Report Urges Expansion of Virtual Dental Homes



The State of California’s independent Little Hoover Commission has released a report saying that Denti-Cal, the state’s Medicaid dental program, underserves its 13 million clients and alienates practitioners. Among the report’s recommendations, the agency supports the passage of AB 648, which will expand teledentistry statewide.

The University of the Pacific’s Arthur A. Dugoni School of Dentistry has been leading the charge with its Virtual Dental Home System. After a 6-year grant-funded demonstration, the program led to legislation that expanded the scope of practice for allied dental personnel and required Denti-Cal to pay for teledentistry services.

“Around two thirds of people can be kept healthy in community sites by the services provided there by dental hygienists, and most of the remaining one third who have advanced problems can be helped to get treatment in dental offices and clinics,” said Dr. Paul Glassman, professor and director of the Pacific Center for Special Care.

Dental hygienists and assistants visit schools, Head Start centers, community centers, and long-term care facilities with a portable dental chair, laptop computer, digital camera, handheld x-ray machine, and other dental equipment. Then, they conduct exams, take x-rays and pictures, create charts, and collect dental and medical histories.

Next, these personnel upload the information they gather to a secure website where a dentist can review it and prescribe a treatment plan. The hygienists and assistants also can perform preventive and early intervention procedures such as cleaning, scaling, varnishing, sealing, and interim fillings within the scope of regulations on site. Patients with more complicated needs get appointments to see the dentist in person.

The Little Hoover Commission noted that many Californians with Denti-Cal benefits struggle to find places to use them as entire counties lack providers because most dentists don’t want to participate in Denti-Cal, due to its low reimbursement rates, restrictive rules, and reliance on outdated administrative processes. Teledentistry could overcome those geographic limitations in finding care.

“The Affordable Care Act has brought hope of health coverage for millions without insurance, but the situation with Denti-Cal is only getting worse with 3 million newcomers added to a program already short of dental providers,” said commission chair Pedro Nava.

Furthermore, the report noted growing rates of tooth decay and a lack of understanding about basic preventive dental care among families. The hygienists and assistants staffing these virtual dental homes would provide education about proper care as well. The report also featured other recommendations based on input from experts including Glassman such as:

  • A Legislature-set target of 66% of children using benefits to make annual dental visits;
  • Reducing red tape at the Department of Health Care Services to make it easier for dentists to enroll in Denti-Cal;
  • The creation of an evidence-based advisory group of dental and health experts to guide Denti-Cal priorities and policy decisions;
  • The formation of a coalition including state government, major funders, and nonprofit groups to reorient the oral health-care system toward preventive care;
  • Legislature oversight of Denti-Cal’s targeted financial incentives to dentists who provide preventive care for children and encourage pilot projects that similarly use small targeted financial incentives to boost preventive care for children.

“The Commission is encouraged by a wealth of powerful emerging ideas in California and also within Denti-Cal to focus on preventative care and take services to where they are needed,” said Nava. “Fixing Denti-Cal is not about one big solution, but many, to do better by people who have benefits and need places to use them.”

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