By Eileen Espejo

Smiling. Eating. Talking.

These are all things that we do with our mouths, and more specifically, with our teeth. When our mouths are in pain, the impact is far reaching. As adults, we can find ways to adapt or work through the pain, despite our better judgement. But when it comes to children, the situation can be much worse. It is more difficult for kids to push through oral health issues, and they should not have to. When a child is in pain, that pain not only affects her ability to smile, and talk, and eat; it hinders her from learning, playing, feeling good about herself, and being a kid.

This is why oral health care is so critical for children.

And yet, oral health care doesn’t get the attention it deserves, particularly when it comes to prevention. Only 50 percent of children on Denti-Cal receive annual dental visits, and California has the second worst rate in the nation when it comes to oral health problems for elementary-aged children. While well-child visits and vaccination recommendations are adhered to consistently, necessary dental check-ups are often overlooked.

Why is regular dental care – which is crucial to preventing, diagnosing and treating chronic diseases such as childhood cavities – not standard practice for all kids?

The answer is complicated, but can be broken down into two basic issues: education and access.

Education, or in this case, a lack thereof, is a large part of the problem. Many parents and caregivers are provided with misinformation about the importance of their child’s oral health or may be unaware of what it is their kids need when it comes to oral health. And pediatricians, who should include mouth/tooth checks during well-child visits and can administer fluoride treatments, are often unaware that this falls within their scope of services or lack the sufficient training and capacity to include preventive dental services into their clinical practice.

Local health jurisdictions play an important role in improving education for parents, caregivers, and service providers. At Children Now, we’re working with local health jurisdictions – that have been creating countywide oral health strategic plans – in order to raise awareness about existing policies and programs that are available to ensure children and families can access oral health services. We serve on several county workgroups that are implementing plans to increase access to oral health services via education to stakeholders or by integrating dental care into medical sites. For example, we highlight how health plans that serve children and families enrolled in Medicaid are required to provide certain dental services and referrals, and encourage local health departments to meet with health plan representatives to engage participation on the oral health plan.

In order to strengthen the link between parents and caregivers, pediatricians, and dental providers, Children Now also successfully launched a medical-dental pilot program in Los Angeles County through which pediatricians connected patients under 5 who had not received a dental check-up to a local dentist. This pilot was developed after learning that 1) there was interest among dental plans and medical plans to increase dental utilization among younger children; and 2) these plans and the State were able to determine a way to share data with pediatricians about children who had not had a dental visit. By doing so, when a child visited her pediatrician, the office could educate and share resources with her parent or caregiver so that she is taken to a dental provider.

The second issue is one of access: California, like many states, does not have enough dentists who accept people enrolled in public assistance programs like Medicaid, and, even among those that do, they are unwilling to take on young children as patients. Therefore, Children Now is pursuing several strategies to increase access to oral health care for all children in California, but especially for those who are most vulnerable and at-risk.

One way in which Children Now seeks to increase access to care is by ensuring adequate collection and reporting of data, so that we are better informed about the prevalence of dental disease. Established in 2006, the Kindergarten Oral Health Assessment (KOHA) is a requirement – to provide proof of an oral health assessment – for children entering the public school system in kindergarten or 1^st grade. KOHA is a focal point in the establishment of a more robust state oral health surveillance system and in facilitating the linkage of young children to dental care. To that end, we are working with local health and education partners in multiple counties, as well as the State Dental Director and the Superintendent of Public Schools, in order to improve the collection and reporting of KOHA.

For this work, Children Now has developed and distributed 13 county profiles, including Amador, San Joaquin, San Francisco, and Los Angeles, that track dental performance indicators and KOHA. These profiles are being used by local stakeholders to see how kids in their counties are faring when it comes to oral health and to determine how best to leverage existing agencies and programs.

In San Joaquin County, for example, local stakeholders are using the data profiles to inform their work to improve oral health outcomes for children, and more specifically, to find ways to recruit and engage stakeholders to learn about and participate in existing initiatives, such as the Dental Transformation Initiative (DTI). San Joaquin is one of several counties that received an award through DTI to conduct a local dental pilot to improve dental utilization among children enrolled in Medi-Cal.

“We love the data that Children Now provides on oral health. Well, perhaps not love, as the data showed our great unmet needs in our community regarding oral health. We were able to use that data in our proposal for the Dental Transformation Initiative. We now have that funding, and are working on having local data that we can really love. We are incredibly grateful for the county profile that allowed us to tell this important story. And a bonus, Children Now worked with us to make sure the data was helpful and meaningful to us, and assisted us in getting additional data.”
—Lani Schiff-Ross, Executive Director, First 5 San Joaquin

While we still have a long way to go, we are making some progress. Since 2016, the number of dentists providing preventative care services to children on Denti-Cal has increased more than 7 percent, and the number of individual services provided has increased by 14.8 percent.¹ We look forward to growing these numbers this year, and ultimately ensuring that all children have access to quality oral health care.

If you’re interested in reviewing the current county oral health profiles, you can access them using the links below. We’ll update this page as new profiles are completed and available.

Eileen Espejo leads the organization’s efforts to improve oral health care quality and access for children in California. This work has included leading a medical-dental collaboration project in Los Angeles County to increase dental utilization among children under age 6 enrolled in Medi-Cal, and helping the state implement a pediatric oral health action plan as called for by the Centers for Medicare & Medicaid Services. These projects are now being scaled through the Perinatal Infant Oral Health Quality Improvement Project on which Ms. Espejo serves as an advisory member, as well as in Sacramento County. Due to these projects and other advocacy Ms. Espejo has supported, she serves in several capacities as a leader in local health departments’ oral health strategic plans. She is a leader or member of many coalitions, including:

– Advisory Member, California Oral Health Strategic Planning Committee

– Advisory Member, Perinatal Oral Health Quality Improvement Project

– Chair, Alameda County Oral Health Committee

– Advisory Member, Alameda County Local Oral Health Plan

– Co-Chair, San Mateo County Children’s Oral Health Workgroup

– Advisory Member, Los Angeles County Local Oral Health Plan

– OH2020 Network, National Oral Health Connection Team and Western Region Oral Health Connection Team Leader

Prior to joining Children Now, Ms. Espejo was Director of Youth Governance at the Youth Leadership Institute and a Legislative Affairs Associate for the Corporation for National Service. She is an alumna of the University of California, Davis and the Coro Fellows Program in Public Affairs.