Even though she had 12 cavities, 3-year-old Vanessa Sepulveda never complained about pain.
But on Wednesday, lying in a state-of-the-art dental operating room at PDI Surgery Center in Windsor, general anesthesia was used to help her deal with filling and crowning her caries — the likely result of drinking juice since she was 7 months old.
"We used to put it in her baby bottle with water so it wouldn't be so sweet," said her father, Ignacio Sepulveda of St. Helena. "We now know that she should eat apples and other fruit, instead of drinking them," he said in Spanish.
Sepulveda is part of what local officials are calling a growing North Coast health care crisis that only now is being assessed in Sonoma County. According to a study by the Sonoma County Task Force on Oral Health, yet to be formally released to the public:
-- In 2010, there were only 15 dentists for 109,000 low-income residents in Sonoma County — a fraction of the pool available to those with private insurance.
-- In 2009, 52 percent of the county's third-graders had a history of tooth decay, exceeding the state average.
-- The county's impoverished third-graders are more than twice as likely to suffer from untreated tooth decay as children from more affluent families.
The report is expected to be reviewed by the county Board of Supervisors next month.
Located adjacent to the Windsor Golf Club on 19th Hole Drive, the non-profit surgery center is the last line of defense for thousands of low-income children in the North Coast who have little access to routine dental care.
Though many of them have public dental insurance, almost no private practice dentists in the area will accept their coverage. At the same time, state budget cuts to dental programs and a recession that has left many local residents without private dental insurance has "pushed Sonoma County's fragile oral health &‘system' to the breaking point," the report said.
"It's a disgrace. We have not given resources to dentistry and we've acted like it's a problem that doesn't exist," said retired Kaiser Permanente pediatrician Kathy Foster.
Foster, one of the founding board members of PDI Surgery Center, is among two dozen health care professionals who participated in the task force, which sought to assess the state of oral health in Sonoma County.
The report highlights a number of factors that have led to the current troubles. Denti-Cal (Medi-Cal's dental program) no longer pays for adult dental treatment; Medicare does not cover routine dental care for the elderly; and most private practice dentists will not see children with Denti-Cal because of low reimbursement rates.
"It's alarming and it is very concerning," said Mark Netherda, the county's interim public health officer. "It needs to be brought to everyone's attention and it needs to be changed.
Netherda said the task force was commissioned by the county Department of Health Services, First 5 Sonoma County and the Redwood Community Health Coalition. Its goal was to come up with solutions that could get at the problem within a three-year time frame.
These include expanding access through local health centers and programs like St. Joseph Health System's mobile dental clinic; integrating oral health care with perinatal programs; expanding the use of dental hygienists in the primary care setting; train primary care staff to make oral health assessments normally done in a dentist's office.