HomeMy WebLinkAboutneeds-assessment-2025THE OFFICE OF DENTAL HEALTH
ALAMEDA COUNTY
ORAL HEALTH NEEDS
ASSESSMENT
DECEMBER 2025
2 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
CONTENTS
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Accomplishments from 2019–2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
County Demographic Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Oral Health Outcomes of Alameda County Residents . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Young Children (0–5 Years Old) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
School-Aged Children (6–20 Years Old) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Self-reported Condition of Teeth Among Teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Adults Oral Health Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Self-reported Condition of Teeth Among Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Older Adults (65 Years and Older) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Oral and Pharynx Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Dental Services Utilization Among Medi-Cal Dental Beneficiaries . . . . . . . . . . . . . . . . . .22
Annual Dental Visits by Age Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Preventive Dental Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Use of the Emergency Department for Non-Traumatic Dental Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Common Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Sugary Drink Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Protective Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Dental Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Oral Health Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Community Water Fluoridation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Available Resources and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 3
Qualitative Data Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Focus Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Key Informant Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Kindergarten Oral Health Assessment (KOHA) Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Perinatal Dental Environmental Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Strategic Planning Community Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Community Input . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Identified Data Gaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Conclusion and Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Appendix A: Key Informant Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Appendix B: School Health Centers with Dental Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Appendix C: KOHA Partners Interview Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
4 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
LIST OF FIGURES
Figure 1: Alameda County Residents by Age Category, 2025 and Projected 2030 Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Figure 2: Alameda County Population by Race, 2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Figure 3: Poverty Rate Among Children and Youth Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Figure 4: Population 25+ by Educational Attainment in Alameda County and CA, 2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Figure 5: Self-reported Condition of Teeth Among Teens in Bay Area Region and California, 2019 and 2022 . . . . . . . . . . . . . . . . . .18
Figure 6: Percentage of Children 5+ who Missed School Due to Dental Problem in Alameda County and CA, 2023–2024 . . . . .19
Figure 7: Self-Reported Condition of Teeth Among Adults in Alameda County and CA, 2019 and 2022 . . . . . . . . . . . . . . . . . . . . . . . .19
Figure 8: Age-adjusted Prevalence of Adults 65+ with Total Tooth Loss, Alameda County and CA, 2018-2022 . . . . . . . . . . . . . . .20
Figure 9: Age-adjusted Incidence Rate Cases of Oral Cavity and Pharynx Cancer by 100,000, by Race/Ethnicity,
All Stages and Late Stage, 2017–2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Figure 10: Utilization of Annual Dental Visit by Medi-Cal Dental Beneficiaries by Age Group in Alameda County and CA, 2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Figure 11: Utilization of Annual Dental Visit by Medi-Cal Dental Beneficiaries Aged 0–20 by Race/Ethnicity in Alameda County, 2019–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Figure 12: Utilization of Annual Dental Visit by Medi-Cal Dental Adult Beneficiaries Aged 21–64 in Alameda County
and CA, 2017–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Figure 13: Utilization of Annual Dental Visit by Medi-Cal Dental Adult Beneficiaries Aged 65+ in Alameda County and CA, 2017–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Figure 14: Utilization of Preventive Dental Services by Medi-Cal Dental Eligible Children Aged 0–5, in Alameda County and CA, 2017–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Figure 15: Utilization of Preventive Dental Services Among Children with Medi-Cal Dental Aged <1, 1–2, and 3–5,
Alameda County, 2017–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Figure 16: Utilization of Preventive Dental Services by Medi-Cal Dental Eligible Children Aged 0–20, in Alameda County and CA, 2017–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Figure 17: Use of Sealants Among Children with Medi-Cal Dental Aged 6–9 and 10–14 in Alameda County and CA, 2018–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Figure 18: Receipt of Dental Visit During Pregnancy Among Alameda County and CA Residents with a Recent Live Birth,
2016–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Figure 19: Receipt of Dental Visit During Pregnancy in Alameda County and CA Among Medi-Cal Beneficiaries with a Recent Live Birth, 2016–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Figure 20: Average Rate of ED Visits for NTDC per 100,000 Population, Alameda County and CA, 2020–2021 and 2022–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Figure 21: Rate of ED Visits for NTDC per 100,000 Population in Alameda County by Age Group, 2020-2021 and
2022–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Figure 22: Age-adjusted Rate of ED Visits NTDC per 100,000 Population in Alameda County by Race/Ethnicity, 2020–2021 and 2022–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Figure 24: Percentage of Children with Dental Insurance in Bay Area Region and CA, 2019–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Figure 25: Geographic Distribution of Dentists by Region, Alameda County, 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Figure 26: Geographic Distribution of Medi-Cal Dental Providers by Region, Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Figure 27: Percentage Distribution of Dentists and General Population by Race/Ethnicity in Alameda County, 2024 . . . . . . . . .38
LIST OF TABLES
Table 1: Dental Visits During Pregnancy by Sociodemographic Factors, 2022–2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Table 2: Certified Eligible for Medi-Cal Population in July 2020 and 2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Table 3: Spoken Languages by Dentists, 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Table 4: Dental Specialties, 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 5
EXECUTIVE SUMMARY
Introduction
Oral health is a vital component of overall well-being,
yet significant disparities persist across Alameda
County, particularly among low-income, racially
and ethnically diverse groups, and underserved
populations. The 2025 Alameda County Oral Health
Needs Assessment provides a comprehensive
overview of the county’s oral health landscape,
highlighting progress made since 2018 and
identifying ongoing challenges and opportunities for
improvement. The findings aim to guide and inform
future policy advocacy, improve data collection,
and enhance cross-sector collaboration to address
systemic inequities.
Methodology
The assessment used a mixed-methods approach,
combining quantitative and qualitative data. Using a
methodology consistent with the 2018 assessment,
primary data were gathered through key informant
interviews and focus groups, and were supplemented
by surveys of community members, stakeholders,
and dental providers collaborating with the Office
of Dental Health (ODH) across multiple programs.
Secondary data were drawn from the same core
databases used in the prior assessment to support
continuity and allow for comparison over time.
Accomplishments (2019–2024)
Throughout the past five years, the ODH continued
to strengthen its comprehensive approach to
improving oral health outcomes through equitable
program expansion, systems integration, and strategic
collaboration.
ODH advanced equitable access to oral health care
across Alameda County by coordinating services for
underserved populations, expanding school-based
and perinatal programs, and strengthening provider
training and referral systems. Through targeted
communication and education efforts, ODH increased
community awareness and early prevention practices.
Workforce development was supported through
mentorship, academic partnerships, and leadership
cultivation. Integration of oral health into medical care
was promoted via provider training and implementing
a closed-loop referral process. Sustainability was
ensured by embedding a core program component,
the dental care coordination, into county operations
and supporting policy advocacy. Program
development was guided by continuous monitoring
and evaluation, ensuring alignment with community
needs and public health best practices. Stakeholder
engagement remained central, with inclusive
workgroups and committees shaping strategic
priorities and fostering collaboration.
Key Findings
»Nearly one in four children ages 0–5 and half of
school-aged children have caries experience, and
only 43% of children with Medi-Cal 0–20 received
preventive dental services in 2023.
»Kindergarten Oral Health Assessment (KOHA)
participation remains consistently low across
Alameda County. In 2018–2019, only 53% of
schools reported KOHA data; by 2024–2025, this
dropped to 36%.
»Despite importance of dental sealants to prevent
cavities, only 11% of Medi-Cal beneficiaries aged
6–9 and 6% of those aged 10–14 received dental
sealants in 2023.
»Despite increase in the overall percentage of
receiving dental care during pregnancy, disparities
exist in receiving dental care among subgroups of
pregnant people.
»By 2030, Alameda County’s population is projected
to age significantly, with residents 65 and older
increasing by more than 23%.
»Among older adults, oral cavity and pharynx cancer
risk and burden are highest in men and particularly
in White men, while older adults who are Black are
more likely to be diagnosed at late stage.
»The high rate of seeking dental care at emergency
6 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
department (ED) for non-traumatic dental
conditions (NTDC), especially among African
American residents, indicates inadequate access to
ongoing preventive and restorative care.
»There is shortage of specialty dental providers and
a lack of workforce diversity compared with the
communities they serve, limiting equitable access
to care.
»County-level representative population-based
data on oral health status and service utilization
are limited for many population groups, making it
difficult to monitor inequities and plan and evaluate
interventions across the life course and groups.
Recommendations
Young Children
Integration: Include dental care in routine pediatric
visits and create referral systems to dental homes.
Awareness: Educate families about the importance
of early dental care through early childhood
programs.
On-Site Services: Provide preventive dental
services in community settings.
Address Barriers: Work with community
health workers to overcome access issues like
transportation and language.
School-Aged Children
Education: Inform families about dental sealants
and Medi-Cal benefits.
Access: Expand school-based dental programs via
partnerships.
Data & Billing: Improve oral health data collection
and advocate for billing systems that capture
preventive services.
Kindergarten Oral Health Assessment
(KOHA)
Capacity Building: Train school staff to better
implement KOHA and report data.
On-Site Services: Organize dental screening
events at schools.
Access & Engagement: Help families complete
assessments and connect children to dental care.
Pregnant and Postpartum People
Equity Focus: Target outreach to underserved
Medi-Cal populations.
Integration: Add oral health assessments to
prenatal/postpartum visits.
Referral Systems: Link prenatal care with dental
providers to establish dental homes.
Awareness: Promote oral health through early
childhood and maternal programs.
Older Adults
Advocacy: Support expanded dental coverage for
seniors.
Training: Educate aging services staff on oral
health.
Service Expansion: Deliver dental care in senior
living facilities.
Continuing Education: Provide CE courses in
geriatric dentistry.
Cancer Screening: Promote oral cancer screening
and tobacco cessation for high-risk groups.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 7
Emergency Department Visits for Non-
Traumatic Dental Conditions
Referral Systems: Support creating referral
pathways within hospitals that connect patients to
dental care.
Advocacy: Inform advocacy efforts about the
importance of sustaining an adequate Medi-Cal
Dental coverage.
Workforce Development
Cultural Competency: Train providers in inclusive
care practices.
Specialty Network: Build a referral network for
specialized dental care.
Diversity Pipeline: Support training programs for
diverse dental professionals.
Identified Data Gaps
Surveillance System: Develop a coordinated oral
health surveillance system across partners.
Data Sharing: Establish shared data agreements to
support standardized, de-identified data collection.
Reporting Tools: Strengthen screening
and reporting systems through training and
standardized tools.
Conclusion
The 2025 Needs Assessment underscores both
the progress made and the persistent challenges in
achieving oral health equity in Alameda County. The
findings directly inform the 2025–2030 Oral Health
Strategic Plan, which aims to close gaps in access,
improve data-driven decision-making, and ensure
that all residents—regardless of income, race, or
background—can achieve optimal oral health.
8 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
INTRODUCTION
Oral health is an essential component of overall well-
being for both children and adults. It impacts physical,
mental, social, and economic health, influencing
self-esteem, daily activities, and quality of life. Tooth
decay is one of the most common chronic illnesses in
children. National data show that about 11% of children
aged 2–5 and nearly 18% of those aged 6–8 have
untreated cavities in their primary teeth. Among teens
aged 12–19, roughly 10% have at least one untreated
cavity in their permanent teeth. These proportions are
even more significant for children of color and those
from lower-income backgrounds, who experience
higher rates of decay.1
Access to preventive dental care and timely treatment
is key to reducing the risk of tooth decay and
supporting lifelong oral health. However, substantial
barriers still exist, especially for vulnerable and
underserved populations. Expanding access to dental
services helps prevent disease, reduce disparities,
and improve overall community health.2
The Alameda County Oral Health Needs Assessment
was funded mainly by the California Department of
Public Health, Office of Oral Health, Moving California
Oral Health Forward. This assessment was developed
to provide a comprehensive understanding of the
county’s oral health landscape, with a focus on
identifying disparities in oral disease burden and
access to dental care, available resources, service
gaps, and opportunities for improvement.
The assessment focused on priority populations,
including children, adults, pregnant people, and
older adults. It identified key issues such as the wide
prevalence of untreated tooth decay in children,
limited access to preventive care, and underutilization
of dental services among Medi-Cal enrollees. The
assessment also highlighted the progress that has
been made since the previous needs assessment
conducted in 2018. The findings aim to guide and
inform future policy advocacy, improve data collection,
and enhance cross-sector collaboration to address
systemic inequities.
This comprehensive approach is designed to ensure
that all Alameda County residents, regardless of
background or income, can enjoy optimal oral health.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 9
METHODOLOGY
The needs assessment was led by
staff from the Alameda County Local
Oral Health Program (LOHP). Using
a methodology consistent with the
2018 assessment, primary data were
gathered through key informant
interviews and focus groups, and
were supplemented by surveys of
community members, stakeholders,
and dental providers collaborating
with the Office of Dental Health
(ODH) across multiple programs.
Secondary data were drawn from
the same core databases used in
the prior assessment to support
continuity and allow for comparison
over time.
The seven-step model for conducting
needs assessments, developed
by the Association of State and
Territorial Dental Directors (ASTDD),3
was used as a guide to conduct the
Alameda County’s oral health needs
assessment. The steps are outlined in
the diagram on the right.
The key areas of the assessment included:
»Main accomplishments since 2019
»Residents Demographic Characteristics
»Oral Health Outcomes
»Dental Services Utilization
»Common Risk Factors
»Protective Factors
»Available Resources
»Findings of Qualitative Data Analysis
Secondary Data Sources
»U.S. Census Bureau is the federal government’s
largest statistical agency. Detailed population-
level data on demographics (age, race/ethnicity,
sex), socioeconomic status (income, education,
employment), housing, and geographic distribution
were collected from their portal.
»Centers for Disease Control and Prevention
(CDC-PLACES data) provides model-based
estimates based on data from the Behavioral Risk
Factor Surveillance System (BRFSS).
»Healthy Alameda County: Some data related to
population demographics and common oral health
risk factors are derived from Healthy Alameda
County. This website is intended to help community
members and policymakers learn about the health
of the community.
10 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
»The California Health Interview Survey (CHIS) is a
leading source of credible and comprehensive data
on the health and health care needs of California’s
large and diverse population. Each year, CHIS
interviews more than 20,000 households on a wide
range of health matters.
»Department of Healthcare Services (DHCS):
Data on Medi-Cal eligibility, enrollment, and
utilization, including detailed information on dental
service access, claims, provider participation, and
preventive care use are available on the portal.
»California Health and Human Services Agency
Open Data Portal: This platform offers wide
range of public health and social service datasets,
including indicators related to healthcare access,
provider networks, public assistance programs,
education, and community health outcomes.
»California Department of Health Care Access and
Information (HCAI): The Emergency Department
Encounters and Dental Provider profiles were
obtained from the HCAI data.
»The National Cancer Institute is the U.S.
government’s quality improvement agency for
cancer research. The State Cancer Profiles are
produced in collaboration between the National
Cancer Institute and the Centers for Disease
Control and Prevention.
»Community Programs Dental Screening
»Head Start
»Federally Qualified Health Centers:
Tiburcio Vasquez Health Center
»Big Smile for Mobile Dental Services
»System for California Oral Health Reporting
(SCOHR): SCOHR is the centralized reporting
system adopted by the Office of Oral Health for
managing kindergarten oral health assessment
(KOHA) data.
Primary Data
ODH staff, ODH consultants (Miriam Abrams, Dr. Jared
Fine, and Dr. Bahar Amanzadeh), and the Alameda
County Public Health Department (ACPHD)—Quality
Improvement & Accreditation (QIA) Division team
were involved in both the primary data collection and
analysis processes for this assessment. These data
captured the real-life experiences of Alameda County
residents and included insights and perspectives from
a broad range of populations and agencies, including
those who serve children, pregnant and postpartum
individuals, older adults, and people with special
health-care needs, among others.
FOCUS GROUPS
Twenty-eight community focus groups were
conducted by ACPHD-QIA team in seven languages
across 20 community organizations throughout
the County as part of the Alameda County Health
Needs Assessment. Participant-reported dental
concerns from the focus groups were systematically
synthesized to identify common themes and insights.
KEY INFORMANT INTERVIEWS
Key Community Partners:
As part of updating the oral health strategic plan, in
June and July of 2024, consultant Miriam Abrams
conducted eight key informant semi-structured
interviews, reflecting a variety of current and potential
partner organizations. Participants represented
organizations serving priority populations, including
pregnant people, older adults, children aged 0–5,
school-aged children, individuals with special
health care needs, as well as representatives of the
County Oral Health Commission and one of the local
dental societies. For the interview guide and the
list of organizations and programs the interviewees
represented, please see Appendix A.
Kindergarten Oral Health Assessment (KOHA) Partners:
In collaboration with the UCSF Dental Public Health
Residency Program, ODH hosted a resident in
2024–2025. The main resident’s project was to
conduct a series of interviews with school districts
representatives in Alameda County to better
understand the KOHA implementation. Eight school
district representatives were interviewed to identify
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 11
challenges in implementing KOHA and collecting
and reporting KOHA data into SCOHR. Participants
were selected based on their prior experience
or knowledge of KOHA reporting systems and
procedures. The series of interviews was conducted
between March and April 2025, using a semi-
structured interview format.
PERINATAL DENTAL ENVIRONMENTAL SCAN
An environmental scan was conducted between June
2023 and December 2023 to systematically assess
resources and identify gaps in dental care access for
the perinatal population, with the goal of informing
future strategies and interventions to improve oral
health access and outcomes for pregnant and
postpartum individuals.
A comprehensive, multimethod approach was
designed to identify resources and gaps in dental
care for the perinatal population. The methods
included several primary data collection strategies:
»Population Survey (N=59): In English, Spanish, and
Cantonese to capture participants’ perceptions
of access barriers, dental care use, awareness of
available resources, and recommendations for
improvement.
»Stakeholders’ Surveys (community partners
(N=21) and dental providers (N=45)): Gathered
input from community partners and dental
providers on current practices, provider training
and comfort in serving pregnant patients, service
delivery challenges, and strategies to improve
access and integration.
»Focus Groups (N=13): Total of three focus groups,
held in English and Spanish to collect qualitative
insights into participants’ dental care experiences,
beliefs, and barriers to care.
»Key Informant Interviews (N=11): Conducted with
healthcare providers, dental professionals, and
community leaders to explore systemic barriers,
workforce gaps, and potential solutions.
»Referral Form Analysis (N=146): Reviewed data
from care coordination referrals (Sept 2023–Jan
2024) to describe demographics and dental needs
of referred pregnant and postpartum patients.
»Patient Satisfaction Surveys (N=44): Administered
by phone to assess satisfaction with care
coordination services and gather suggestions for
improvement.
STRATEGIC PLANNING COMMUNITY MEETINGS
The ODH convened two large in-person community
meeting in November 2024 and May 2025 to
gather a dedicated group of community leaders,
health professionals, and advocates to discuss
the Oral Health Strategic Planning 2025–2030.
Participants outlined key goals and strategies, and
they framed the implementation priorities and offered
suggestions on data sharing and coordination—
essential components for evaluating the progress and
outcomes of implemented activities.
COMMUNITY INPUT
The ODH collected a series of success stories
and conducted patient satisfaction surveys, which
contributed to improving, strengthening, and
sustaining our efforts. This data captured what is
working, where gaps exist, and how ODH initiatives
impact real people. The success stories were
captured from ongoing communication with key
partners and community members.
ODH SCREENING DATA
ODH School-Based Dental Program conducts dental
screening at Berkeley and Livermore school districts.
Additionally, the clinical team visits five WIC sites
across Alameda County to offer dental screening for
beneficiaries. Findings of those dental screenings are
included in this report.
12 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
ACCOMPLISHMENTS FROM 2019–2024
The Office of Dental Health (ODH) made significant
strides across all six focus areas: Access,
Communication and Education, Oral Health Workforce
Development, Integration of Oral Health and Medical
Care, Policy and Sustainability, and Surveillance and
Evaluation. The accomplishments outlined below
reflect the commitment to advancing oral health
equity for all Alameda County residents.
Access to Oral Health Care
ODH plays a central role in increasing access to oral
health services across the county. As a part of the
Healthy Teeth Healthy Communities (HTHC) initiative,
a robust countywide care coordination system
was implemented. This model of care coordination
demonstrated success in bringing people into care,
impacting state policy for the Community Health
Worker benefit. Despite funding cutbacks in 2020,
from 2022–2025, the ODH care coordination team
assisted 2,220 children to establish a dental home.
ODH expanded the dental sealant program in
Berkeley Unified School District to Livermore Valley
Joint Unified School District. From January 2019
to June 2024, 1,955 students were screened, 604
received dental sealants, and 900 received fluoride
varnish and teeth cleaning.
In early 2023, the California Department of Public
Health awarded the ODH a three-year grant to
develop a model for improving access to dental care
for pregnant and postpartum individuals in the county,
called the Perinatal Dental Demonstration Project
(PDDP).
Since its launch, the PDDP has successfully increased
awareness about the importance and safety of dental
care during pregnancy by providing oral health
training to staff and other professionals involved
with pregnant and postpartum individuals, including
WIC, Early Childhood programs, public health
nurses, home visitors, and prenatal care sites, such
as the Comprehensive Prenatal Services Program
(CPSP) coordinators. Over 150 key staff from various
programs attended at least one training session.
In partnership with the Alameda County Dental
Society through the Community of Practice program,
a free continuing education (CE) course focusing
on the importance and safety of dental care during
pregnancy was offered to local dental providers to
improve their capacity to serve this population.
A key achievement of this project was establishing
a closed-loop referral process, which ensures that
referral sources are informed about the status of their
referrals on a regular basis. In this process, patients
referred to ODH from CPSP coordinators, WIC, and
community partners were connected to appropriate
dental care via ODH’s care coordination team.
Through this interdisciplinary collaboration, the care
coordination team has successfully facilitated over
300 dental appointments for the perinatal population
since the project launch.
Communication and Education
ODH continued to elevate oral health as a public
health priority by regularly participating in community
outreach events, offering direct engagement with
residents across diverse communities. These efforts
helped build trust, increase awareness about oral
health services, and connect families to dental homes.
From 2021–2025, ODH staff engaged with 20,557
residents through these outreach events. ODH
provided specialized oral health trainings to prenatal
medical providers, primary care medical providers
and clinical staff, as well as early childcare center
staff, to strengthen early prevention, screenings and
referral practices. We conducted 59 sessions from
2020–2025, training 1,391 staff members at partner
organizations as well as medical professionals. In
addition, ODH developed and distributed oral health
education resources tailored for all life stages, from
early childhood through older adulthood.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 13
Oral Health Workforce Development
ODH developed a Community of Practice (COP) for
dental professionals, a continuing education and
mentorship program for general dentists focused
on treating priority populations, in collaboration with
the UCSF School of Dentistry. ODH expanded COP
through a new partnership with Alameda County
Dental Society, ensuring ongoing professional
development and a shared commitment to oral health.
ODH has actively contributed to strengthening the
capacity of the oral health workforce by hosting
residents from the UCSF dental public health
residency program and interns from the Health Career
Connection program. This opportunity provides them
with valuable hands-on experience in the public
health field. Through this partnership, residents
and interns gain real-world exposure to aspects of
county-level oral health programming, including
program evaluation and performance management,
development and dissemination of large-scale
health communication messages, and oral health
integration within prenatal care and early childhood
centers. These experiences not only enhance their
understanding of population-based oral health
approaches but also help build a pipeline of skilled
future professionals.
Integration of Oral Health and
Medical Care
ODH strengthened the integration of oral health
into broader health systems, including training
430 primary care providers and clinic staff on the
application of fluoride varnish during well-child visits.
The establishment of a closed-loop referral process
between ODH and CPSP coordinators as prenatal
care providers, and WIC as an early childhood care
program, represents meaningful integration of oral
health into these care settings. This initiative marks
an important step forward in collaborative and
coordinated patient care.
Policy and Sustainability
Following the conclusion of the HTHC grant in 2020,
ODH embedded key components—particularly care
coordination and the Community of Practice—into
ongoing county efforts, ensuring their continuation
beyond the life of the grant. ODH also supported
sustainability across the county by partnering with
and advocating for community-based organizations as
they sought funding and policy changes to integrate
care coordination into their workflows and to continue
implementation of other strategic plan priorities.
Surveillance and Evaluation
ODH maintained a strong commitment to data-driven
planning and decision-making. The infrastructure
built throughout previous strategic plans supported
continued monitoring of service gaps, workforce
capacity, and oral health disparities. Evaluation
activities helped shape program design and
policy recommendations, ensuring alignment with
community needs and public health best practices.
Stakeholders Engagement
Throughout the last five years, ODH maintained a
strong commitment to keeping stakeholders and
community partners actively engaged. Engagement
continues through three dedicated workgroups
focused on Early Childhood, Children with Special
Health Care Needs, and Individuals Experiencing
Homelessness. In addition, a KOHA Committee,
established in early 2024, strengthens participation in
KOHA at the district, school, and student levels. The
Oral Health Committee of the Alameda County Public
Health Commission meets quarterly and plays a vital
role in aligning countywide oral health efforts with
broader public health priorities. As part of updating
the 2019–2024 Oral Health Strategic Plan, ODH
hosted two large in-person stakeholder meetings
to foster partner buy-in and ensure continued
participation in implementing the 2025–2030 plan.
14 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
COUNTY DEMOGRAPHIC PROFILE
According to the Healthy Alameda County4 and as of
this report, the total population of Alameda County
is 1.62 million people. Over the last five years, the
population decreased by 3.32%, which is higher than
the state average of 1.69%. By age, the largest age
group in Alameda County is 35–64 years, comprising
41.94% of the population. Young Adults (18–34 years)
account for 22.25%, while School-Age Children (5–17
years) make up 14.00%. Seniors (65+ years) represent
16.81%, and Young Children (0–4 years) constitute only
5.01%.
Alameda County’s population is projected to undergo
notable demographic shifts by 2030. The most
significant trend is the rapid growth of the older
adult population, with residents aged 65 and older
increasing by more than 23% (from approximately
273,000 to 337,000).
On the other hand, younger age groups are expected
to decline. The school-age population (5–17 years) will
decrease by about 4.6%, and the young adult group
(18–34 years) will drop by 8.3%. The working-age
group (35–64 years) will grow modestly by 4.4%. The
0–4 years group will see a slight increase of 5.6%.5
Overall, these trends point toward an aging county
with fewer young residents, as shown in Figure 1.
FIGURE 1: ALAMEDA COUNTY RESIDENTS BY AGE CATEGORY, 2025 AND PROJECTED 2030 DISTRIBUTION
By race, Alameda County is quite diverse, with a
particularly high percentage of Asian residents
compared to other racial groups. The county also
has a notable percentage of Black/African American
residents and a lower percentage of White residents
compared to the state average (39%), as shown
in Figure 2. By ethnicity, 24% of the population is
Hispanic/Latino, compared to 42% statewide.
FIGURE 2: ALAMEDA COUNTY POPULATION BY RACE,
2025
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 15
By spoken languages, Alameda County exhibits
notable linguistic diversity, particularly due to a
significant number of Asian/Pacific Islander and
Indo-European language speakers. The proportion of
Spanish speakers in Alameda County is significantly
lower than the state average of 28%. The following
languages are also spoken in the county: Chinese
(9%), Hindi or related languages (5%), and Filipino/
Tagalog (4%).
The overall economic status of Alameda County
is relatively favorable and stronger than that of
California as a whole. However, disparities among
some groups are evident. Almost 6% of the Alameda
County families live below the federal poverty level,
which is lower than the California average (9%). The
percentage of families with children below the poverty
line in Alameda County is 3.68%, well below the
California average of 5.83%.
Data from the American Community Survey, 2022,
shows that disparities in poverty rate by race/ethnicity
are evident, with African American/Black and Pacific
Islander populations experiencing the highest poverty
levels, followed by American Indian/Alaska Native and
Hispanic/Latino/a/x groups, all exceeding the overall
poverty rate and more than double the rate among
White residents. These inequities are even more
pronounced when focusing on children under 18, with
African American/Black children experiencing the
highest poverty rate at 32.3%, nine times and seven
times more likely than White children (3.3%) and Asian
children (4.5%), respectively, as shown in Figure 3.
FIGURE 3: POVERTY RATE AMONG CHILDREN AND YOUTH UNDER 18
Alameda County demonstrates a notably higher level of educational attainment compared to the California
state average. A significantly larger proportion of its residents hold Bachelor’s, Master’s, and Doctorate
degrees, compared to state average. Conversely, the county has a smaller share of individuals with less than an
associate’s degree compared to California, as shown in Figure 4.
16 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
FIGURE 4: POPULATION 25+ BY EDUCATIONAL ATTAINMENT IN ALAMEDA COUNTY AND CALIFORNIA, 2025
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 17
ORAL HEALTH OUTCOMES OF ALAMEDA COUNTY
RESIDENTS
In this section, we will examine available data that
can shed light on the status of oral health of Alameda
County residents through the life course. Data
sources included local screening dental programs,
including ODH’s school-based dental program
and other dental providers, SCOHR data for the
Kindergarten Oral Health Assessment,6 CHIS data for
self-reported condition of teeth and missed school
days for dental problems,7 CDC-PLACES data for the
total tooth loss among adults 65+,8 and the State
Cancer Profile for the prevalence of Oral and Pharynx
cancer.
Young Children (0–5 Years Old)
Data showing the current oral health status of children
aged 0–5 years comes from the Office of Dental
Health program, Head Start, Early Head Start, Tiburcio
Vasquez Health Center, and the Alameda County
Dental Society. During FY 24–25, these organizations
assessed the oral health of 831 children. The findings
showed that 153 children (18%) had untreated decay.
At least 82 children, or 9%, needed urgent dental
care. Caries experience was noted in 203 children,
representing 24% of those assessed.
School-Aged Children (6–20 Years Old)
ODH School-Based Dental Program
The dental screening of 576 students at Berkeley
School Unified and two schools in Livermore School
District showed that during the last two school years,
2023–2024 and 2024–2025, 29% had untreated
tooth decay, and 8% required urgent dental care.
Additionally, 50% of the screened students had
experienced caries, which includes both treated and
untreated tooth decay.
Big Smiles
Big Smiles Dental offers on-site dental services across
various districts in Alameda County. During the 2024–
2025 period, they provided care to multiple schools
throughout the county, examining a total of 1,886
students. Among these students, 19% had untreated
tooth decay, and 6% needed urgent dental care.
Kindergarten Oral Health Assessment
(KOHA)
The Kindergarten Oral Health Assessment (KOHA)
is a California state mandate that requires children
enrolled in public school for their first year in
Transitional Kindergarten (TK), Kindergarten, or first
grade to receive a dental screening from a licensed
dental professional. Schools are responsible for
collecting the completed assessment forms and
entering the data into the SCOHR, which supports
statewide oral health surveillance.
According to SCOHR data, in school year 2018–2019,
53% of Alameda County schools reported KOHA
data to the system. Among the 19,900 enrolled
kindergarten students, 23% completed and returned
their KOHA forms, 2% submitted waivers, and 75%
did not return their forms to school. Of the submitted
waivers, 72% cited non-consent or the belief that
the child would not benefit from the assessment. In
school year 2024–25, only 36% of schools submitted
KOHA reports to SCOHR. Among the students in
those reporting schools, 35% completed and returned
the KOHA form, 26% submitted a waiver, and 39% did
not return any form. Of the students who submitted
a waiver, 89% cited either a lack of dental insurance
or difficulty finding a provider who accepts their
insurance.
Although the KOHA data entered into SCOHR reflects
the oral health status of students who completed and
returned the KOHA form, such as experiencing tooth
decay or having untreated tooth decay, it appeared
unreliable and was challenging to use in this report.
Therefore, we limited our reporting in this document
to the measures described above. This challenge
underscores the need for improved technical
assistance and resources to support school districts in
accurately entering KOHA data.
18 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
The Office of Dental Health (ODH) will work
collaboratively with school districts to strengthen
KOHA mandate implementation. Planned efforts
include providing training to school staff, improving
data entry processes, coordinating on-site dental
screening events at schools, and helping schools
address additional access barriers that prevent
families from completing the assessment.
Self-reported Condition of Teeth
Among Teens
Figure 5 illustrates trends in teens’ self-reported
condition of teeth in the Bay Area Region and
California for 2019 and 2022 when asked: “How
would you describe the condition of your teeth?”
Bay Area regional data was used instead of Alameda
County’s data due to the statistical instability for this
measure at the county level.
In 2019, 62% of Bay Area teens rated their teeth as
excellent/very good, compared to 57% in California.
By 2022, these percentages have declined to 52%
in the Bay Area and 48% statewide. Throughout both
years, a consistently higher percentage of teens
in the Bay Area perceived their dental condition
as excellent/very good compared to the statewide
average. The proportion of teens reporting their teeth
as good rose from 27% in the Bay Area teens and 31%
statewide in 2019 to 32% and 36%, respectively, in
2022. Eleven percent of teens in the Bay Area (which
was statistically unstable) and 12% statewide reported
the condition of their teeth as fair/poor, which
increased to 16% in both the Bay Area and California
in 2022.
FIGURE 5: SELF-REPORTED CONDITION OF TEETH AMONG TEENS IN BAY AREA REGION AND CALIFORNIA, 2019
AND 2022
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 19
Missed School Days Due to Dental Problems
Dental diseases and the pain they cause are significant
contributors to missed school days among children,
impacting both educational achievement and overall
well-being. As part of the CHIS, respondents were
asked: “During the past 12 months, did (he/she) miss
any time from school because of a dental problem? Do
not count time missed for cleaning or a check-up.” This
variable is not asked of everyone: Asked of children
aged 5 and older who attend school.
FIGURE 6: PERCENTAGE OF CHILDREN 5+ WHO
MISSED SCHOOL DUE TO DENTAL PROBLEM IN ALAMEDA COUNTY AND CALIFORNIA, 2023–2024
Figure 6 displays the percentage of children aged 5
and older who missed school due to dental problems
in Alameda County and California, based on data
from pooled (combined) years, 2023 and 2024, to
address data instability observed in individual annual
estimates. Alameda County showed a higher rate
(10.2%) than Statewide average (7.1%).
Data for the years 2018–2019 were determined to be
statistically unstable for both Alameda County and
Bay Area Region. Subsequently, they were not used
for comparison.
Adults Oral Health Status
Self-reported Condition of Teeth
Among Adults
Figure 7 illustrates the self-reported condition of
teeth among adults in Alameda County and California
in 2019 and 2022 when asked: “How would you
describe the condition of your teeth?” In 2019, nearly
50% of adult respondents in both Alameda County
and Statewide classified the condition of their teeth
as “good/fair”, which was slightly higher than the
proportion rating their teeth condition as “excellent/
very good” (44% in Alameda and 42% Statewide).
By 2022, this pattern remained consistent: 44% of
adults in the County reported their teeth condition as
“good/fair,” compared to 42% reporting “excellent/
very good.” Statewide, 49% of adults considered the
condition of their teeth as “good/fair” compared to
41% “excellent/very good,” during the same year.
A notable increase occurred in the percentage of
adults considering the condition of their teeth as
“poor” between 2019 and 2022, rising from 4% to 11%
in Alameda County, compared to only a one percent
increase Statewide.
FIGURE 7: SELF-REPORTED CONDITION OF TEETH AMONG ADULTS IN ALAMEDA COUNTY AND CALIFORNIA,
2019 AND 2022
20 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
Older Adults (65 Years and Older)
Figure 8 depicts the age-adjusted prevalence of
adults aged 65 and older in Alameda County and
California who have lost all their teeth from 2018 to
2022. The graph demonstrates a steady decrease in
* Data for American Indian/Alaska Native has been suppressed to ensure confidentiality and stability of rate estimates as
counts were fewer than 16.
the prevalence from 9.4% in 2018 to 5.8% in 2022 in
Alameda County. In contrast, California showed an
increase in this prevalence from 7.7% in 2018 to 9.4%
2020. Statewide data for 2022 is not yet available.
FIGURE 8: AGE-ADJUSTED PREVALENCE OF ADULTS 65+ WITH TOTAL TOOTH LOSS, ALAMEDA COUNTY AND
CALIFORNIA, 2018-2022
Oral and Pharynx Cancer
Oral cancer forms in tissues of the mouth or the
oropharynx (the part of the throat at the back of
the mouth). The known risk factors for developing
oral cancer are tobacco use and heavy alcohol
consumption. According to the American Cancer
Society, individuals who both smoke and drink
excessively are 30 times more likely to develop oral
cancer than those who do not smoke or drink.9
The data on incidence rate for oral cavity and pharynx
cancer is derived from the National Cancer Institute
and State Cancer Profile for incidence across different
population subgroups.10 The analysis of age-adjusted
incidence rates for oral cavity and pharynx cancer
from 2017 to 2021 reveals notable disparities by race/
ethnicity, age, and sex. The average incidence rate is
9.5 per 100,000, showing a slight decrease from the
previous period, 2016-2020, at 9.4 per 100,000.
Figure 9 shows the age-adjusted incidence rate of
oral cavity and pharynx cancer by 100,000, by race/
ethnicity, all stages, and late stage, 2017–2021.*
White individuals bear the highest overall burden,
with incidence rates of 12.5 per 100,000 for all stages
and 8.2 per 100,000 for late-stage disease. Black
individuals, while having a lower overall incidence (6.7
per 100,000), face the highest proportion of late-stage
diagnoses, with approximately 75% (5 out of 6.7 per
100,000) of cases identified at an advanced stage.
Asian and Pacific Islander individuals have a relatively
high incidence rate of 8 per 100,000, with 4.7 per
100,000 (59%) presenting with late-stage disease.
Hispanic populations have the lowest incidence, at
5.5 per 100,000 for all stages and 3.5 per 100,000 for
late-stage cases.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 21
The age-related burden is dramatic: incidence rises from 5.2 per 100,000 among those under 65 to 39 per
100,000 among those 65 and older. There is also a pronounced sex disparity, with males experiencing more
than twice the incidence seen in females (13.4 vs. 6.1 per 100,000). These findings underscore the importance of
focusing prevention, screening, and early detection efforts on White and Black communities, older adults, and
males to reduce both overall incidence and late-stage diagnosis.
FIGURE 9: AGE-ADJUSTED INCIDENCE RATE CASES OF ORAL CAVITY AND PHARYNX CANCER BY 100,000, BY
RACE/ETHNICITY, ALL STAGES AND LATE STAGE, 2017-2021
22 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
DENTAL SERVICES UTILIZATION AMONG MEDI-CAL DENTAL
BENEFICIARIES
This section summarizes the prevalence of key dental
utilization measures, including annual and preventive
dental visits and sealant use, among Medi-Cal
dental beneficiaries. The Medi-Cal Dental program is
California’s version of the federal Medicaid program.
Data is derived from the California Health and Human
Services Open Data Portal.11
An annual dental visit is recorded when a beneficiary
receives qualifying dental care at least once per
calendar year. This includes a range of services
such as diagnostics (e.g., X-rays), preventive care,
treatments, and surgeries, as well as visits to safety
net clinics dedicated to serving underserved or
vulnerable communities.
A preventive dental visit is documented each
calendar year when a beneficiary obtains services
specifically aimed at preventing oral health issues, like
professional cleanings, sealant applications, fluoride
treatments, or other preventive encounters at safety
net clinics.
Use of sealant: A dental sealant is a protective
coating that is painted onto the chewing surfaces
of the back teeth. It acts as a barrier to preventing
cavities in children.
It should be noted that beginning in 2019, CPT
code 99188 was incorporated into both annual and
preventive dental visit codes. This code captures
fluoride varnish applications provided by medical
professionals, offering a more comprehensive view
of preventive dental service access and utilization
among the Medi-Cal population. Additionally, in 2018,
the Dental Transformation Initiative (DTI) was launched
to enhance the delivery and coordination of dental
care for Medi-Cal beneficiaries. Together, these efforts
can be partly attributed to the observed increase in
Medi-Cal dental service utilization in 2019.
Annual Dental Visits by Age Groups
Figure 10 displays the percentage of annual dental
visit utilization among Medi-Cal Dental beneficiaries
by age group in Alameda County and California in
2023. For children aged 0–5, utilization rates were
slightly similar, at 44% in Alameda County and 45%
statewide. For those aged 6–20, Alameda showed
a 45% utilization rate, lower than California’s 50%.
Among adults aged 21–64, Alameda had the lowest
rate at 19%, compared to 24% in California. For adults
aged 65+, utilization was 24% in Alameda and 26%
statewide.
Overall, the highest utilization was observed among
the 6–20 age group, while the lowest was among
adults aged 21–64 in both regions. Across all age
groups, California consistently had higher utilization
rates than Alameda County.
FIGURE 10: UTILIZATION OF ANNUAL DENTAL VISIT BY MEDI-CAL DENTAL BENEFICIARIES BY AGE GROUP IN
ALAMEDA COUNTY AND CALIFORNIA, 2023
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 23
Children Aged 0–20
Figure 11 illustrates trends in annual dental visit
utilization among Medi-Cal Dental beneficiaries aged
0–20 in Alameda County across different racial and
ethnic groups from 2019 to 2023. Asian children
consistently had the highest utilization rates, with a
slight decrease from 58% in 2019 to 52% in 2023,
followed by Hispanic children, whose rates also
declined slightly from 54% to 51% over the same
period. Steeper decreases were observed among
Black, Native Hawaiian or Pacific Islander, and White
children, who had the lowest utilization rates in both
years (31% in 2019, 26% in 2023). Alaskan Native
or American Indian children showed no change,
remaining at 41% in both years. Despite the relatively
higher rates among Asian and Hispanic children, the
overall trend reflects persistent disparities in access to
dental care for children and youth in Alameda County.
FIGURE 11: UTILIZATION OF ANNUAL DENTAL VISIT BY MEDI-CAL DENTAL BENEFICIARIES AGED 0–20 BY RACE/
ETHNICITY IN ALAMEDA COUNTY, 2019–2023
Adults Aged 21–64
Figure 12 illustrates the utilization of annual dental
visits among Medi-Cal Dental adult beneficiaries aged
21–64 in Alameda County and California from 2017 to
2023. Throughout this period, California consistently
showed higher utilization rates compared to Alameda
County. From 2017 to 2019, both regions experienced
a steady increase in utilization: Alameda County rose
from 19% to 21%, while California increased from 21%
to 25%. However, in 2020, both saw a sharp decline,
largely attributed to the COVID-19 pandemic and its
impact on access to dental services.
FIGURE 12: UTILIZATION OF ANNUAL DENTAL VISIT BY MEDI-CAL DENTAL ADULT BENEFICIARIES AGED 21–64 IN
ALAMEDA COUNTY AND CALIFORNIA, 2017–2023
24 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
By 2021, utilization rate of annual dental visit among
adults aged 21–64 began to rebound. Alameda
County returned to 19% and remained stable through
2023. California showed a stronger recovery,
reaching 23% in 2021 and slightly increasing to 24%
by 2023.
Older Adults
Figure 13 illustrates the utilization of annual dental
visits among Medi-Cal adult beneficiaries aged 65
and older in Alameda County and California from
2017 to 2023. Both regions experienced a gradual
increase in utilization rates from 2017 to 2019. In
Alameda County, the rate rose from 22% to 25%,
while California saw an increase from 23% to 26%.
A sharp decline occurred in 2020, likely due to the
COVID-19 pandemic, with utilization dropping to 17%
in Alameda and 20% statewide. By 2021, rates began
to rebound—22% in Alameda and 24% in California—
and continued to rise steadily through 2023, reaching
24% in Alameda County and 26% in California.
FIGURE 13: UTILIZATION OF ANNUAL DENTAL VISIT BY MEDI-CAL DENTAL ADULT BENEFICIARIES AGED 65+ IN
ALAMEDA COUNTY AND CALIFORNIA, 2017–2023
Preventive Dental Services
Children Ages 0–5
Figure 14 shows the percentage of children aged 0-5
eligible for Medi-Cal Dental who utilized preventive
dental services in Alameda County and California
from 2017 to 2023. Utilization rates in Alameda
County were generally nearly similar to the state
average, ranging from 32% to 43%. Alameda County
and California were at their lowest at 32% in 2020,
most likely due to the COVID-19 pandemic, followed
by a steady increase, reaching 43% in 2023. Notably,
there was an observed increase from 2018 to 2019,
coinciding with the addition of CPT code 99188 and
the initiation of the Dental Transformation Initiative
(DTI).
FIGURE 14: UTILIZATION OF PREVENTIVE DENTAL SERVICES BY MEDI-CAL DENTAL ELIGIBLE CHILDREN AGED
0–5, IN ALAMEDA COUNTY AND CALIFORNIA, 2017–2023
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 25
Breaking down the age group 0-5 into 3 age groups:
<1, 1–2, and 3–5 years old showed some disparities
among groups, as shown in Figure 15. Overall, there is
a consistent trend of higher utilization among children
3–5 years old, increasing from 48% in 2017 to 52%
in 2023. In contrast, children aged <1 had the lowest
utilization, remaining below 5% across all years,
despite the recommendation by both the American
Academy of Pediatrics and the American Academy of
Pediatric Dentistry that children should receive their
first dental visit by their first birthday or first tooth.
There was an observed drop in utilization across
groups in 2020, mostly due to COVID-19 pandemic.
The slight increase observed in 2019 can be partly
attributed to the introduction of the CPT code 99188,
and the implementation of the DTI in the county.
FIGURE 15: UTILIZATION OF PREVENTIVE DENTAL SERVICES AMONG CHILDREN WITH MEDI-CAL DENTAL AGED
<1, 1–2, AND 3–5, ALAMEDA COUNTY, 2017–2023
Children Ages 0–20
Figure 16 presents the utilization of preventive dental
services among Medi-Cal Dental eligible children
aged 0–20 in Alameda County and California from
2017–2023, compared to the state target. Over this
period, Alameda consistently lagged the California
average, with rates ranging from 35% to 44%. Both
regions showed a gradual increase in utilization rates
over the years, with a noticeable dip in 2020, likely
due to the COVID-19 pandemic. In 2019, Alameda
County reached its highest utilization rate at 44%,
while California peaked at 47%. Despite these gains,
both remained below the statewide target of 47.8%.
From 2021 to 2023, a gradual recovery was observed
in both regions; however, neither met the state
benchmark during this period.
FIGURE 16: UTILIZATION OF PREVENTIVE DENTAL SERVICES BY MEDI-CAL DENTAL ELIGIBLE CHILDREN AGED 0–20, IN ALAMEDA COUNTY AND CALIFORNIA, 2017–2023
26 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
Use of Sealants
Dental sealants are a simple, effective, and affordable
way to prevent cavities, especially in children. They
work by coating the chewing surfaces of back teeth,
blocking out food and bacteria that cause decay.
Public health programs, particularly school-based
sealant initiatives, have been shown to significantly
reduce oral health disparities and save on treatment
costs. These programs are especially impactful for
children in low-income communities who may not
have regular access to dental care.12
Figure 17 illustrates the use of dental sealants among
children ages 6–9 and 10–14 with Medi-Cal Dental
in Alameda County and California from 2018 to
2023. Sealant rates among children 6–9 years old
continue to be higher than those 10–14 years old in
both Alameda County and California, despite the
importance of sealants in dental cavity prevention
in both age groups. Throughout the years, children
ages 6–9 in California had the highest sealant usage,
ranging from 13% in 2020 to 18% in 2019, with a
steady rate of 17% in both 2022 and 2023. Alameda
County’s 6–9 age group consistently followed,
maintaining rates around 12% for most years but
dropping to a low of 9% in 2020 before gradually
recovering to 11% by 2023. For children aged 10–14,
California also showed higher usage (10% annually
except for a slight dip to 8% in 2020), while Alameda
County rates were lower, starting at 7%, dipping to 5%
in 2020, and returning to 6% by 2023.
The graph reveals a significant dip for all groups in
2020, likely due to pandemic-related disruptions,
followed by a partial recovery in subsequent years.
Overall, sealant use in Alameda County remains lower
than the California average, especially among older
children.
FIGURE 17: USE OF SEALANTS AMONG CHILDREN WITH MEDI-CAL DENTAL AGED 6–9 AND 10–14 IN ALAMEDA
COUNTY AND CALIFORNIA, 2018–2023
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 27
Pregnant People
During pregnancy, various physical and nutritional
changes can negatively affect oral health and
well-being. Hormonal changes may lead to gum
inflammation, known as pregnancy gingivitis, which
affects up to 75% of pregnant individuals. Tooth
decay is also common, driven by factors such as food
cravings and more frequent snacking. Untreated oral
diseases in pregnancy may result in poor pregnancy
outcomes, including premature delivery and low
birth weight. The landmark 2012 publication, Oral
Health Care During Pregnancy: A National Consensus
Statement, highlighted that dental care during
pregnancy is important, safe, and recommended,
yet many pregnant individuals still face substantial
barriers to accessing care. Recognizing these ongoing
challenges, the American Public Health Association
(APHA) released a policy brief in 2020 calling for
expanded education, integration of health services,
and improved insurance coverage to enhance dental
access for pregnant individuals.
Therefore, maintaining optimal oral hygiene and
obtaining routine dental cleanings during pregnancy
are critical components of maternal health care.
Despite this, many pregnant individuals do not receive
dental services due to a range of factors, including
limited access to providers who accept Medi-Cal and
persistent misconceptions regarding the safety of
dental treatment during pregnancy.
This section presents an analysis of self-reported oral
health data among pregnant people from the 2016–
2017 through 2022–2023 California Maternal and
Infant Health Assessment (MIHA).
Figure 18 presents the percentage of individuals
receiving dental care during pregnancy in Alameda
County and California. Alameda County has
consistently exceeded the statewide average over the
past several years, as shown in the data from 2016
to 2023. The rate peaked at 54% in Alameda County
during 2017–2018 and, despite a notable decline
through 2020–2021, the rate rebounded to 51% in
2022–2023. In contrast, the California state average
remained lower, dipping to 40% in 2020–2021 before
increasing to 48% most recently. Both Alameda
County and statewide rates now align closely with
California’s 2028 benchmark goal of 48%, reflecting
measurable progress towards improving access to
prenatal dental services at county and state levels.
FIGURE 18: RECEIPT OF DENTAL VISIT DURING PREGNANCY AMONG ALAMEDA COUNTY AND CALIFORNIA
RESIDENTS WITH A RECENT LIVE BIRTH, 2016–2023
2022-2023
28 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
Among Medi-Cal beneficiaries with a recent live birth,
Alameda County demonstrated higher rates of dental
visits during pregnancy compared to the California
average for the same population in most years
from 2016 to 2023, as shown in Figure 19. Rates in
Alameda peaked at 52% in 2017–2018, then declined
to a low of 30% in 2020–2021 before recovering to
38% in the latest reporting period. The statewide
** For 2022, the Federal Poverty Guideline for a single-person household in the contiguous states was $13,590, and for a
four-person household, it was $27,750. These guidelines are set by the Department of Health and Human Services and vary
by household size, with separate, higher guidelines for Alaska and Hawaii.
average remained lower throughout the timeline,
reaching only 32% in 2020–2021 and increasing to
40% in 2021–2023. Despite improvements in the most
recent years, both Alameda County and California
access for this population declined in 2023, indicating
ongoing barriers to care and missed opportunities for
intervention specifically for this population.
FIGURE 19: RECEIPT OF DENTAL VISIT DURING PREGNANCY IN ALAMEDA COUNTY AND CALIFORNIA AMONG
MEDI-CAL BENEFICIARIES WITH A RECENT LIVE BIRTH, 2016–2023
In 2022–2023, the percentage of women with a
recent live birth who received a dental visit during
pregnancy was higher in Alameda County (51%)
compared to the statewide average of California
(48%), as shown in Table 1. Examination by family
income reveals greater disparities: women from
households above 200% of the federal poverty
guideline (FPG)** had substantially higher rates of
dental visits (59%) in both Alameda County and
California, compared to only 41% in Alameda and
39% statewide among those at or below 100% FPG.
Rates of dental visits were also higher among those
with private prenatal health insurance (58% Alameda,
56% California) compared to those with Medi-Cal
(38% Alameda, 40% California). Age and educational
attainment were both associated with higher dental
visit rates, with the highest utilization among older
women (62% for age 35+ in Alameda, 54% statewide)
and college graduates (61% Alameda, 60% California),
while the lowest rates were observed among younger
age groups and those with a high school education or
less (33–38%) in both Alameda County and California.
These findings indicate persistent socioeconomic
disparities in access to dental care during pregnancy
at both the county and state levels.
2022-2023
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 29
TABLE 1: DENTAL VISITS DURING PREGNANCY BY SOCIODEMOGRAPHIC FACTORS, 2022–2023
Total
Alameda County 51%
California 48%
Family Income <=100% FPG 101–200% FPG >200% FPG
Alameda County 41%41%59%
California 39%38%59%
Prenatal Health Insurance Medi-Cal Private
Alameda County 38%58%
California 40%56%
Age 15–24 25–34 35+
Alameda County 33%47%62%
California 38%48%54%
Educational Attainment High school or less Some college College graduate
Alameda County 38%36%61%
California 39%41%60%
30 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
Use of the Emergency Department for
Non-Traumatic Dental Conditions
Limited access to preventive and routine dental care
often leads to untreated dental problems, causing
individuals to seek help for non-traumatic dental
conditions (NTDCs) in emergency departments (EDs).
EDs can only provide temporary relief, primarily
through prescribing pain medications, including
opioids, or antibiotics, rather than treating the root
cause. A recent CDC data brief shows that opioid
prescriptions for dental pain at ED visits have declined
recently, but opioids alone or combined with other
analgesics remain a common approach when dental
care is inaccessible. It is noteworthy to mention that
public insurance is the payor for the majority of all
these visits, representing not only a substantial and
avoidable public expense but also highlighting deeper
systemic challenges in connecting the population to
timely and regular dental care.13
Figure 20 displays the average rate of ED visits for
NTDC per 100,000 population in Alameda County
and California for two time periods: 2020–2021 and
2022–2023.
In 2020-2021, Alameda County had an ED visit
rate of 325.2 per 100,000 population, which was
notably higher than California’s statewide rate of
278.5 per 100,000. By 2022–2023, rates increased
in both regions, with Alameda rising to 382.1 and
California to 349.3 per 100,000 population. Overall,
the graph highlights that ED visits for NTDC rose
in both Alameda County and California over the
analyzed periods, and Alameda County consistently
experienced higher visit rates compared to the
statewide average.
FIGURE 20: AVERAGE RATE OF ED VISITS FOR NTDC PER 100,000 POPULATION, ALAMEDA COUNTY AND
CALIFORNIA, 2020–2021 AND 2022–2023
Figure 21 displays the rate of ED visits for NTDC per
100,000 population by age group, comparing 2020–
2021 rates to those in 2022–2023. There was an
overall increase in ED visit rates across all age groups
in 2022–2023 compared to the earlier period. The
largest increases were observed in children ages 0–5
years, with the 1–2-year-old group showing the most
dramatic rise. Individuals aged 18–34 have the highest
rate among adult age groups and higher than the
average for all ages. These trends suggest a growing
burden of emergency dental visits, particularly among
very young children and young adults.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 31
FIGURE 21: RATE OF ED VISITS FOR NTDC PER 100,000 POPULATION IN ALAMEDA COUNTY BY AGE GROUP, 2020–2021 AND 2022–2023
When age-adjusted rates of ED visits for NTDC were
broken by race and ethnicity for 2020–2021 and
2022–2023, striking disparities were observed, as
shown in Figure 22.
African American residents are dramatically more
likely to visit an ED for dental issues than other
groups, with a rate of 1,107.5 per 100,000 population in
2022–2023—nearly three times the county average
(382.1) and far surpassing rates among Hispanic
(443.8), White (233.2), and Asian (135.8) populations.
Disparities persisted across both years, with African
American residents also reporting the highest NTDC
ED visit rate in 2020–2021 (974.5).
FIGURE 22: AGE-ADJUSTED RATE OF ED VISITS NTDC PER 100,000 POPULATION IN ALAMEDA COUNTY BY
RACE/ETHNICITY, 2020–2021 AND 2022–2023
32 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
COMMON RISK FACTORS
In the next section, we will examine the extent of
common risk factors that contribute to dental diseases
in the population. Sugary drink consumption, tobacco
use, and diabetes are frequently associated with
increased rates of tooth decay and gum disease.
These behaviors and conditions can damage oral
tissues, lower resistance to infection, and complicate
effective prevention and treatment.
Sugary Drink Consumption
The consumption of sugary drinks is associated
with weight gain, obesity, and an increased risk of
dental cavities. The most recent guideline from the
Department of Health and Human Services and the
U.S. Department of Agriculture recommend limiting
daily consumption of the added sugars to less than 10
percent of calories per day.14
In the next section, we will examine the extent of
consuming Sugar-Sweetened Beverages (SSB) in
Alameda County, based on data derived from Healthy
Alameda County and CHIS. This indicator reflects the
percentage of persons who reported drinking soda or
other SSB at least once per day.
In 2021–2022, 9.6% of adults in Alameda County
reported daily consumption, compared to 14.6%
statewide. This represents a slight decrease from
9.9% in 2019–2020, while the state average increased
from 13.7%.15
Consumption patterns vary across communities.
The highest rates were observed in Ashland (15.7%),
Cherryland (15.6%), and Hayward (13.4%), with
elevated rates also noted in San Leandro and San
Lorenzo. In contrast, the lowest rates were found
in Piedmont (5.1%), Berkeley (5.4%), and Pleasanton
(6.8%).6
It is worth noting that among children and teens,
when respondents were asked, “[Yesterday,] how
many glasses or cans of sweetened fruit drinks,
sports drinks, or energy drinks did you (your child)
drink?”, 15% reported drinking two or more glasses in
Alameda County, compared with 19% statewide.16
Tobacco Use
Tobacco use, whether smoked or smokeless, has
serious consequences for oral health. It increases
the risk of oral cancer, gum disease, tooth loss, and
cavities. Tobacco also slows healing after dental
procedures, raises the chance of dental implant
failure, and contributes to bad breath, dry mouth, and
tooth staining. Smokeless tobacco also increases
the risk of oral cancer and mucosal lesions and
can cause gum thickening, tooth discoloration, bad
breath, enamel erosion, gum recession, bone loss,
periodontal disease, cavities from added sugars, and
ultimately tooth loss.17
Recent studies suggest that vaping is linked to
higher risks of periodontitis and dental caries. People
who vape appear to experience more oral health
problems than non-smokers, although these effects
are generally less severe than those seen with
conventional cigarette use. The growing popularity
of vaping, particularly among youth, underscores the
need for increased awareness of its potential oral
health harms.18
In the next section, we will examine the extent of
smoking and e-cigarette use among adults and teens
in Alameda County, compared to California, based on
data derived from Healthy Alameda County and CHIS.19
Adult Smoking in Alameda County
According to data from 2022–2023, 6.9% of adults in
the county reported currently smoking, slightly higher
than the California state average of 5.5%. This marks
an increase from 5.7% in 2019–2020, while the state
rate declined from 6.7% during the same period.
Smoking prevalence varies notably by age, gender,
and race/ethnicity. Adults aged 25–44 had the highest
smoking rate at 9.5%, followed by those aged 45–64
(6.4%), 18–24 (5.2%), and 65+ (3.1%). Men were nearly
twice as likely to smoke as women (9.2% vs. 4.7%).
By race/ethnicity, Black/African American had the
highest smoking rate at 14.4%, followed by Hispanic/
Latino (10.7%), Asian (5.4%), and White (3.7%).
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 33
Geographically, smoking rates also varied across
cities. The highest rates were observed in Ashland
(8.4%), Cherryland (7.1%), and Oakland (6.9%), while
the lowest were in Piedmont (2.4%), Albany (3.4%),
and Berkeley (3.7%).
Adult E-Cigarette Use in Alameda County
This indicator reflects the percentage of adults who
reported using electronic cigarettes (e-cigarettes or
vapes) in the past 30 days. In Alameda County, adult
e-cigarette use increased from 2.5% in 2019–2020
to 4.5% in 2021–2022, aligning closely with the
California state average of 4.6% during the same
period. This upward trend suggests a growing need
for public health efforts focused on vaping prevention
and cessation among adults.
Use of e-cigarettes varies across communities. The
highest rates were observed in Ashland (5.9%),
Cherryland (5.5%), and Berkeley (5.3%), while
the lowest rates were found in Piedmont (2.5%),
Pleasanton (3.7%), and Castro Valley (3.8%).
Teen E-Cigarette Use in Bay Area Counties
According to CHIS data, teen respondents were
classified as current e-cigarette smokers if they
reported using an e-cigarette or other electronic
vaping product at least once in their lifetime and on
at least one day in the past 30 days. For this indicator,
data from the Bay Area Counties region were used,
and survey years 2022–2024 were pooled to deal
with data instability for Alameda County.
Current e-cigarette use was higher among teens in
the Bay Area region than in California overall during
the years 2022–2024. An estimated 5.6% of Bay Area
teens were current e-cigarette smokers, compared
with 3.4% of teens statewide.
Teen Cigarette Use in Oakland
This indicator reflects the percentage of high school
students who reported smoking cigarettes on at least
one day in the past 30 days. In Oakland, cigarette use
among high school students increased from 2.4% in
2019 to 3.8% in 2021.
*** Women who were diagnosed with diabetes only during their pregnancy were not included in this count.
By race/ethnicity, White teens in Oakland reported the
highest rate of smoking cigarettes on at least one day
in the past 30 days (14.5%), compared with Hispanic/
Latino teens (3.2%) and Black/African American teens
(1.6%).
Diabetes
Diabetes poses a serious threat to oral health.
Individuals with diabetes are at increased risk for
periodontal disease, dry mouth, oral infections such
as thrush, delayed healing after dental procedures,
and tooth decay. These oral health issues are not
only more common but also more severe in people
with diabetes. Importantly, the relationship between
diabetes and oral health is bidirectional. Poor
glycemic control can exacerbate oral health problems,
while untreated oral infections and inflammation
can make it more difficult to manage blood sugar
levels. This underscores the need for integrated care
approaches that address both medical and dental
health, particularly in high-risk communities.20
According to data from CHIS, when respondents
were asked if they had ever been diagnosed with
diabetes,*** 9.2% of adults in Alameda County
were diagnosed with diabetes, compared to 11.2%
statewide in 2022–2023. The previous year, the
county’s rate was even higher at 11.5%, surpassing the
state average of 10.7%. Certain cities within the county
experience disproportionately high rates of diabetes,
including San Lorenzo (15.9%), San Leandro (15.7%),
and Union City (15.6%). In contrast, cities like Berkeley
(6.7%), Piedmont (8.3%), and Albany (8.6%) report
lower prevalence.
Older adults are particularly affected, with 18.6% of
Alameda County residents aged 65 and older living
with diabetes. Racial and ethnic disparities are also
evident: prevalence is highest among individuals
identifying as two or more races, non-Hispanic
(11.4%), followed by Asian (10.6%), Hispanic (10.4%),
Black/African American (10.1%), and White (6.5%)
populations.21
34 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
PROTECTIVE FACTORS
Dental Insurance
Health and dental insurance play a critical role in
improving access to care by reducing financial
barriers that often prevent people from seeking
needed health services. Having adequate coverage
increases the likelihood of routine dental visits and
preventive care, leading to earlier detection of oral
health problems and better overall health outcomes.
Table 2 demonstrates the numbers and percentages
of Alameda County residents who were certified
eligible for Medi-Cal in July 2020 and 2025,
compared to California, according to the Department
of Health Care Services data.22 From July 2020 to
July 2025, the percentage of certified eligible Medi-
Cal enrollees increased from 25% to 30% in Alameda
County, and from 33% to 38% statewide, as shown in
the table below.
TABLE 2: CERTIFIED ELIGIBLE FOR MEDI-CAL POPULATION IN JULY 2020 AND 2025
JULY 2020 JULY 2025
Count
Medi-Cal
Eligible Population
Percentage
Medi-Cal
Eligible
Count
Medi-Cal
Eligible Population
Percentage
Medi-Cal
Eligible
Alameda County 412,583 1,679,664 25%502,817 1,649,199 30%
California 13,001,042 39,535,726 33%14,764,909 39,299,708 38%
According to data from the California Health Interview
Survey, the percentage of adults with dental insurance
increased in both Alameda County and California
between 2019–2023, while the rate declined among
children in the Bay Area region and California over
the same period. Overall, Children continue to have
dental insurance at a higher rate than adults at both
at county and state levels, as shown in Figures 23
and 24. Bay Area regional data was used instead of
Alameda County’s data due to the statistical instability
for this measure at the county level.
FIGURE 23: PERCENTAGE OF ADULTS WITH DENTAL INSURANCE IN ALAMEDA COUNTY AND CALIFORNIA,
2019–2023
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 35
FIGURE 24: PERCENTAGE OF CHILDREN WITH DENTAL INSURANCE IN BAY AREA REGION AND CALIFORNIA,
2019–2023
Oral Health Workforce
This section presents an overview of the dental
workforce availability in Alameda County, using
HCAI23 licensure renewal data to describe the
characteristics of the local dental workforce and
DHCS24 data to illustrate the geographic distribution
of Medi-Cal–enrolled dental providers. As this is the
first time, we have received data HCAI, comparative
analysis is limited; however, these findings establish a
valuable baseline for future evaluation of the county’s
dental workforce.
Alameda County’s dental workforce in 2024 shows
notable geographic and demographic variation, with a
total of 1,529 dentists.
Geographic Distribution
The map below illustrates substantial variation in
the ratio of residents to dentists across Alameda
County. The overall county average is 1,106 persons
per dentist, but this ratio varies across regions, from
more favorable availability of dentists in Tri-Valley/East
County (728 persons per dentist) and Tri-City/South
County (774) to higher ratios in North County (1,032),
Eden Area/Central County (1,629), and Oakland,
where the ratio reaches 1,786 persons per dentist,
indicating the least availability.
36 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
FIGURE 25: GEOGRAPHIC DISTRIBUTION OF DENTISTS BY REGION, ALAMEDA COUNTY, 2024
The ratios of Medi-Cal enrollees to Medi-Cal dental providers vary markedly across Alameda County, indicating
uneven access to care for Medi-Cal members. Countywide, there are 3,276 Medi-Cal enrollees per provider, but
this ratio ranges from 1,500 enrollees per provider in Tri-Valley/East County to 2,381 in Tri-City/South County,
3,233 in Eden Area/Central County, 4,742 in North County, and 4,970 in Oakland, where Medi-Cal enrollees
face the most limited provider availability, as shown in the map below. While many providers are accepting new
patients, some are not, further constraining access in areas that already have high enrollee-to-provider ratios.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 37
FIGURE 26: GEOGRAPHIC DISTRIBUTION OF MEDI-CAL DENTAL PROVIDERS BY REGION, ALAMEDA COUNTY
Racial and Ethnic Profile
The HCAI data revealed significant racial/ethnic
distribution of dentists when compared to the
county’s general population, as shown in Figure 26.
Asian, non-Hispanic dentists represent 66%, while
comprising only 35% of the general population. This
indicates their substantial overrepresentation in the
dental workforce. White, non-Hispanic individuals
make up 19% of dentists, compared to 28% of the
population, showing a moderate underrepresentation.
Hispanic individuals of any race account for only
4% of dentists, despite representing 24% of the
population—a notable underrepresentation. Black,
non-Hispanic individuals also constitute 4% of
dentists, while making up 9% of the population,
reflecting another significant gap.
In addition to the larger racial groups, Pacific Islander,
non-Hispanic, make up 0.96% (15 dentists), and
American Indian, non-Hispanic, comprises just 0.88%
(13 dentists). These proportions highlight the limited
representation of these groups within the county’s
dental workforce.
38 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
FIGURE 27: PERCENTAGE DISTRIBUTION OF DENTISTS AND GENERAL POPULATION BY RACE/ETHNICITY IN ALAMEDA COUNTY, 2024
Spoken Languages
The linguistic profile of dentists in Alameda
County demonstrates significant diversity, which
has important implications for language access in
dental care. Table 3 shows the seven most spoken
languages by dentists in Alameda County. English
only remains the predominant language, spoken by
41.24% of dentists (631 providers). While this is a large
share, it means that nearly 59% of dentists speak at
least one additional language, highlighting strong
multilingual capacity in the county. Hindi emerges as
the second most common language at 14.82% (227
dentists), then Spanish and Mandarin follow closely,
accounting for 11.28% (172 dentists) and 10.63% (162
dentists) respectively. These languages are critical
for serving large South Asian, Latino, and Chinese-
speaking populations in Alameda County. Tagalog
(8.24%, 126 dentists) and Cantonese (6.45%, 99
dentists) further underscore the county’s linguistic
diversity, particularly among Filipino and Cantonese-
speaking communities. Punjabi, spoken by 6.11% (93
dentists), adds another layer of cultural and linguistic
representation.
TABLE 3: SPOKEN LANGUAGES BY DENTISTS, 2024
Language Weighted
Percent
Estimated
Count
English only 41 .24%631
Hindi 14 .82%227
Spanish 11 .28%172
Mandarin 10 .63%162
Tagalog 8 .24%126
Cantonese 6 .45%99
Punjabi 6 .11%93
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 39
Dental Specialties
Table 4 indicates the percentage and count of dentists
with their specialty in Alameda County in 2024. Most
dentists in the County continue to practice general
dentistry, with a smaller but essential representation
across various specialties. This distribution reflects the
limited availability of specialized care in the county.
»General Practice dominates the dental workforce,
accounting for nearly 80% of all practitioners.
»Pediatric Dentistry and Orthodontics are the most
common specialties, each comprising around 5%
of the workforce.
»Surgical and advanced specialties such as Oral
Surgery, Periodontics, and Endodontics are
present but limited in number.
»Public Health Dentistry and Dental Anesthesiology
remain critically underrepresented, with fewer
than 10 practitioners combined.
»Oral Medicine has no reported specialists in
the county, indicating a potential gap in care for
patients with complex oral-systemic conditions.
TABLE 4: DENTAL SPECIALTIES, 2024
Primary Area of
Practice
Weighted
Percent
Estimated
Count
General Practice 79 .80%1,220
Pediatric
Dentistry 5 .33%81
Orthodontics 5 .00%76
Oral and
Maxillofacial
Surgery
3 .58%55
Periodontics 2 .31%35
Endodontics 2 .08%32
Prosthodontics 1 .07%16
Public Health 0 .35%5
Dental
Anesthesiology 0 .22%3
Other 0 .21%3
Oral and
Maxillofacial Pathology 0 .07%1
Oral Medicine 0 .00%0
Retirement
In 2024, when asked about their anticipated
retirement timelines, most dentists (57%) indicated
plans to retire in 11 years or later, suggesting relative
stability in the workforce. Meanwhile, 21% expect to
retire within 6 to 10 years, 17% within 3 to 5 years, and
5% plan to retire in less than 2 years.
Other Dental Workforce
According to 2024 HCAI data, Alameda County’s
dental workforce extends beyond dentists to include
a substantial number of allied dental professionals
who play a critical role in oral health care delivery.
»Registered Dental Assistants (RDAs): The largest
segment of the allied workforce, with 1,129
professionals, RDAs are essential for supporting
clinical operations, assisting with procedures, and
ensuring efficient patient care.
»Registered Dental Hygienists (RDHs): Numbering
674, RDHs provide preventive services such as
cleanings, oral health education, and periodontal
care, contributing significantly to disease
prevention and early intervention.
»Registered Dental Hygienists in Alternative
Practice (RDHAPs): Although a smaller group (30
professionals), RDHAPs are uniquely positioned to
serve patients in nontraditional settings, including
community-based and home care environments,
improving access for vulnerable populations.
Community Water Fluoridation
Community Water Fluoridation is the controlled
adjustment of fluoride in public water supplies to the
optimal level for preventing tooth decay. Recognized
by the CDC as one of the ten greatest public health
achievements of the 20th century, water fluoridation
is a safe and cost-effective strategy to reduce dental
caries across the lifespan.25 The optimal fluoride level
recommended by the U.S. Public Health Service is
0.7 mg/L (parts per million [ppm]) to maintain caries
prevention benefits and reduce the risk of dental
fluorosis.26
In Alameda County, community water fluoridation
40 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
coverage is inconsistent and varies by city and water
district. Key highlights include:
»Cities with fluoridated water: Oakland, Alameda,
Berkeley, Hayward, Pleasanton, and Fremont,
among others, receive fluoridated water from the
San Francisco Public Utilities Commission (SFPUC)
and other sources that fluoridate.
»Cities without fluoridated water: Livermore, several
smaller communities and private water systems,
especially in the eastern and unincorporated areas
of the county, do not receive optimally fluoridated
water. 27
Available Resources and Programs
ODH Programs:
The Office of Dental Health (ODH) works on
strengthening the county’s oral health system
by connecting residents to needed dental care,
delivering preventive services in community settings
like schools and WIC sites, and building the capacity
of both dental and medical providers. By expanding
the oral health workforce and collaborating with
community partners, the program helps increase
access and reduce barriers to care. ODH administers
the following programs:
DENTAL CARE COORDINATION
ODH accepts referrals from partner organizations to
support families in finding a dentist, scheduling dental
appointments, providing oral health counseling, and
linking them to appropriate care and community
resources. Eligible populations include children ages
0–20 and perinatal individuals who reside in Alameda
County and are eligible for Medi-Cal Dental.
HEALTHY SMILES
Initiated in 2002, this program provides gap coverage
for urgent dental needs for children aged 0–19 who
are uninsured or underinsured. Families receive
assistance with scheduling an appointment or referral
to a dentist within Alameda County for preventive
care or dental treatment needs at no cost.
SCHOOL-BASED DENTAL SEALANT PROGRAM
Provides essential dental screenings and sealants
directly to students at schools and connects them to
urgent dental services when needed.
ODH-WIC COLLABORATION
The ODH clinical team provides on-site preventive
services for the WIC beneficiaries, assists them in
establishing dental homes, and participates in their
community event.
COMMUNITY PRACTICE (COP) PROGRAM
It provides free continuing education to dental
professionals, enhancing their skills and capacity to
serve priority populations and promote equitable oral
health care.
OUTREACH AND EDUCATION THROUGH
PARTNERSHIPS
Capitalizing on our strong and well-established
partnerships with community-based organizations and
programs, ODH staff participate in community events
to improve oral health awareness among community
members and share available resources. The program
also offers oral health training for organizational staff
and provides community workshops.
PERINATAL DENTAL DEMONSTRATION PROJECT
A three-year, state-funded project (2023–2025) is
piloting a model to improve access to dental care for
pregnant and postpartum individuals in the county.
In collaboration with prenatal care providers and
early childhood programs, the initiative promotes
the importance and safety of dental care for both
pregnant individuals and their infants. Efforts focus
on integrating dental assessment and referral into
prenatal and early childhood care and providing
dental care coordination for pregnant and postpartum
patients who need assistance finding a dental
provider.
THE ORAL HEALTH COMMITTEE AND
WORKGROUPS
ODH works closely with and is guided by
organizations serving priority populations in Alameda
County. The Oral Health Committee of the Public
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 41
Health Commission meets once every quarter.
ODH has also formed workgroups that include
local organizations and community members who
understand the unique oral health needs of the
priority population. These groups work continuously
to improve coordination and accountability throughout
the implementation of the five-year Oral Health
Strategic Plan, ensuring that we effectively meet the
needs of our community.
School Health Centers with Dental Services:
There are 13 School Health Center (SHC) locations
that offer preventive and treatment dental services
in Alameda County. Of these, 11 sites have dental
operatories located onsite, providing convenient
access for students. Two SHCs are situated adjacent
to schools, Edendale Middle School (Fuente) and
San Leandro High School (Barbara Lee Center), while
one site, Elmhurst, delivers services through a mobile
dental van. The full list and location of those centers is
in Appendix B.
Other ACPHD Programs:
NUTRITION SERVICES
Nutrition Services promote healthy eating and
active living across Alameda County by engaging
with communities to improve access to fresh foods,
encourage physical activity, and reduce chronic
disease. Nutrition services lead a variety of disease-
and population-specific health education initiatives
throughout the County.
One of the nutrition services programs is the Diabetes
Program, which provides self-management classes
for adults diagnosed with pre-diabetes and Type 2
diabetes and develops a treatment plan to assist
participants in controlling their condition. ODH
supports this program by offering staff oral health
training to promote the importance of oral health for
patients with diabetes.
Nutrition Services supports several health campaigns
throughout the year to help Alameda County
residents maintain and improve their healthy habits.
ODH participates in one of their campaigns, Rethink
Your Drink, encouraging the community to choose
healthier beverages and raise awareness about the
harmful effects of sugary drinks on dental health
through their presentations and distributing resource
materials at community outreach events and on social
media.
TOBACCO CONTROL PROGRAM
The Tobacco Control Program provides tobacco
education, prevention services, and technical
assistance to government agencies, community-
based organizations, law enforcement, hospitals,
clinics, businesses, and residents.
ODH supports these efforts by providing a tobacco
cessation continuing education course unit for
dental providers as part of the COP program and in
collaboration with Alameda County Dental Society
Training. ODH also shares the Tobacco Cessation
Toolkit for Dental Providers with participants.
CARE PARTNERS
Care Partners is a care coordination program that
provides engagement, information, education,
resources, and advocacy to older adults and people
with disabilities in Alameda County so that they can
stay safely at home with an improved quality of life.
ODH provides oral health training for the program’s
staff to equip them with essential oral health
information and available resources tailored to the
needs of older adults.
MATERNAL, PATERNAL, CHILD, AND ADOLESCENT
HEALTH (MPCAH) PROGRAM
Maternal, Paternal, Child, and Adolescent Health
(MPCAH) coordinates services for Alameda County
families—including teens, pregnant women, mothers,
fathers, caregivers, and children. The program
improves access to comprehensive, quality health
care with a focus on early intervention and prevention.
ODH supports the MPCAH program and its Home
Visiting Integration & System of Care program
by providing oral health training for staff, inviting
their team leaders to participate in the Oral Health
Committee and Workgroups, and offering dental care
coordination for their clients as needed.
42 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
COMMUNITY ASSESSMENT, PLANNING, AND
EVALUATION (CAPE)
CAPE provides information, evaluation, planning, and
technical support to programs, partners, decision
makers, and residents to improve community health
and address health inequities. ODH has been working
collaboratively with CAPE, managing and analyzing
program’s data and analyzing secondary data to
inform about oral health at the county level.
QUALITY IMPROVEMENT & ACCREDITATION
DIVISION (QIA)
QIA supports all ACPHD programs by offering
tailored technical assistance, training, resources,
and innovative solutions to advance continuous
quality improvement and enhance public health
outcomes. ODH staff regularly participate in the
workforce development trainings to strengthen their
programmatic skills and get professional support as
needed.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 43
QUALITATIVE DATA FINDINGS
Focus Groups
Findings from community focus groups reveal that
access to dental care continues to be a significant
challenge for many residents, particularly those
belonging to vulnerable groups such as older adults.
Some participants reported that dental services are
expensive and difficult to obtain in a timely manner,
with older adults highlighting the increased difficulty
in paying for costly procedures. In addition, some
community members noted barriers in finding
affordable dentists, while caregivers and parents
expressed a need for more dental screenings in
schools to support children’s oral health. These
collective voices underscore persistent gaps in
access and affordability for essential dental services,
especially among seniors and children in the
community.
Key Informant Interviews
Key Community Partners
The key informant interviews were conducted to
gather partner perspectives on the Office of Dental
Health’s current performance, future direction, and
role within the broader oral health system in Alameda
County. Interview questions explored ODH’s strengths
and areas for improvement, community oral health
needs and gaps, emerging opportunities and threats,
promising practices, and ODH’s unique contributions
relative to other organizations. The objective
was to generate practical, stakeholder-informed
recommendations to guide strategic planning,
strengthen partnerships, and prioritize actions that will
improve oral health outcomes for priority populations.
The findings below provide a detailed picture of
ODH’s contributions, emerging community needs,
and opportunities for strengthened coordination,
communication, and sustainability. The interviews
analysis revealed five main themes as summarized
in the following section: 1. Strengths, 2. Areas for
Improvement, 3. Community Oral Health Needs and
Challenges, 4. Promising Practices, and
5. Recommendations.
Summary of Themes Findings
Theme 1: Strengths
ODH is widely viewed as a trusted, responsive
partner with strong relationships across community
organizations and systems. Partners especially
praised staff’s approachability, follow-through, and
active participation in collaborations that support
pregnant people, young children, and children with
special health care needs.
Theme 2: Areas for Improvement
Partners noted that limited staffing, turnover, and
broader county administrative constraints can disrupt
relationships and slow program momentum. They also
reported a need for more proactive communication
and clearer role definition to increase awareness of
ODH’s services and collaboration opportunities.
Theme 3: Community Needs and Challenges
Interviewees described persistent gaps in oral health
knowledge, particularly around early prevention,
dental visits by age one, and the safety of dental
care during pregnancy. Ongoing access, workforce,
insurance, and cost barriers, especially for Medi-
Cal-enrolled families, continue to limit the ability to
establish and maintain dental homes.
Theme 4: Promising Practices
Partners highlighted several existing efforts as
strong foundations for future work, including Head
Start toothbrushing and classroom education, care
coordination and navigation models, the Rethink
Your Drink campaign, and the KOHA program.
These initiatives were seen as effective vehicles for
prevention, behavior change, and linkage to care.
Theme 5: Recommendations
Key recommendations centered on strengthening
coordination and resource-sharing infrastructure,
including an online portal and searchable provider
44 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
database; expanding education and outreach with
consistent, multilingual messaging; and deepening
collaboration and integration across public health and
education systems. Partners also emphasized the
importance of advocacy to improve Medi-Cal provider
participation, support elder-friendly dentistry, and
advance long-term workforce and access solutions.
Kindergarten Oral Health
Assessment (KOHA) Partners
The KOHA partners’ interviews aimed to understand
the KOHA implementation process, identify the
related barriers and facilitators experienced by
the school districts, and explore opportunities to
improve the school districts’ KOHA participation. The
qualitative analysis revealed the five main themes
summarized below. For the interview guide, please
refer to Appendix C.
Summary of Themes Findings
Theme 1: Schools and students’ participation in
KOHA
Participants have shared that many schools struggle
to obtain completed KOHA forms from families,
resulting in low return rates and incomplete data.
Because KOHA is not legally enforceable like
immunization requirements, schools have no
mechanism to require participation, and there is no
formal accountability or incentive structure at the
school, district, or county levels to support consistent
follow-through. Limited staff capacity to remind and
follow up with families, combined with a cumbersome
multi-page form and the lack of translations into key
languages, further depresses return rates and creates
barriers for families, especially those with limited
English proficiency. Some districts have improved
participation by adjusting deadlines and leveraging
school-based health centers to complete assessments
on-site.
Theme 2: Access to dental professionals
Interviewees described ongoing systemic and
resource constraints that make it difficult for schools
and families to fully participate in KOHA. Access
to dental care remains limited in many low-income
communities, and some schools lack the staffing,
funding, or partnerships needed to bring dental
providers on campus or organize regular on-site
screenings. At the same time, participants noted that
when families have an established dental home and
schools have school-based health centers, it becomes
much easier for students to get assessment forms
completed and for KOHA participation to fit naturally
into existing care and school health routines.
Theme 3: Lack of awareness, communication,
and key stakeholders’ involvement
Interviewees described significant process and
capacity barriers that undermine consistent KOHA
and SCOHR reporting, even when staff are committed
to the requirement. A general lack of awareness,
training, and clear role definition, especially amid
turnover and staffing cuts, has left many schools
uncertain about what needs to be reported, how
to use SCOHR, and who is responsible, leading to
incomplete, inconsistent, or missing data. These gaps
are compounded by competing priorities such as
immunizations and attendance, the loss of centralized
district data-entry support, reliance on outdated forms
at some sites, and wide variation in local practices,
although targeted leadership outreach, technical
assistance from ODH and state or county partners,
and principal- and nurse-led communication efforts
have begun to improve awareness, form completion,
and reporting in some districts.
Theme 4: Operational
Interviewees described operational barriers that
make it difficult for schools and districts to implement
KOHA reliably, even when they value the requirement.
Misaligned timelines between dental and other health
forms, heavy workloads, and small or overstretched
teams mean that KOHA tasks such as collecting forms,
tracking completion, and entering data are often
delayed or deprioritized compared with higher-stakes
requirements. At the same time, participants noted that
when schools have dedicated on-site support staff,
such as health assistants who are embedded in daily
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 45
school operations, these staff can consistently monitor
needs, collect forms, follow up with families, and help
keep KOHA activities on track.
Theme 5: Best Practices and Recommendations
Interviewees described a set of emerging best
practices and recommendations to strengthen KOHA
implementation by making the process easier for
families, schools, and providers. They emphasized
proactive communication and technical assistance,
including having the LOHP participate in school nurse
meetings to explain KOHA requirements, offer hands-
on support, and ensure consistent messaging across
districts. Collecting KOHA forms during registration,
sending due-date reminders before major school
breaks, and encouraging active involvement from
registrars, enrollment staff, directors of student
services, and principals were highlighted as effective
strategies to boost family participation and improve
completion rates.
Participants also recommended system-level
improvements, such as having dental providers enter
data directly into electronic systems, simplifying and
shortening forms, aligning KOHA deadlines with
other health requirements, exploring automated or
technology-assisted data capture, and gathering
feedback from school sites and dental professionals.
Those approaches would reduce manual workload,
minimize data errors, and move toward a more
streamlined, sustainable KOHA process.
Perinatal Dental Environmental Scan
The next section presents findings of the
environmental scan conducted between May 2023
and November 2023 to assess available resources
and existing gaps related to oral health services for
the pregnant and postpartum population in Alameda
County. The findings served as a foundation to
inform the subsequent phases of the Perinatal Dental
Demonstration Project.
Population Survey
A survey targeting pregnant and postpartum
individuals revealed important insights into dental
care perceptions, barriers, and needs. Key findings
include a high recognition of the importance of dental
care (99%), but significant barriers such as cost, lack
of information, and inconvenient appointment times
hinder access for 57% of respondents. While 53%
had a dental visit in the past year, 40% had not seen a
dentist for over a year. Only 55% were aware of Medi-
Cal Dental coverage.
Half of the respondents did not receive dental care
advice during pregnancy, with physicians being the
most common source for those who did (29%). Only
10% received advice from a dental provider. Of those
who received advice, 64% were more likely to visit
the dentist, especially when advised by physicians or
doulas.
The survey highlighted the need to integrate dental
care into prenatal care settings, increase awareness,
and target interventions to address barriers and
improve access to dental services for pregnant
individuals.
Key Partners Survey
A survey of stakeholders working with pregnant and
postpartum individuals revealed general agreement
on the importance of oral health during pregnancy.
However, only 37% felt confident discussing dental
care with their clients, and 38% believed cultural
norms discouraged dental visits. Suggestions to
improve access included enhanced training with
cultural sensitivity, integrating oral health into
workflows, and providing relevant educational
materials.
Dental Providers Survey
A survey of 45 dental providers revealed that 64%
felt comfortable treating pregnant patients, though
36% were somewhat to very uncomfortable. Despite
guidelines affirming the safety of dental care during
pregnancy, 40% preferred providing preventive
services in the second trimester, with 63% favoring
this trimester for restorative services. Concerns
included safety, anesthesia, medication, x-rays, and
legal issues. Additionally, 27% of respondents do
not treat pregnant women with Medi-Cal due to
46 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
enrollment and reimbursement issues. However,
77% believed that adding Medi-Cal incentives could
motivate more dentists to treat this population. Some
suggested training needs for dental providers include
pharmacology, managing co-morbidities, and handling
emergencies.
Focus Group Findings
Three focus groups with 13 diverse pregnant and
postpartum participants revealed key barriers to
dental care during pregnancy, including concerns
about the safety of dental procedures, x-rays, and
medications. Some participants were advised by their
dentists to postpone dental care until after pregnancy,
leading to misconceptions about its safety and
importance. Additionally, many participants expressed
the need for assistance in finding a dentist.
Key Informant Interviews
Eleven interviews with key informants working with
this priority population revealed a significant need to
equip organizational staff with oral health information
to educate families effectively. Oral health was
identified as a primary unmet need. Suggestions
included sharing community-based research on
the safety and importance of dental care during
pregnancy, establishing a network of dental and
medical providers to reinforce oral health messages,
inviting experts to share best practices, and creating
an efficient referral process between medical and
dental providers. The ongoing shortage of dental
providers and support staff, exacerbated by the
COVID-19 pandemic, was also highlighted.
Referral Forms
The ODH care coordination program started
accepting referrals for pregnant and postpartum
individuals in July 2023. An analysis of 146 referral
forms from September 2023 to January 2024
revealed that most referred individuals were aged
25–34 (60%), followed by those aged 35 and above
(23%) and 15–24 years (18%). Hispanics constituted
the largest ethnic group (58%), with a notable
preference for Spanish (49%) over English (32%).
Dental concerns were absent in 62% of cases, but
issues like dental pain (16%), gum disease, and
tooth decay/broken teeth (11% each) were reported.
Urgency of care was mixed, with 40% requiring urgent
care and 60% considering their needs routine.
Patients’ Satisfactory Survey Findings:
The responses of the care coordination patient
satisfaction survey from pregnant and post-
partum patients highlighted the strong impact of
the care coordination program in assisting those
patients with dental appointment scheduling
and addressing additional needs. The team’s
flexibility, communication, and attentiveness to
patients’ schedules and challenges were frequently
mentioned. Many respondents appreciated the team’s
efforts to provide timely appointments, assist with
transportation issues, and offer ongoing follow-up
support. A few standout comments that effectively
convey the program’s success were:
“Got me an appointment ASAP, something
that I couldn’t do for myself; Advocated for me
effectively and in a timely manner.”
“Everything: great with scheduling;
had a problem with my ride, but the team
was able to help me call another ride.”
“Very careful with the appointment; Speaking
with me made everything go smoothly afterward,
especially given that I had experienced many
setbacks with making an appointment.”
These quotes underscore the program’s efficiency,
advocacy, and positive outcomes for patients in
accessing dental care.
Strategic Planning
Community Meeting
In November 2024, about 60 community stakeholders
and partners came together to reaffirm that
advancing oral health equity in Alameda County
requires prioritizing underserved populations,
young children, people with disabilities, those
experiencing homelessness, Medi-Cal beneficiaries,
and uninsured families. Participants emphasized
the need to expand and diversify the oral health
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 47
workforce, address structural and financial barriers
to care (such as low reimbursement, transportation,
childcare, and long wait times), and leverage schools,
childcare settings, and community organizations as
key access points. The group refined a set of strategic
focuses and articulated a 2035 vision of universal
coverage, coordinated care, diverse providers, robust
data sharing, and timely inclusive services with no
disparities in oral health outcomes.
Community Input
Alameda County Office of Dental Health (ODH)
regularly collects oral health success stories as a
qualitative primary data source to demonstrate real-
world program outcomes. These stories provide direct
evidence from participants, partners, and community
members about how ODH programs are helping to
improve oral health across Alameda County. A brief
description of services provided and representative
testimonial quotes from various ODH programs are
provided below.
School-Based Sealant Program:
In partnership with selected elementary schools in
Berkeley and Livermore, ODH provides free preventive
dental services to third-grade students enrolled in
14 elementary schools across these districts. These
services include oral screenings, sealants, polishing,
fluoride varnish, and classroom-based oral health
education to ensure that students not only receive
necessary care but also develop lifelong oral health
habits. Selected testimonials from key personnel at the
elementary schools are shared below.
“This has been a wonderful collaboration to detect
early decay for our third-grade students at Marylin
Avenue and Junction School. The partnership has
allowed those students identified at the screenings
to receive dental care with outside partnerships, our
students, who otherwise would not have gotten care,
received free sealants to prevent future decay and
problems. All of this has allowed students to remain
in school and thrive.”
—School Nurse
“This is such a great public-school service! Thank you
for your service to our students.”
—Principal, Emerson Elementary School, Berkley
Unified School District
WIC Dental Days Program:
Another program the clinical team at ODH is
implementing is the WIC dental days program, where
the team provides on-site dental screenings, fluoride
varnish treatments, anticipatory guidance, and offers
dental care coordination for WIC beneficiaries at
five County WIC sites. The director of WIC shared a
testimonial with ODH stating:
“ODH and WIC have had a strong partnership since
the late 2000s. The Dental Day program was piloted
in Hayward and since then has been implemented
at 5 of the PHD WIC’s locations all over Alameda
County. It continues to be a successful collaboration,
providing dental screenings and fluoride varnish
to young children as young as 1 year old... It has
expanded to also serve pregnant mothers in the last
two years. Families are appreciative and thankful
that this service is available at their local WIC office.
I recall the ADA Executive Director, in the late 2000s,
saying that this partnership is the ‘Cadillac of dental
care!’ And after 15+ years, it’s still going strong!”
—WIC Director
Dental Care Coordination Program:
Since the early 2000s, ODH’s dental care coordination
model has significantly improved access to dental
services for Medi-Cal–eligible clients aged 0–20 and
the perinatal population through collaboration with
WIC and other community-based organizations and
clinics. The ODH-FSCCs connect families with dental
providers by educating families on the importance of
dental care, assisting with appointment scheduling,
and helping establish a consistent dental home. Staff
update referral statuses with partnering agencies as a
closed-loop referral approach. A few testimonials from
served clients are presented below.
“Having someone help make sure what I was looking
for was available for my child.”
“I am very grateful for your help. My child was able to
have his dental emergency taken care of very soon.
48 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
Your reminder texts and calls helped me remember
to take my son to his appointments. Thank you very
much!”
Perinatal Dental Demonstration Project:
This project has strengthened the collaboration
between ODH and community partners to improve
access to dental care for pregnant and postpartum
individuals in Alameda County. By providing oral
health training and establishing a closed-loop referral
process connecting patients to care, the project
has helped facilitate dental care for the perinatal
population. The following testimonial from a CPSP
coordinator highlights how this collaboration has
enhanced access to dental care and supported
healthier outcomes for expectant individuals and
families.
“I want to express my sincere gratitude for the
invaluable partnership we’ve established with the
Alameda County Office of Dental Health. Before our
collaboration, many of our patients faced significant
challenges accessing essential dental care. The
streamlined referral process, expertly managed by
you and your team, has been transformative…. This
collaborative approach eliminates a major hurdle for
our patients, significantly improving their access to
critical oral health services. The positive impact on
our patients’ well-being and their overall experience
has been truly rewarding. We here at Eastmont
Wellness Center Women’s Services are incredibly
appreciative of this successful partnership and look
forward to its continued success.”
—A CPSP Coordinator.
Input from Key Partners:
ODH collaborates with a broad network of partners
to ensure coordinated efforts in addressing shared
oral health priorities. These partners include internal
county programs, early childhood education
programs, primary care clinics, Federally Qualified
Health Centers (FQHCs), and local dental providers.
Key partners frequently express their appreciation
of the collaboration and its outcomes. Below is a
testimonial from a local dental provider.
“Since 2019, my team and I have had the privilege
of partnering with the ODH. Over the years, this
relationship has consistently provided a streamlined
referral channel and improved access to care for
vulnerable and underserved pediatric patients,
including those with special health care needs. One
of the most valuable aspects of this partnership
has been the ease of communication through
the dedicated staff members. Through the ODH’s
ongoing efforts, including CE opportunities and
focused workgroups, we’ve also built relationships
with other like-minded providers and organizations
who share our commitment to serving children in
need. I’m truly grateful for the impact
this partnership has had on our practice
and the patients we serve.”
—A local dental anesthesiologist
Community of Practice:
In partnership with the Alameda County Dental
Society through the Community of Practice (COP)
program, ODH offers free continuing education
(CE) courses for dental professionals to enhance
their capacity to serve priority populations and to
strengthen a shared commitment to oral health.
Post-session surveys and two-month follow-up
surveys are conducted with participating dental
professionals. Selected quotes are presented below.
“Essential and super helpful educational materials
and real-life cases. Big thanks to Dr. Saghezchi!”
—Dentist, Private provider, CE participant,
course titled Oral Surgery
“Good reminder to open our practices to
those who have intellectual disabilities
and see what we can do.”
—Dentist, FQHC, CE participant,
course titled Special Care Dentistry
“Great presentation. Useful tips and strategies to
help us talk to patients about tobacco cessation.”
—Dentist, CE participant course titled
Tobacco Cessation in Dental Settings
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 49
IDENTIFIED DATA GAPS
Gaps in Local Data
County-level representative population-based data on
oral health status and service utilization is limited for
many population groups, making it difficult to monitor
inequities and plan and evaluate interventions across
the life course and groups.
Children
Data from school-based dental screenings are
fragmented, as providers do not have a standardized
mechanism for aggregating and sharing these data
countywide.
KOHA data are underutilized because not all schools
submit data to the state system, and concerns remain
about completeness and data entry accuracy.
The Basic Screening Survey (BSS) of third graders
only provides regional estimates, and local data
stratified by key sociodemographic factors are sparse
or unavailable.
Adults
Quantitative data on the oral health status of pregnant
and postpartum people is not currently available,
despite strong evidence that parents’ oral health
directly influences their young children’s oral health
outcomes.
Surveillance data on the oral health status of high-risk
adults, including people with diabetes, are limited,
even though diabetes is associated with increased
risk and severity of periodontal disease.
Data on older adults’ oral health are also scarce, with
a lack of data for community-dwelling seniors and
those in long-term care settings.
Special Populations
There is no routine local data collection on oral health
status and dental care access for people experiencing
homelessness, people with special health care needs,
foster youth, or immigrant and refugee communities,
even though these groups face significant barriers to
care.
Prevention Policies and Protocols
The county lacks a centralized inventory of school
oral health policies and protocols (e.g., KOHA
implementation practices, fluoride varnish protocols,
sealant programs, oral health education), limiting the
ability to monitor policy adoption and impact.
Local data is not systematically collected on the
proportion of residents in each city who regularly
consume optimally fluoridated tap water.
There is no countywide information on the number
and geographic distribution of dental practices
that routinely screen for tobacco use and provide
cessation counseling, despite the importance of
tobacco exposure for oral health outcomes.
50 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
RECOMMENDATIONS
Recommendations to Address Data
Gaps
Build a coordinated surveillance system
Develop an Alameda County oral health surveillance
framework that defines core indicators, data sources
and population groups, aligned with state and national
guidance.
Establish data-sharing agreements with major
systems (Managed-Care Plans, FQHCs, hospitals,
school districts, WIC, early childhood programs, home
visiting, long-term care) to routinely receive de-
identified, standardized oral health data.
Ensure all new and improved data systems can
disaggregate by race/ethnicity, language, income,
disability, geography, and housing status to identify
inequities and track progress over time.
Strengthen existing data sources
Improve KOHA and school screening data quality
through providing technical assistance and staff
training, clear workflows, and regular data validation,
and advocate for enhancements to SCOHR reporting
and feedback tools.
Explore the use of automated technology to scan
KOHA forms to streamline reporting. This will also
help reduce manual data entry to avoid human errors.
Dental providers participating in community screening
events to use the same basic screening tool, allowing
standardized data capture and documentation across
providers and events.
Recommendations to Address Gaps in
Services and Disparities
KEY FINDING: Nearly one in four children ages
0–5 and half of school-aged children have caries
experience, and only 43% of children with
Medi-Cal 0–20 received preventive dental
services in 2023.
Recommendations:
Integrate dental assessment, anticipatory
guidance, and Fluoride Varnish within the
primary care setting and at well-visit child.
Implement a closed-loop referral process
between primary care sites, pediatric
providers, early childhood programs, and
prenatal acre sites so families are actively
connected to dental providers and children
establish a dental home.
Promote awareness among families
and caregivers about the importance of
establishing a dental home by age one
through CPSPs, WIC, home visiting, and early
childhood education programs.
Coordinate with dental providers to offer
on-site preventive services (e.g., screening,
fluoride varnish, sealants) in public health
and community settings frequented by young
children and school-aged youth.
Assist families in addressing structural
barriers (transportation, insurance literacy,
language, and limited clinic hours) by
collaborating with community health workers
and care coordinators to support families in
attending visits.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 51
KEY FINDING: KOHA participation remains
consistently low across Alameda County. In 2018–
2019, only 53% of schools reported KOHA data; by
2024–2025, this dropped to 36%.
Recommendations:
Provide technical assistance and training to
school staff.
Coordinate on-site dental screening events at
schools.
Support schools in addressing barriers
that prevent families from completing the
assessment.
Ensure that students identified as
needing dental care to be connected to
appropriate dental providers and help
establish a dental home.
KEY FINDING: Despite the importance of dental
sealants to prevent cavities, only 11% of Medi-Cal
beneficiaries aged 6–9 and 6% of those aged
10–14 received dental sealants in 2023.
Recommendations:
Increase parent and caregiver awareness
about the benefits of sealants and the fact
that these services are covered for children
with Medi-Cal.
Expand school-based and school-linked
sealant programs so more FQHCs, mobile
dental providers, and RDHAPs would deliver
on-site services in high-need schools and
community settings.
Advocate for a billing system that allows
FQHCs to document specific preventive
services delivered at each encounter,
including fluoride varnish and sealants, to
better track performance.
KEY FINDING: Despite the increase in the overall
percentage of receiving dental care during
pregnancy, disparities exist in receiving dental care
among subgroups of pregnant people.
Recommendations:
Integrate oral health assessment and
anticipatory guidance into prenatal and
postpartum medical visits, including
counseling on how new parents can protect
their own and their infant’s oral health.
Establish a closed-loop referral process
between sites serving perinatal populations,
including prenatal care, social programs,
and dental care coordination programs, so
pregnant and postpartum people are actively
connected to dental providers and supported
in establishing a dental home for themselves
and their infants.
Promote awareness among pregnant and
postpartum individuals through CPSP,
WIC, home visiting, and early childhood
education programs, about the importance of
maintaining oral health during pregnancy and
establishing a dental home for the child by
age one.
KEY FINDING: By 2030, Alameda County’s
population is projected to age significantly, with
residents 65 and older increasing by more than
23%.
Recommendations:
Inform advocacy efforts to prioritize
comprehensive and adequate dental
coverage for older adults.
Partner with programs and organizations
serving this population to train staff on
oral health and how to connect clients to
appropriate dental care.
Collaborate with RDHAPs to expand on-site
preventive and basic dental services in senior
52 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
living facilities and other congregate settings.
Provide regular continuing education
opportunities on geriatric dentistry for dental
and medical providers.
KEY FINDING: Among older adults, oral and
pharynx cancer risk and burden are highest in men
and particularly in White men, while older adults
who are Black are more likely to be diagnosed at
the late stage.
Recommendations:
Advocate for implementing risk-based
oral cancer screening protocols in dental
and medical settings for highrisk groups,
particularly when combined with a history
of tobacco or alcohol use or Human
Papillomavirus (HPV) infection.
Disseminate tobacco cessation counseling
toolkits to dental providers to support
integration of cessation services into routine
care.
Coordinate training for dental providers in
geriatric dentistry to better address the needs
of older adults.
Partner with programs and organizations
serving these populations to increase
awareness among highrisk subgroups about
the importance of oral cancer screening.
KEY FINDING: The high rate of seeking dental
care at the emergency department (ED) for
nontraumatic dental conditions, especially among
African American residents, indicates inadequate
access to ongoing preventive and restorative care.
Recommendations:
Work with hospitals to establish a dental
referral process that connects ED patients to
community health centers or dental homes
for follow-up care.
Inform advocacy efforts about the importance
of sustaining Medi-Cal Dental benefits for
adults to prevent costly and inefficient ED
visits for NTDC.
KEY FINDING: There is shortage of specialty
dental providers and a lack of workforce diversity
compared with the communities they serve,
limiting equitable access to care.
Recommendations:
Provide dental workforce training on
culturally and linguistically appropriate
standards and responsive care.
Collaborate with dental societies to establish
a specialty dental provider network to
address the need for this care.
Collaborate with residency programs at
FQHCs to train a diverse dental workforce,
including residents from diverse racial/ethnic
backgrounds, with a focus on Dental Public
Health.
KEY FINDINGS: County-level representative
population-based data on oral health status and
service utilization are limited for many population
groups, making it difficult to monitor inequities
and plan and evaluate interventions across the life
course and groups.
Recommendations:
Develop a coordinated oral health
surveillance system with shared data
agreements across major community and
health partners, enabling standardized, de-
identified data collection and disaggregation
to monitor inequities and progress.
Strengthen existing data quality and
reporting systems, such as dental screenings
and SCOHR, through training, technical
assistance, and the use of standardized
screening tools across providers.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 53
CONCLUSION AND NEXT STEPS
Over the last five years, ODH has built a strong
network of partners working together to expand
and improve oral health services for low-income and
racially and ethnically diverse communities. Efforts to
integrate oral health into schools, medical practices,
young children’s services, and programs such as WIC
and Head Start have contributed to lasting changes in
these systems. School-based initiatives that combine
oral health education, screening, preventive services
such as fluoride varnish and sealants, and linkage
to dental homes are showing promise in supporting
lifelong positive oral health behaviors.
Despite this progress, substantial challenges remain.
Available data reveal marked disparities in oral
health status and in access to prevention by race/
ethnicity, with dental caries and untreated decay
continuing to affect many children. These findings
have substantially informed the local leaders and
community partners in the development of the
Alameda County Oral Health Strategic Plan for 2025–
2030. The new plan is designed to address many of
the identified gaps in data, access, and services, and
to guide coordinated efforts toward improving oral
health and reducing inequities across the county.
54 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
APPENDICES
Appendix A: Key Informant Interviews
List of Represented Organizations or
Programs
California Children’s Service Program
Care Partners Program
Hayward Unified School District
Oakland Unified School District,
Health & Wellness Services
Alameda County Dental Society,
Community Outreach Committee
Castro Valley School Board,
Public Health Commissioner
WIC Manager
Comprehensive Prenatal Services Program
Coordinator, Alameda Health System Women’s
Wellness Clinic, Eastmont
Interview Guide
INTRODUCTION:
Alameda County Office of Dental Health is starting
a strategic planning process to determine how we
can increase our impact. We are starting the process
by gathering input from key people, including you,
as well as others in the field. Your input will help us
evaluate the ODH performance during the currently
implemented strategic plan and inform how we can
improve and strengthen our collaboration in the
upcoming plan for 2025–2030. We will be analyzing
and summarizing the results of all the people and
organizations we are interviewing and discussing
them at our strategic planning retreat this fall.
QUESTIONS:
1. Strengths: What do you think the Office of Dental
Health does best? What are its strengths? Where
are we having an impact?
2. To improve: How could we improve? How could
we increase our impact?
3. Community needs and wants: What are the
greatest needs, gaps, and/or challenges to
improve oral health in Alameda County?
4. Opportunities and threats: What are the
opportunities? (What is happening in the
community—locally, statewide and/or nationally
that could impact oral health, and/or the
programs and populations the interviewee is
involved with?) What is important to keep in
mind as we plan for the future? What are the
threats? (e.g. funding cuts, decreases in program
participation, etc.)
5. Promising practices: What are practices that
show promise in effectively reaching this
population and/or in improving oral health? What
has momentum? How might ODH effectively
build on this? What might be some opportunities
to collaborate about this?
6. ODH’s unique role: Thinking about other
organizations/entities (including your own) who
are already addressing the issues identified in
questions #3 and #4 fairly well, what role could
ODH play in addressing the identified issues,
needs, gaps and/or take advantage of the
opportunities. What does ODH uniquely bring to
these issues? Who are potential partners for this,
including your organization?
7. Prioritizing recommendations: If you could wave
a magic wand and change/improve one thing
about ODH (and/or the specific program), what
would it be?
8. Closing question: Anything else we haven’t
covered that you think is important to address in
the strategic planning process?
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 55
Appendix B: School Health Centers with Dental Services
Agencies School District
East Bay Agency for Children
Frick Health Center Frick United Academy for Language Oakland
East Bay Asian Youth Center
Shop 55 Wellness Center Oakland High Oakland
Fred Finch Youth Center
Rising Harte Bret Harte Middle School Oakland
La Clinica de La Raza
Fuente Wellness Center Edendale Middle School (offsite)San Lorenzo
Havenscourt Health Center Coliseum College Preparatory Academy Oakland
Roosevelt Health Center Roosevelt and Garfield Oakland
Tiger Clinic Fremont High Oakland
LifeLong Medical Care
Elmhurst Health Center Elmhurst United Middle (van)Oakland
West Oakland Health Center West Oakland Middle Oakland
Emeryville Health Center Anna Yates & Emery High Emery
Native American Health Center
Madison Health Center Madison Park Academy Oakland
United for Success Health
Center United For Success Middle & Life Academy High Oakland
Barbara Lee Center San Leandro High (offsite)San Leandro
56 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
Appendix C: KOHA Partners Interview Guide
1. Please tell me about your District’s KOHA program
and your role regarding KOHA.
2. Please tell me about the current process
regarding KOHA.
3. How are KOHA data collected?
a. Prompt: do you bring in screeners to the school
or send forms home?
4. Who else helps you with the KOHA program?
5. Please tell me about the current system used for
reporting KOHA data. Please walk me through the
process first. Keep track of each step and who
does each step.
6. What are the steps on reporting?
7. What is your role on KOHA reporting?
8. Who enters the data into SCOHR?
a. Can you describe their steps or strategy for
data entry?
9. How would you describe your experience with
KOHA reporting?
10. What would make KOHA data reporting easier?
11. What are the challenges in reporting?
a. What have you and your team tried to
overcome those challenges?
12. How often is KOHA data reported?
13. What other priorities compete with KOHA for your
and your team’s time? How serious is KOHA?
14. Would on-site screenings facilitate KOHA at your
school district?
15. Is there anything you would like to add?
Anonymous demographic questions
1. Gender
2. Position/Title
3. Years in school system
4. Years working with KOHA
5. Number of schools supporting
Thank you very much for your participation.
THE OFFICE OF DENTAL ORAL HEALTH NEEDS ASSESSMENT 2025 57
ENDNOTES
1 Centers for Disease Control and Prevention. “2024 Oral Health Surveillance Report: Selected Findings.” Retrieved from
https://www.cdc.gov/oral-health/php/2024-oral-health-surveillance-report/selected-findings.html
2 American Dental Association. “Oral-Systemic Health.” Available at: https://www.ada.org/resources/research/science-and-
research-institute/oral-systemic-health
3 Association of State and Territorial Dental Directors. State Oral Health Improvement Planning and Needs Assessment.
Available at: https://www.astdd.org/state-oral-health-improvement-planning-and-needs-assessment/. Accessed December
1, 2025.
4 Healthy Alameda County. 2024 Demographics: Ethnicity Data for County–Alameda. Claritas data, updated March 2024.
Available at: https://www.healthyalamedacounty.org/demographicdata?id=238§ionId=941. Accessed December 3,
2025.
5 California Department of Finance, Demographic Research Unit. Population Projections, Baseline 2024 (Vintage 2025).
Available at: https://dof.ca.gov/forecasting/demographics/projections/. Accessed December 3, 2025.
6 System for California Oral Health Reporting (SCOHR). AB 1433 Kindergarten Oral Health Assessment Overview [Internet].
Available at: https://www.ab1433.org/home/overview. Accessed December 5, 2025.
7 UCLA Center for Health Policy Research. (2023). Access CHIS Data. California Health Interview Survey. https://
healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis/access-chis-data.
8 Centers for Disease Control and Prevention. PLACES: Local Data for Better Health–2024 data [Internet]. Atlanta (GA):
CDC. Available at: https://data.cdc.gov/
browse?category=500+Cities+%26+Places&q=2024&sortBy=relevance&tags=places&pageSize=20. Accessed December
5, 2025.
9 American Cancer Society. (2018). Risk Factors for Oral Cavity and Oropharyngeal Cancers. Available at: https://www.
cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer/causes-risks-prevention/risk-factors.html.
10 National Cancer Institute; Centers for Disease Control and Prevention. State Cancer Profiles–
Oral Cavity & Pharynx Cancer Incidence Rates, California by County (2017–2021). Bethesda (MD):
NCI; Atlanta (GA): CDC. Available at: https://statecancerprofiles.cancer.gov/incidencerates/index.
php?stateFIPS=06&areatype=county&cancer=003&race=00&sex=0&age=001&type=incd. Accessed December 5, 2025.
11 California Health and Human Services Agency. Healthcare–California Health and Human Services Open Data Portal
[Internet]. Sacramento (CA): CHHS. Available at: https://data.chhs.ca.gov/group/healthcare. Accessed December 5, 2025.
12 Griffin SO, Naavaal S, Scherrer CR, Griffin PM, Harris K, Chattopadhyay S. School-based dental sealant programs prevent
cavities and are cost-effective. Health Affairs (Millwood). 2016;35(12):2233-2240. doi:10.1377/hlthaff.2016.0839.
13 Schappert SM, Santo L. Emergency department visits for tooth disorders: United States, 2020–2022. NCHS Data Brief.
2025 Jun;(531):1–11. Available at: https://www.cdc.gov/nchs/products/databriefs/db531.htm. DOI: 10.15620/CDC/174597.
14 Dietary Guidelines for Americans, 2020–2025. 9th ed. U.S. Department of Agriculture and U.S. Department of Health
and Human Services; December 2020. Available at: https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_
Guidelines_for_Americans-2020-2025.pdf. Accessed November 26, 2025.
15 Healthy Alameda County Indicator Dashboard. Oakland (CA): Alameda County Public Health Department;
2021–2022 data, updated 2024 Oct. Available at: https://www.healthyalamedacounty.org/indicators/index/
view?indicatorId=5261&localeId=238. Accessed November 26, 2025.
16 UCLA Center for Health Policy Research, California Health Interview Survey; [cited 2025 Nov 26]. Available at: https://
healthpolicy.ucla.edu/our-work/askchis/askchis-dashboard#!/results.
17 Tobacco use and cessation: American Dental Association; [updated 2024; cited 2025 Nov 26]. Available at: https://www.
ada.org/resources/ada-library/oral-health-topics/tobacco-use-and-cessation.
58 THE OFFICE OF DENTAL HEALTH ORAL HEALTH NEEDS ASSESSMENT 2025
18 Iacob AM, Escobedo Martínez MF, Barbeito Castro E, Junquera Olay S, Olay García S, Junquera Gutiérrez LM. Effects
of vape use on oral health: A review of the literature. Medicina (Kaunas). 2024;60(3):365. doi:10.3390/medicina60030365.
Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10972225/.
19 Healthy Alameda County Indicator Dashboard. Oakland (CA): Alameda County Public Health Department;
2021–2022 data, updated 2024. Available at: https://www.healthyalamedacounty.org/indicators/index/
view?indicatorId=8&localeTypeId=39. Accessed November 26, 2025.
20 Diabetes and oral health: National Institute of Dental and Craniofacial Research, National Institutes of Health; [updated
2024]. Available at: https://www.nidcr.nih.gov/health-info/diabetes. Accessed November 26, 2025.
21 Adults with diabetes. Healthy Alameda County Indicator Dashboard. Oakland (CA): Alameda County
Public Health Department; c2024. Available at: https://www.healthyalamedacounty.org/indicators/index/
view?indicatorId=81&localeId=238. Accessed November 26, 2025.
22 California Department of Health Care Services. Medi-Cal Certified Eligibles Data by Month with Demographics–By
Medicare Dual Status. Sacramento (CA): California Health and Human Services Open Data Portal; 2017–2025. Available at:
https://data.chhs.ca.gov/dataset/medi-cal-certified-eligibles-with-demographics-by-month/resource/9ade93e4-0676-4117-
adbe-a53378d7fe84. Accessed December 1, 2025.
23 Department of Health Care Access and Information (HCAI). “Health Workforce Data.” California Health Workforce
Research Data Center. Updated September 29, 2025. Available at: https://hcai.ca.gov/workforce/health-workforce/
workforce-data/.
24 California Department of Health Care Services. “Medi-Cal Dental Provider Directory Search.” Medi-Cal Dental Program.
Available at: https://dental.dhcs.ca.gov/Members/Medi_Cal_Dental/Find_A_Dentist/DentalProviderDirectorySearch.
Accessed December 17, 2025.
25 American Public Health Association. Water fluoridation. Available at: https://www.apha.org/topics-and-issues/
fluoridation. Accessed December 1, 2025.
26 U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health
Service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health
Reports. 2015;130(4):318–331. doi:10.1177/003335491513000408. Available at: https://pmc.ncbi.nlm.nih.gov/articles/
PMC4547570/. Accessed December 1, 2025.
27 Fluoride Action Network. California 2020 Fluoridation Status Report [Internet]. 2021 Aug 16. Available at: https://
fluoridealert.org/content/california-2020-fluoridation-status-report/. Accessed December 5, 2025.
THE OFFICE OF DENTAL HEALTH
1100 San Leandro Blvd., 4th Floor, San Leandro, CA 94577
(510) 208-5900
acphd.org/about/our-organization/community-health-services-division