Throughout the pandemic, Americans have celebrated farm workers for keeping food on the table in the toughest of times. Yet, we conveniently forget about their sacrifice as those same workers toil in the heat without access to preventative dental care. As a private practice dentist in Ventura County, a major agricultural center, who offers my services at low or no-cost to farm workers and their families, I’ve seen first-hand the detrimental effects of this lack of access to basic dental care.

Let me tell you about the father of a young patient of mine, Juan, who works in nearby fields. Juan left Mexico to make a better life for himself and his family. When Juan brought one of his six children in for a dental checkup, I noticed Juan himself looked unwell. He told me that he had a painful toothache. I offered to examine him, but he hesitated because he was afraid of the cost. I assured him that I could provide an exam at no cost and he hesitantly agreed. I was shocked to see how severely damaged his teeth were. He explained that he’s never had any dental care. He also shared that when he came to the U.S., he quickly adopted a diet that consisted of fast food, candy, soda, and sports drinks. Sadly, I had to tell him that his resulting tooth decay would mean that he would probably have to lose most of his teeth.

When migrant farm workers come to this country, they are given what is called Restricted scope Medi-Cal. At face value, this may seem compassionate. However, the care they receive is severely limited and this has consequences for both their dental and medical health.

Restricted scope Medi-Cal provides limited health coverage such as emergency and pregnancy services. (1) For dental care, this lack of access to preventive services translates to late-stage dental disease, prolonged suffering, expensive emergency room visits and ultimately tooth loss. Earlier treatment options, such as fillings, root canals, dentures, crowns, and bridges, are not even options. For farm workers, who are barely being paid a living wage, pursuing non-covered preventive services that will help educate them regarding the importance of dental health and its relation to their overall health is not even on their radar.  Interventions at this juncture become a choice between putting food on the table and trying to save teeth.

Basic human compassion demands that we expand Restricted scope Medi-Cal. At first glance, some may see this as entitling people to health care services that they don’t deserve. But we must be more thoughtful and appreciate the unfairness and consequences of not providing proper preventive care to the people who work tirelessly for our benefit. Poor oral health leads to poor overall health, decline in well-being, time lost at work, and decreased productivity. (2) Not providing farm workers with preventive dental care is fiscally short-sighted.

Denying farm workers access to preventive dental care and only providing emergency dental services is costly. California recently ranked #1 as the most expensive state for Emergency Room visits, with a typical visit costing nearly $3,000 before insurance (3).  After receiving costly tests in the Emergency Room, patients are often redirected to a dental office that accepts Medi-Cal. The dental office is only reimbursed for either prescribing an antibiotic or removing teeth (on average about $20-60). Restoring the lost tooth is not included. Replacing lost teeth or restoring teeth that are severely decayed is important to a patient’s overall health and well-being, but it is expensive. Some dentists may be unable to take on these uncompensated costs. On the other hand, a routine dental visit, that could prevent dental emergencies and late stage dental disease, costs around $200-$300. It’s simply poor economics and poor quality of care to deny access to preventive dental care.

We can do better. Expanding Restricted scope Medi-Cal to include preventive dental coverage saves money and keeps our workforce healthy and productive. Basic preventive dental care should be a basic human right.

1. Young Adult Full Scope Expansion - California. https://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB104/YAE-Webinar.pdf. Accessed July 28, 2022.
2. Baiju RM, Peter E, Varghese NO, Sivaram R. Oral Health and quality of life: Current concepts. Journal of clinical and diagnostic research: JCDR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535498/. Published June 2017. Accessed July 28, 2022.
3. The most expensive states for ER visits, ranked. By Jessica Learman December 4,2020.

Dr. Marie Alejandrino-Buell is a general dentist in private practice in Oxnard, CA who is passionate about improving the lives and dental health of our migrant farm workers and their families.