Arturo Hilario
El Observador
Dental health is crucial to overall health, and it’s something that some people unfortunately learn after much pain and a trip to the emergency room.
The state of California has the most dentists per population of any state in the country, but despite the numbers of providers, they are not distributed evenly amongst vulnerable populations and may not meet the cultural and linguistic needs of certain communities.
This lack of care in certain regions leads to disadvantaged populations who are more likely to put off oral healthcare until it may be too dire to ignore.
One solution to helping these populations is through the use of dental therapists to bridge the gaps of oral health in the state which is concentrated in certain regions but absent in others.
Dental therapists are licensed professionals who work under the supervision of dentists to perform routine dental procedures such as exams and fillings. They practice in regions with chronic shortages of dentists such as rural communities, tribal lands, and low-income neighborhoods.
These types of efforts result in bridging language and culture gaps, as well as providing shorter wait times and opportunities to access treatment and prevention and avoid more invasive procedures and emergency room situations in the future.
A grassroots campaign made up of multiple community organizations that provide resources and guidance to those seeking dental care are sounding the alarm about oral health and its importance to overall health. These groups are themselves made up of Promotoras Comunitarias, and underserved community members that understand the intricacies and cultural needs of their neighbors.
California Oral Health Equity Coalition (COHEC) connects communities with licensed dental therapists directly to immigrant, elderly and indigenous populations, with the goal being to serve the underrepresented groups that are in need of care and also provide support in different areas of life beyond oral health.
Recently we spoke with Fabiola Montiel, spokesperson of Visión y Compromiso, the organization that leads COHEC and represents its partner organizations.
Montiel laid out he work that COHEC does, the importance of seeking oral healthcare before it becomes an emergency and higher-cost burden, and how the organizations help not only with finding healthcare options, but protecting themselves and their communities against a federal government who has sought to terrorize marginalized groups over the past year.
Initiatives like COHEC seek to advance racial and economic justice for those living in the state, by bridging gaps in care and informing communities about their rights and benefits while living in the golden state.
Thank you Fabiola for taking time to talk about the issue of dental health in underserved communities and about your organization. To start off, could touch on what the coalition does and what avenue it serves within underserved communities in the state?
Well, COHEC is a grassroots campaign led by various organizations that are dedicated to community wellbeing and health, including tribal and other marginalized communities across the state.
We serve those communities, and what we want to do is to bring the solution of dental therapists to California. And we call it a solution because dental therapy has been proven to be a community-driven solution to expand access to quality, affordable, and culturally relevant oral healthcare.
This is what the coalition is, and the coalition is currently led by Visión y Compromiso, so it’s a part of it, the Dolores Huerta Foundation, SCOPE (Strategic Concepts in Organizing and Policy Education), ARI Community Services, and the California Rural Indian Health Board.
There are a couple of reasons why people don’t get their oral health checked out often and seek preventive care. Could highlight a couple of those reasons and why it is important to get checked out in general for dental health?
Dental health is important for overall health. And let’s start there. I think we could more to understand that dental health is integral to our overall physical health. Some of the barriers that have been observed are that there’s just not enough healthcare across the state, so there’s a lack of dentists to provide care for everybody in the state. Now, sometimes the communities that do have access to dental care, maybe they don’t have it in a way that it is responsive to their own needs.
So if we talk about a family that may or may not be well-versed in English and goes into this very intrusive checkup, they might not understand fully what is happening. They might not have the, what we call the cultural and linguistically relevant attention that they deserve. There’s another lack of opportunity where wait times are so long and so delayed that a person, a child, an adult can go in with a cavity in one of their teeth, but because the wait times are so, so, so long, by the time they reach that care they need, it’s something more complicated.
The barriers have always been there, they have only been intensified lately, but we continue showing up, we continue building community collaboration, partnerships, and opportunities for community members to know where to go, where they have trust and get the services, the attention, and the dignity that they deserve.
It’s something more complicated that needs more time, needs more attention, and it’s also going to increase in costs for everybody. There is also some racial disparities that we have observed that cavities are more prominent in Latino children. We know that 72% of Latino children have cavities, and in contrast with 40% of white children.
And it’s similar to African American children, who have untreated cavities, double to the rate of the white children. So there is this barrier to access care per neighborhood, per ethnicity, per language, because wait times are very long, and it’s just not enough. It is just a bigger demand than what exists to treat that demand.
What happens is that not only can a cavity result into something bigger, but it actually can also land you in an emergency room. And here in California, we see that around 50,000 times a year people go to the emergency room for totally preventable dental care attention, and that costs the state $120 million annually to therefore treat the consequences of this. It’s just access, taking equity access to healthcare and specifically here in oral care.
Other barriers could be dealing with the maze of insurance carriers and even low-cost options like Medi-Cal. Again, the language barrier also comes into play there. I was wondering how your organization can help people get through those barriers or kind of be a bridge of information to get people that help that they need?
There is already a system, a medical system, that it is cumbersome. And as you mentioned, there are language barriers. And also requirements sometimes change and people don’t have enough time to know that they have changed. And that leads to some people being pushed out of Medi-Cal.
There are about 15 million Californians that are enrolled in Medi-Cal. And out of this, only 50% of children enrolled received dental healthcare in 2024. Now, there are individual organizations. We do a lot. Visión y Compromiso, for instance, recruits, trains, and supports the leadership of Promotoras Comunitarias. And promotoras comunitarias are in the community. They go, they knock on doors, they ask people what their main issues are, and then they dig deeper. So promotoras are able to serve as the bridge, the “puentes comunitarias”, bridges between the communities and the public health programs and social services. And we do that every single day.
So what we really want to do is to bring in dental therapy to California because dental therapists receive the same training as dentists to perform the treatments and the procedures that they are allowed to perform by the same Board of Dentists, they take the same exams. They are true professionals that we know come from the community, and they already bring all this knowledge about the community. They bring in this culturally and linguistically relevant care, and that is a solution.
Dental therapy is the solution because then they can work together with the healthcare center, with dentists, and in tandem respond to more common issues about dental or care that can be solved quickly, reduce wait timelines, and ultimately give the oral health that the people need. And they can work in collaboration with not only a specific dentist, but they can work in collaboration with community health centers.
Dental therapists are also movable. They can go, they can walk to a specific location where people meet. We’ve seen that sometimes there is a dentist a day, you know, the dentist visits a school, and over the weekends there are pop-ups, dental check pop-ups. Dental therapists can go to schools, they can access Indigenous populations and they can also go to the reservations here in California.
We have been talking about children and adults, but what about seniors? Seniors and lack of access to oral care is a major issue, and seniors are also less likely to be able to travel distances 1 hour each way, or to wait for a long time for their treatment, or to actually wait in the healthcare environment a couple of hours until they are received for a cavity.
So dental therapists can also go to senior centers or to specific retirement homes and other community centers where people already gather. They already have— they already trust that center. Dental therapists can be that solution to access their oral care equitably and via culturally and relevant and culturally and linguistically relevant services.
One other factor that is not easy to look away from the threat from a federal level to these communities, and specifically the treatment of Latino and immigrant communities by the current administration, even in California. What do you say if people might be cautious and avoid dental care or healthcare because they do not want to get involved in the system that might lead to their detention?
I mean, I think that is a fair question, although to answer that question, we should be asking the federal institutions, what are they doing, right? Because we community members, we are at the expense of an abuse of power and a authority under an authoritarian government that seeks to use terror tactics to terrorize the population, and they’re doing it actually pretty well.
So that is a fair question. But what do we do as community members? What do we do as community-based organizations? We, we fight back. We resist. And the way that we resist is by providing information to community members about Know Your Rights, about mental health and community well-being. Our community-based organizations, we are doing that.
Visión y Compromiso, since January 2025, we have had monthly presentations. Monthly training for Promotoras and community-based organizations on Know Your Rights. And we also have monthly training on mental health and well-being because we know that the community members have agency and community members have determination. Community members understand the risks that their families can face, but they also know that we can support them by knowing their rights, by helping them know their rights, by showing them how to practice their rights.
We do practice, we do role plays. When, you know, somebody comes and knocks at the door, what do you do? Somebody stops you on the street, what do you do? And we role play it because it is not something that we think might happen. It’s something that, well, when it happens, how are you going to respond?
So giving the community the tools they need to be able to build them not only intellectually and know the words and carry a postcard or a card, but actually practice how it feels when you are at the hands of somebody who absolutely will abuse their power and authority over you, and how you can get out of it in a way that is still dignifying for you as a community member.
Those are the things that we can do. We can also advocate. We advocate at the local level, at the state level, and at the federal level to ensure that despite these policies, there, there can be still due process. If now the Supreme Court says that, yes, you can racially profile anyone down the street, we, from wherever we can, we fight back, we support, we advocate.
And then we just go back to the community members. We continue going back to community members. We continue We continue telling them, “Now and when you’re ready, the services are there for you. Now and when you’re ready, we know that your health is important and it’s important to us, and we’re here to tell you where the resources are.”
Now, specifically to dental therapy, the dental therapist can go to community members, community centers where we already have monthly farmers market in Boyle Heights, and we collaborated with a local organization, but we also bring in other resources, and maybe there is a lawyer present, and we could do these collaborations with dental therapy. So, the resources are there, the networks are there.
We continue to build the networks; we continue to strengthen the networks despite the barriers. The barriers have always been there, they have only been intensified lately, but we continue showing up, we continue building community collaboration, partnerships, and opportunities for community members to know where to go, where they have trust and get the services, the attention, and the dignity that they deserve.
For people, individuals, families, seniors, what would be the easiest first step to take to contact COHEC or similar groups and get started on this journey to better dental health and getting in touch with dental therapists?
Very interesting question, and it’s a historical one because the way that Visión y Compromiso started engaging in dental care and healthcare, came from the Promotoras. So our organization is founded by Promotoras and by Promotoras’ need to elevate their issues and what’s important to them for their families and their communities.
So oral care is something that Promotoras know that’s important, but it’s also something that they hear community members say is important. I would say that community members, they already know a lot about their local community organizations, so continue reaching out to them. And also, if specifically for COHEC, we have our website, and they can, they can look at the website.
What can community members do? Community members can always advocate kitchen-table issues, you know, like table conversations. Maybe people don’t know what dental therapy is? What is a dental therapist? Okay, why is it important?
We talked about 11 million Californians that are underserved access to this kind of care. We do year-round advocacy like physically going to Sacramento, but we have different forums and fairs. We visit our representatives in their offices and tell them what’s important to us. So using your voice for advocacy. And also, this year is, you know, it’s a year to be more involved in the electoral process. It’s a year of election. So what we also do is we provide candidate community forums. So people know who is running, hear from them directly so they can make an informed decision.
And if they can’t vote, they can tell others about what they have heard and what are the priorities for the well-being of their communities. So I would say go to our website, go to a webinar, sign up to receive the COHEC newsletter, and continue to advocate as they have done every day, as they do every day, continue to advocate for the well-being of their families and communities.
For more information on the initiatives and work of the California Oral Health Equity Coalition please visit COHEC.org.
