Times are tough enough for Californians; they're even tougher for Californians' teeth.
"One-quarter of all adults and 28% of children in California have untreated dental caries [cavities]," says Len Finocchio, a senior program officer at the California Healthcare Foundation, a health advocacy group.
"Our research tells us that many people in California have been avoiding routine care that might have cost about $100 for a checkup and cleaning, and then find themselves in the emergency room, where they get only an antibiotic, a bill that can average over $600 and instructions to see a dentist."
Just ask Socorro Salazar, 55, of Pico Rivera. Worried about the cost, Salazar avoided the dentist for eight years until last year, when he finally gave in to pain. By then he needed at least six teeth extracted and replaced -- at a cost of $19,000.
Salazar is hardly alone. Thirty percent of Californians report poor or only fair dental health, according to a study published last year by the foundation, with cost being the leading barrier to dental care, even among people with dental insurance.
That's because insurance -- which often pays most, or all, of the cost of preventive care, including cleaning and checkups -- can require patients to cover more than half of the bill for fillings, extractions, root canals and tooth implants, says Wynne Grossman, head of the Dental Health Foundation, a nonprofit group based in Oakland.
The foundation provides oral healthcare for low-income children and advocates for the inclusion of dental benefits in health reform.
The numbers are even more striking among minorities. According to a 2007 Harris Interactive poll, 20% of whites report only fair or poor dental health, but those percentages rise to 40% for African Americans and 43% for Latinos.
The same poll found that, while recommendations are for adults to see a dentist for a checkup every six months, close to 30% of Californians have not seen a dentist in more than a year; 10% have never seen a dentist or have not seen one in more than five years.
Below are places to find less expensive dental care in the Los Angeles area. For other strategies to reduce costs, such as negotiating with your dentist and exploring treatment options, please see our online story at latimes.com/health.
Check out dental schools ...
Three dental schools and several dental hygiene schools offer lower-cost (and sometimes free) care in the Los Angeles area. With the economy down and the recent cuts to Medi-Cal, the clinics have gotten busier, so ask about hours, appointments and even public transportation and parking before you show up.
Expect to pay less if a student does all the work, more if you request a faculty member as your practitioner. but keep in mind, says Richard G. Stevenson, professor of clinical dentistry at UCLA School of Dentistry, that students don't get to care for patients until about their third or fourth year of dental school (after many simulated cases) and that they're supervised by teachers with years of dental experience. Fees are generally lowest if the bulk of care is delivered by a student.
There's a trade-off, of course; procedures can take three times as long as in a private practice, Stevenson says, and you'll probably have a lot of stopping and starting as students go through a procedure, waiting at each step to get the next go-ahead from a faculty member, who is supervising other students, and their patients, at the same time. Too much amalgam in that filling? You'll wait while the instructor reminds the student how to measure and fill.
But we suspect that many people would be willing to trade time for savings. Salazar ultimately was charged $6,000 instead of the quoted $19,000 by having his care done at a UCLA clinic. He got some of the savings by asking whether he could be the test patient for student proficiency exams, which cut his costs but sometimes had him at the clinic from early morning until late at night.
Experts at the National Institute of Dental and Craniofacial Research in Bethesda, Md., recommend asking dental school clinics if there are clinical trials for any new devices or procedures.
Current trials around the country include ones for dental implants, dental sedation and comparing brushing and flossing. Find listings for dental trials at www.nidcr.nih.gov/clinicaltrials.
The dental schools may also have some free community clinics and mobile vans, says Beth Truett, head of Oral Health America, a nonprofit group based in Chicago aimed at educating consumers about dental care.
Ask about the full range of services when you call to make an appointment. USC, for example, keeps a few appointment slots open each day for emergencies and often charges only $40 for the visit.
UCLA School of Dentistry: uclasod.dent.ucla.edu (click on "patient care" ); (310) 825-2337.
USC School of Dentistry: dentistry.usc.edu (click on "becoming a patient"); (213) 740-2805. For possible same-day emergency appointments, call (213) 740-1576.
Loma Linda University School of Dentistry: www .llu.edu/dentistry (click on "patient services"); (909) 558-4675. For urgent-care appointments, call (909) 558-4666.
Some dental hygiene schools host clinics. Contact the schools on this California Dental Hygienists' Assn. list to see if schools near you offer such clinics: www.cdha.org/education/dh_schools.htm.
... And community clinics
Many, though not all, community health clinics in California offer a full range of dental services free or on a sliding scale based on income.
Until recently, the average wait had been 28 days, but that may have increased with the recent Denti-Cal cuts. Call ahead to make sure dental care is still provided and to make an appointment.
And if you're having an emergency, such as severe pain, call to find out about walk-in appointments. You may have to wait, but they could be available. Recent data from the clinics found that 20% of people who make appointments failed to show up on the scheduled day.
Find clinics that offer dental services by calling the California Primary Care Assn. at (888) 895 0808 or through the California Dental Assn. at www.cda.org/clinics (expect to be asked for income information).