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State Spotlight: Here to Stay! California Leaps to Number 9

After lower-half performances in the past two sets of the A State of Decay report rankings, California made a big move this time, jumping from 30th into the top 10 at number 9.

With the full set of 13 Medicaid services now restored and a State Oral Health Plan (SOHP) with SMART objectives ready to carry the state through 2028, California is planning for a prolonged stay near the top of the national rankings.

Despite its traditional focus on healthy lifestyles, California’s attention to oral health has been mixed. When the Great Recession hit the state budget particularly hard, dental benefits were eliminated from Medicaid. In 2000, fewer than 30% of state residents benefited from community water fluoridation (CWF), said Jayanth V. Kumar, DDS, MPH, Dental Director with the California Department of Public Health.

But by 2015, the CWF coverage had reached 64%, the economy made its comeback, and two Medicaid benefits were added. The rest of the Medicaid services are now covered, and California now has solid scores on all but one variable used in the state rankings.

Jayanth V. Kumar, DDS, MPH, Dental Director with the California Department of Public Health presenting at an advisory committee meeting

Kumar and his team are working now on that — an older adult Basic Screening Survey. The Center for Oral Health, with support from the California Wellness Foundation (Cal Wellness) and the Archstone Foundation, is developing the first documentation of the oral health care needs of older adults in California. It should be available this year.

“Stakeholder engagement has been a major force behind many of these initiatives,” Kumar said.

The Senior Dental Center established by Gary and Mary West is providing care while it also gathers and analyzes data and publishes reports on its findings. South of San Francisco, the San Mateo County Peninsula Health District Initiative in Geriatric Oral Health seeks to ensure optimal oral health among older adults residing there.

Having recently moved into his current position from a similar one in New York, Kumar is accustomed to the special needs of a geographically dispersed, populous, and culturally diverse state. Still, California presents unique challenges, he explained.

Even with funding and a state mandate in place, the complex water system in California makes fluoridation impossible in some communities because of factors such as multiple wells and water contamination by agricultural fertilizers and other chemicals. Drought conditions have also played into decisions to delay fluoridation.

The good news right now is that the largest city in the country without fluoridation, San Jose, has begun fluoridating its water on a pilot basis, and all of its residents should soon be benefiting from this public health intervention.

The state’s SOHP, the California Oral Health Plan 2018–2028, provides a roadmap for collaborative action going forward.

“The Oral Health Program will serve as the backbone for collective action,” Kumar said. “The goals, objectives, and strategies provide a common agenda for all sectors.”

The plan calls for support of all 61 local health jurisdictions backed by an $18 million budget. Following a needs assessment and development of a community health improvement plan, the local jurisdictions will implement interventions to improve oral health in their communities. Funds are also being used at the state level to support oral health literacy initiatives, a surveillance system to track progress, and demonstration projects.

Kumar plans to leverage these activities in partnership with the state’s dental association and other oral health stakeholders, all with the goal of improving the oral health of older adults. It’s a winning formula – one that should keep California near the top of A State of Decay rankings in the next edition, and beyond.


West Health. Oral healthcare and care coordination. Retrieved from: http://www.westhealth.org/our-focus/chronic-care/oral-healthcare-care-coordination

California Department of Public Health. California Oral Health Plan 2018–2028. Retrieved from: https://www.cdph.ca.gov/

San Mateo County. Oral health strategic plan 2017–2020. Retrieved from:

The Wisdom Tooth Project is a program of Oral Health America