UCSF Dental School Dean Answers Questions About Denti-Cal

A: Our school is one of five dental schools in California. As you would expect, our mission is to educate dentists and dental specialists of the future. But we also provide dental care to thousands of underprivileged adults and children every year.

Similar to medical students in their residency, dental students learn and refine clinical skills through supervised training with patients. In fiscal year 2007-2008, 33 percent of all UCSF dental student surgery procedures – a total of 20,292 – were performed on adult and child patients with Denti-Cal benefits.

A: We see thousands of Denti-Cal patients in our clinic on Parnassus Avenue. But it’s also important to understand that cuts to adult Denti-Cal are not just an urban issue. There are 233 communities in California that, by federal standards, have a shortage of dentists. UCSF dental students provide much-needed access to care at 21 sites throughout Northern California, many of which are funded through adult Denti-Cal. These sites are community and family care clinics and community centers that provide medical and dental care to the underserved.

During the past five years, our senior dental students provided unreimbursed treatment to almost 63,000 patients and carried out more than 72,000 procedures, for an equivalent of $6,547,417 in care delivered to underserved California residents.

A: In addition to the obvious benefits of reduced pain and suffering, healthier patients are less costly; they miss fewer days of work and make fewer trips to hospital emergency rooms. We know from the recent experience of [UCSF-affiliated] San Francisco General Hospital [SFGH], which treats many low-income patients, that the cost implications are huge.

In April 2008, mid-year San Francisco budget cuts forced SFGH to reduce clinic time in its oral surgery program from five to three days. Long wait times meant many patients could not be seen in the clinic. For a few patients who weren’t able to access the clinic for simple primary oral care, a dental cavity progressed to a life-threatening head and neck infection.

The result was a fourfold increase in hospital admissions at SFGH due to untreated dental disease, compared to the two-year period preceding the cuts. These patients easily could have been treated on an outpatient basis for an average cost of $100 for an X-ray and tooth extraction. Instead, the cost to the health care system was significantly higher, since these patients eventually went to the SFGH Emergency Department, and some were treated in the operating room and hospitalized for several days.

A: Absolutely. As Denti-Cal cuts force more clinics in San Francisco and throughout California to reduce primary dental care, this scenario will only worsen. SFGH, for example, is the only county hospital in the city, and the hospital’s oral surgery program and Emergency Department threaten to be overwhelmed with indigent patients who have nowhere else to turn.

In addition, with fewer adult Denti-Cal patients, the federally qualified health centers – which receive federal funding based on the number of patient “encounters” they handle – are in jeopardy of cutting additional medical services or closing altogether. They often are the only source of primary care for many California families, and reducing health centers’ abilities to serve underprivileged communities simply would force many adults and children to forgo early or preventive treatment until they are at their sickest.

A: The state’s pipeline of new dentists – especially those who understand the dental issues prevalent among underserved residents – is at risk. The externship program and our San Francisco clinics provide necessary, hands-on clinical training for dental students. Nearly 44 percent of all root canals and almost half of all denture procedures performed by UCSF dental students are on Denti-Cal patients.

Without this experience, many students would have difficulty completing course and graduation requirements. In addition, all our students rotate to externship sites located throughout California, and many return to those sites after graduation to meet health care needs in rural areas.

A: Helping people access primary dental care is critically important, so we will offer dentistry services to patients who had Denti-Cal benefits on a cash basis at a reduced fee level. Procedure costs will be available at the clinic. We know many patients won’t return, however, which creates a gap in our dental student training.

We recently were approved as a Delta Dental insurance provider, so I also encourage anyone with these benefits to use our clinic. It’s cost-effective, and our senior dental students are supervised and highly skilled on the latest procedures.