Ken Carlson

County Pulse: Medi-Cal plan launches oral health effort in Stanislaus, San Joaquin

According to health experts, many low-income children in the Central Valley are not getting those early visits to the dentist and there’s growing concern the results are devastating.

During that first visit for a year-old child, parents are counseled on good oral hygiene for their kids. They learn the benefits of fluoride treatments and to avoid habits that promote tooth decay in youngsters.

Parents may not know that cavities are caused by bacteria, which are transmitted from mother to child unless precautions are taken.

Local dental clinics continue to see 3- or 4-year-old children with rampant tooth decay. It puts the kids in danger of painful abscesses or even blood infections that will send them to the hospital for lifesaving treatment. Children distracted by toothaches generally don’t fare well in school.

Health Plan of San Joaquin, a managed-care plan for Medi-Cal recipients in Stanislaus and San Joaquin counties, has launched an initiative called “Oral Health for Children Starts at Birth.”

The plan based in French Camp wants to try tackling the public health issue from the prevention side. For starters, it is boosting the reimbursement for pediatricians and nurse practitioners in its network to provide fluoride varnish treatments for children up to 6 years old.

While many low-income kids are not getting dental care, young children may have nine visits with a pediatrician before first seeing a dentist. The varnish treatments are easily done in a pediatrician’s exam room and can be handled by nurses or medical assistants, said Dr. Lakshmi Dhanvanthari, chief medical officer of Health Plan of San Joaquin.

The plan also is expanding the pharmacy benefit for families, allowing them a 100-day supply of fluoride drops and tablets. Experience shows use of the drops or tablets declines if parents have to get monthly refills from the drugstore.

The oral health initiative includes an education and public awareness component. In addition, “lunch and learn” presentations are being held for physicians and other clinicians in the HPSJ network.

Dhanvanthari said the health plan, with 152,000 children in its two-county network, has an opportunity to make a difference, even though none of the providers in the network are dentists. Medi-Cal dental benefits were carved out of the medical managed-care system and are administered by a state agency.

“Prevention is the first step we need to take to improving the oral health of children in the community, so that is how we are approaching it,” Dhanvanthari said.

Health Plan of San Joaquin has been locked in a dispute with dental surgery centers, where many young children with rampant tooth decay end up. There is apparently enough severe caries among kids in the Northern San Joaquin Valley to keep three of those surgery centers operating full time – in Salida, Stockton and Atwater.

More than a year ago, the health plan stopped routinely paying the centers for administering general anesthesia, which is used to put the kids to sleep while dentists fix more than a dozen cavities or extract decayed teeth. It’s considered the more compassionate way to treat children 7 years old and younger who can’t sit still in a dental chair or would be traumatized by extensive drilling.

HPSJ has cited the national concerns about general anesthesia for young children and its effects on the developing brain. Following studies that suggested a link between anesthesia and learning disabilities, the Food and Drug Administration is reviewing the use of anesthesia in young children. No one has said that children shouldn’t have surgery, but the consensus, as described at, is that more studies on the possible link with learning disabilities are needed and perhaps safer ways developed for administering anesthesia to children who need surgery.

Dr. Michael Cadra, an oral and maxillofacial surgeon in Modesto, said he believes that anesthesia is safely administered to kids at facilities such as Children’s Dental Surgery Center in Stockton. He has long advocated for a broader education campaign to prevent caries in Stanislaus County children.

“I applaud them for going after the prevention angle,” Cadra said. “There is more dental disease now than ever before.”

Cadra said that for decades California went without a state dental director to lead public initiatives on oral health. After Gov. Jerry Brown appointed Jayanth Kumar to the post in June, Cadra was among 30 professionals who heard a presentation by the new director. “I told him Stanislaus County is probably going to be in the top five counties that need assistance,” Cadra said.

Cadra points to illiteracy as a primary reason for oral health problems. As stated by the Stanislaus Literacy Center, more than 100,000 adults in the county “have difficulty using an ATM machine or reading a bus schedule.”

Dr. Maggie Park, children services medical director for San Joaquin County, presented some data at Thursday’s lunch-and-learn in French Camp. The California Smile survey found that 28 percent of children in kindergarten and third grade have untreated tooth decay.

In 2005, the Dental Health Foundation, which surveyed 186 elementary schools, discovered that 4 percent of schoolchildren needed urgent dental care and were sitting in the classroom in pain.


Health Plan of San Joaquin was able to renew a contract that allows its participants to see Sutter Gould Medical Foundation physicians.

When negotiations stalled in October, more than 7,000 Medi-Cal recipients were faced with finding new health care providers. A previous contract between Health Plan of San Joaquin and Sutter Gould expired Oct. 31.

David Hurst, vice president of external affairs for HPSJ, said the health plan and Sutter Gould made concessions on their proposals “to arrive at an outcome that minimized disruption for our members.”

Sutter Gould said Thursday it is pleased to continue to provide care for the patients.

Medi-Cal is the state and federal health program for low-income mothers and children and for single adults who gained eligibility under the Affordable Care Act. Under the state’s managed-care model, Stanislaus County participants have a choice of two Medi-Cal plans: Health Plan of San Joaquin and Health Net.

Ken Carlson: 209-578-2321