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Pacific paves way for hygienists to fill holes in California’s Denti-Cal program

Jul 24, 2015

Nicolette Moultrie, a dental hygienist who sees 1,700 children a year at Head Start preschools in Northern California, often has to spend six hours or more on the phone to line up a dentist when she encounters a child who requires urgent dental care.

Now she’ll be able to treat many cavities on the spot, in telehealth consultation with a dentist, thanks to the work of the Pacific Center for Special Care at University of the Pacific’s Arthur A. Dugoni School of Dentistry in San Francisco.

Nabeel Cajee, a 2015 graduate of Pacific's Arthur A. Dugoni School of Dentistry, talks about how Pacific research is transforming access to dental care.

"It's amazing," says Moultrie, chair of the Dental Assisting Department at Diablo Valley College, which has campuses in Pleasant Hill and San Ramon. "California is on the cutting edge."

Moultrie is among the first 14 dental hygienists in the state trained to apply ITRs, or interim therapeutic restorations, outside a research study. ITRs require no drilling or anesthesia, arrest tooth decay, and can delay the need for a traditional filling for several years or more.

The training, offered for the first time in California this summer at University of the Pacific's Stockton campus, was made possible by a new teledentistry law informed by the work of Paul Glassman, a professor of dentistry and director of University of the Pacific’s Center for Special Care. 

The teledentistry law, which took effect in January, authorizes hygienists to become certified to decide which dental x-rays to take before a new patient sees a dentist. It also empowers hygienists to apply ITRs in consultation with a dentist over the Internet. 

Hygienists participated in the Stockton training along with the dentists from their programs who will evaluate x-rays remotely and make the calls about which teeth can be treated in a community setting. 

The goal of the teledentistry law is to increase access to dental care for patients who lack the resources or ability to visit a dentist. 

Right now University of the Pacific is the only institution authorized to provide the training required for certification. But Glassman hopes others will follow.

"The idea is to train the trainers who will go out and train others, and bring this model of care to underserved patients throughout California," Glassman said. 

The first training workshop drew hygienist-dentist teams from 14 dental hygiene programs from around the state. In addition to the two-day workshop, hygienists must complete an online training and practice in a lab using dental models. Certification requires 30 hours of training altogether.

As part of the June 26-27 workshop, hygienists provided free care to about 80 Stockton-area patients who had been referred from health fairs. 

One patient, Mary Gordon of Stockton, said the last time she saw a dentist was in 2014. She learned she needed several fillings, but put the work off because the price tag was too steep.

At the workshop, Gordon received ITRs that should last long enough for her to save enough money for traditional fillings.

"There were no shots, no drilling, no pain," Gordon said. "It was easy." 

Dentist Ray Doumanian, who teaches in the dental hygiene program at Fresno City College, hopes to have all the hygienists in his program trained in the procedure.

"Dental care shouldn't be just for the wealthy," Doumanian said. "This is going to allow us to reach a segment of the population that is not being served. It's win-win-win."

Glassman and the staff at the Pacific Center for Special Care established the effectiveness of this teledentistry approach during six years of pilot studies in communities across California. Thirteen hygienists were trained as part of these research projects, and placed more than 900 ITRs without a single complication.

As hygienists become certified, Glassman hopes to implement ”virtual dental homes” throughout California. Under this model, hygienists take equipment to community settings and provide care for patients without a dentist onsite. The hygienists communicate with the team dentist using a telehealth system.

The model is designed to reach underserved populations, including children in Head Start centers and elementary schools, older adults in nursing homes and disabled adults in residential care settings.  A bill now in the state Legislature would authorize $4 million to train providers and communities to create these Virtual Dental Homes. 

The need is acute. The California State Auditor, in a report issued in December, found that in 32 of the state's 58 counties, there were too few dentists to serve children enrolled in Medi-Cal. Five counties had no active Medi-Cal dentists. In 11 counties, not a single dentist accepted new Denti-Cal patients.

In California, 24 percent of all children complete elementary school without ever having seen a dentist. And the situation is even worse for low-income children and children from minority groups. In 2013, only 41 percent of children eligible for Medi-Cal received any dental services.

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