April 6, 2016
A bipartisan independent oversight agency spotlights growing concern for California’s Denti-Cal system in a new report criticizing how care is being provided to low-income adults and children.
California’s Little Hoover Commission recently released “Fixing Denti-Cal”, a report on California’s Dental Medicaid program. Included in the 11 recommendations in the report is a specific recommendation to fund a statewide expansion of teledentistry and the Virtual Dental Home system.
The Virtual Dental Home system was developed by the Pacific Center for Special Care at University of the Pacific’s Arthur A Dugoni School of Dentistry. A six-year grant-funded demonstration of the Virtual Dental Home system resulted in legislation that expanded the scope of practice of allied dental personnel and required Denti-Cal to pay for services provided using store-and-forward teledentistry.
The report also quoted and included a number of recommendations proposed by Dr. Paul Glassman, professor of dental practice and director of the Pacific Center for Special Care.
Dr. Glassman testified to the Commission in November 2015 on the Virtual Dental Home system, describing how it takes dental hygienists and dental assistants out of the office and into the field to examine people where they are — in schools, Head Start centers, community centers and long-term care centers. Dental assistants under the supervision of a distant dentist arrive with a portable dental chair, laptop computer, digital camera and hand-held X-ray machine to do exams, take X-rays and pictures, create dental charts and collect dental and medical histories. They upload the information gathered to a secure website, where a dentist can review it and prescribe a treatment plan. Dental assistants and hygienists can perform preventive and early intervention procedures in the community site to the extent allowed in their scope of practice. These procedures include cleaning and scaling, applying fluoride varnish, dental sealants, interim fillings, and providing education about prevention. For more complicated work they help patients make an appointment with the dentist who created the treatment plan to complete more complicated care.
As Dr. Glassman explained to the Commission, “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.”
Formally known as the Milton Marks “Little Hoover” Commission on California State Government Organization and Economy, the Little Hoover Commission was established in 1962. The Commission’s mission is to investigate state government operations and produce reports, recommendations and legislative proposals to promote efficiency, economy and improved service.