An inconvenient tooth

Clean and sober since January 2012, Heather Mostajo was eager to enter the workforce. But there was a problem: Her teeth were in terrible condition.

“That was my biggest hang-up with my self-esteem about being able to attend an interview,” says Mostajo, 38. “Your appearance, your smile. They look at that.”

This was not a new problem for her. She spent years too embarrassed even to smile. Fighting back tears, she remembers her choice last year to not join her three kids and three stepchildren in their Christmas family portrait.

The California Dental Association says that some 10 million residents experience barriers to dental care. While recent laws and concerted efforts by California’s dentists have helped to ameliorate the problem, there remain serious gaps in care for less-affluent adults.

“The need is so great,” says Cathy Levering, executive director of the Sacramento District Dental Society. “And the problem is, it’s not just the indigent. It’s the working poor, the people who have no benefits and are working but can’t afford dental care.”

It’s particularly bad here in Sacramento.

According to Levering, every county across the state has a free clinic providing dental services to the poor. The county clinic in Sacramento, however, only performs extractions and care for abscesses—the dental equivalent of an emergency-room visit. Preventative care, such as teeth cleaning and fillings, is not available.

For residents without insurance, oral-care options remain tenuous. The rollout for Covered California will not include dental care, as that is no longer a part of the Affordable Care Act. Denti-Cal, the state’s oral extension of Medicaid that was cut in 2009 due to budget woes, will again be available in 2014, but with a 10 percent drop in reimbursement to dentists providing the services.

In the meantime, working-class and poor adults often must rely on volunteer efforts from the dental community. One effort to increase smiles across the state is CDA Cares, a semiannual volunteer effort where dental professionals provide free care to residents who can’t afford it on their own. Last year, the California Dental Association held two daylong events, one in Modesto and another at Cal Expo here in Sacramento, providing more than 17,000 dental procedures to almost 3,700 uninsured residents.

Terry Jones, chairman of the Sacramento County Medi-Cal Dental Advisory Committee and dentist for three decades, says that despite monetary woes and state funding cuts to programs in recent years, dental professionals throughout Sacramento have worked to fill in the gaps for the uninsured. More than a dozen clinics in the region, for instance, provide low-cost care (if only just for pain relief and extraction referrals), and many practices work with the Sacramento District Dental Society to provide services to lower-income residents on a sliding-scale price system.

Levering says that grants to the Sacramento District Dental Foundation, the nonprofit arm of SDDS, have helped Sacramentans in need to receive care. “The hospitals and other organizations have been great in providing these grants,” she says, “[but] I think it’s a Band-Aid.”

Jones agrees, pointing to the immense crowds drawn each year to CDA Cares events. “The fact that people stand in line for two days to get dental treatment makes you think, ’Oh my God, this is terrible.’”

A similar thought, one surmises, went through Senate President Pro Tem Darrell Steinberg’s mind last year, when he visited the CDA Cares event at Cal Expo. Moved by what he saw that day, Steinberg this summer managed to reinstate Denti-Cal into Gov. Jerry Brown’s state budget—a big win for both the state’s dental association and SDDS.

Today, the dental community remains hopeful. Care for California’s children is in a markedly better condition than for adults, and uninsured pregnant women have access to services. Even with the exclusions of dental services in “Obamacare,” dentists hope that universal dental care will be the next logical conversation once the program is in place.

“The fact that it’s considered an essential health benefit is critical,” says Jones. “Dental care has a serious impact on the overall well-being of the individual.”

Last Tuesday, October 1, Mostajo received her full set of dentures after a year’s worth of oral surgery, which included removal of rotten teeth and reconstructive work on a jaw once disfigured as a result of domestic abuse.

She was able to receive her teeth thanks to a collaborative effort between Women’s Empowerment, a group dedicated to getting homeless women under a roof and in the workforce, and SDDS’ Smiles for Big Kids program.

Over the past year, Mostajo has gained both permanent housing and employment in a clerical position. But as the holiday season approaches, it’s the new smile for which she is most excited.

“Last Christmas, they did family pictures, and I never wanted to be in them,” she says. “This year, I get to be in there with my kids.”