Originally published in The Mercury News.

By Sandt Kleffman

July 5, 2013

LeAna Powell, already missing two front teeth, has so much pain from several molars that she pops pain pills routinely and tries to eat only soft food.

She thought it would be OK to munch some popcorn, but when she tried it a few days ago, a chunk of a back tooth fell out.

“That’s the most embarrassing thing,” said the 29-year-old Oakland resident. “The first thing you want to do is cover your mouth and go home. You think, ‘Oh my god, what do my teeth look like now?’”

Relief may be in store for Powell and others now that state lawmakers have partially restored dental coverage for 3 million adults on Medi-Cal who lost the benefit in a 2009 budget cut.

They will have to wait awhile longer, however. The coverage, known as Denti-Cal, won’t begin until May. Still, Powell and others were elated.

“I started crying when I heard about this because this is going to change my life,” she said.

Medi-Cal, the state-federal health insurance program for low-income people, will once again cover X-rays, cleaning, routine exams, some root canals, crowns and full sets of dentures. It will not, however, cover partial dentures and certain other procedures for adults.

The Legislature stopped short of allocating the $130 million needed for a full restoration of benefits, instead making $16.9 million available this fiscal year and $77 million next year.

“This is a huge victory, a huge step forward,” said Vanessa Cajina, legislative advocate for the Western Center on Law and Poverty.

When left untreated, small cavities become bigger ones and can lead to sharp toothaches, abscessed teeth, bleeding gums and other problems, said Anthony Mock, chief of general dentistry for the Alameda Health System, which operates Highland Hospital in Oakland. Mock noted that cavities and gum disease may contribute to other illnesses, including heart disease and diabetes.

State lawmakers left the Medi-Cal dental coverage for children intact, even as they eliminated the adult benefit.

For Powell, a single mother with a 9-year-old son, having two missing front teeth has been a constant embarrassment. She fears it could make it difficult to find a job once she completes training as a nurse.

“The first thing people notice is your smile,” she said. “When you’re talking to possible employers, they judge you. Some people think you’re on drugs, or they think you’re not brushing your teeth.”

Even worse has been the pain, which she can do little about. Shortly before the elimination of benefits, Medi-Cal paid for her to have two root canals, but then would not cover crowns after the budget cut went through.

A dentist told her she needed $1,375 worth of work. Saving that kind of money is impossible, she says: She has no car and receives $516 a month through the state’s CalWORKs program.

“I’ve become almost a vegetarian because I can’t eat meat,” she said. “It gets in these holes in my teeth and it hurts so bad. It’s like migraine pain.”

Although she is happy the state will restore some benefits, she worries it might not cover all the work she needs, and she fears losing more teeth before the coverage begins.

San Mateo resident Sheri Wagner is one of the lucky ones. She endured tooth pain for a year but just as it became unbearable, she got a root canal through the Samaritan House, a nonprofit that operates free clinics in San Mateo and Redwood City.

The Samaritan House referred her to periodontal specialist Brenda Lewis in San Mateo, who agreed to help prepare one of her teeth for a crown for free.

The 54-year-old single mother receives no health insurance through her part-time retail sales job.

“A lot of companies are cutting back on hours to avoid benefits,” she said. “It’s too bad that health care has become a luxury.”

Wagner has applied for Medi-Cal and hopes to be approved soon.

Getting free care is not an option for many people. The Samaritan House has a waiting list of a year or two for most new patients seeking dental care, said Dick Gregory, who directs its dental clinics.

Once coverage is restored, Gregory said he is concerned whether there will be enough dentists willing to see the influx of patients with untended dental problems. Even before the 2009 cut, many dentists were declining to take Medi-Cal patients because of low reimbursement rates.

Perhaps nowhere has the cut’s effect been more evident than at Highland Hospital in Oakland. People start lining up for its drop-in dental clinic at 5:30 a.m. and may wait four to five hours. The public hospital, which treats people regardless of their ability to pay, has 13 rooms for general dentistry and oral surgeries.

The number of people with drop-in emergencies at its dental clinic jumped by 70 percent from 2008 to 2011, costing the hospital about $1.7 million annually, Mock said. Patients seeking dental care in the hospital emergency department have nearly doubled.

“Once adult services were eliminated in 2009, a lot of patients couldn’t find providers who will treat them,” he said. At Highland, he added, “they are triaged. We see the worst ones first.”

Edited June 11, 2018.