Silver Smiles: South Santa Cruz County children struggle to get dental care

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WATSONVILLE -- Jasmin Munoz, 13, is used to the whirring and scraping of dental instruments. Facing a fifth cavity, the Cesar Chavez Middle School eighth-grader recently spent an afternoon in a dentist chair getting a filling, while her mother Maria waited in the lobby.

In the past, Munoz would truck her seven children to Salinas, where she said more dentists took her insurance for low-income families, Denti-Cal, and had appointments available.

But this time, Munoz, her daughter and two grandchildren walked to the appointment.

Since October 2009, a portable classroom in the back of H.A. Hyde Elementary School has served as a primary dental care clinic for children in the area. Part of a citywide project between the health clinic Salud Para La Gente and the schools of the Pajaro Valley Unified School District, the Hyde dental clinic is open Thursdays after school, with two treatment rooms, a small waiting area and a desk for checking in and making appointments.

The school clinic system serves the needs of many families seeking primary care, but for specialty care, such as orthodontics, children must be referred out of town, creating travel and financial hardship for families, since not all orthodontic treatments are covered by Denti-Cal.

Dentists also said there is little of the oral and nutritional health education needed to keep children's teeth healthy and cavity-free.

But for Munoz, the basics are enough for now, even though at least two of her teenagers need braces. The clinic is no-frills, but Munoz said she could not care less.

"It's close," she said in Spanish. "I live nearby. It's a jump away."

Getting primary dental care

Among primary health care needs for Watsonville children, one of the largest is dentistry, said Dr. Cristina Landayan, the dentist at the Hyde clinic and at Clinica del Valle del Pajaro. Young children with multiple cavities are common, she said, even though it isn't normal.

"You see a lot of kids smiling with a lot of metal in their mouths," she said. "If they have pain, they won't go to school."

Tooth decay is primarily a bacterial disease that damages the enamel of teeth, leading to pain and possibly infection. Infections have been tied to other illnesses, such as systemic bacterial infections and heart disease.

Occasionally, untreated infections can lead to death.

Salud data for 2010 incoming kindergarten children paints a striking picture: Based mostly on children in Watsonville and the surrounding area, less than 10 percent of students at any one school had what dentists considered healthy teeth. At one school, which Salud would not identify, more than one-quarter of entering kindergarten students had pronounced cavities, and one in five of 816 rising kindergarten students screened had some form of dental decay.

First 5 California, a children's advocacy organization, said tooth decay strikes about half the kindergarten students in the state.

A 2009 report from the UCLA Center for Health Policy Research found that about a half million of California's 7.2 million school-age children missed at least one day of school in 2007 because of dental issues such as toothaches. First 5 California lists tooth decay as one of the most common childhood illnesses in the state. Nationwide, according to the U.S. Department of Health and Human Services, tooth decay is the top childhood illness, five times more common than asthma.

The UCLA report said in families that speak a language other than English, children are more likely to miss multiple days because of toothaches than their English-speaking peers.

And poorer children are more likely to miss school than their wealthier peers, likely because of affordability and accessibility.

In Watsonville, 75 percent of families speak a language other than English at home; 94 percent of those families speak Spanish, according to U.S. Census data averaged between 2006 and 2008.

For the same period, the median income is barely $50,000, about twice the federal poverty limit for a family of five.

While basic dental care is covered at the Pajaro Valley school-based clinics, anything beyond X-rays, cleanings, fillings and extractions are referred to specialists.

The cost for braces, said Landayan, can run into the thousands of dollars.

During Jasmin's visit, her sister Perla, 17, came to meet her family. The Pajaro Valley High School junior said she's long needed braces. Jasmin needs them too, said Landayan, and Maria Munoz said she can't pay for either, because they aren't covered by Denti-Cal.

"I guess I'll get a job," Perla said. "I guess I'll do a payment plan."

And she'll likely head back to Salinas, where most of Salud's orthodontic referrals are sent.

The need for specialists

Of all medical specialties in Watsonville, the need for dental specialists, such as orthodontists and pediatric dentists is greatest, said Laurie Mireles, director of grants and outreach for Salud.

"Sending our kids out even to Salinas, for someone who doesn't have a car, no money or has to take a day off, it's a huge burden," she said.

The school-based clinics aren't set up to administer nitrous oxide, which pediatric dentists give to children who are too scared or fidgety to treat.

While Dr. Landayan treated Jasmin, her niece and nephews watched at the behest of their grandmother. Jocelyn, 5, was next, and was terrified.

But after a half hour, with Munoz begging her to calm down, Landayan gave up. Jocelyn twisted on the chair, refused to open her mouth and wailed in fear.

"I tried two or three times with the mirror," Landayan said.

The California Dental Association lists 24 dentists in Watsonville; four are enrolling new Denti-Cal patients. One orthodontist accepts Denti-Cal, according to the California Department of Healthcare Services.

The search for a dentist that could fix a chipped tooth ate most of Maria Muro's day, as she drove her son Rogelio Meza from appointment to appointment, starting at the Cesar Chavez Middle School clinic. Meza, 18, got smacked in the mouth by a ball while drinking from a glass soda bottle.

"It makes a bad picture for me," said the New School student.

Muro, who doesn't work, said she's paid about $90 each for several office visits with doctors who don't take Medi-Cal and none have been able to help fix her son's tooth.

"It's an appointment here, an appointment there," Muro said in Spanish. "We can't afford a lot of stuff."

The root cause of so many root canals

Lidia Santillan, of Watsonville, brought her two step-children, Jennifer Medina, 7, and Joshua Medina, 8, to the dental clinic at Cesar Chavez Middle School because Jennifer needed a filling.

She was one of many parents at the clinic that day who said their children didn't eat that much sugar. But when probed further, she said the children drank a lot of juice and ate too much candy.

Parents like Santillan aren't lying, said Dr. Dennis Balayut, clinical director of dentistry for Salud. They just don't realize how much sugar is in the foods their children eat, and many equate the word sugar with granular sugar, rather than as a component of foods in the form of high fructose corn syrup or other sweeteners.

After finishing her appointment, Jasmin Munoz reached two fingers into a pocket to pull out candy.

"It's very obvious their nutritional counseling needs aren't met," he said, citing research showing a correlation between obesity and dental disease.

Researchers at Case Western Reserve University in Cleveland found earlier this year that the prevalence of periodontal disease in a group of 13,665 was 76 percent higher in obese people aged 18 to 34 years. In the Pajaro Valley, 36 percent of children in fifth, seventh and ninth grades are overweight, where the average of overweight students in those grades in Santa Cruz County is closer to the state average at 24 percent, according to the California Healthy Kids Survey.

Many dentists in the area also point to the lack of fluoridated water in Watsonville. Fluoride is a naturally occurring chemical that helps keep teeth from eroding due to high-sugar, high-acid foods common in our diets. Studies show children's teeth incorporate fluoride as they grow, making them more resilient.

Many residents in Watsonville oppose flouridation, questioning the safety of adding chemicals to the water supply. They argue that enough fluoride is found in fortified toothpastes and oral washes, and if parents watch sugar intake, cavities would be less of a problem.

In 2005, three years after voters struck down the addition of fluoride to the water supply, the city of Watsonville took their fight to the state Supreme Court. The city lost, and has been fighting ever since to keep flouride out of the water.

The California Dental Association Foundation has offered a grant to install a flouridation system, but the city council is split on whether to accept the grant. When the vote comes, likely in August, it's expected to be a close call, whether for or against.

The Santa Cruz Sentinel would like to thank Mariela Fernandez, receptionist at Salud Para La Gente's school-based dental clinics, for her assistance in translating.