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City addresses silent epidemic

By Steve Brown Special to the Daily Planet
Saturday December 02, 2000

This is one in a series of articles the Daily Planet will run over a year, looking at how the city is addressing the dispirit health needs of low-income minority residents.  


Many of Berkeley’s children have been struck by a silent, crippling epidemic, one that is almost entirely preventable – dental disease.  

The U.S. Department of Health and Human Services calculates that dental decay is five times more common in children than asthma and seven times more common than hay fever. Yet it goes mostly untreated, especially in vulnerable minority and low-income populations. According to reports provided by the city’s Health Department, in Berkeley, 50 to 60 percent of Child Health and Disability Prevention reporting forms list dental disease as the primary diagnosis. Low-income children were found to miss 12 times as many school days due to dental problems as their high-income neighbors. 

A primary cause of these problems, said Dr. Jared Fine, Alameda County’s Dental Health Administrator, is that health insurance isn’t really health insurance, since it doesn’t include dental care.  

“For every child without medical insurance, there are nearly three children without any dental insurance,” he said.  

He likens some current children’s dental programs to “what medical care was like before I was born.” 

Fine addressed the little-discussed public health crisis at a hearing Thursday in the Richmond City Council Chambers, hosted by the California Assembly Budget Subcommittee on Health and Human Services, where Assemblymember Dion Aroner presided. In his testimony, Fine proposed both profound restructuring of the provider-reimbursment schedules for Medi-cal and Denta-cal programs and early intervention in elementary schools to screen children, seal their teeth for protection against decay and treat them if needed. 

“The state of California’s response to this issue has been notably weak,” said Dr. Laurence Platt, the opening speaker at the hearing, which was also attended by Assemblymember Gilbert Cedillo and Assemblymember-elect Wilma Chan. The pain of tooth problems, he said, “is not a mild pain, and it is experienced by over half our schoolchildren today.” 

In his testimony, Fine explained that this epidemic is almost entirely preventable. “In dentistry, a lot of medical areas, we have some real silver bullets,” he said. “We have the tools to prevent childhood dental disease.”  

Fine is trying to put some of those tools to work in Berkeley’s schools in a proposal he authored that goes before the City Council Tuesday.  

The resolution calls for a contract with the Alameda County Public Health Department for $65,000 – already in the city’s budget – to be spent on an annual oral health program in the city’s elementary schools. 

“It is just a tremendous program because it will virtually eliminate tooth decay,” said Dr. Poki Namkung, the city’s health officer. “This program goes to schools, screens all the kids using volunteer dentists and hygenists, seals their teeth and fills them if needed.” 

Fine, who has supervised a similar program in the Oakland Unified School District started in 1991, believes that bringing dental care into schools solves many of the problems – particularly lack of transportation – that keep minority and low-income children out of the dentist’s office.  

“The schools are a non-traumatic, safe place to be,” he says. 

Other experts testifying before the committee noted that due to complex reimbursement and pre-approval requirements for Denta-cal programs, even parents of children needing dental surgery have to make appointments up to four months in advance.  

“Those kids should be in the operating room today,” said Dr. Ariane Terlet of La Clinica de la Raza in Oakland’s Fruitvale District. Some of the dentists present said they had stopped accepting poor patients on Denta-cal because of frequently missed appointments and low reimbursement rates for providers. Bringing volunteer dentists into the schools, Fine believes, could eliminate many of these hurdles and eliminate perhaps 85 percent of children’s dental health problems. 

There were some raised eyebrows among the assemblymembers during the hearing. When Terlet attributed part of the crisis to a lack of dental hygenists in California, Aroner said, “I didn’t know we have a dental hygienist shortage.” Audience members and panelists responded with a chorus of groans and vigorous nods to underscore the existence and severity of the shortage.  

Another dentist, Fred Coleman of Oakland, surprised Aroner and Cedillo by telling them that a bill they’d passed to raise provider reimbursement rates across the board had not functioned as intended. He said it raised the rates for only just a few technical procedures.