in part because he is eating too many sweets and drinking milk before falling asleep. Later, a dentist at the Venice Family Clinic 16 miles away will pull up his records online and consult with Rodriguez on his case – without ever necessarily seeing the patient.

It’s all part of a free “teledentistry” program for low-income patients in California who don’t have access to regular dental care. Often they’re stymied by high costs and a shortage of dentists who treat the poor. Many also face language barriers, lack legal immigration status, are afraid of dentists or have a poor understanding of what causes dental problems.

“The only thing that they know is that they have to provide for their family and that’s the most important thing for them,” said Rodriguez, who comes to the Volunteers of America Silva Head Start program on a regular basis.

Rodriguez is among 15 specially trained hygienists and dental assistants who work online with dentists as part of a $2.5 million experiment designed to deliver preventive dental care and education to underserved populations. Funded for now by grants from nonprofits, trade associations and others, the Virtual Dental Home Demonstration Project has been launched in 50 locations throughout the state, including Pacoima, Santa Monica, San Jose, Santa Cruz, East Palo Alto, San Francisco, Sacramento and Eureka.

With special permission from the state, the hygienists and dental assistants travel from place to place performing basic procedures not in their scope of practice – for instance, deciding which X-rays to take or installing temporary fillings that help prevent early decay from progressing – then consult remotely with dentists on how to proceed. Sometimes, after doing what they can, they send a patient to a dentist’s office.
Operating at community sites ranging from schools to nursing homes, the program is meant to boost access and maximize the expertise and efficiency of the people delivering care.

The Virtual Dental Home Demonstration Project “really changes the idea of what the dental team and the dental practice is – from being confined to the four walls of a dental office to now having a team that can be spread out,” said Dr. Paul Glassman, a dentist at the University of the Pacific in San Francisco, who started the program.

A bill pending before the state Legislature would expand the Virtual Dental Home approach statewide and require Medi-Cal, the government health insurance program for the poor and disabled, to pay for procedures facilitated by the Internet.

The bill, AB 1174, passed unanimously in the Assembly. It is expected to come up for vote in the state Senate later this year and enjoys wide bipartisan support. Expanding the program statewide would increase costs minimally in the short term – by upward of $500,000 a year, according to a State Assembly’s Appropriations Committee fiscal analysis. If teledentistry takes off, the costs could be higher.

Advocates think the return on that investment could be substantial. For every dollar spent in preventive services like the ones provided through the Virtual Dental Home demonstration project, an estimated $50 is saved on more expensive, complicated procedures, said Dr. James Stephens, president of the California Dental Association.
However, some dental organizations around the country have spoken out against letting hygienists, assistants and other mid-level providers do procedures typically reserved for dentists. In Maine, dentists have fought a bill creating a special category of provider called dental therapists, who would perform some of the duties of hygienists and dentists.

This story was produced in collaboration with the Los Angeles Daily News. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

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