California’s Oral Health Picture: The Good, the Bad and the Toothy

December 24, 2015

As California is beginning to re-embrace the importance of investment into dental health, the American Dental Association, Health Policy Institute (HPI) released a fact sheet on all 50 states’ oral health care system. California’s dental profile has some good things, some bad things and some unsightly things going on in its oral health system.

The green stuff between California’s teeth (aka, the bad):

  • California’s Medi-Cal fee-for service dental services are reimbursed at only 29% of what private dental services are reimbursed.
  • Over the past 10 years (2003-2013) Medi-Cal reimbursement has been on a downward trend landing at a 31.6% decrease in reimbursements.
  • Only 29% of dentists in the State participate in Medi-Cal.
  • Although higher than the national average (14%), the percentage of children with sealants on a permanent molar is extremely low at 15%.

California is notorious for having one of the lowest Medicaid reimbursement rates in the nation for physicians and the rates are even worse for those in oral health. It is clear that due to such low reimbursement rates from the State, dental providers are reluctant to take on Medi-Cal patients. This provider shortage issue will endure and be exacerbated as more and more children are enrolled in Medi-Cal.

California’s Pearly Whites (aka, the good):

  • The percentage of Medi-Cal children that had a dental visit increased from 32% in 2000 to 45% in 2013.
  • Private plans are charging less for children and adults oral health services, from 2000 to 2013.
  • The number of dentists in California is increasing and has surpassed the national average.
  • Low-income adults in California have healthier teeth (7.7 oral health status) compared to low-income adults in the nation (7.2 oral health status).

Offering and encouraging oral health at a young age, as seen with the increase in dental visits, is a key prevention initiative and can only increase the State’s oral health profile. Dental health workforce is a limiting factor to providing needed services, and the growing number of dentists is an encouraging trend for the State.

The Toothy (aka, the unsightly):

  • California’s percentage of water fluoridation (64%) is very low where even many of the Southern states, like Kentucky, Tennessee, Georgia and Alabama, have higher percentage of fluoridated water.

Although California leads the way in many public health initiatives (think tobacco, seat belt and helmet laws); unfortunately, the push for fluoridation in public water systems is severely lacking. Fluoridation is naturally occurring in water and its benefits have been demonstrated in numerous research papers. Hopefully, with the new Dental Director, Dr. Jayanth Kumar, greater education dissemination of the positive effects of fluoridated water (tooth decay prevention, dental caries prevention (1)) will better inform Californians and lead to greater acceptance and promotion of fluoridation.

As emphasized by Dr. Kumar at last month’s policy café organized by the Community Clinic Association of Los Angeles County, one of the main priorities for California is implementing an oral health data infrastructure. Reports and systems that capture the type of information presented in the HPI’s report are a step in the right direction for California’s nascent oral health system.

For the full California Oral Health Care System fact sheet, go here.

For the full report, including national trends and other state profiles, go here.

1. CDC. (Feb 1991). Review of fluoride: Benefits and risks. Retrieved from